ABSTRACT Aim This study was conducted to determine the effects of the frequency of repositioning during phototherapy on neonates' bilirubin levels and comfort. Methods This was a single‐centre, three‐arm, pretest‐posttest parallel‐group randomized controlled trial conducted in a neonatal intensive care unit. Participants were randomly assigned to one of three groups: the supine position group ( n = 20), the hourly position change group ( n = 20), and the control group (2‐h position change) ( n = 20). The bilirubin levels and comfort levels of the neonates were evaluated. Results It was determined that there was no difference between the groups in terms of baseline total bilirubin (TB) levels, TB levels at the end of 24 h, and time neonate was not under phototherapy ( p > 0.05). The effect of the interventions on the comfort score was found to be statistically significant ( p < 0.001). The mean levels were 10.28 ± 0.92 in the supine group, 10.63 ± 0.81 in the hourly position change group, and 7.14 ± 0.28 in the control group. The effect of group, time, group and time on the comfort score was also statistically significant ( p < 0.001). Conclusions The results obtained in this study show that there is no statistically significant difference in bilirubin levels between the different positional groups during phototherapy. Neonates in the control group were found to have higher comfort compared to the other two groups.
ABSTRACT Aims To develop and temporally validate a dynamic nomogram for predicting postdischarge nausea and vomiting (PDNV) in adults undergoing elective ambulatory surgery and to support team‐based, nurse‐coordinated discharge risk assessment. Background PDNV can impair recovery and increase unplanned healthcare use. Static risk scores do not incorporate intraoperative physiological changes or early postanaesthesia care unit (PACU) findings. Design A retrospective cohort study. Methods Adults aged 18 years or older undergoing elective ambulatory surgery between 2023 and 2025 were included. The outcome was nausea, vomiting, retching or rescue antiemetic use within 24 h after discharge. Penalized regression selected predictors from preoperative, intraoperative, PACU and discharge data, followed by logistic regression refitting and nomogram construction. Internal validation repeated imputation, tuning, selection and refitting in 1000 bootstrap samples. Performance was evaluated using discrimination, calibration, Brier score, expected‐to‐observed ratio, decision curve analysis and temporal validation. Results Nine predictors were retained. In the development cohort, the optimism‐corrected C‐index, calibration slope, Brier score and expected‐to‐observed ratio were 0.79, 0.91, 0.131 and 1.01, respectively. In the temporal validation cohort, the corresponding AUC, calibration slope, Brier score and expected‐to‐observed ratio were 0.77, 0.93, 0.139 and 1.05. The nomogram provided greater net benefit than the Apfel score across threshold probabilities of 10%–30%. Conclusion The nomogram showed acceptable discrimination and generally preserved calibration. It may support team‐based discharge assessment, but external validation, electronic workflow integration and prospective usability evaluation are required before routine implementation.
ABSTRACT Aim This study aimed to evaluate the effects of Acceptance and Commitment Therapy, relative to usual care, on psychological flexibility, resilience, caregiving burden, anxiety and depression in primary caregivers of patients with decompensated cirrhosis. Background Primary caregivers of decompensated cirrhosis patients face high rates of anxiety and depression due to long‐term caregiving stress, financial burdens and disease uncertainty. Acceptance and Commitment Therapy improves mental health in other chronic disease caregivers, but its effects on cirrhosis caregivers in China remain unstudied. Design This was a randomized, assessor‐blinded, parallel‐group trial comparing Acceptance and Commitment Therapy‐enhanced care with routine care alone in primary caregivers during hospitalization. Method A total of 120 caregivers were recruited at a Chinese hospital (January–April 2023) and randomly allocated to control (routine care) or intervention (routine care plus six‐session Acceptance and Commitment Therapy) groups. Validated scales assessed psychological flexibility, resilience, burden, anxiety and depression at admission, discharge and 1 month postdischarge. Data were analysed using chi‐square tests, independent t ‐tests for baseline comparisons and repeated‐measures ANOVA with Bonferroni post hoc tests for pairwise comparisons. Results Compared to controls, the intervention group showed significantly lower scores in caregiving burden, anxiety, depression and psychological rigidity, alongside higher psychological resilience at discharge and 1‐month follow‐up. No adverse events were recorded in either group. Conclusion In this single‐centre trial, Acceptance and Commitment Therapy reduced psychological rigidity and caregiving burden and improved psychological resilience. Its emphasis on accepting uncontrollable realities and acting on personal values may be well suited to the volatile context of cirrhosis caregiving, but multicentre trials with longer follow‐up are needed before wider implementation. Trial Registration Chinese Clinical Trial Registry: ChiCTR2600131432.
ABSTRACT Background Patients undergoing prolonged complex surgery are vulnerable to perioperative pressure injuries. The clinical value of adjunctive pressure‐mapping systems in this setting remains uncertain. Aims This study aimed to evaluate whether real‐time intraoperative pressure‐sensing monitoring, used in addition to standard pressure injury prevention care, was associated with differences in perioperative pressure injury incidence and related outcomes among adults undergoing prolonged high‐risk surgery. Methods A total of 250 adults undergoing prolonged cardiac, hepatobiliary, neurosurgical, or orthopaedic procedures were enrolled. Participants received either standard institutional pressure injury prevention care alone or standard care plus real‐time pressure‐sensing monitoring, with group allocation determined by device availability and operating‐room scheduling logistics. The primary outcome was newly identified perioperative pressure injury through postoperative day 7. Secondary clinical outcomes were time from surgery to injury onset and hospital length of stay. Results Pressure injuries occurred more frequently in the monitoring group than in the standard‐care group (68.0% vs. 53.6%, p = 0.02), whereas injury severity and anatomical distribution were comparable. Time to documented injury was shorter, and postoperative pain scores and hospital stay were lower and shorter in the monitoring group. Interface‐pressure data were available for the monitoring group only and are reported descriptively. Conclusions Real‐time pressure‐sensing monitoring, when added to standard preventive care, was associated with improved selected secondary outcomes but did not reduce pressure injury incidence and was associated with a higher injury frequency in this cohort. These findings should be interpreted cautiously given the non‐randomised design and baseline differences between groups.
INTRODUCTION:Nurses are highly susceptible to musculoskeletal disorders, with psychosocial workplace factors contributing to increased risk. However, the underlying mechanisms of this association remain unclear. This study explores the mediating role of stress in the link between psychosocial factors and musculoskeletal disorders among nurses. METHOD:A survey was conducted with 155 nurses at an academic hospital in Yogyakarta, Indonesia, from December 2023 to February 2024. Data were gathered on psychosocial factors-including work demands, interpersonal relations and leadership, work-individual interface, social capital, health and well-being-alongside stress and musculoskeletal disorders. The analysis was performed using partial least squares structural equation modelling via SmartPLS software. RESULTS:Findings indicated that stress acts as a mediator in the relationship between psychosocial factors and musculoskeletal disorders. Among the five psychosocial dimensions examined, interpersonal relations and leadership had the most significant indirect effect on musculoskeletal disorders via stress. Complementary mediation suggested additional mechanisms linking psychosocial factors and musculoskeletal disorders. CONCLUSION:This study underscores the significant role of stress in shaping how psychosocial factors influence musculoskeletal disorders. Organizations should manage psychosocial factors to reduce stress and mitigate MSDs, promoting better nurse well-being and work outcomes.
