AIMS:This review aims to synthesize qualitative evidence on patients' lived experiences of advanced practice nursing. DESIGN:Qualitative systematic review. DATA SOURCES:The studies included in this review were sourced from PubMed, Web of Science, The Cochrane Library, Embase, and CINAHL. Studies were limited to those published from database inception to March 5, 2026. REVIEW METHODS:The review adhered to the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) guidelines. Two independent reviewers screened titles, abstracts, and full-text articles to assess eligibility for inclusion. Data were extracted and analyzed using thematic synthesis. Confidence in findings was assessed using the CERQual approach. RESULTS:Thirty-seven studies were included. Five themes emerged from patients' accounts: (1) feeling seen and heard through therapeutic presence; (2) understanding illness through explanation and dialogue; (3) building trust through competence and respect; (4) gaining confidence and agency in self-management; and (5) experiencing coherent and coordinated care across services. CONCLUSIONS:Patients experienced advanced practice nursing as a relational, educational, and coordinating form of care. APNs were valued not only for their advanced clinical expertise but also for the way they listened, explained, built trust, supported patient agency, and helped patients navigate fragmented healthcare systems. These findings suggest that the effectiveness of APN care is closely linked to relational continuity, individualized communication, and system-level coordination. CLINICAL RELEVANCE:Understanding patients' lived experiences of advanced practice nursing can help nurses and healthcare organizations strengthen patient-centred care. The findings highlight the importance of protecting time for listening, supporting clear and individualized communication, building trustful partnerships, encouraging patient participation, and recognizing APNs' role in coordinating care across complex healthcare systems.

ObjectiveThis study aims to explore the attitudes and involvement of physicians, nurses and patients in fall risk management, focusing on the factors influencing physicians' participation.MethodsThis study utilized a convenience sampling, 4,272 participants (580 physicians, 2,775 nurses, 917 patients) from 19 Chinese provinces were enrolled via Questionnaire Star from 11 April to 31 May, 2024. The survey included general information, tripartite fall management perspectives, and 27-item medical staff/patient questionnaires. Medical staff evaluated fall risk through assessment, prevention, and management; patients reported adherence and staff participation.ResultsPhysicians and nurses showed comparable attitude scores (55.02 ± 8.124 vs 54.58 ± 9.096, P = 0.227), but physicians had higher participation (51.47 ± 9.703 vs 42.77 ± 12.052, P < 0.001). Key factors influencing physicians' engagement included education level, gender, and nurses' invitation frequency/awareness of fall management importance. Staff identified patient noncompliance, disease complexity, and low risk awareness as challenges; patients cited disease severity, environmental hazards, and insufficient education.ConclusionEffective fall prevention requires multidisciplinary collaboration. Nurses predominantly lead fall management, while physicians demonstrate limited involvement, closely tied to nurses' proactive engagement invitations. Cultivating a culture where nurses actively invite physician collaboration is critical to enhancing safety strategies.

BACKGROUND:The end-of-life experience is a multidimensional concept that involves multiple domains, such as physical, social, caregiving, and environmental aspects, but previous studies have examined only individual factors. Analyzing the heterogeneity of older adults' end-of-life experiences via comprehensive evaluation indicators can enhance understanding of the end-of-life process and inform the development of personalized care strategies. AIM:To identify end-of-life experience patterns among older adults via comprehensive evaluation indicators.Design, setting/participants:In this cross-sectional study, Chinese Longitudinal Healthy Longevity Survey (CLHLS) data were used. Older adults (aged 65 years and older) who died between 2008 and 2018 were selected. Data on the physical condition, family support, caregiving, and place of death of older adults were extracted to perform a latent class analysis to identify end-of-life experience patterns. A multinomial logistic regression was employed to explore the association between demographic characteristics and class membership, and an ordinal logistic regression was used to examine the relationship between class membership and pain near death. RESULTS:A total of 15,844 deceased older adults were included in the study. Latent class analysis identified three end-of-life experience patterns: 'limited companionship-institutional death' (14.28%), 'functional disability-family care' (60.70%), and 'living well-affordable caregiving' (25.02%). Females who lived in cities were more likely to belong to the functional disability-family care class. The living well-affordable caregiving class was associated with the lowest level of pain near death. CONCLUSIONS:Further strategies need to be implemented to address gender and urban‒rural inequities in end-of-life care. It is crucial to prioritize expanding access to community-based healthcare resources and offering comprehensive training for family caregivers.

