PurposeThis review aimed to summarize and map the existing literature to clarify the temporal and spatial distribution, interconnections, and emerging trends in Intensive care unit-acquired weakness (ICU-AW) research.Patients and methodsBibliographic records were retrieved from the Web of Science Core Collection (WoSCC) and PubMed database. VOSviewer and CiteSpace were used to visualize the publication landscape, analyze citation patterns and collaborative networks, and conduct cluster analysis, burst keyword detection, and timeline mapping.ResultsA total of 1,449 publications from WoSCC and 648 publications from PubMed were included in analysis, representing contributions from 72 countries, 6,908 authors, and 365 journals. In recent years, authors from Asian countries and journals focusing on clinical nutrition have shown rapid growth. We identified 11 thematic clusters and 67 burst keywords from WoSCC publications, indicating a shift in research focus toward early identification, early functional rehabilitation, and nutritional support. External validation of the research topics and trends in PubMed database yielded results consistent with the preliminary analysis.ConclusionOver the past two decades, research on ICU-AW has expanded steadily, with increasing contributions from East Asia and nutrition- and neuromuscular-focused journals, while Europe, North America, and critical care publications continue to dominate. A total of 11 major research clusters were identified, encompassing the diagnosis, prevention, treatment, and prognosis of ICU-AW. These findings map the evolution of research themes and may help identify emerging directions and generate hypotheses for future studies.

Background Pain is a prevalent and distressing symptom in ICU patients, and suboptimal pain management in the ICU is associated with prolonged mechanical ventilation, increased delirium, and elevated healthcare costs. Nurses are central to pain assessment and management, yet substantial practice variations persist. Multiple influencing factors have been identified, but their interplay in shaping clinical behaviours remains poorly understood. Objective This study aims to explore the factors influencing ICU nurses' pain management behaviours guided by the COM-B (Capability-Opportunity-Motivation-Behavior) model, and to understand how these behaviours are shaped in complex clinical contexts. Study Design A descriptive qualitative design was adopted. Semi-structured interviews were conducted with 21 nurses from eight ICUs in a tertiary hospital in southern China between January and February 2026. Data were analysed using directed content analysis guided by the COM-B model. Findings Three themes and nine subthemes emerged: (1) Capability: analgesic knowledge application, pain perception and interpretation, and clinical decision-making; (2) Opportunity: organisational climate, interprofessional communication, and resource availability; (3) Motivation: professional identity, competing priorities, and external feedback. All three factors operated throughout the pain management process. Capability factors primarily influenced nurses' clinical interpretation and judgement of pain-related information, opportunity factors facilitated whether pain assessment could be translated into clinical action, and motivation factors shaped the priority assigned to pain management amid competing clinical demands. Conclusion: ICU nurses' pain management behaviours extend beyond simple pain assessment or the execution of medical orders, requiring complex clinical judgement based on patients' clinical conditions and contextual factors. This study provides a behavioural explanation of these practices and offers a foundation for developing targeted, context-specific interventions.

Background Understanding which clinically obtainable indicators are associated with financial vulnerability at discharge has implications for post-discharge service planning and resource allocation. This study examined whether nutritional status and multidimensional frailty mediate the relationship between ICU length of stay and financial toxicity in middle-aged and older ICU survivors. Methods In this single-centre cross-sectional study, 422 ICU survivors aged 45 years or older were recruited before hospital discharge. Nutritional status, multidimensional frailty, and financial toxicity were assessed using the Mini Nutritional Assessment–Short Form, Tilburg Frailty Indicator, and Comprehensive Score for Financial Toxicity. Structural equation modelling was used to test a serial mediation model with adjustment for selected demographic and clinical covariates. Results Longer ICU LOS was associated with poorer nutritional status (β = −0.256, p = 0.001), and poorer nutritional status was associated with greater frailty (β = −0.325, p < 0.001). Better nutritional status (β = 0.148, p = 0.003) and lower frailty (β = −0.118, p = 0.014) were associated with higher COST scores, indicating lower financial toxicity. The direct association between ICU LOS and COST score was not significant. The indirect association through nutritional status alone was significant (B = − 0.069, 95% CI − 0.130 to − 0.008, p = 0.027), whereas the frailty-only pathway was not. The sequential pathway through nutritional status and frailty was not significant (B = − 0.018, p = 0.058). Conclusions Longer ICU stay was indirectly associated with greater financial toxicity, primarily through poorer nutritional status. These findings suggest that nutritional screening before discharge may help identify ICU survivors at early risk of financial vulnerability, and that incorporating nutritional status into pre-discharge assessment protocols may support more targeted referral to post-discharge support services.

