Background:Digital health technologies offer a promising approach to strengthening self-management capacity among patients with chronic obstructive pulmonary disease (COPD), yet clinical application is hampered by poor adherence, low sustained engagement, and limited self-management ability. Although previous studies have identified general self-management challenges in COPD, few have systematically investigated patients' preferences for digital tools or translated these insights into actionable design principles. This hinders the user-centred development and effective deployment of digital interventions for this population. Objective:This study aimed to explore the self‑management challenges and preferences for mobile health (mHealth) among COPD patients, with the ultimate goal of translating these findings into design principles for a persuasive self‑management application. Methods:We conducted in-depth personal interviews with 15 patients with COPD and five healthcare professionals to explore the challenges of self-management and preferences for mHealth. Data were analyzed using thematic analysis. Subsequently, a structured expert consultation was held to translate the findings into key principles for a persuasive self-management application. Results:Five themes regarding barriers to effective self-management were identified: (1) negative emotional experience, (2) poor health literacy, (3) insufficient family support, (4) inadequate professional health care, and (5) economic burden. Patients expressed four key preferences for digital health technologies: (1) simplicity, (2) personalized decision support, (3) self-report, (4) early warning of deterioration. Furthermore, the panel discussion distilled these findings into eight essential key principles: motivation, simplicity, credibility, guidance, personalization, self-report, warning, and continuity. Conclusion:This study provides new insights into user-centered mHealth tools for COPD self-management. We derived core design principles from patients' demands to inform targeted digital interventions. These principles require validation in female, higher-literacy and multi-center samples before wide application. Future work will complete the remaining CeHRes Roadmap stages of design, operationalization and evaluation to refine this framework.

Background:Kinesiophobia (fear of movement) is a significant barrier to pulmonary rehabilitation and functional recovery in patients with Chronic Obstructive Pulmonary Disease (COPD). Despite its considerable impact on clinical outcomes, this concept currently lacks a unified definition and comprehensive theoretical framework. Objective:To clarify the concept of kinesiophobia in COPD by identifying its defining attributes, antecedents, and consequences, and to integrate these elements into a cohesive conceptual framework. Methods:A comprehensive literature search was performed in CNKI, Wanfang, VIP, Web of Science, PubMed, CINAHL, and Cochrane Library databases from inception to April 1, 2025. Following Rodgers' evolutionary methodology, two researchers independently screened studies and conducted a systematic thematic synthesis. Results:Twenty-nine studies met inclusion criteria. Kinesiophobia in COPD is characterized by four defining attributes: symptom hypervigilance, maladaptive cognition, complex emotional responses, and behavioral avoidance. These are influenced by sociodemographic, disease-related, and psychological antecedents, and lead to functional decline and reduced quality of life. Conclusion:This analysis synthesizes a unified conceptual framework that integrates dyspnea-related and pain-related kinesiophobia, addressing a critical gap in the literature. This framework provides the foundation for developing precise assessment tools and mechanism-based interventions tailored to specific fear subtypes, ultimately aiming to disrupt the debilitating cycle of fear and avoidance in COPD.