BACKGROUND:Dyspnea is a prevalent and profoundly distressing symptom. Fan therapy, a simple nonpharmacologic intervention, has shown potential in alleviating dyspnea. However, its effects remain unclear. OBJECTIVE:We aimed to update and expand the existing evidence on the effectiveness and perceptions of fan therapy in adults with dyspnea to inform clinical symptom management. METHODS:This review followed PRISMA 2020. A comprehensive literature search was performed across multiple databases, including PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Wanfang Data and Chinese Scientific Journals Full-text Database, from inception through March 20, 2025. Two reviewers independently screened studies, extracted data and assessed risk of bias. Quantitative synthesis was performed using Review Manager software, version 5.3. Qualitative findings were synthesized narratively. RESULTS:This review included 15 studies (623 participants). In meta-analysis, the overall effect on dyspnea severity was not statistically significant; however, post hoc subgroup analysis by outcome assessment timing showed a significant short-term reduction within 5-10 min after fan therapy (SMD = -0.41, 95% CI: [-0.70, -0.11], p = 0.007, I2 = 32%). No significant differences were observed in physiological parameters, physical activity levels, self-efficacy, or caregiver-related outcomes. Furthermore, qualitative evidence indicated that patients, clinicians and caregivers generally expressed positive views toward fan therapy, considering it an effective and accessible nonpharmacological intervention. CONCLUSIONS:Fan therapy may provide short-term relief of dyspnea in adults, with limited evidence of sustained benefit and no consistent effects on physiological or other related outcomes. Given its acceptability, low-cost and portability, it may be considered a practical adjunct for dyspnea management, although longer-term trials are needed. RELEVANCE FOR CLINICAL PRACTICE:Fan therapy can be used as an adjunct to disease-targeted treatments in the management of dyspnea, particularly in community nursing, low-cost and resource-limited settings. PATIENT OR PUBLIC CONTRIBUTIONS:Not applicable.

Pressure injury poses a critical challenge in geriatric care. Current computer-aided diagnosis is limited by an exclusive reliance on surface texture, neglecting subcutaneous hemodynamics essential for distinguishing Reactive Hyperemia from Stage 1 PI and detecting Deep Tissue Pressure Injuries. To address this, we constructed a customized cross-polarized acquisition system and a dedicated clinical dataset. We present the Physio-Guided Network (PGNet), a multi-modal framework leveraging remote Photoplethysmography (rPPG) to provide complementary non-contact hemodynamic cues related to local microcirculatory dynamics. Specifically, we engineered a Frequency-Domain SNR-Weighted strategy to retrieve attenuated physiological signals from necrotic tissue, and a Physio-Visual Gating Unit for dynamic modality arbitration. Patient-level leave-one-out validation supports the feasibility of the proposed framework for differentiating morphologically similar early pressure injury states. The results indicate that rPPG-driven hemodynamic guidance provides complementary information beyond visual-only analysis. By bridging superficial morphology with non-contact hemodynamic sensing, this study demonstrates the clinical relevance and technical feasibility of rPPG-guided multimodal analysis for early pressure injury warning, providing patient-level evidence that supports its potential value for differentiating clinically ambiguous RH, S1, and DTPI cases and laying the groundwork for future multicenter, device-independent validation.