Background:China's rapidly aging population and high burden of frailty make proactive preparation for future care increasingly urgent, yet few older adults engage in such preparation. Existing interventions often overlook the heterogeneity between prefrail and frail populations and lack precision-oriented digital strategies. Objective:Building on a series of prior empirical studies, this study aimed to develop and pilot-test a digital intervention to support preparation for future care among community-dwelling older adults with prefrailty and frailty. Methods:The "Yi Yang Plan," a WeChat mini-program, was developed through a rigorous multiphase process, including a scoping review, a convergent mixed methods study, and a structural equation model. These findings informed the design of a tailored, stage-specific intervention targeting the distinct needs of prefrail and frail older adults. An interdisciplinary team subsequently refined the intervention using an iterative design approach. The intervention modules comprised 4 processes: Awareness Enhancement, Care Resources, Care Decision-Making, and Care Planning. Pilot testing involved expert panel consultations and think-aloud tests. Expert characteristics, engagement, and authority coefficients were assessed, and feedback was synthesized using content analysis. Feasibility and acceptability among older adults and their family members were evaluated through task completion metrics, satisfaction surveys, think-aloud protocols, and semistructured interviews. Results:Seven experts participated in the consultation, with an engagement coefficient of 100% and an authority coefficient of 0.88. Recommendations were synthesized into four key themes: (1) establishing mechanisms for care plan updating and review, (2) strengthening user-centered design, (3) implementing dynamic resource management and robust data security measures, and (4) enhancing integration with community care systems and policy frameworks. A total of 20 older adults and 20 family members were recruited. All participants successfully completed the assigned tasks, with a mean completion time of 20.7 (SD 5.2) minutes. Satisfaction ratings were generally favorable. The qualitative findings indicated that the intervention was perceived as useful and professionally designed, while also identifying several challenges, including variability in preparation for future care readiness and educational levels, limited interactivity, insufficient practical content, and reliance on support from adult children. Suggested improvements included enhanced personalization, additional supportive tools, improved usability, greater involvement of adult children, and stronger integration with offline services. Conclusions:The "Yi Yang Plan" demonstrated preliminary scientific validity, feasibility, and acceptability as a multidisciplinary, collaboratively developed digital intervention to support preparation for future care among older adults with prefrailty and frailty. By translating prior empirical and theoretical findings into a differentiated, precision-oriented digital strategy, this study advances interventions beyond conventional one-size-fits-all approaches. Future iterations should focus on optimizing system architecture, user interface design, platform functionality, and implementation strategies. Further research should conduct higher-quality randomized controlled trials to evaluate the platform's effectiveness.