Background Chronic Obstructive Pulmonary Disease (COPD) is a globally burdensome chronic disease characterized by persistent respiratory symptoms and progressive airflow limitation, which severely impairs patients’ quality of life and prognosis. Effective self-management is crucial for COPD management, as targeted self-management interventions have been shown to improve disease outcomes. Digital health technologies (DHTs) offer an innovative approach to address the challenges of traditional self-management and provide sustainable support for patients’ long-term disease management. However, existing digital interventions for COPD commonly face several major challenges, including low user engagement, poor long-term adherence, and high participant withdrawal rates, highlighting an urgent need for optimized digital solutions. Objective This study aimed to develop a user-centered mobile application tailored to meet self-management needs of patients with COPD under the guidance of the Centre for eHealth and Wellbeing Research (CeHRes) Roadmap and persuasive system design (PSD) principles, as well as to evaluate its usability performance. Methods The development of the COPD Digital Health Self-Management System (COPD DHSS) was guided by the CeHRes Roadmap.The process commenced with a comprehensive literature review, semi-structured interviews involving fifteen COPD patients and five healthcare providers, and expert panel discussions (n=7) to identify challenges in COPD self-management and define the key values for the DHTs into self-management protocols. Based on these key values, the research team identified PSD features. These PSD features were integrated with COPD self-management evidence synthesis and were utilized to inform the design of the COPD DHSS prototype. A mixed-methods evaluation was employed: Sixteen COPD patients were recruited to test the COPD DHSS. After one month of system deployment, the System Usability Scale (SUS) was administered to evaluate usability metrics. Participants subsequently engaged in focus group discussions to provide feedback on user experience. Results A User-Centered Mobile Application for COPD was successfully developed through a structured process. The system integrated patient self-reported data with evidence-based best practices for COPD self-management, generating personalized recommendations to enhance patients’ self-management capabilities and improve disease prognosis and quality of life. Usability testing was conducted with 16 COPD patients, whose average age was 71.5 (±6.9) years. Of these participants, 14 (87.5%) maintained twice-weekly app usage throughout the evaluation period. The median SUS score was 76.25(66.88, 83.13),indicating an acceptable level of usability. User feedback consistently indicated that the COPD DHSS demonstrated favorable usability characteristics. Conclusions Integrating the CeHRes Roadmap with PSD principles, this study successfully developed a usable, user-centered mobile application tailored to the self-management needs of older patients with COPD. It also demonstrates how a structured, theory-driven approach can translate patient and stakeholder insights into a practical digital tool that is both acceptable and usable for this target population. It can serve as a paradigm for applying mobile health technology in chronic disease self-management.

Background Cardiac exercise rehabilitation is an important intervention for disease management of patients with coronary heart disease (CHD) after percutaneous coronary intervention (PCI). Still, the participation and compliance with exercise rehabilitation remain suboptimal. Mobile health technology is a promising approach to promoting involvement in cardiac exercise rehabilitation. Remote rehabilitation can overcome the problems existing in traditional rehabilitation. Objective This study aimed to evaluate the effects of an eHealth cardiac rehabilitation (CR) platform based on the persuasive systems design model in addition to standard CR after PCI on physical activity (PA), exercise endurance, self-perceived fatigue, exercise self-efficacy (ESE), and quality of life for patients after PCI. Methods A single-blinded, parallel, randomized controlled trial design was used. The study was conducted in the Department of Cardiology of a tertiary hospital in Hangzhou, China. A total of 180 eligible patients with CHD were enrolled from June to December 2023. Participants were randomly assigned (1:1) to the intervention group or the control group, with 90 patients in each group. The study is a 24-week eHealth CR program. The primary outcome was PA level; the secondary outcomes included exercise endurance, self-perceived fatigue, ESE, and quality of life. Data on the primary and secondary outcome measures were collected at baseline (T0), at 12 weeks of intervention (T1), and at 4 (T2), 8 (T3), and 12 (T4) weeks of follow-up. The generalized estimating equation model was used to examine changes in the outcome variables between the 2 groups across the study end points. Results Generalized estimating equation analyses revealed significant group-by-time interactions for all outcome measures (all P<.001). At T4, compared with the control group, the intervention group demonstrated statistically significant improvements in the following outcomes: PA: median 1723.00 versus 805.50 Metabolic Equivalent Task minutes per week (β coefficient=937.29, 95% CI 867.61-1006.97); 6-minute walk distance: median 436.00 versus 405.00 m (β coefficient=31.00); self-perceived fatigue: median 9.00 versus 10.00 (β coefficient=–1.00, indicating reduced fatigue); ESE: 61.11 versus 27.78 (β coefficient=33.33); Short Form of 36 Health Survey Questionnaire score: 91.19 versus 84.13 (β coefficient=7.06; all P<.001). Notably, there was no significant difference in self-perceived fatigue between the 2 groups at T1 (P=.50). Conclusions The findings of this study demonstrate the effectiveness of the eHealth CR based on the persuasive systems design model in addition to standard CR after PCI in improving the PA level, exercise endurance, ESE, quality of life, and self-perceived fatigue of patients. These findings also provide insights into the application of an eHealth cardiac exercise rehabilitation interventions to enhance the rehabilitation of patients with CHD. Trial Registration China Clinical Trials Registry (ChiCTR) ChiCTR2300071666; https://www.chictr.org.cn/showprojEN.html?proj=197908

