Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are major drivers of hospitalisation, readmission and mortality. Patient delay, the interval between the onset or recognition of exacerbation symptoms and the first contact with a healthcare professional, represents a potentially modifiable part of the overall prehospital delay. Existing evidence on why people with COPD delay seeking care is fragmented, based on heterogeneous definitions of delay and limited sets of predictors, and has not yet been synthesised within a coherent theoretical framework. This protocol describes a systematic review and meta-analysis to identify determinants of delayed care-seeking during AECOPD, structured by Andersen’s Behavioural Model of Health Service Use.

We will include observational analytic studies (prospective or retrospective cohort, case-control and cross-sectional designs) involving adults (≥18 years) with physician-diagnosed COPD who have experienced at least one AECOPD. The primary outcome is delayed care-seeking, defined as the time interval between onset or recognition of exacerbation symptoms and first contact with a healthcare professional or facility; studies must report a clear definition of "delay" and provide effect estimates (or sufficient data to calculate them) for associations between candidate determinants and delayed presentation or delay duration. Determinants of interest will be mapped onto Andersen’s predisposing, enabling and need-related domains. We will search PubMed, Web of Science, CINAHL, Cochrane Library and EMBASE from database inception to the date of the final search, supplemented by grey literature searching, backward reference list screening and forward citation tracking, without restrictions on country or, where feasible, language. Two reviewers will independently perform study selection and data extraction and will assess risk of bias using study design-specific critical appraisal tools appropriate to cohort, case-control and cross-sectional studies. Where at least three studies report comparable effect measures for the same determinant–outcome pair, random-effects meta-analyses will be conducted; otherwise, findings will be synthesised narratively. Certainty of evidence for key associations will be graded using the grading of recommendations assessment, development and evaluation approach adapted for observational and prognostic evidence.

Ethical approval is not required for this systematic review and meta-analysis, as it will use data extracted exclusively from published studies and other publicly available sources, with no involvement of individual participants or identifiable personal data. The findings of this review will be disseminated through publication in a peer-reviewed journal and presentation at relevant academic and clinical conferences. The results are expected to inform clinicians, nurses and policymakers about key determinants of delayed care-seeking during AECOPD, and to support the development of theory-informed, targeted interventions aimed at promoting timely healthcare utilisation.

This study has been registered in the PROSPERO (CRD420251244791).

The incidence of malnutrition is high in enterostomy patients, which impacts their nutritional status and requires targeted dietary management strategies to improve outcomes. This study evaluated the knowledge, attitude and practice (KAP) of dietary management among enterostomy patients, identified influencing factors and provided recommendations for comprehensive nutritional care.

Cross-sectional study.

43 hospitals in Hubei Province.

A convenience sample of 643 enterostomy patients was surveyed between November 2024 and April 2025. The inclusion criteria were as follows: (1) age of 18 years or older; (2) at least 4 weeks post-enterostomy surgery with recovery at home and (3) provision of informed consent and voluntary participation in the study. The exclusion criteria included: (1) inability to eat normally due to illness or other reasons and (2) presence of consciousness, cognitive or communication disorders.

KAP questionnaire score, social alienation scale score and general information.

Of 621 valid responses (96.58% valid questionnaires), the average KAP score was 185, with 79.07% achieving a passing score (≥111). Moderate social isolation was observed with a mean score of 40.04±13.98. Regression analysis revealed that social isolation (β=–0.393, p

Enterostomy patients showed moderate to high knowledge, positive attitudes and good practices in dietary management, but experienced moderate social isolation. A multidisciplinary nutrition team should assess patients’ nutritional, physiological, psychological and social support needs. Personalised dietary plans based on education level and diverse educational methods can enhance intervention effectiveness. Encouraging self-care and leveraging the ‘Internet Plus’ platform for regular progress monitoring can improve self-management capabilities. Continuous monitoring of nutrition and quality of life is essential to support enterostomy patients. These findings may have implications for enterostomy care in resource-limited settings, including low-income and middle-income countries, where multidisciplinary nutrition teams and patient education resources may be limited.