Background: Patients undergoing lung cancer surgery frequently experience postoperative discomfort. Although enhanced recovery after surgery (ERAS) effectively reduces length of stay and complications, patients' subjective comfort is often underaddressed. The aim of this study is to evaluate the impact of a comfort-enhanced recovery after surgery (ComERAS) protocol on perioperative comfort, quality of life (QoL), and patient satisfaction among surgical lung cancer patients. Methods: A single-center, single-blind, randomized controlled trial design was employed. Patients were randomly assigned at a 1:1 ratio to the ComERAS group or the standard ERAS group. The ComERAS group received personalized comfort management provided by a multidisciplinary team, including preemptive multimodal analgesia, a "minimal-tube" strategy, early mobilization, traditional Chinese medicine interventions, and psychological support. Primary outcomes were General Comfort Questionnaire (GCQ) scores at discharge (T1). Secondary outcomes included GCQ score at 1 month postoperatively (T2), QoL, anxiety, depression and patient satisfaction. Analyses followed the intention-to-treat principle. Results: There were 134 participants randomized and 121 participants completed the 1-month follow-up. Compared with the ERAS group, the ComERAS group had significantly higher overall comfort scores at discharge (+1.05, P=0.01) and at 1 month (+0.57, P=0.006), improved self-care ability, and lower symptom burdens related to cough, pain, sleep, and fatigue (P<0.05). Moreover, the ComERAS group improved emotional function, overall QoL, and patient satisfaction (P<0.05). Conclusions: The ComERAS protocol significantly improved perioperative comfort, emotional function, QoL, and patient satisfaction during the first postoperative month in patients after lung cancer surgery. These findings offer empirical evidence and a practical framework for shifting perioperative care from a "medicine-centered" to a "patient-experience-centered" approach. While supporting the immediate value of prioritizing comfort, further studies on extended follow-up and multicenter validation are warranted. Trial Registration: Chinese Clinical Trial Registry ChiCTR2500109153.

Abstract Background Transitioning to the role of advanced practice nurses is dynamic and challenging. Deeply exploring the transition experience and developing corresponding intervention strategies can make the transition smoother. China’s development of advanced practice nursing remains at a nascent stage, exhibiting localized characteristics. However, limited knowledge exists regarding experiences, feelings, and challenges of advanced practice nurses in the region. This study explored the transition experiences of novice advanced practice nurses in China. Methods A descriptive phenomenological qualitative design was used. Twenty-three advanced practice nurses were recruited using purposive sampling technique. Data were collected using face-to-face interviews and analysed using thematic analysis. Results “Navigating the uncharted waters” was the overarching theme, which linked four themes: (1) being constrained by the practical environment; (2) reconstructing professional identity; (3) bearing multiple burdens; and (4) steering my own course. The study found that, notwithstanding institutional barriers and an unfamiliar environment, these participants actively reconstructed their professional identities to meet evolving expectations, shouldered workload, interpersonal, and psychological burdens, and steered their own course through the initial transition phase. Furthermore, distinctive characteristics were identified among Chinese advanced practice nurses, specifically the phenomenon of “disguise” in their work practice and a strong aspiration for a graduate degree. Conclusions This study reveals that the role transition for advanced practice nurses is a complex and demanding process, profoundly shaped by the practical environment. The findings further highlight the importance of adaptive coping behaviours, particularly personal resilience and proactive learning. Healthcare institutions, nursing organizations, and national policymakers should offer strong support by enhancing educational programs and developing transition plans, thereby creating a positive environment for advanced practice nurses. Future longitudinal research should explore the experiences of advanced practice nurses throughout various career stages and identify the factors that influence their professional trajectories. Trial registration Our study does not report healthcare interventions on human participants. Clinical trial number: not applicable.