BackgroundInhaled medication is the preferred route of administration for patients with chronic obstructive pulmonary disease (COPD). The compliance rate of inhaled medication in patients with COPD is <50%, which increases the risk of acute exacerbations. Considering the complex steps of inhaled medication, improving inhaled medication compliance not only requires consistent medication frequency and medical advice but also an evaluation of whether the patient has mastered the inhaler technique to achieve the correct dose. ObjectiveThis study aimed to explore the effectiveness of an inhaled medication education program (Inhaling-Health website) based on the Fogg Behavior Model and gamification design on inhaled medication compliance and other health-related outcomes in patients with COPD. MethodsIn a randomized, 2-arm, concurrent parallel design, we enrolled 102 patients with COPD from respiratory medicine clinics at 2 hospitals in Zhejiang Province, China, between April and May 2023. Participants were randomly assigned to either the control group (51/102, 50%) or the experimental group (51/102, 50%). All participants completed the intervention, with 94 participants completing 6 months of follow-up. Two independent-sample 2-tailed t tests and the Mann-Whitney U test were used to analyze group differences, and generalized estimating equations were used to analyze repeated measurements. ResultsAfter the intervention, all outcome measures improved compared to baseline. The generalized estimating equation showed that, compared to the control group, the Inhaling-Health website led to a gradual improvement in total adherence-to-inhaler scores starting from 2 months after the intervention (median 51.00, IQR 49.00-52.25 vs median 50.00, IQR 47.00-51.00; Z=–2.014; P=.04). It had a separate positive effect on inhaler technique. In addition, the website was more effective in reducing the modified Medical Research Council score than routine inhaled medication education, starting from 4 months after intervention (median 1.00, IQR 1.00-2.00 vs median 1.00, IQR 0.00-2.00; Z=–2.260; P=.02). The website was also more effective than the conventional intervention in improving Chronic Obstructive Pulmonary Disease Knowledge Questionnaire scores, beginning at the end of the intervention (mean 6.14, SD 1.83 vs mean 7.06, SD 1.82; t1=–2.551; P=.01). ConclusionsThe gamified inhaled medication education program based on the Fogg Behavior Model can improve inhaled medication adherence, inhaler technique accuracy, health literacy, lung function, and health-related quality of life; help reduce the severity of dyspnea and COPD physical symptoms; and reduce the risk of acute exacerbations in patients with COPD. This study can provide a reference for inhaled medication education in patients with COPD. Trial RegistrationChina Clinical Trials Registry (ChiCTR) ChiCTR2300070213; https://www.chictr.org.cn/showprojEN.html?proj=194829

Medication nonadherence after percutaneous coronary intervention (PCI) remains a major barrier to secondary prevention. Prior SMS-based interventions have shown inconsistent results, often limited to reminders without addressing behavioral or psychological determinants. To evaluate the effectiveness and feasibility of a theory-informed, WeChat-based text-messaging program for improving adherence and patient-reported outcomes in post-PCI patients. A nonrandomized, quasi-experimental parallel-group study with a mixed-methods design was conducted from July 2022 to April 2023 at a tertiary hospital in Hangzhou, China. Patients were allocated by ward admission to intervention or control groups. The intervention comprised a 12-week WeChat program with daily medication reminders and educational messages mapped to COM-B domains and behavior change techniques. The primary outcome was adherence (MMAS-8); secondary outcomes were medication beliefs (BMQ-Specific), self-efficacy (SEAMS), and health status (SAQ). Outcomes were measured at baseline, discharge, and 12 weeks by blinded assessors. Analyses used ANCOVA with baseline adjustment and multiple imputation. After 12 weeks, semi-structured telephone interviews with intervention participants explored usability, message clarity and relevance, reminder helpfulness, timing and tone, and unmet needs. Interviews were conducted by an independent researcher, purposively sampled until thematic saturation, and thematically analyzed from verbatim transcripts. Of 180 patients screened, 92 were enrolled and 87 (94.6%) completed follow-up. At 12 weeks, adherence was higher in the intervention group (adjusted mean MMAS-8, 7.38 vs 6.20; mean difference, 1.18 [95% CI, 0.95–1.41]; P<.001). Secondary outcomes also favored the intervention, including improved beliefs, self-efficacy, and quality of life. Feasibility benchmarks were exceeded, with deliverability 97.9%, retention 95.7%, and acceptability scores >8/10. Interviews confirmed usability and highlighted the need for personalization. A theory-informed, WeChat-based program improved adherence, beliefs, self-efficacy, and quality of life after PCI. The intervention was feasible, acceptable, and scalable. Randomized trials are warranted to confirm long-term effectiveness and cost-effectiveness. Chinese Clinical Trial Registry (ChiCTR2200061353) https://www.chictr.org.cn/bin/project/edit?pid=172238