Single-modality motor rehabilitation is often insufficient to address the complex functional restoration needs of patients with chronic ankle injuries following surgery. Research indicates that non-invasive neuromodulation techniques, such as intermittent theta-burst stimulation (iTBS), may enhance motor recovery by increasing cortical excitability and facilitating neural network reorganisation. Compared with exercise therapy alone, this study aims to explore the rehabilitation efficacy of combining iTBS with exercise therapy in patients with chronic ankle injuries following surgery. It also investigates the associated cortical network modulation, providing scientific evidence to optimise rehabilitation strategies for these patients.

This study is a prospective, multicentre, randomised controlled trial with single-blind assessment. A total of 28 patients with chronic ankle injuries following surgery were enrolled and randomly assigned to either the experimental group or the control group according to centre-stratified randomisation. The experimental group will receive iTBS combined with exercise therapy, while the control group will receive sham iTBS combined with exercise therapy. Both groups will undergo one session per day, 5 days per week, for a total of 3 weeks. The primary outcome measure will be the American Orthopaedic Foot & Ankle Society Ankle-Hindfoot Score (AOFAS). Secondary outcome measures will include isokinetic muscle strength assessment of the ankle dorsiflexor and plantarflexor muscles, Visual Analogue Scale (VAS) scores, ankle joint range of motion (ROM) and the 10-Metre Walk Test. Functional near-infrared spectroscopy (fNIRS) and transcranial magnetic stimulation (TMS) will also be used to assess cortical functional activity and neurophysiological changes. All outcome measures will be collected at baseline prior to enrolment, post-intervention at week 3, and at follow-up at week 6. Primary outcomes analyses will use group-by-time comparisons to examine between-group differences in functional and neurophysiological measures.

The study has received approval from the Medical Ethics Committee of Jiangsu Province (Suqian) Hospital (Application No. 2025-SR-0333). All participants will provide written informed consent before enrolment. Results will be disseminated through peer-reviewed journals and scientific conferences.

ChiCTR2500110905.

V1.0.

To review the application of prediction models and risk factors identified by prediction models for invasive fungal infection (IFI) in children, and assess model performance, methodological rigour and applicability.

This is a systematic review of diagnostic prediction models and a meta-analysis of the risk factors. This study was registered on PROSPERO and performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis and Prediction model risk of bias assessment tool.

PubMed, Embase (Ovid), Medline, Cochrane Library and four Chinese Databases were searched on 10 Mar 2025.

We included original studies that developed diagnostic prediction models for IFI in children and excluded the informal records.

Odds ratio (OR) with 95% confidence interval (CI) was calculated for risk factors, and a random-effects meta-analysis was applied to factors reported in at least two studies. For prediction models, a descriptive analysis was conducted to summarise model characteristics, model performance and the risk of bias.

Nine studies were included from 4069 articles. Nine studies developed ten diagnostic prediction models, and logistic regression was the most commonly used method. The predictive performance showed an area under receiver operating curves (AUROC) ranging from 0.76 to 0.95, but meta-analysis of AUROC was not conducted due to heterogeneity. All studies were identified as having a high risk of bias in critical appraisal, particularly in the analysis, mainly due to the lack of validation, as well as the failure to appropriately evaluate model performance and overfitting. Only two of nine studies that developed prediction models used internal or external validation.

Logistic regression is a common method for predicting IFI in children, although machine learning methods have been popular in prediction models. Our study identified all studies as high risk of bias. To reduce bias, studies should use calibration measures, internal and external validation more frequently, and consider shrinkage methods when developing models.

Post-COVID-19 respiratory infection patterns require updated epidemiological data. To investigate the prevalence and infection patterns of upper respiratory tract infections (URTIs), a survey was conducted to assess the presence of influenza A (IFV A), influenza B (IFV B), respiratory syncytial virus (RSV), human rhinovirus (HRV), adenovirus (Adv), and SARS-CoV-2 among outpatients diagnosed with URTIs.