BackgroundPostoperative delirium (POD) after cardiac surgery in the intensive care unit (ICU) has a high incidence and poor outcomes. Virtual reality (VR) is a non-pharmacological intervention of growing interest, but its effects in cardiac surgery patients remain underexplored.AimTo evaluate the feasibility of a perioperative VR-based intervention program and to explore its preliminary clinical effects on POD, anxiety, depression, cognition, sleep, and mobility in cardiac surgery patients.Study designA randomized controlled trial was conducted from February to March 2025 in a tertiary hospital in China. Forty participants undergoing elective cardiac surgery were assigned to usual care (control group) or usual care plus daily VR sessions from preoperative preparation until ICU discharge (intervention group) (n = 20 each). Outcomes included delirium incidence, severity, duration, onset time, and changes in stress, cognition, sleep, and mobility with time perioperatively.ResultsIn this pilot trial, the intervention group had a lower incidence of delirium than the control group (5% vs. 35%, p = 0.048). However, the study was not powered to detect differences in delirium incidence, and the limited number of events (n = 8) makes this estimate unstable. Therefore, this finding should be interpreted as a hypothesis-generating signal only, not as evidence of clinical efficacy. The intervention group also had lower delirium severity, higher Barthel Index scores, and shorter ICU length of stay (all p < 0.05). In addition, patients in the intervention group had lower stress levels at multiple perioperative time points, better sleep on the first and last ICU nights, and higher cognitive scores at ICU discharge than those in the control group. Repeated-measures analyses suggested favorable changes over time in anxiety, depression, and sleep in the intervention group.ConclusionPerioperative VR-based multicomponent intervention was feasible and well accepted in this pilot study, and may indicate potential benefit in reducing POD and improving selected psychological and functional outcomes in cardiac surgery patients. These findings are preliminary and require confirmation in larger, adequately powered multicenter trials.

When the goals of care for a critically ill child in the pediatric intensive care unit (PICU) shift from curative treatment toward palliative care, parents’ experiences are often complex and multifaceted. This review aimed primarily to synthesize qualitative evidence on parents’ experiences and, secondarily, to examine the interpretive relevance and boundaries of Weick’s sensemaking framework after the data-driven synthesis had been completed. We conducted a qualitative systematic review using the Joanna Briggs Institute (JBI) meta-aggregation approach. PubMed, Embase, CINAHL, Web of Science, the Cochrane Library, and ProQuest were searched from inception to 2 February 2026. Two reviewers independently screened studies, extracted author-generated analytical findings and supporting participant illustrations, and appraised methodological quality. Findings were synthesized inductively; the 15 resulting subdomains were subsequently mapped to Weick’s seven properties of sensemaking. Ten studies were included. Meta-aggregation generated five interrelated synthesized findings: (1) confronting and understanding the end-of-life reality; (2) finding recognition and support through relational networks; (3) maintaining the parental role; (4) safeguarding comfort, dignity, and farewell; and (5) continuing care and connection after the child’s death. Parents’ experiences encompassed efforts to understand a changing clinical situation, rely on relationships with clinicians and others, remain involved as parents, protect the child’s comfort and dignity, and sustain connection after death. Weick’s framework helped interpret how parents used clinical cues, relationships, identity, and caregiving actions to construct a workable understanding of events, but gave less attention to grief-related emotions, surrogate decision-making burden, cultural and spiritual meaning, organizational constraints, and continuing bonds. The findings may inform family-centered communication, parental-role support, individualized end-of-life care, and bereavement services in the PICU.

Device-enabled telemedicine is increasingly used in prehospital trauma, but reported workflows remain heterogeneous across operational settings, device types, and study designs. A workflow-oriented synthesis is needed to clarify which telemedical actions are being evaluated, what device categories enable them, what clinical utilities are reported, and which implementation barriers recur across studies. To map device-enabled telemedicine in prehospital trauma by linking telemedical actions, enabling device categories, reported clinical utilities, and implementation barrier domains. We conducted a scoping review following the Arksey and O’Malley framework and PRISMA-ScR reporting guidance. Four databases were searched for peer-reviewed primary studies published from 1 January 2010 to 1 July 2025. Eligible studies evaluated prehospital trauma workflows in which a device-enabled telemedical function informed triage, diagnosis, monitoring, or treatment decisions. Using inductive content analysis, we mapped included studies to a four-layer framework of telemedical actions, device categories, clinical utilities, and implementation barriers. Twenty-two studies were included. Most evaluations were simulation-based (15/22, 68.2