Background: Emergency nursing requires advanced competencies, yet current training in China lacks theoretical grounding and career alignment. Based on Kolb’s experiential learning theory, this study develops a tiered core-competency program corresponding to nurses’ professional stages (N1–N4), aiming to foster systematic training and sustainable workforce development. Methods: A mixed-methods research design was employed. First, a preliminary draft of the training program was developed through systematic literature review and semi-structured interviews. Subsequently, from September to November 2025, 18 experts with over 10 years of emergency nursing experience from four provinces were invited to participate in two rounds of Delphi expert consultation. A Likert 5-point scale was used to evaluate the importance of program items, with consensus criteria set as follows: mean importance score ≥4.0, coefficient of variation ≤0.25, and agreement rate (score ≥4) ≥75%. The expert positivity, authority coefficient, and opinion coordination degree were evaluated through questionnaire recovery rate, authority coefficient (Cr), and Kendall's coefficient of concordance (Kendall's W), respectively. Results: The effective recovery rates of both rounds of expert consultation questionnaires were 100%, with expert authority coefficients of 0.913 and 0.917, indicating the credibility of the consultation results. After two rounds of revisions, a final training program was developed, comprising 5 first-level indicators, 15 second-level indicators, and 48 third-level indicators. All indicators achieved high consensus, and the program systematically integrated the learning cycle of Kolb's experiential learning theory with the competency advancement pathway for competency advancement from novice (N1) to expert (N4) levels. Conclusion: This study successfully established China's first emergency nursing core competency tiered training program based on Kolb's Learning Cycle theory, spanning the entire career trajectory of nurses. The program demonstrates both systematic design and operational feasibility, providing not only a scientific framework for standardized training, competency certification, and continuous professional development of emergency nurses, but also offering theoretical foundations and practical guidelines for sustainable workforce development in emergency nursing.

Background Falls are a leading global cause of injury and mortality in older adults, necessitating understanding risk factor interplay for prevention. This study aims to investigate complex interactions among risk factors associated with future falls and fall-related injuries in older adults. Methods A prospective cohort study used China Health and Retirement Longitudinal Study (2015 and 2018) data from 8,316 community-dwelling older adults. Falls and fall-related injuries were self-reported. The least absolute shrinkage and selection operator (LASSO) regression was employed for variable selection. A Bayesian network analysis utilizing the Max-Min Hill Climbing algorithm and Bayesian estimation method was subsequently implemented to identify interactions among risk factors related to falls and fall-related injuries. Results Fall incidence was 23.29%, and the incidence of severe injuries after falls was 10%. According to variables identified by LASSO regression, two Bayesian networks were constructed for falls (21 nodes and 48 directed edges) and fall-related injuries (20 nodes and 48 directed edges). Results revealed complex associations among the risk factors for falls and fall-related injuries, highlighting direct factors such as fall history, hip fracture history and balance, as well as the indirect effects of factors such as age, vision and cognitive function. Some specific combinations of direct risk factors contributing to a high probability of falls and fall-related injuries were also identified. Conclusion Falls and related injuries are frequent in community-dwelling older adults, associated with by multiple interconnected factors. Bayesian network analysis helps uncover the relationships between these variables and quantify the associations of major factor. Clinical practice may benefit from prioritizing multifactorial exercise programs targeting grip strength, lower limb strength, and balance. Consideration should be given to fall risk assessments and tailored interventions for older adults with prior falls, hip fracture history, or those using walking aids to effectively reduce falls and related injuries.

Pressure overload and volume overload produce different patterns of left-ventricular remodelling, but their circRNA-related molecular responses have not been directly compared across the same time course. We analysed mouse transverse aortic constriction and aortic-regurgitation models at 2 and 5 weeks using echocardiography, histology, left-ventricular circRNA sequencing, public mouse miRNA/mRNA datasets, and human cardiac transcriptomic datasets. The circRNA data separated sham, early, and later remodelling states and showed different patterns in pressure- and volume-overloaded hearts. In pressure overload, wall thickening, cardiomyocyte hypertrophy, fibrosis, and later systolic dysfunction were accompanied by candidate axes involving electrical-contractile regulation, calcium handling, stress buffering, metabolism, and extracellular matrix. Ctbp2-miR-218 was linked to Cacna1g, Hcn4, and Kcnd2; Faf1-miR-25/92 to Atp2a2, Cacna1c, and Kcnd2; and Tasp1/Tlk1-miR-29 to collagen- and elastin-related matrix targets. In volume overload, chamber dilatation was accompanied by candidate target changes in matrix, vascular/endothelial, G-protein-coupled receptor, junctional, and stress-response biology, although hypertrophy and collagen deposition on histology were still modest. Comparison across models showed limited overlap at the circRNA and exact circRNA-miRNA levels, with partial sharing of extracellular-matrix, collagen, and integrin signals at the target-gene and functional-module levels. Human aortic stenosis and heart-failure datasets showed corresponding changes in these downstream target modules. These data nominate load-related circRNA-miRNA-target candidates and target modules for experimental testing in cardiac remodelling.

