Conectar
To identify distinct social network types among young-old adults based on the characteristics of social network structure and to explore the relationship between different types, socio-demographic characteristics and subjective cognitive decline.
A cross-sectional study was conducted from July 2022 to October 2023.
A total of 652 young-old adults aged 60–74 years completed the sociodemographic questionnaire, the subjective cognitive decline questionnaire-9 and the self-designed egocentric social network questionnaire. The types of social networks were identified by latent profile analysis. Univariate analysis and binary logistic regression were used to analyse the influencing factors of subjective cognitive decline.
The incidence of subjective cognitive decline was 38%. Social networks of young-old adults tended to be large, predominantly family-centred and characterised by strong contact strength, high density and significant demographic heterogeneity among network members. Four social network types were identified: diverse-moderate, family-dense, family-strong and friend-loose. Young-old adults embedded in the family-dense and family-strong types were more likely to develop subjective cognitive decline than those in the diverse-moderate type. Additionally, age, education level, previous occupation, daily sleep duration and exercise were related to the incidence of subjective cognitive decline.
The findings highlight the relatively high incidence of subjective cognitive decline in young-old adults that is notably influenced by the type of social network they are embedded in. More attention needs to be paid to identifying and supporting young-old adults at high risk of subjective cognitive decline, especially to promote their social integration and friend network building, to improve their subjective cognitive function.
The findings emphasise the importance of considering the structure and composition of social networks when addressing subjective cognitive decline among young-old adults. A diversified social network incorporating both familial and friendship ties may provide enhanced cognitive protection. Therefore, interventions targeting subjective cognitive decline should promote the expansion of friendship-based relationships and foster the development of more heterogeneous and multi-source networks.
STROBE checklist.
Not applicable.
To assess the supply, demand, and utilisation of master's degree nurses in China's top-tier hospitals and identify recruitment and retention challenges.
A convergent parallel mixed-methods design.
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.
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.
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.
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.
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.
This study adhered to the Mixed Methods Article Reporting Standards.
No contributions from patients or the public were involved in this study.
The study aims to investigate patients' perceptions of recurrence risk associated with atrial fibrillation, with the goal of establishing a theoretical foundation for developing future measurement scale and intervention strategies.
A qualitative interview study.
Seventeen patients diagnosed with atrial fibrillation at a Grade-A tertiary hospital participated in semi-structured, in-depth interviews conducted between October and December 2024. Participants were selected via purposive sampling. The data were analysed employing thematic analysis in accordance with Colaizzi's method. The study adhered to the Consolidated Criteria for Reporting Qualitative Research checklist.
The perceptions of recurrence risk among patients with atrial fibrillation can be summarised into five themes: (1) perceived likelihood of recurrence, (2) perceived severity of recurrence, (3) perceived triggers of recurrence, (4) emotional reaction to recurrence, and (5) efficacy perception of managing recurrence risk.
Perceptions of recurrence risk among patients with atrial fibrillation are diverse and often underestimated due to limited knowledge and subjective symptom interpretation, affecting health behaviours. Understanding patients' subjective appraisals, emotions, and perceived efficacy is essential. Validated assessment tools and tailored risk communication may enhance self-management and support targeted interventions.
This study provides critical insights into how atrial fibrillation patients perceive their risk of recurrence. It also provides a theoretical foundation for creating validated assessment tools and tailoring individualised health education and intervention programmes.
Patients were involved in the study design, data collection, and interpretation of findings. Their contributions included providing feedback on the initial interview guide to ensure relevance and clarity, participating in in-depth interviews to share their lived experiences with atrial fibrillation recurrence, and offering reflections on key themes emerging from the data.