ObjectiveTo explore the correlations among fear of recurrence, post-traumatic stress disorder (PTSD), social support and disease recurrence in patients discharged after severe acute pancreatitis (SAP), so as to provide evidence for psychological intervention and recurrence prevention in SAP survivors.MethodsA total of 855 adult inpatients newly diagnosed with SAP at Sir Run Run Shaw Hospital, Zhejiang University School of Medicine from January 2020 to April 2025 were retrospectively enrolled. Baseline clinical data and 12-month post-discharge follow-up data including SAP recurrence events and psychological scale scores were collected. Intergroup comparison, correlation analysis, multivariate Logistic regression, linear regression and mediating effect model analyses were performed for statistical analysis.ResultsThe patients were divided into the recurrence group (144 cases) and non-recurrence group (711 cases). Baseline demographic characteristics, past medical history, etiology and disease severity were comparable between the two groups, except that the recurrence group had a significantly higher ICU admission rate (p = 0.026). The recurrence group presented significantly higher Fear of Progression Questionnaire-Short Form (FoP-Q-SF) and PTSD self-rating scale (PTSD-SS) scores, higher PTSD prevalence and severity, and lower Perceived Social Support Scale (PSSS) scores and proportion of high social support (all p < 0.001). Fear of recurrence was positively correlated with PTSD-SS scores (ρ = 0.64, p < 0.001). Multivariate regression analysis confirmed that fear of disease recurrence was positively associated with post-traumatic stress disorder (PTSD), while higher levels of social support were negatively associated with PTSD. PTSD-SS scores were positively associated with acute pancreatitis recurrence. Mediating effect analysis showed that PTSD had no significant mediating effect between social support and recurrence, nor between fear of recurrence and recurrence (all p > 0.05).ConclusionFear of recurrence is positively associated with PTSD symptoms in SAP patients, while high social support is negatively associated with this adverse psychological impact via a buffering interaction effect. PTSD severity is independently associated with an increased risk of SAP recurrence. These findings highlight the importance of psychological assessment and social support interventions in the long-term management of SAP survivors.

OBJECTIVE:To explore intensive care unit (ICU) healthcare professionals' perceptions and experiences of shared decision-making with conscious patients. DESIGN:A qualitative descriptive study using semistructured interviews. SETTING:Three ICUs at a Joint Commission International-accredited hospital in Hangzhou, Zhejiang Province, China. PARTICIPANTS:16 ICU healthcare professionals (9 females, 7 males; aged 23-45 years) were interviewed between September and November 2024. RESULTS:We identified 10 subthemes that were classified into three themes: (a) conscious but not ready: unstable decision-making ability, insufficient emotional readiness and limited cognitive evaluability; (b) the roles of doctors and nurses in shared decision-making (SDM): physicians as advisors, not decision-makers, nurses' limited role in SDM and fragmented team communication hinders information flow and (c) the double-edged sword of patient participation: protection or blame, collaboration or burden, hope or harm and being caught between values. CONCLUSIONS:ICU healthcare professionals acknowledge the value of involving conscious patients in SDM but also recognise its complexity. Challenges include assessing patients' fluctuating decision-making capacity, poor team communication and the potential for both benefit and harm. These findings highlight the need for clearer professional roles and more structured support.

ObjectiveThis study aimed to investigate the factors influencing self-care among older patients with heart failure (HF) and their spouses from a dyadic perspective.MethodsAn explanatory sequential mixed-methods design was employed. In the quantitative phase, 145 dyads of older HF patients and their spouses were recruited from a tertiary hospital in Zhejiang, China. Validated instruments were used to measure patient self-care, spouse contribution to self-care, disease-specific health literacy, mutuality, and social support. Multiple linear regression and the Actor-Partner Interdependence Model (APIM) were conducted separately for three self-care subscales (maintenance, management, confidence). In the qualitative phase, 10 dyads were purposively sampled for one-to-one semi-structured interviews, and data were analyzed via Colaizzi’s phenomenological method. Quantitative and qualitative findings were integrated adhering to the Theory of Dyadic Illness Management (TDIM).ResultsBoth patients and spouses scored below the 70-point adequacy threshold across all three self-care subscales. APIM revealed significant actor effects of health literacy and mutuality on self-care for both dyad members. Significant partner effects were observed in two dimensions: spouse mutuality was positively associated with patient self-care maintenance (B = 5.352, 95% CI: 0.631–9.828, p = 0.027), and spouse health literacy was positively associated with patient self-care confidence (B = 0.364, 95% CI: 0.193–0.533, p < 0.001). No significant partner effect was detected in the self-care management dimension, which showed suboptimal model fit and was thus interpreted as exploratory. No significant paths of traditional social support were retained in final models. Qualitative findings identified four thematic levels (individual, dyadic, family/social, cultural), supplementing contextual factors such as economic burden, reliance on digital healthcare services, and neglect of spousal caregivers. The integration provided a plausible contextual hypothesis for the null quantitative association between traditional social support and self-care.ConclusionHealth literacy and mutuality are core correlates of self-care among older Chinese HF patient-spouse dyads, with dimension-specific dyadic interaction patterns. Clinical interventions should develop tailored dyadic support strategies for distinct self-care dimensions, and pay attention to optimizing age-friendly digital healthcare services and improving caregiving culture. This study provides exploratory evidence for context-specific extension of the TDIM framework.