Fatigue is one of the most common and distressing symptoms in patients with chronic obstructive pulmonary disease (COPD). This study applied MICT, EFT and their combination (MICT and EFT) to COPD patients with fatigue through factorial design analysis method, aiming to explore non-drug management strategies that are more conducive to relieving fatigue in COPD patients. This study had a total of 112 participants. Patients were randomly divided into Control group, MICT group, EFT group and Combination group (MICT-plus-EFT group) by random number table method. The intervention duration was 8 weeks. The results showed that there were statistically significant differences in fatigue scores, anxiety and depression scores, sleep quality scores, and 6MWT scores among the four groups at T1, T2, and T3(P<0.05). The results of factorial analysis showed that there was no significant interaction between MICT and EFT on fatigue score, HADS score, PSQI score and 6WMT.The overall effect of the combined intervention was better than that of the single intervention, but the effect of the combined intervention may simply be the superposition of the effects of the two measures.

The quality of bowel preparation is an important factor in the success of colonoscopy. However, multiple influencing factors that function together can lead to inadequate bowel preparation. The main objective of this study was to explore the specific factors that affect the quality of bowel preparation, with the goal of deriving and validating a predictive model for inadequate bowel preparation in Chinese outpatients. A prospective observational study. We conducted a prospective study in a tertiary hospital in Zhejiang Province that included elective colonoscopy outpatients treated between December 15, 2022 and August 12, 2023. Clinical data related to the patient characteristics and patient bowel preparation were collected to analyze the risk factors of inadequate bowel preparation in outpatients. The quality of bowel preparation was assessed by using the Boston bowel preparation scale (BBPS). Inadequate bowel preparation was defined as a total BBPS score of < 6 or any segment score of < 2. The predictive model was constructed based on multivariate logistic regression, and the discrimination and calibration of the prediction model were evaluated via internal and external validation; additionally, a clinical decision curve was drawn to evaluate the clinical utility of the model. A total of 1314 patients were included from December 15, 2022 through May 31, 2023 (derivation cohort, n = 1035) and from June 1 through August 12, 2023 (external validation cohort, n = 279). Inadequate bowel preparation occurred in 260 of 1035 patients in the derivation cohort (25.1%). Multivariate analysis identified that male sex (OR = 1.690, 95% CI: 1.242-2.300), diabetes (OR = 1.769, 95% CI: 1.059-2.954), constipation (OR = 2.375, 95% CI: 1.560-3.617), history of colorectal surgery (OR = 2.915, 95% CI: 1.455-5.840), a high fiber diet used at 24 h before examination (OR = 2.662, 95% CI: 1.636-4.334) and the time interval from the end of the bowel preparation to the start of the colonoscopy (PC) >5 h (OR = 2.471, 95% CI: 1.814-3.366) were independent risk factors. We derived a model to identify patients with inadequate cleansing by using data from patients in the derivation cohort and tested it in the validation cohort. The area under the curve (AUC) was 0.704 (95% CI: 0.667-0.741), with a calibration value of p = 0.632 in the derivation cohort. Bootstrap cross-validation showed a good model calibration condition. For the validation cohort, the AUC was 0.704 (95% CI: 0.628-0.779), and the calibration value was p = 0.376. We identified the influencing factors of outpatient bowel cleansing that are associated with patient clinical characteristics and bowel preparation-related behaviors. A model was constructed and validated to identify patients who were at high risk of inadequate bowel preparation by using six simple variables, which included male sex, diabetes, constipation, history of colorectal surgery, a high fiber diet used at 24 h prior to examination, and PC > 5 h. The clinical decision curve showed that the constructed prediction model has some clinical utility based on results from the derivation cohort and validation cohort.