by Xinyu Zhang, Yoo Jung Oh, Yunhan Zhang, Jianfeng Zhu
The digital age has fueled a surge in ADHD self-diagnosis as people turn to online platforms for mental health information. However, the relationship between validation-seeking behaviors and self-perception in these online communities and users’ self-perception has received limited scholarly focus. Drawing on self-verification theory and utilizing natural language processing to analyze 452,026 posts from the r/ADHD subreddit, our study uncovers distinct patterns in validation-seeking behaviors. Results show that (a) self-diagnosed individuals with ADHD are more likely to seek social validation and media validation and to report higher levels of negative self-image and internalized stigma than clinically diagnosed individuals, (b) social validation was strongly associated with both positive and negative self-perceptions; and (c) diagnosis status significantly moderated these relationships, such that the effects of social validation on self-image and stigma were consistently weaker for the self-diagnosed group. Theoretically, this study extends self-verification theory by demonstrating that professional verification hierarchically moderates self-verification effectiveness. This implies a practical need for clinicians to acknowledge online validation seeking and for digital communities to affirm user experiences while mitigating stigma.Coronary artery bypass grafting (CABG) is a standard treatment for coronary artery disease, particularly in patients with multivessel disease. Connecting the saphenous vein graft (SVG) to the right internal mammary artery (RIMA) instead of the aorta has been proposed as an alternative approach to minimise aortic manipulation and potentially improve graft patency. This study aims to determine whether the RIMA-SVG technique is non-inferior to the conventional Aorta (Ao)-SVG approach in terms of 1-year graft patency, while also comparing perioperative complications and short-term clinical outcomes.
This non-inferiority, single-centre, prospective, double-blind, randomised clinical trial will enrol 300 patients undergoing CABG. Participants will be randomised into two surgical groups (RIMA-SVG vs Ao-SVG). The primary outcome is the 1-year SVG patency rate, assessed using coronary CT angiography. Secondary outcomes include perioperative complications, all-cause mortality, major adverse cardiovascular and cerebrovascular events (MACCE), and surgical site infections occurring during hospitalisation and up to 1 year postoperatively. Randomisation will be computer-generated, and all procedures will be performed by experienced surgeons. Patients will be followed up 12 months post-surgery. Non-inferiority will be established if the upper bound of the one-sided 97.5% CI for the difference in graft occlusion rates is less than the prespecified non-inferiority margin of 10%.
This study has been approved by the Ethics Committee of the Second Hospital of Jilin University (No. 460) and registered at ClinicalTrials.gov (NCT06787651). All participants will provide written informed consent before enrolment. To ensure data integrity and minimise bias, randomisation details will be concealed from researchers until surgery, and data analysts will remain blinded to group assignments. The findings will be disseminated through academic journals and conference presentations to promote knowledge sharing and clinical application in the field of cardiovascular surgery.
To evaluate the association between the stress hyperglycaemia ratio (SHR) and baseline stroke severity in patients with acute ischaemic stroke (AIS) and to investigate whether the relationship is non-linear.
Retrospective cohort study.
A tertiary hospital in Zhejiang Province, China.
1479 consecutive AIS patients admitted within 24 hours of symptom onset between 2016 and 2022.
SHR was calculated as fasting plasma glucose (mmol/L) divided by glycated haemoglobin (HbA1c, %). Stroke severity was assessed by the NIH Stroke Scale (NIHSS) and categorised as mild (NIHSS ≤5) or moderate to severe (NIHSS >5). Associations between SHR and stroke severity were examined using multivariable logistic regression, generalised additive models and threshold effect analysis.
Patients with more severe strokes had significantly higher SHR values (median 0.99 vs 0.94; p
SHR is independently associated with greater stroke severity at admission. Values below 1.3 may reflect heightened metabolic stress and could help inform early risk stratification in AIS management, but their discriminative power is limited and should be interpreted in conjunction with other clinical indicators.
by Lingling Wu, Kaijian Zhu
PurposeExcessive daytime sleepiness (EDS) seriously affects quality of life and may increase the risk of life-threatening situations, such as motor vehicle accidents. Solriamfetol is a novel medication approved for the treatment of EDS and serves as an alternative to traditional stimulants. This retrospective pharmacovigilance study aimed to analyze adverse events (AEs) related to solriamfetol based on real-world data.
MethodsData regarding solriamfetol-related adverse events were retrieved from the FDA Adverse Event Reporting System (FAERS) from Q3 of 2019 to Q1 of 2024. A total of 1550 reports on solriamfetol-related AEs were analyzed using disproportionality analysis to identify AE signals across various organ systems.
ResultsA large proportion of AEs were reported among female patients (64.06%), primarily including those with narcolepsy (38.13%) and obstructive sleep apnea (3.68%). The most frequently reported AEs included headache, anxiety, and drug ineffectiveness, with 46.8% of AEs occurring within 7 days of treatment initiation. Furthermore, solriamfetol was significantly associated with psychiatric and nervous system disorders as well as cardiac and general disorders.