BACKGROUND:Generative artificial intelligence (GenAI) is increasingly influencing nursing practice and education, yet a gap remains between technological advances and clinical nurses' competencies. Research from nurses' perspectives that systematically differentiates and prioritizes GenAI learning needs remains limited. OBJECTIVE:To investigate clinical nurses' current use of GenAI and their learning attitudes, and to categorize and prioritize their learning needs using the Kano model. METHODS:A cross-sectional survey was conducted among 1219 clinical nurses in a tertiary hospital in China. Eighteen GenAI-related learning needs were classified using the Kano model. Better-Worse coefficients were calculated and visualized in a quadrant plot. The Average Satisfaction Coefficient (ASC) was further used to rank attributes within each quadrant. RESULTS:Most participants reported prior use of GenAI (87.69%) and positive attitudes (97.10%), while only 7.39% had received formal training. Six learning needs were identified as one-dimensional attributes, primarily related to practical applications such as teaching material development and patient education. One attribute (personalized nursing education) was classified as attractive. Eleven items, including foundational knowledge, ethics, and advanced clinical applications, were classified as indifferent. Within this category, usage standards, nursing rounds, and multidisciplinary case discussions showed relatively higher ASC values. CONCLUSION:Nurses' GenAI learning needs are currently oriented toward practical, application-focused skills. Curriculum development may benefit from a phased approach that prioritizes high-impact practical skills while progressively incorporating foundational, ethical, and advanced competencies. Ethics should be included as a core component. Educator preparedness and pedagogical leadership are important for effective integration of GenAI into nursing education.

BackgroundCareer decision-making difficulties are often associated with negative outcomes, including decreased motivation for learning, weakened professional identity, increased burnout, and a higher risk of turnover. However, most research has concentrated on the overall levels of career decision-making difficulties, overlooking the potential variations among different student subgroups. This gap hinders the creation of targeted intervention strategies.PurposeThis study aimed to identify latent profiles of Career decision-making difficulties among undergraduate nursing students and explore factors associated with these profiles.DesignA cross-sectional study.MethodsA convenience sampling method was employed to recruit 562 undergraduate nursing students from three universities in China. Participants completed validated measures assessing demographics, learning engagement, perceived social support, and career decision-making difficulties. Latent profile analysis identified distinct profiles of career decision-making difficulties, and multinomial logistic regression examined the associated factors.ResultsThree distinct career decision-making difficulties profiles emerged: multidimensional decision-making block (58.5%), knowledge-action disconnection (34.0%), and information-driven advantage (7.5%). Perceived social support, learning engagement, and class leadership status were significantly associated with these career decision-making profiles.ConclusionNursing students face diverse career decision-making challenges, highlighting the need for tailored institutional support. Students in the “Multidimensional Decision-Making Block” profile may benefit from structured career development courses. For the “Knowledge-Action Disconnection” profile, strengthening career information processing is crucial. Enhancing learning engagement, decision-making skills, and support networks can reduce uncertainty and better prepare students for their professional futures.