This study aimed to assess the levels of physical activity (PA) in people with chronic obstructive pulmonary disease (COPD), investigate the impact of dyspnea-related kinesiophobia on them, and further examine the moderated mediation effects of exercise perception and exercise self-regulatory efficacy on this relationship. This cross-sectional study was conducted from December 2023 to May 2024. Data were collected using the Breathlessness Beliefs Questionnaire, International Physical Activity Questionnaire - Long Form, Exercise Benefits/Barriers Scale, and Exercise Self-Regulatory Efficacy Scale. Descriptive statistics and Process macro in the SPSS program were used for data analysis. A total of 239 patients with COPD were included, and median physical activities were 64.50 (28.00, 126.55) MET-h/week. Dyspnea-related kinesiophobia was negatively correlated with exercise perception, exercise self-regulatory efficacy, and PA (r = -0.503, -0.739, -0.657, P < 0.01). Exercise self-regulatory efficacy partially mediated the impact of dyspnea-related kinesiophobia on PA (β = -0.255, 95% CI [-0.353, -0.164]), and exercise perception moderating this mediating pathway (β = 0.100, P = 0.030; β = 0.412, P < 0.001). People with COPD commonly have dyspnea-related kinesiophobia and experienced physical inactivity. The moderated mediation model provides a better understanding of how dyspnea-related kinesiophobia, exercise self-regulatory efficacy, and exercise perception work together to influence PA. Interventions seeking to improve the levels of PA in patients with COPD should consider these elements.

ObjectiveTo translate the Patient Chronic Illness Resource Survey(CIRS) into Chinese,and to test its reliability and validity in patients with chronic obstructive pulmonary disease(COPD).MethodsAccording to the Brislin classic back translation model,Chinese version of Chronic Obstructive Pulmonary Disease Patient Chronic Illness Resource Survey was developed.From September 2022 to December 2023,a convenience sampling method was used to select 411 patients with chronic obstructive pulmonary disease who visited a tertiary grade A hospital in Yiwu city for investigation.And the reliability and validity of the scale were tested.ResultsThe Chinese version of Chronic Obstructive Pulmonary Disease Patient Chronic Illness Resource Survey included 5 dimensions and a total of 16 items.The content validity index of the scale leve was 0.98.The content validity index of the scale item level was 0.921⁃1.000.Five common factors with eigenvalue greater than 1 were extracted,with a cumulative variance contribution rate of 79.056%.Social Support Rating Scale(SSRS) was used as the criterion to calculate the correlation validity,with a correlation coefficient of 0.960(P<0.001).The total Cronbach's alpha coefficient of the scale was 0.819.The Cronbach's alpha coefficients of the five dimensions were 0.803⁃0.891.The test⁃retest reliability of the scale was 0.991.ConclusionsThe reliability and validity of the Chinese version of Chronic Obstructive Pulmonary Disease Patient Chronic Illness Resource Survey were fine.And it could be used as a measurement tool for the social resource utilization of COPD patients.

Background Self-efficacy for postoperative rehabilitation management is the key to rapid recovery after lung cancer surgery. Identification of protective and risk factors is a prerequisite for programs to enhance self-efficacy. The aim of this study was to determine the relationship between health belief and self-efficacy for postoperative rehabilitation management, and to further elucidate the mechanisms by which health belief improve patients' self-efficacy for postoperative rehabilitation management by enhancing pulmonary exercises compliance and reducing self-perceived symptom burden. Methods A total of 231 patients who underwent lung cancer resection from March 2023 to August 2023 were conveniently selected and investigated using the general information questionnaire, MD-Anderson Symptom Inventory, Pulmonary exercises compliance questionnaire, Champion’s health belief model scale, and Self-efficacy scale for postoperative rehabilitation management of lung cancer. The mediating roles of pulmonary exercise compliance and symptom burden in the relationship between health belief and self-efficacy for postoperative rehabilitation management were analyzed by structural equation modeling using IBM AMOS 22.0. Results Patient pulmonary exercise compliance (β = 0.59, p < 0.05) had a direct effect on self-efficacy for postoperative rehabilitation management, while pulmonary exercise compliance negatively affected self-perceived symptom burden (β=-0.22, p < 0.05) and symptom burden negatively affected self-efficacy for postoperative rehabilitation management (β=- 0.12, p < 0.05), and health belief indirectly influenced self-efficacy for postoperative rehabilitation management through the interlocking mediating effects of pulmonary exercise compliance and symptom burden. Conclusions Pulmonary exercise compliance and self-perceived symptom burden chain-mediated between health belief and self-efficacy for postoperative rehabilitation management, and health belief can influence symptom burden and self-efficacy for postoperative rehabilitation management through pulmonary exercise compliance.