Deep tissue pressure injuries (DTPI) are clinically recalcitrant due to a “dual-barrier” challenge: the dense necrotic tissue that physically impedes drug penetration and the enzymatic microenvironment that accelerates drug degradation. Herein, we identify the spatiotemporal depletion of endogenous microRNA-223 (miR-223) as a molecular driver of chronic inflammation and impaired angiogenesis in DTPI. Hence, we engineered an in situ self-solidifying nanogel spray (TRF) by encapsulating sticky-end miR-223-loaded deep-penetrating tetrahedral framework nanodevices (T-223) within a thermosensitive matrix. Specifically designed to tackle the dual barriers, the T-223 cage shields the miRNA cargo from nuclease degradation while leveraging its tetrahedral geometry to penetrate the necrotic tissue, thereby replenishing the depleted miR-223 pool in deep-seated lesions. Mechanistically, T-223 reprograms the inflammatory microenvironment by repolarizing macrophages toward a pro-regenerative M2 phenotype, which subsequently directs endothelial cell migration and proliferation to restore the macrophage-mediated immune-vascular axis. The in situ gelation of the TRF spray ensures conformal coverage of irregular wound cavities, preventing drug washout. In a murine DTPI model, the “nutrient reservoir” TRF releases the “molecular fertilizer” T-223 to debride the deep necrotic “soil,” accelerating healing and achieving functional repair characterized by synergistic anti-inflammation and pro-angiogenesis. This study establishes a non-invasive and deep-penetrating “molecular debridement” strategy, offering a therapeutic solution for similar chronic wounds.

CONTEXT:Patients receiving palliative care often experience multiple transitions among care settings at the end of life, with transitions from home to inpatient settings being the most common. However, how these transitions occur and how care needs and preferences change over time have not been systematically synthesized. OBJECTIVE:To synthesize the experiences of patients receiving palliative care and their caregivers regarding transitions from home to inpatient settings. METHODS:A qualitative evidence synthesis was conducted following JBI guidance and reported in accordance with ENTREQ. The PubMed, Web of Science, Cochrane Library, Embase, CINAHL, CNKI, WanFang, and VIP databases were searched from inception to January 2024 and updated in March 2026. The eligible studies were assessed using the Joanna Briggs Institute critical appraisal instrument for qualitative research. Thematic synthesis was conducted by using Thomas and Harden's approach. FINDINGS:A total of nine studies were included. Three themes emerged: 1) triggers for making decisions, including symptom crises, caregiving burden, treatment preferences, and reluctance to die at home; 2) concerns about inpatient care, involving continuity of care, communication, and comfort; 3) reflections on the care transfer, with caregivers viewing the transition as the right decision and describing a calmer period with their loved ones. CONCLUSIONS:Preferences regarding the place of care at the end of life are not a clear and stable choice but are shaped by uncertainty relating to the illness, the caregiver and the services needed.

Background Transitioning to the role of advanced practice nurses is dynamic and challenging. Deeply exploring the transition experience and developing corresponding intervention strategies can make the transition smoother. China's development of advanced practice nursing remains at a nascent stage, exhibiting localized characteristics. However, limited knowledge exists regarding experiences, feelings, and challenges of advanced practice nurses in the region. This study aims to explore the transition experiences of novice advanced practice nurses in China. Methods A descriptive qualitative design was used. Twenty-three advanced practice nurses was recruited using purposive sampling technique. Semi-structured and face-to-face interviews were conducted to collect the data, and the thematic analysis was used to analyse the data. Results “Navigating the uncharted waters” was the overarching theme, which linked four themes: (1) being constrained by the practical environment; (2) reconstructing professional identity; (3) bearing multiple burdens; and (4) steering my own course. Furthermore, distinctive characteristics were identified among Chinese advanced practice nurses, specifically the phenomenon of "disguise" in their work practice and a strong aspiration for a graduate degree. Conclusions This study reveals that the role transition for advanced practice nurses is a complex and demanding process, profoundly shaped by the practical environment. The findings further highlight the importance of adaptive copingbehaviours, particularly personal resilience and proactive learning. Healthcare institutions, nursing organizations, and national policymakers should offer strong support by enhancing educational programs and developing transition plans, thereby creating a positive environment for advanced practice nurses. Trial registration Our study does not report healthcare interventions on human participants. Clinical trial number: not applicable.