BACKGROUND: With population aging accelerating in China, frail older adults living in the community face complex care demands. However, limited research has focused on identifying the core demands and its influencing factors in this population. This study aimed to (1) construct the network structure of community care services needs and identify the core demands among frail older adults; (2) compare the network structures of community care needs and core demands between pre-frail and frail groups; and (3) explore the key factors influencing the core demands based on Andersen’s Behavioral Model. METHODS: A cross-sectional survey was conducted among 340 pre-frail and frail community-dwelling older adults in Zhejiang province, China. Data were collected through face-to-face interviews using structured electronic questionnaires, covering sociodemographic characteristics, health status, and 20 items on community care service needs. Network analysis was used to identify core demands, compare subgroups, and examine influencing factors using R (v4.4.0) with the EBICglasso method and the “bootnet”, “qgraph”, and “NetworkComparisonTest” packages. RESULTS: “Regular mental comfort by volunteers or social workers” played a central role in the community care needs among pre-frail older adults, whereas “Household management services” played a central role in the community care needs among frail older adults. “Marital Status” and “Living arrangement” emerged as the most influential determinants of core needs in both subgroups. However, the stability of the determinant network was relatively low among frail older adults, therefore findings should be interpreted cautiously. CONCLUSIONS: Household management was the core demand among frail older adults, emphasizing the need for daily life support. In contrast, the core demand for pre-frail adults was emotional comfort, suggesting the value of early psychosocial care. These findings highlight the need for community care to differentiate service priorities according to frailty stages. Interventions should be tailored to marital status and living arrangement to ensure that community care align with individual contexts.

Family members of intensive care units (ICUs) often experience psychological difficulties like anxiety and depression, which affect family functioning and their ability to support patient recovery. Digital health interventions (DHIs) offer accessible and timely support; yet, evidence regarding their effectiveness for ICU families demonstrates inconsistent. This systematic review and meta-analysis aimed to explore the impact of DHIs on psychological outcomes, quality of life (QoL), and quality of communication (QOC) among ICU family members. A total of 9 databases (CNKI [China Knowledge Resource Integrated Database], Wanfang, VIP [Weipu Database], SinoMed, Cochrane Library, PubMed, Embase, CINAHL, and Web of Science) were searched for randomized controlled trials (RCTs) published up to October 11, 2025. Eligible studies evaluated DHIs targeting adult ICU patients’ family members and reported psychological outcomes, QoL, or QOC; interventions used solely for monitoring or tracking were excluded. Furthermore, 2 reviewers independently screened studies, extracted data, and assessed the risk of bias using the Cochrane Risk of Bias Tool. Random-effects meta-analyses were performed using the Hartung-Knapp-Sidik-Jonkman method. Prediction intervals (PIs) were calculated to reflect between-study heterogeneity. Subgroup analyses were performed by patients’ primary diagnosis, relationship with patients, and type of digital health technology. Evidence quality was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. In total, 17 RCTs involving 1864 participants were included. Interrater agreement was high across study selection and assessment processes (κ=0.55-1.00). Most studies were judged to have some concerns about the risk of bias. Meta-analyses showed no statistically significant pooled effects of DHIs on anxiety (standardized mean difference [SMD] –0.34, 95% CI –0.68 to 0.00; 95% PI –1.46 to 0.79; P=.05), depression (SMD –0.26, 95% CI –0.52 to 0.01; 95% PI –1.11 to 0.60; P=.06), posttraumatic stress disorder (SMD –0.21, 95% CI –0.49 to 0.06; 95% PI –1.03 to 0.60; P=.11), QoL (SMD 0.09, 95% CI –0.10 to 0.28; 95% PI –0.41 to 0.60; P=.36), or QOC (SMD 0.14, 95% CI –0.03 to 0.31; 95% PI –0.26 to 0.55; P=.10). Wide PIs indicated substantial variability in intervention effects across settings. The certainty of evidence ranged from very low to moderate. This review emphasizes significant uncertainty in estimated effects and provides the first thorough synthesis of RCT evidence on DHIs for ICU family members. The inherently high heterogeneity and low certainty of the underlying evidence limit the conclusions of this review, despite its methodological rigor and use of PIs. Compared with previous reviews, this review concentrates on the ICU family members and includes more recent research. Future studies should focus on high-risk subgroups, use mixed methods designs, and develop theory-informed, personalized, and interactive DHIs. DHIs may enable proactive, customized communication techniques for families of ICU patients, even when there are few formal clinical recommendations. PROSPERO CRD420251044704; https://www.crd.york.ac.uk/PROSPERO/view/CRD420251044704