ObjectiveThe early identification and diagnosis of transplant-associated thrombotic microangiopathy (TA-TMA) are essential yet difficult in patients underwent hematopoietic stem cell transplantation (HSCT). To develop an evidence-based, nurse-leading early warning model for TA-TMA, and implement the healthcare quality review and improvement project. MethodsThis study was a mixed-methods, before-and-after study. The early warning model was developed based on quality evidence from literature search. The healthcare quality review and improvement project mainly included baseline investigation of nurse, improvement action and effectiveness evaluation. The awareness and knowledge of early parameter of TA-TMA among nurses and the prognosis of patients underwent HSCT were compared before and after the improvement. ResultsA total of 1 guideline, 1 evidence synthesis, 4 expert consensuses, 10 literature reviews, 2 diagnostic studies, and 9 case series were included in the best evidence. The early warning model including warning period, high-risk characteristics and early manifestation of TA-TMA was developed. The improvement action, including staff training and assessment, suspected TA-TMA identification and patient education, was implemented. The awareness and knowledge rate of early parameter of TA-TMA among nurses significantly improved after improvement action (100% vs. 26.7%, P < 0.001). The incidence of TA-TMA was similar among patients underwent HSCT before and after improvement action (2.8% vs. 1.2%, P = 0.643), while no fall event occurred after improvement action (0 vs. 1.2%, P < 0.001). ConclusionThe evidence-based early warning model and healthcare quality improvement project could enhance the awareness and knowledge of TA-TMA among healthcare providers and might improve the prognosis of patients diagnosed with TA-TMA.

BACKGROUND The high incidence and mortality of gastric cancer (GC) pose a significant threat to human life and health, and it has become an important public health challenge in China. Body weight loss is a common complication after surgical treatment in patients with GC and is associated with poor prognosis and GC recurrence. However, current attention to postoperative weight change in GC patients remains insufficient, and the descriptions of postoperative weight change and its influencing factors are also different. AIM To investigate body weight changes in patients with GC within 6 mo after gastrectomy and identify factors that influence dynamic body weight changes. METHODS We conducted a prospective longitudinal study of 121 patients with GC and collected data before (T0) and 1 (T1), 3 (T2), and 6 (T3) mo after gastrectomy using a general data questionnaire, psychological distress thermometer, and body weight measurements. The general estimation equation (GEE) was used to analyze the dynamic trends of body weight changes and factors that influence body weight changes in patients with GC within 6 mo of gastrectomy. RESULTS The median weight loss at T1, T2, and T3 was 7.29% (2.84%, 9.40%), 11.11% (7.64%, 14.91%), and 14.75% (8.80%, 19.84%), respectively. The GEE results showed that preoperative body mass index (BMI), significant psychological distress, religious beliefs, and sex were risk factors for weight loss in patients with GC within 6 mo after gastrectomy (P < 0.05). Compared with preoperative low-weight patients, preoperative obese patients were more likely to have weight loss (β = 14.685, P < 0.001). Furthermore, patients with significant psychological distress were more likely to lose weight than those without (β = 2.490, P < 0.001), and religious patients were less likely to lose weight 6 mo after gastrectomy than those without religious beliefs (β = -6.844, P = 0.001). Compared to female patients, male patients were more likely to experience weight loss 6 mo after gastrectomy (β = 4.262, P = 0.038). CONCLUSION Male patients with GC with high preoperative BMI, significant psychological distress, and no religious beliefs are more likely to lose weight after gastrectomy.