Background:Burnout is highly prevalent among intensive care unit (ICU) nurses and poses a serious threat to workforce stability, nurses' well-being, and patient safety. Work time pressure has been identified as a key occupational stressor in critical care settings; however, the mechanisms through which work time pressure contributes to burnout among ICU nurses remain insufficiently understood. Clarifying these mechanisms may help identify potential targets for burnout prevention in ICU settings. Objective:This study aimed to examine the association between work time pressure and burnout among ICU nurses and to explore the mediating roles of work-family conflict and sleep quality in this relationship. Methods:A cross-sectional survey was conducted among 545 ICU nurses from four hospitals in Chengdu, Lanzhou and Sanya, China. Data were collected using validated self-report questionnaires measuring time pressure, work-family conflict, sleep quality, and burnout. Structural equation modeling (SEM) was employed to test the hypothesized mediation model. Indirect effects were examined using a bootstrapping procedure with 5,000 resamples. Results:Work time pressure was positively associated with burnout among ICU nurses. Work-family conflict and sleep quality each independently mediated the relationship between work time pressure and burnout. In addition, a significant serial mediating effect was observed, indicating that higher time pressure was associated with increased work-family conflict, which in turn was related to poorer sleep quality and subsequently higher levels of burnout. Conclusion:Work time pressure is an important risk factor for burnout among ICU nurses. Work-family conflict and sleep quality play both independent and sequential mediating roles in this relationship. These findings suggest that reducing work-related time pressure, supporting work-family balance, and promoting healthy sleep may contribute to burnout prevention among ICU nurses.

BACKGROUND:Global aging and rising severe illnesses prevalence have increased demand for palliative care, widening service gaps. Policy support is vital for advancing high-value services. AIM:To unveil the 35-year evolution of palliative care policy in mainland China. DESIGN:An in-depth analysis of the external and internal characteristics of palliative care policy documents. Developmental periods were delineated using core characteristics, key events, and annual releases. Network analysis mapped intersectoral collaboration in palliative care policy-making. Text mining techniques, including burst words and word frequency analysis, identified policy priorities and inclinations. Policy instruments were classified using Rothwell and Zegveld's framework to analyze the policy landscape and its evolution. SETTING/PARTICIPANTS:Palliative care policies, the research subject of this study, were retrieved from Chinese legal databases and government websites. RESULTS:Policy evolution spanned five periods: germination (1991-2002), exploration (2003-2010), expansion (2011-2015), rapid development (2016-2019), and stable development (2020-2023). Intersectoral collaboration among policymakers evolved from single-department regulation to multi-sectoral governance, with the National Health Commission serving as the pivotal entity. Policy priorities and inclinations reflected the unification of policy terminology, the establishment of an institution-community-home continuum, and the active incorporation of local elements. Policy instruments transitioned from imbalance to greater balance over time, although several sub-instruments remained underutilized. CONCLUSIONS:Mainland China has established a comprehensive palliative care policy framework with distinctive features, with development particularly accelerating after 2016. Nonetheless, gaps persist in dedicated legislation or planning, financially sustainable funding strategies, integration into health professional education, and supportive digital infrastructure. Future efforts should prioritize the transition from framework-building to ensuring equitable access.