ObjectiveTo explore the lived experiences of social alienation among Chinese women with gynecologic malignancies and identify the meanings they attached to social withdrawal and reconnection.MethodsThis descriptive phenomenological study was conducted in a tertiary hospital in Hangzhou, China, in April 2025. Twelve women with histopathologically confirmed gynecologic malignancies were recruited through purposive sampling with maximum variation. Semi-structured face-to-face interviews were audio-recorded, transcribed verbatim, and analyzed using Colaizzi’s seven-step phenomenological method.ResultsThree themes and eight subthemes were identified. Participants described withdrawing from others to protect a threatened identity, including concealing the illness to avoid attention and restricting daily movement and social contact. They also described living in a body that feels changed and exposed, reflected in physical exhaustion and functional limits, changes in appearance and anticipated judgment, and concerns about family reputation and financial strain. Finally, they expressed a desire for understanding and a return to normal life, including feeling misunderstood in relationships and work and seeking work, normality, and meaningful connection. Across accounts, social alienation appeared to arise from the interaction of symptom burden, visible treatment effects, anticipated social judgment, practical constraints, and limited opportunities for understanding and support.ConclusionSocial alienation among women with gynecologic malignancies is a multidimensional experience shaped by bodily change, social responses, and practical barriers to participation. Supportive care should include psychosocial assessment, family-informed communication, peer support, and individualized assistance with social and occupational reintegration.

High-quality clinical databases are essential for advancing research and clinical practice in emergency and critical care medicine.With the widespread adoption of Electronic Health Record(EHR)systems across hospitals in China,vast amounts of clinical information have been digitally archived.

BACKGROUND:Shared decision-making is widely promoted in ICUs but remains challenging. As sedation strategies evolve, more conscious patients can participate, yet studies often overlook their experiences, focussing on family and clinicians. AIM:To explore the expectations of conscious ICU patients regarding their participation in shared decision-making and identify the factors influencing their level of engagement. STUDY DESIGN:A qualitative descriptive study was used. The data were collected using semi-structured interviews conducted between July and August 2024 at a university hospital in Hangzhou, China. Data were subjected to thematic analysis. Twelve conscious adult ICU patients (GCS = 15) with full decision-making capacity were recruited. FINDINGS:We identified 10 subthemes that were classified into three themes: (a) transfer of decision-making power: family members are better spokespersons, physician's authority, limited space for autonomy; (b) the complexity of patients' participation in decision-making: family-centred decision-making preferences, silent compromise and altruism, fluidity in decision-making; and (c) factors influencing the transfer of decision-making power: low decision-making efficacy, negative emotions, the financial costs of each decision and information vacuum. CONCLUSIONS:Conscious ICU patients prioritise respect, clear communication and sufficient information over asserting their rights. They rely on family support and find ICU decision-making stressful and fluid. Decisions should consider the family's well-being, as members may conceal their views for harmony. Culturally adapted models are needed to help patients express their needs. RELEVANCE TO CLINICAL PRACTICE:Understanding the decision-making preferences of conscious ICU patients is crucial for improving shared decision-making. Providing clear communication, emotional support and culturally sensitive approaches can help patients actively engage in the decision-making process.