A community-based cross-sectional study.

Three cities in Sichuan, China.

1174 outpatients diagnosed with URTIs from December 2023 to February 2024.

Oropharyngeal swabs were collected using sterile flocked swabs, preserved at 4°C and analysed within 24 hours. Viral nucleic acid was extracted automatically and detected via multiplex PCR-melting curve analysis.

Results showed in positive detection rates varied significantly by age (p

This study reveals persistent influenza dominance and age-stratified co-infection risks and provides critical baseline data for optimising respiratory infectious disease control in the post-pandemic era.

To evaluate the cost-effectiveness of the levonorgestrel intrauterine system (LNG-IUS) compared with hysteroscopic niche resection (HNR) for women with niche-related postmenstrual spotting.

Economic evaluation from a healthcare perspective, conducted alongside a randomised controlled trial with 12 months of follow-up.

A single-centre study at a university hospital in Shanghai was carried out between October 2019 and January 2021.

A total of 208 women aged 18–48 years with niche-related spotting who were suitable for a HNR, defined as a residual myometrium of at least 2.2 mm confirmed by MRI.

Participants were randomly assigned to LNG-IUS insertion (n=104) or HNR (n=104).

The primary outcome was reduction in postmenstrual spotting at 6 months, defined as ≥50% decrease in spotting days compared with baseline. Cost-effectiveness was expressed as incremental cost-effectiveness ratios (ICERs), calculated by dividing cost differences in effective rate and spotting days.

Mean costs (diagnostic, examination, surgical) were compared between groups using Student’s t-test, standardised to 2019 price levels. Uncertainty around cost-effectiveness was assessed with non-parametric bootstrapping and cost-effectiveness acceptability curves.

At 6 months, 78.4% (80/102) of women in the LNG-IUS group and 73.1% (76/104) in the HNR group reported improvement in spotting symptoms (RR 1.07, 95% CI 0.92 to 1.25). Spotting reduction was greater with LNG-IUS (0.0 days, IQR 0.0 to 2.8) compared with HNR (2.0 days, IQR 0.8 to 4.3; p

LNG-IUS is highly cost-effective compared with HNR for the treatment of niche-related postmenstrual spotting at 6 months. These findings support LNG-IUS as first-line therapy for niche-related spotting in women with a residual myometrium ≥2.2 mm.

ChiCTR1900025677.

Hand osteoarthritis (OA) is a prevalent and debilitating joint disorder that impairs daily functioning and quality of life. Current treatments are often inadequate in managing the symptoms and progression of the disease. The cytokine interleukin (IL)-17 has been implicated in the inflammatory processes associated with OA, making it a potential target for therapeutic intervention. This trial aims to evaluate the efficacy of vunakizumab, an IL-17A inhibitor, in reducing pain and improving functional outcomes in patients with erosive hand OA.

This multicentre, randomised, placebo-controlled, double-blind trial will enrol 150 participants aged 30–80 years with symptomatic erosive hand OA. Participants will be randomised in a 1:1 ratio to receive either vunakizumab 120 mg or placebo subcutaneously every 4 weeks for 24 weeks, with a loading dose injection period during the first 4 weeks. The primary outcome is the change in hand pain assessed by the Visual Analogue Scale at 28 weeks. Secondary outcomes include changes in physical function measured by the Functional Index for Hand Osteoarthritis, the Quick Disabilities of the Arm, Shoulder and Hand questionnaire and the Health Assessment Questionnaire, as well as changes in grip strength and radiographic and MRI evaluations of the hands.

Written informed consent will be obtained from all participants. The study was approved by the Ethics Committee of Shanghai Sixth People’s Hospital (2024–217) and will adhere to the Declaration of Helsinki. Research results will be published in peer-reviewed journals.