AIM:To evaluate the quality, risk of bias, and clinical applicability of prediction models for fall-related injuries in older adults. BACKGROUND:Numerous prediction models for fall-related injuries in older adults have been developed, but their quality and applicability in clinical practice and future research remain uncertain. METHODS:We systematically searched Medline (via OVID), Embase (via OVID), Cochrane Library, CINAHL (via EBSCO), Web of Science, and Scopus from inception to May 23, 2024, for English-language publications. All observational and experimental studies reporting the development or validation of any multivariable prediction model for fall-related injuries in older adults were included. The risk of bias and applicability was assessed using the PROBAST, and the reporting quality was measured based on the TRIPOD + AI checklist. Data were synthesized using a narrative synthesis approach. RESULTS:Thirty-one models from 15 studies were included. Twelve studies focused on the development and/or internal validation of a model, two studies dealt with development and external validation using a nonrandom split-sample, and one study externally validated existing models. The reported model discriminative statistics exhibited a broad range, from 0.54 to 0.89, in internal or external validation contexts. The risk of applicability was low for all studies, while the overall risk of bias was high in all studies (100.0%). High bias risk was notably prevalent in the analysis domain (100% of studies) and observed in the predictors (33.3%), participants (26.7%), and outcome (6.7%) domains. Median adherence to TRIPOD + AI reporting items was 56.4%. CONCLUSION:The discriminative ability in the prediction models of fall-related injuries in older adults varied widely, with all models exhibiting a high risk of bias according to the PROBAST. Upcoming research should focus on developing high-quality and reproducible models that undergo proper external validation, followed by studies on implementation. IMPLICATIONS FOR NURSING MANAGEMENT:Existing fall-related injuries prediction models exhibit high bias and inconsistent accuracy, limiting clinical utility. Nursing leaders should advocate for future models that undergo thorough internal and external validation, ensure sufficient events per variable, properly handle missing data, and adopt transparent reporting practices. This will underpin data-driven clinical decisions and enable targeted fall prevention strategies in vulnerable older adults.

The increasing frequency and magnitude of natural disasters worldwide have raised the demand for advanced robotic systems in disaster response. In this research, a comprehensive bibliometric analysis of 2,201 Web of Science database papers was investigate systematically global research trends, patterns and emerging frontiers in disaster robotics. CiteSpace, the Bibliometrix R package, and VOSviewer were used for data analysis. The results reveal a fluctuating yet consistently rising publication trends from 1992 to 2025. Asia leads global research output, with Japan as the most productive country but with limited international collaboration, while European countries engage in more extensive international cooperation. The Journal of Field Robotics is identified as the most influential publication in this field. Over time, research on disaster robots has gradually shifted from hardware development to intelligence technologies, such as deep learning and perception-enabled robotic systems. The study provides valuable insights to guide future research directions and strengthen global collaboration in disaster robotics.

Background Falls and related injuries among older adults represent a significant public health issue, adversely affecting their quality of life and increasing the socioeconomic burden. This study aims to develop a risk stratification prediction model based on machine learning algorithms. Methods Using a convenience sampling method, a total of 402 older adults scheduled for discharge at the Center of Gerontology and Geriatrics of West China Hospital, Sichuan University from April to September 2024 were enrolled. The participants were followed for 6 months. The participants were categorized into three groups: non-fall, no/minor injury, and moderate to severe injury group. Least absolute shrinkage and selection operator (LASSO) regression was applied to screen candidate predictors. Multinomial logistic regression (MLR), random forest (RF), support vector machine (SVM), and naive Bayes (NB) were employed for model development, with internal validation performed via 5-fold cross-validation. Model performance was assessed via the macro-average AUC, F1 score and Brier score. The optimal model was interpreted using SHAP analysis. This study was approved by the Committee of Ethics of West China Hospital of Sichuan University (Approval No. 2024–923). Results The SVM demonstrated the best performance, with a macro-average AUC of 0.856 (95% CI: 0.837–0.878), and F1-score of 0.527 (95% CI: 0.410–0.619), and a Brier score of 0.086 (95% CI: 0.078–0.091). Conclusions This study developed a risk-stratified prediction model for fall-related injuries in older adults. The SVM model is capable of accurately predicting the risk levels of fall-related injuries in older adults. Registration www.chictr.org.cn ChiCTR2400085499. Registered 11/6/2024, first recruitment 13/6/2024.