AIMS:This meta-synthesis of qualitative studies aimed to explore the experiences and perspectives of healthcare providers in the Intensive Care Unit (ICU) setting regarding the implementation of early mobilization. DESIGN:A qualitative systematic review and meta-synthesis was conducted. The review protocol was registered with PROSPERO (CRD420251057721). DATA SOURCES:Six databases (PubMed, EMBASE, Web of Science, CINAHL, CNKI and Wanfang Data) were searched from inception to March 5, 2025. A total of 759 records were identified, and 34 studies met the eligibility criteria and were included in the final meta-synthesis. REVIEW METHODS:We evaluated the quality of the included studies using the Critical Appraisal Skills Programme-Qualitative Research Checklist. RESULTS:Thirty-four studies conducted in 13 countries and involving 699 ICU healthcare providers were included. Four analytical themes were generated: characteristics of early mobilization, the inner setting of implementation, the key role system and core determinants of successful implementation. CONCLUSION:Early mobilization in ICUs should be understood as a multidimensional implementation process rather than a single rehabilitation task. Sustainable practice depends on the characteristics of the intervention, organizational readiness, clearly defined interprofessional roles, patient engagement and process-level strategies such as preplanning, real-time monitoring, debriefing and feedback. The findings support the development of context-sensitive implementation strategies to translate early mobilization evidence into routine ICU care. IMPACT:This review underscores the critical importance of organizational support, team collaboration mechanisms and the professional capacity building of healthcare providers in advancing early mobilization within ICU settings. Frontline clinicians should be equipped with targeted training and structured planning tools, while leadership is encouraged to foster a culture of shared responsibility and continuous improvement. PATIENT OR PUBLIC CONTRIBUTION:This qualitative systematic review did not involve original patients or the public. Therefore, this is not applicable.

AimTo develop and internally validate prediction models estimating the individual probability of high decisional regret at 6 months among family surrogate decision-makers (FSDMs) of intensive care unit (ICU) patients, and to compare regression-based and machine-learning approaches with respect to discrimination, calibration and clinical utility.DesignA single-center prospective cohort study for the development and internal validation of prediction models.MethodsThis single-center observational prediction-model study was conducted in five ICUs of a tertiary university-affiliated hospital in Hangzhou, China, from October 2023 to October 2024. We enrolled 336 family surrogate decision-makers. Sociodemographic characteristics, health literacy, eHealth literacy, anxiety, depression, trust in physicians, and family functioning were collected within 3 days after ICU discharge. Decisional regret was assessed 6 months after hospital discharge using the Decision. Regret Scale and analyzed as a binary outcome, with a transformed score of ≥25 defining high decisional regret. Candidate predictors were selected using univariate analysis and least absolute shrinkage and selection operator regression. Logistic regression, random forest, support vector machine, and extreme gradient boosting models were developed and internally validated using a 70:30 train-test split. Model performance was assessed by discrimination, calibration, and decision curve analysis. SHAP analysis was used as an exploratory interpretability method.ResultsAmong 336 family surrogate decision-makers, 165 (49.11%) had high decisional regret and 171 (50.89%) had low decisional regret. Univariate analysis identified nine variables associated with decisional regret, including health literacy, trust in physicians, patient survival status, relationship to the patient, household income, anxiety, depression, and family functioning (all p < 0.05). In the test set, logistic regression showed the strongest overall performance (AUC 0.875, 95% CI 0.808–0.942; accuracy 0.752; sensitivity 0.702; specificity 0.796; F1 score 0.725). It also showed the most stable calibration and clinical net benefit. The final model comprised five predictors: eHealth literacy, trust in physicians, average monthly household income, anxiety and depression. In a secondary explanatory analysis, each contributed independently to the predicted probability (all p < 0.05); these estimates are reported to aid interpretation of the model and are not intended as causal effect estimates. Exploratory SHAP analysis identified trust in physicians, anxiety, and eHealth literacy as prominent contributors to model predictions.ConclusionDecisional regret was common among ICU family surrogate decision-makers. Trust in physicians, eHealth literacy, household income, anxiety, and depression were key predictors. Among the candidate models, logistic regression provided the best balance of discrimination, calibration, and clinical utility, suggesting that a parsimonious and interpretable model may support early risk screening in ICU family-centered care.

It reviewed the development and conceptual framework of "4Ms" （mentation， mobility， medications， and what matters most） elder⁃friendly services， their clinical applications， and implications for implementation in China.The aim is to promote the application of the "4Ms" elder⁃friendly care service model and provide references for future research and practice.