BackgroundEmbodied conversational agents (ECAs) are computer-generated animated humanlike characters that interact with users through verbal and nonverbal behavioral cues. They are increasingly used in a range of fields, including health care. ObjectiveThis scoping review aims to identify the current practice in the development and evaluation of ECAs for chronic diseases. MethodsWe applied a methodological framework in this review. A total of 6 databases (ie, PubMed, Embase, CINAHL, ACM Digital Library, IEEE Xplore Digital Library, and Web of Science) were searched using a combination of terms related to ECAs and health in October 2023. Two independent reviewers selected the studies and extracted the data. This review followed the PRISMA-ScR (Preferred Reporting Items of Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) statement. ResultsThe literature search found 6332 papers, of which 36 (0.57%) met the inclusion criteria. Among the 36 studies, 27 (75%) originated from the United States, and 28 (78%) were published from 2020 onward. The reported ECAs covered a wide range of chronic diseases, with a focus on cancers, atrial fibrillation, and type 2 diabetes, primarily to promote screening and self-management. Most ECAs were depicted as middle-aged women based on screenshots and communicated with users through voice and nonverbal behavior. The most frequently reported evaluation outcomes were acceptability and effectiveness. ConclusionsThis scoping review provides valuable insights for technology developers and health care professionals regarding the development and implementation of ECAs. It emphasizes the importance of technological advances in the embodiment, personalized strategy, and communication modality and requires in-depth knowledge of user preferences regarding appearance, animation, and intervention content. Future studies should incorporate measures of cost, efficiency, and productivity to provide a comprehensive evaluation of the benefits of using ECAs in health care.

Patients with moderate to severe COPD frequently experience dyspnea, which causes these patients to acquire a fear of dyspnea and a fear of activity. This study developed a cognitive intervention combined with active cycle of breathing technique (ACBT) intervention program based on the fear-avoidance model, with the goal of evaluating the program's effectiveness in improving dyspnea-related kinesiophobia in patients with moderate to severe COPD. This study had a total of 106 participants. For 8 weeks, the intervention group (N=53) received cognitive combined with ACBT, while the control group (N=53) received standard care. The findings of the four times the dyspnea belief questionnaire were collected indicated that the combined intervention had a better impact on reducing dyspnea-related kinesiophobia than did routine nursing (P<0.05), and the impact persisted even after the intervention. Additionally, it may enhance dyspnea and quality of life, increase exercise capacity, and lower the BODE index.

Percutaneous coronary intervention (PCI) helps treat coronary artery disease but only provides short-term relief and doesn’t stop disease progression. Exercise rehabilitation can improve outcomes for patients after PCI and lower the risk of death and new heart problems, but many patients struggle to stick with their exercise routines. Spouses play a crucial role in supporting patients and helping them stay committed to their rehabilitation. This study aims to evaluate the effectiveness of a couple-based exercise program in improving exercise adherence among post-PCI patients. This study used a quasi-experimental design, 70 dyads were recruited for a 12-week investigation. Participants were divided into an intervention group to receive the Couple-Based exercise program and a control ensemble for conventional exercise-based cardiac rehabilitation. The primary parameter under examination was exercise adherence. Secondary endpoints encompass exercise self-efficacy, the 6-minute walk test, the 9-item Patient Health Questionnaire, and the Generalized Anxiety Disorder Scale. Data were harvested at baseline and post-intervention (12 weeks). Following a three-month monitoring period, noticeable differences were observed in the Couples exercise group compared to the control group in the realms of exercise adherence, exercise self-efficacy, the 6-minute walk test, and anxiety-depression indices (P < 0.05). A couple-based exercise program developed based on a developmental-contextual framework improves exercise adherence and exercise self-efficacy, enhances cardiac function and exercise capacity, and improves anxiety and depression in post-coronary arteriography patients. This approach is likely to be an effective way to improve rehabilitation outcomes, leading to the broader goal of improving patient prognosis and reducing adverse cardiovascular events. The study’s registration was recorded with the Chinese Clinical Trials Registry (12/04/2022, registration number ChiCTR2200058600).