BACKGROUND:Patient classification systems (PCSs) are frequently used to estimate hours of nursing care to support budgeting and guide staffing decisions. However, despite a clear clinical need, there is as yet no validated and reliable PCS designed specifically for gastroenterology wards. OBJECTIVE:To develop a PCS tailored to gastroenterology wards that can accurately quantify nursing workload and support evidence-based nurse staffing decisions. METHODS:This study used Orem's self-care theory and Henderson's human needs theory as a foundation and applied machine learning techniques to construct a PCS for a gastroenterology ward in a general tertiary hospital. Patients were enrolled using convenience sampling, and information on their demographic characteristics, together with daily nursing activities and frequencies, was retrospectively extracted from the hospital information system (HIS) between July 1, 2019, and June 30, 2020. A workload measurement method was used to calculate the amount of nursing care received by each patient over a 24-hour period, thereby forming the study database. A decision tree model was developed to classify patients. The PCS was subsequently refined and validated using a prospective observational study of 357 patients conducted from December 1, 2022, to March 31, 2023. RESULTS:The final PCS included two primary categories and five subcategories, each of which was defined by specific patient characteristics and their corresponding 24-hour nursing time requirements: Category 1: "Day of surgery and first postoperative day," in which patients were subdivided into three levels based on surgical complexity, self-care capacity, and illness severity (Surgery 1, Surgery 2, and Surgery 3), requiring 1.66, 2.82, and 4.15 nursing hours per 24 h, respectively, and Category 2: "Other days" patients, who were subdivided into two groups based on critical illness, self-care ability, and disease severity (Category 1 and Category 2), with each requiring 0.96 and 3.42 nursing hours per 24 h, respectively. Internal and external validation demonstrated good model fit and acceptable predictive performance. CONCLUSIONS:Patients could be rapidly classified using defined indicators, enabling accurate prediction of their 24-hour nursing care requirements. The PCS exhibited strong internal consistency, stability, and generalizability, thereby supporting the reliability of its results. IMPLICATIONS FOR NURSING MANAGEMENT:This PCS provides a scientific basis for nurse staffing decisions and may support hospital administrators and health authorities in the development of data-driven nurse workforce allocation policies.

Introduction Chronic obstructive pulmonary disease (COPD) has an unpredictable clinical course, causing difficulties in short-term mortality prediction, overtreatment and delayed palliative care. Existing prediction models are limited and lack applicability to Chinese elderly patients with advanced COPD. Given the heavy disease burden and limited palliative care in China, we designed this multicentre cohort study to develop a 6-month mortality prediction model for elderly patients with advanced COPD to aid risk stratification, timely palliative care and efficient healthcare resource allocation. Methods and analysis Patient recruitment has been ongoing since May 2024 and will be completed by December 2026, with a 12-month follow-up to be completed by December 2027. Eligible patients are being enrolled, and multidimensional baseline data including demographic characteristics, clinical indicators, laboratory results, comprehensive geriatric assessment and COPD-specific prognostic factors are being systematically collected. All participants will receive 12 months of standardised follow-up (monthly for the first 6 months and quarterly thereafter) to monitor 6-month all-cause mortality (primary outcome), as well as survival duration, end-of-life healthcare utilisation and do-not-resuscitate status (secondary outcomes). After completion of data collection, we will employ multiple machine learning algorithms to develop and internally validate a 6-month mortality prediction model with pre-specified centres reserved for external validation. Model performance will be evaluated by discrimination and calibration and head-to-head comparisons with the Body Mass Index, Airflow Obstruction, Dyspnoea and Exercise Capacity (BODE) and Age, Dyspnoea and Airflow Obstruction (ADO) indices will be conducted to verify its clinical value. The findings will provide a China-specific prediction tool for elderly patients with advanced COPD to guide clinical intervention, palliative care referral and healthcare resource allocation. Ethics and dissemination This study was approved by the Biomedical Ethics Review Committee of West China Hospital, Sichuan University (No. 2024-2662) and registered at ChiCTR2500100351. Informed consent is being obtained from all participants. Results will be published in peer-reviewed journals and presented at academic conferences.Trial registration number ChiCTR2500100351.