ConclusionsSolriamfetol-related adverse events were mainly psychiatric, neurological, cardiac, and general disorders, with headache, anxiety, and drug ineffectiveness being the most common. Nearly half of the events occurred within the first week of treatment. Given the limitations of the FAERS database, further prospective studies are needed to confirm these findings.
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.
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.
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.
CRD420251006411.
by Mengqi Yuan, Yajing Yuan, Xiangqun Zhang, Zhenghao Zhu, Chenxi Zhao, Xiangqian Gao, Genyuan Du
Millimeter-wave (mmWave) radar has become an important research direction in the field of object detection because of its characteristics of all-time, low cost, strong privacy and not affected by harsh weather conditions. Therefore, the research on millimeter wave radar object detection is of great practical significance for applications in the field of intelligent security and transportation. However, in the multi-target detection scene, millimeter wave radar still faces some problems, such as unable to effectively distinguish multiple objects and poor performance of detection algorithm. Focusing on the above problems, a new target detection and classification framework of S2DB-mmWave YOLOv8n, based on deep learning, is proposed to realize more accuracy. There are three main improvements. First, a novel backbone network was designed by incorporating new convolutional layers and the Simplified Spatial Pyramid Pooling - Fast (SimSPPF) module to strengthen feature extraction. Second, a dynamic up-sampling technique was introduced to improve the model’s ability to recover fine details. Finally, a bidirectional feature pyramid network (BiFPN) was integrated to optimize feature fusion, leveraging a bidirectional information transfer mechanism and an adaptive feature selection strategy. A publicly available 5-class object mmWave radar heatmap dataset, including 2,500 annotated images, were selected for data modeling and method evaluation. The results show that the mean average precision (mAP), precision and recall of the S2DB-mmWave YOLOv8n model were 93.1% mAP@0.5, 55.8% mAP@0.5:0.95, 89.4% and 90.6%, respectively, which is 3.3, 1.6, 4.5 and 7.7 percentage points higher than the baseline YOLOv8n network without increasing the parameter count.Although a number of preclinical studies have demonstrated the therapeutic potential of puerarin for metabolic-associated fatty liver disease (MAFLD), there is a lack of high-quality clinical evidence. This study aims to evaluate the safety and efficacy of puerarin in patients with MAFLD in a randomised, controlled, crossover trial.
This study will use the randomised, double-blind, placebo-controlled crossover trial design. We plan to enrol 50 patients diagnosed with MAFLD, and they will be randomly assigned in a 1:1 ratio to receive either puerarin or placebo (maltodextrin) after a 2-week adaptation period. Participants in the two groups will receive the daily intervention of puerarin (180 mg/day) and placebo (180 mg/day) for 12 weeks, respectively. After a 4-week washout period, puerarin-treated and placebo-treated participants will cross over to receive the daily intervention of placebo and puerarin for 12 more weeks. The primary outcome measure will be defined as the changes in liver fat content, which will be assessed using MRI-proton density fat fraction before and after 12 weeks of puerarin or placebo supplement in patients with MAFLD. The secondary outcome measures include liver and kidney function changes, lipid metabolism indicators, blood glucose levels, iron metabolism parameters, blood routine, serum high-sensitivity C-reactive protein and anthropometric measurements. Additionally, alterations in gut microbiota composition and metabolic activity will be evaluated using 16S ribosomal RNA gene sequencing and liquid chromatography-mass spectrometry.
The study protocol has been approved by the ethics committee of Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine (Approval Number 2024-1625-208-01). The findings will be published in international peer-reviewed journals and presented at relevant academic conferences.
The trial has been registered with the Chinese Clinical Trial Registry (ChiCTR2400094017).
To assess the performance of a Vision Transformer (ViT)-based deep learning model in classifying oral mucosal diseases (OMD) and to explore the value of the integrated model for clinical support.
A pilot study that combines publicly available datasets with integrated modelling.
Developed an EfficientNet-B0 convolutional neural network and a ViT-B16 model, and tested three integration strategies: average method, weighted method and geometric average method. Evaluation metrics included accuracy, F1 score and inference speed. Diagnostic subject performance was compared between general dentists and oral specialists to validate model efficacy.