ChiCTR2500101031; https://www.chictr.org.cn/showproj.html?proj=264789.

Osteoporosis (OP) is a systemic skeletal disorder that increases fragility and susceptibility to fractures. Despite the availability of teriparatide for the treatment of patients with acute fractures with better efficacy, its long-term daily injection and high cost limit its broader use among a wider patient population, especially for those living in low- and middle-income countries. This study aims to evaluate the efficacy of a novel sequential treatment with teriparatide daily for 6 months followed by denosumab every 6 months for another 18 months, in comparison with denosumab monotherapy every 6 months for 24 months, in reducing the risk of fractures in patients with newly diagnosed osteoporotic fractures. The study will also explore the possible difference between two sequential treatments (shifting to denosumab treatment at 6 or 12 months) in their effect on increasing bone mineral density (BMD).

This study is designed as a multicentre, open-label, randomised controlled trial among 2478 patients with newly diagnosed osteoporotic fractures from 58 hospitals across China. Participants will be randomly assigned in a 10:10:1 ratio to three treatment groups: 24 months of denosumab monotherapy, early sequential treatment (teriparatide for 6 months followed by denosumab for 18 months) and late sequential treatment (teriparatide for 12 months followed by denosumab for 12 months). The primary outcome is the incidence of vertebral fractures over 24 months of treatment. Secondary outcomes include changes in BMD at the lumbar spine, total hip and femoral neck, changes in bone turnover markers (β-carboxy-terminal telopeptide of type 1 collagen and procollagen type 1 N-terminal propeptide), treatment adherence and cost-effectiveness. Follow-up assessments are scheduled at 3, 6, 9, 12, 18 and 24 months post-randomisation for primary and secondary outcomes, and biannually afterwards for the primary outcome.

The study protocol has been registered on ClinicalTrials.gov and has received ethical approval from the Peking Union Medical College Hospital Medical Science Research Ethics Committee (1-22PJ939). The findings will be disseminated through peer-reviewed scientific journals.

NCT05866029.

Postoperative acute pain following video-assisted thoracoscopic surgery (VATS) impedes patient rehabilitation. While multimodal analgesia effectively mitigates postoperative acute pain and facilitates the postoperative rehabilitation process, the efficacy of preventive precision multimodal analgesia (PPMA) remains uncertain. This study designs a PPMA strategy targeting incisional pain, inflammatory pain and visceral pain in VATS. It aims to investigate the impact of the PPMA strategy on the postoperative acute pain process and rehabilitation outcomes.

This multicentre, single-blinded, randomised controlled trial will enrol adult patients scheduled for elective thoracoscopic lobectomy or segmentectomy. A total of 1372 participants will be recruited and randomly allocated in a 1:1 ratio to either the preventive precision multimodal analgesia group (PPMA Group) or the conventional multimodal analgesia group (CMA Group). Patients in the PPMA Group will receive a regimen consisting of local anaesthetic infiltration of surgical incision (for incisional pain), intravenous injection of oxycodone (for visceral pain) and parecoxib sodium (for inflammatory pain) before surgery initiation. Patients in the CMA Group will receive the same regimen after specimen isolation. This trial will be conducted across 13 medical centres in China from 2023 to 2026. The primary outcome is the duration of postoperative acute pain. Secondary outcomes include postoperative analgesic consumption, postoperative pain scores, intraoperative haemodynamic parameters and the Indexes of Consciousness (IoC₁ and IoC₂), as well as intraoperative arterial blood gas and ventilation parameters, intraoperative dosages of general anaesthesia, inflammatory markers at predefined time points, postoperative rehabilitation process and perioperative adverse events and complications.

This study has been approved by the Ethics Committee of Xuanwu Hospital, Capital Medical University (Linyanshen[2023]-NO.012-003-Revised Vision 1). The results will be published in a peer-reviewed journal.

Chinese Clinical Trial Registry (ChiCTR2300072176).