Empowerment is a comprehensive concept involving intrapersonal, interactional, and behavioral aspects. However, there is a lack of a specific empowerment scale for Coronary artery disease (CAD) related to knowledge and skills in China. The reliability and validity of the Coronary Artery Disease Empowerment Scale (CADES) need to be tested. This study aimed to assess the reliability and validity of the Chinese version of CADES among patients with CAD in China. The study adopted a cross-sectional design. After obtaining the copyright by contacting the author, the original English CADES was developed into Chinese by forward translation, back-translation, cross-cultural adaptation, and a pretest (30 patients). The Chinese version of CADES was administered to 391 CAD patients between September 2022 and June 2023, with the reliability and validity of the version evaluated. Exploratory factor analysis and confirmatory factor analysis were performed to examine the underlying factor structure of the translated questionnaire. The Cronbach’s α coefficient, Guttman’s split-half coefficient, and McDonald’s omega coefficient were calculated to verify the scale’s reliability. For the Chinese version of CADES, the scale-content validity index was 0.972, with the item-content validity index ranging from 0.86 to 1.00. The questionnaire comprised 25 items, and exploratory factor analysis extracted four factors with loadings > 0.40, explaining 62.382

BACKGROUND:The effect of intraoperative anesthesia depth monitoring on delirium occurrence and improvement of nursing quality in the post-anesthesia care unit (PACU) remains unclear. We aimed to explore the effect of intraoperative anesthesia bispectral index (BIS) monitoring on delirium occurrence and improvement of nursing quality in the PACU for patients recovering from general anesthesia. METHODS:This randomized controlled trial included 120 patients, aged 20-80 years, classified as grades I-III according to the American Society of Anesthesiologists. The BIS-guided group (group B) underwent intraoperative monitoring of BIS anesthesia depth (maintained within the anesthetic range (40-60)). The depth of anesthesia was not monitored in the non-BIS-guided group (group C). The patient's vital signs were recorded at the beginning of the operation (T0), upon entering the PACU (T1), 15 min after extubation (T2), and after leaving the PACU (T3). Delirium score, emergence period (extubation and PACU observation times), and adverse events in the PACU were monitored. The nursing activity score (NAS) was used to evaluate the quality of care. RESULTS:Group B exhibited significantly lower heart rate and mean arterial pressure at T1 and T2, shorter time to extubation and PACU observation time, and a significantly lower incidence of adverse events than group C. Group B had significantly lower Ricker sedation-agitation scores and a lower incidence of delirium than group C. The NAS was significantly lower for group B than for group C. Patients aged 60-80 years in group C experienced agitation, requiring 30% more frequent assistance from one or two nurses than those in group B. CONCLUSION:Intraoperative BIS monitoring can reduce the incidence of adverse events in the PACU, diminish the incidence of delirium during the recovery period in elderly patients, lessen the nursing workload, improve nursing quality, and promote patient rehabilitation, thus meriting clinical application.

Aims:The Royal Free Hospital Nutritional Prioritizing Tool (RFH-NPT), the Liver Disease Undernutrition Screening Tool (LDUST) and Nutritional Risk Screening 2002 (NRS2002) were used by nurses to screen, compare, and analyze the nutritional status of patients with liver cirrhosis. The application value of different screening tools was summarized in the nutritional screening of patients with liver cirrhosis. Methods:In this study, LDUST, RFH-NPT, and NRS2002 were used by nurses to screen the nutritional status of hospitalized patients with liver cirrhosis within 24-48 h after admission. The study calculated validity indicators such as sensitivity, specificity, the area under the receiver operating curve (AUC), and reliability indicators such as the Kappa coefficient. The efficacy of these screening tools in the nutritional screening of patients with liver cirrhosis was compared. Results:Among the 207 patients, LDUST and NRS2002 identified 72.9 % and 23.7 % as undernourished, respectively. The sensitivity of LDUST and NRS2002 were 92.1 % and 30.0 %, respectively. The Kappa value of LDUST and RFH-NPT was 0.620, and the Kappa value of LDUST compared with NRS2002 was 0.144. Conclusion:This study shows that the Liver Disease Undernutrition Screening Tool, a special screening tool for patients with liver cirrhosis, has a more reliable screening effect and higher sensitivity than NRS2002. The Liver Disease Undernutrition Screening Tool is recommended for nutritional screening in patients with liver cirrhosis.