The integrated model outperformed individual models, with the geometric average integration method achieving an accuracy of 94.32%. When used by general dentists, the diagnostic time was reduced from 241 s to 112.4 s, with an accuracy rate of 93%.
The ViT-enhanced integrated system can improve the classification efficiency of OMD and provide support for non-specialist doctors. However, validation with larger datasets is needed in future research.
This study aimed to develop a scale for nurses’ knowledge, attitudes and practices regarding the prevention and treatment of subcutaneous lipohypertrophy associated with insulin injections and evaluate its reliability and validity.
A Delphi research and cross-sectional survey.
Medical, education and nursing experts from seven different regions conducted Delphi consultation by E-mail or Wechat, whereas clinical nurses from primary, secondary and tertiary general hospitals in different regions of Sichuan Province were conveniently selected for the questionnaire survey.
A total of 16 female experts aged 35–58 years participated in the Delphi expert consultation process; 812 clinical nurses participated in the questionnaire survey.
Content validity, internal consistency reliability and construct validity of the scale.
The scale comprises 3 dimensions and 36 items, with a content validity index of 0.99, a Cronbach’s α coefficient of 0.93, a split-half reliability of 0.87 and a test–retest reliability of 0.93. Exploratory factor analysis revealed a cumulative variance contribution rate of 53.38%, whereas confirmatory factor analysis indicated a 2 degree of freedom 2 ratios of 2.65, a goodness-of-fit index of 0.86, a root mean square error of approximation of 0.06, a root mean square error of 0.04 and a comparative fit index of 0.90.
The developed scale demonstrated strong reliability and validity, enabling the assessment of nurses’ knowledge, attitudes and practices regarding the prevention and treatment of lipohypertrophy associated with insulin injections.
To identify risk factors and develop a predictive model for postdischarge all-cause mortality in patients with heart failure with preserved ejection fraction (HFpEF).
Retrospective cohort study.
Tertiary care, Xiangtan Central Hospital, Hunan, China.
9419 patients with HFpEF, diagnosed between May 2014 and January 2023 according to 2021 European Society of Cardiology criteria (N-terminal pro-B-type natriuretic peptide (NT-proBNP) ≥125 pg/mL, left ventricular ejection fraction ≥50%, New York Heart Association (NYHA) class II-IV). Exclusions were age
All-cause mortality within 3 years of hospital discharge.
10 independent predictors were identified: NT-proBNP, albumin, age, NYHA class III-IV, C reactive protein, right atrial end-systolic diameter, haemoglobin, chronic obstructive pulmonary disease, hyponatraemia and prior percutaneous coronary intervention. The prediction model demonstrated good discrimination, an area under the receiver operating characteristic curve of 0.756 (95% CI 0.743 to 0.769) in the training cohort and 0.764 in the validation cohort. Based on calculated risk scores, patients were classified into low-risk (≤200.36), medium-risk (200.37–232.24) and high-risk (≥232.25) groups, corresponding to 3-year mortality rates of 12.6%, 40.8% and 68.0%, respectively.
A simple clinical model using routinely available parameters enables effective 3-year mortality risk stratification in HFpEF patients after discharge. External validation is needed to confirm its generalisability.
To gain an in-depth understanding of the real support priorities and perceptions of caregivers of individuals receiving care with end-stage heart failure regarding hospice care.
A qualitative descriptive approach was employed.
Using a purposive sampling approach, 16 primary caregivers of individuals receiving care with end-stage heart failure from a tertiary hospital in Hangzhou, Zhejiang province, were selected as interview participants. A semi-structured interview outline based on literature review was used to conduct face-to-face interview. Tape-recorded data with notes were transcribed, and the content analysis method was applied to analyse the data and distil themes.
After integration and analysis of 16 interview transcripts (n=16), the thematic analysis resulted in four themes supporting the overall findings, including seeking collaborative decision-making in palliative care, demand for appropriate healthcare resources, search for emotional respite and support in hospice settings and desire for knowledge and information about hospice care and heart failure. Each theme encompasses two subthemes.
Caregivers of individuals receiving care with end-stage heart failure have multiple care responsibilities and diverse support priorities. Medical personnel should be aware of the burden that family caregivers bear and provide more targeted and individualised assistance to the caregiver. At the organisational level, administrators support priorities to establish comprehensive, lifelong and compassionate hospice services to ensure that the quality of life for caregivers and the quality of care for individuals receiving care can be further enhanced.