Hypertension represents a major public health challenge globally, with a rising prevalence in China. This study aims to explore the factors shaping blood pressure (BP) control among hypertensive patients managed in community health centres (CHCs), with a particular emphasis on the association with age.

This was a population-based, observational study that used healthcare records from CHC in Shenzhen, covering the period from 1 January 2000 to 8 October 2024. Univariate and multivariate logistic regression analyses were employed to assess the independent associations of various factors with BP control rate. Additionally, the study evaluated the relationship between age and BP control across six distinct age subgroups.

The study included 1 073 914 participants who met the eligibility criteria, with 955 415 (88.97%) patients achieving BP control. The median baseline age was 55.9 (IQR 18–109) years. Individuals aged 45 years and above demonstrated better BP control rates (46–55, OR 1.053, 95% CI 1.020 to 1.087; 56–65, OR 1.246, 95% CI 1.205 to 1.289; 66–75, OR 2.183, 95% CI 2.103 to 2.265; >75, OR 2.159, 95% CI 2.060 to 2.262). Among young adults aged 18–35 years, increasing age was consistently associated with poorer BP control across most subgroups. For the middle-aged groups (36–45 and 46–65 years), age had little impact on BP control. In the 66–75 years age range, older age was linked to better BP control in some groups.

The association between age and BP control varied across age groups. Hypertension management strategies should be tailored to address the unique needs of different age groups, geographical regions and targeted populations.

Globally, work rumination is a common phenomenon related to nurse burnout. However, most existing studies focus on the single negative impacts of rumination, with less exploration of its dual effects and antecedents. Therefore, comprehensively exploring the effect of nurse work rumination and its influencing factors is crucial for enhancing the accuracy of nursing management.

Identify the antecedents and dual effects of nurse work rumination to deepen understanding of this phenomenon and provide references for formulating interventions that enhance nurses’ well-being and improve the quality of nursing work.

Included studies were original research articles focusing on work-related rumination of nurses in clinical settings. Excluded studies were those involving nurses without patient contact, rumination unrelated to work, studies not addressing the effects or influencing factors of rumination and non-Chinese or non-English language publications.

CINAHL, Cochrane, EMBASE, MEDLINE, Pubmed, Scopus, Web of Science, Sinomed, Wanfang, VIP and CNKI were searched to identify articles about nurse work rumination which were published up to January 2025.

A scoping review of the published articles of nurse work rumination was performed with the methodological process guided by the framework proposed by Arksey and O’Malley. A three-step coding procedure was used to synthesise the impacts and antecedents of nurse work rumination, which were subdivided into four categories individually based on the conservation of resources theory, the three-dimension theory of happiness and the distinctive features of the nursing profession.

30 articles from 12 countries were included. The findings indicate that nurse work rumination has 28 kinds of impacts, including positive, negative and double-edged sword effects, in four aspects: nursing quality and safety (n=7), happiness (n=7), health (n=10) and relationship (n=4) from 29 articles. The findings also suggest that from 26 articles, work rumination will be influenced by 31 factors, which are based on conservation of resources theory classified into four categories: resource depletion (n=14), resource protection (n=4), consequences of resource depletion (n=5) and behaviour and cognition (n=8).

This scoping review constructs a conceptual framework of ‘antecedent factors-nurse work rumination-dual impacts’ by systematically synthesising 30 studies. Rooted in the conservation of resources theory, three-dimensional theory of happiness and nursing professional characteristics, the framework clarifies the classification logic and internal connections of 31 influencing factors and 28 bidirectional impacts. The positive effect of work rumination can promote nurses’ personal development by facilitating the problem-solving pondering. Nursing managers can leverage this integrated framework to design targeted intervention strategies, maximising the constructive effects of rumination while mitigating its adverse impacts. Classifying the factors affecting nurse work rumination according to the conservation of resources theory provides an important basis for exploring the influence mechanism of nurse work rumination. Future research should focus more on empirical studies on rumination to reduce nurses’ burnout and improve the quality of nursing work.