Colonoscopy is often associated with significant patient pain and anxiety. Virtual reality (VR) technology has been widely used to alleviate pain and anxiety in patients undergoing invasive surgeries. However, there is a lack of reliable evidence supporting its effectiveness in reducing pain and anxiety in patients undergoing colonoscopy. We aim to conduct a meta-analysis to investigate the effectiveness of VR in alleviating pain and anxiety in patients undergoing colonoscopy.
We will search PubMed, EMBASE, Web of Science and the Cochrane Library from inception to August 2024 for randomised controlled trials evaluating VR interventions for patients undergoing colonoscopy, without language restrictions. Two reviewers will independently screen studies, extract data and assess the risk of bias using the Cochrane Risk of Bias tool. The primary outcomes will be patient-reported pain and anxiety. A meta-analysis will be performed using RevMan V.5.4, with subgroup and meta-regression analyses to explore potential heterogeneity. The certainty of the evidence will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach.
This systematic review does not require ethical approval, given that it will not directly utilize information from human participants—instead, the data to be used will be extracted from original studies. Additionally, this systematic review and meta-analysis has been registered with the International Prospective Register of Systematic Reviews (PROSPERO). Following the completion of the systematic review and meta-analysis, we intend to publish the study in an academic journal.
CRD42024580998.
The choice of anaesthetic agents may influence specific aspects of postoperative recovery, such as haemodynamic stability, recovery times and the incidence of adverse events, in patients undergoing day-case laparoscopic cholecystectomy. Propofol is widely used in total intravenous anaesthesia (TIVA) for its favourable recovery profile, while etomidate, valued for its haemodynamic stability, is less commonly used due to concerns about adrenal suppression. This study aims to compare etomidate-based and propofol-based TIVA on postoperative quality of recovery in patients undergoing day-case laparoscopic cholecystectomy, hypothesising that etomidate is non-inferior to propofol.
A multicentre, double-blind, randomised controlled non-inferiority trial was conducted to compare the effects of etomidate vs propofol for TIVA on postoperative quality of recovery in patients undergoing day-case laparoscopic cholecystectomy. A total of at least 336 participants were enrolled and randomly assigned to either the etomidate or propofol group in a 1:1 ratio, stratified by site. The primary outcome was quality of recovery on postoperative day 1, quantified by the Quality of Recovery-15 questionnaire. Non-inferiority between the groups was determined using a margin of –6 points and a 95% CI. Secondary outcomes included perioperative haemodynamic stability, recovery times (eg, response to verbal commands, time to extubation and duration of postanaesthesia care unit stay), postoperative complications (eg, hypoxaemia, nausea/vomiting, delirium) and patient-reported outcomes such as pain, satisfaction and quality of sleep. Long-term outcomes included quality of life at 6 and 12 months, assessed using the 36-Item Short Form Health Survey.
This study was approved by the Ethics Committee of Nanjing University Medical School, Drum Tower Hospital (No. 2024-371-04) and registered in the Chinese Clinical Trial Registry.
ChiCTR2400087413.
Atrial fibrillation (AF) is the most common cardiac arrhythmia, significantly affecting patients’ quality of life (QoL) and increasing the risk of complications such as heart failure, stroke and dementia. In addition to the physical burden, psychological distress, including depression and anxiety, is prevalent among patients with AF and can exacerbate clinical symptoms and worsen overall well-being. While radiofrequency ablation (RFA) is widely used for rhythm control in AF, its long-term effects on both physical and psychological outcomes, including symptom severity, anxiety, depression and QoL, remain underexplored. This study aims to investigate the long-term impact of RFA on both physical and psychological health in patients with AF, using network analysis to explore symptom interrelationships and their collective influence on QoL.
This longitudinal observational study will investigate the evolution of symptom severity, depression, anxiety and QoL in patients with AF undergoing RFA. Data will be collected at four time points: preprocedure (T0), 3 months (T1), 6 months (T2) and 12 months (T3) postprocedure. The study will employ network analysis to examine the dynamic interactions between physical and psychological symptoms, focusing on core symptoms and their impact on patient outcomes. To assess symptom severity, depression, anxiety and QoL, the following standardised tools will be used: the Atrial Fibrillation Severity Scale, Patient Health Questionnaire-9, Generalised Anxiety Disorder-7 and WHO Quality of Life—Brief Version, respectively. Statistical analyses will include network analysis with R software to explore the interrelationships between symptoms, as well as repeated measures multivariate analysis of variance (MANOVA) to assess changes over time and interactions among variables.
The study was approved by the Ethics Committee of the Second Affiliated Hospital, Zhejiang University School of Medicine (SAHZU, No 20250128) and will be conducted in accordance with the Helsinki Declaration and its amendments. Results will be published in peer-reviewed journals, presented at scientific conferences and shared through various popular science forums and patient organisations.
To systematically analyse international empirical literature and establish a comprehensive understanding of the push and pull factors influencing retention and turnover among mid-career nurses.
An integrative review.
PubMed, Web of Science, Scopus, EMBASE (Ovid), and CINAHL (EBSCO) were searched for studies published between January 2001 and November 2024.
An integrative literature review was conducted following the five-step process outlined by Whittemore and Knafl. Articles were screened by title, abstract, and full text based on predefined inclusion and exclusion criteria. The quality of eligible studies was assessed using the Mixed Methods Appraisal Tool (MMAT). Data were extracted and synthesised narratively, and the findings were presented according to the socio-ecological framework.
A total of 1930 studies were identified, with 14 included for analysis: 10 qualitative, 3 quantitative, and 1 mixed-methods study. Guided by the socio-ecological framework, four themes and 10 subthemes emerged: (1) Intrapersonal (professional knowledge/skills, health issues, work-family balance); (2) Interpersonal (professional collaborative relationships, supervisor support); (3) Organisational (organisational characteristics, work characteristics, career development); and (4) Societal (salary/benefits, Social/governmental recognition).
This review reveals the heterogeneity of research on this topic and confirms previous findings. It identifies certain push-and-pull factors common to nurses across all stages of their careers. However, mid-career nurses face unique challenges, including more complex healthcare demands, declining health status, growing family caregiving responsibilities, unclear organisational roles, underutilisation of professional skills, career stagnation, and limitations on salary growth. These findings highlight the need for tailored retention strategies for mid-career nurses.
A “one-size-fits-all” retention strategy does not meet the needs of all nurses. To improve nurse retention rates, it is essential to address the shifting demands and priorities that arise as nurses reassess and transition through different career stages. For mid-career nurses, acknowledging and valuing their expertise and capabilities, providing sufficient resources, and fostering a supportive work environment that promotes career development may be effective strategies for retaining these experienced professionals.
Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
No Patient or Public Contribution.
This study examined the moderating effects of income inequality and nurse–patient relationships on the association between occupational stress and nurse turnover intentions in large urban hospitals in China, providing evidence for developing targeted retention strategies.
A cross-sectional study.
Data from 13,298 nurses in 46 hospitals in Xi'an, China (October–December 2023) were analysed using hierarchical regression to assess associations between occupational stress, organisational and professional turnover intentions and the moderating roles of the expected income achievement rate (calculated as [actual/expected income] × 100%) and nurse–patient relationship quality.
Eighty-three percent of nurses reported moderate-to-severe occupational stress. Compared to nurses experiencing mild stress, those with moderate/severe stress demonstrated significantly higher organisational and professional turnover intentions. After adjusting for covariates, significant interaction effects were observed. Higher expected income achievement rate showed a modest but significant moderating effect, associated with reduced turnover intentions. While the nurse–patient relationship also moderated this relationship, its protective effect was attenuated under conditions of severe stress. Despite small effect sizes, the consistent patterns and theoretical coherence of these interactions warrant further investigation.
Occupational stress significantly predicts nurse turnover intentions in urban Chinese hospitals, with income inequality and nurse–patient relationship quality serving as modifiable moderating factors. Interventions should integrate equitable compensation, nurse–patient relationship enhancement programmes and stress management initiatives.
This study demonstrates that equitable income consistently buffers the effects of occupational stress on nurse turnover, while nurse–patient relationships show stress-level-dependent moderation. By implementing region-specific compensation benchmarks and structured communication training, healthcare policymakers can effectively address economic security and relational care quality in workforce stabilisation.
The study has been reported following the STROBE guidelines.
No patient or public contribution.
FreshRSS 