IntroductionObesity has emerged as a global public health epidemic with far-reaching health consequences. While metabolic bariatric surgery (MBS) is an established therapeutic modality for moderate-to-severe obesity and associated metabolic disorders, enabling rapid weight reduction and metabolic improvement, postoperative weight regain remains a critical barrier to sustaining long-term treatment efficacy. Indeed, the durability of surgical outcomes is heavily contingent upon patients’ ability to engage in sustained self-management behaviors.AimsTo characterize the patterns of self-management behavior among patients after metabolic bariatric surgery using latent profile analysis, and to examine the relationships among these latent profiles.MethodsA cross-sectional study was carried out at one general hospital. A total of 242 patients after metabolic bariatric surgery completed the socio-demographic questionnaire, Bariatric Surgery Self-Management Questionnaire, General Self-efficacy Scale, and International Physical Activity Questionnaire.ResultsThree latent profiles were identified: high self-management behavior group (n = 28, 11.57%), moderate self-management behavior group (n = 156, 64.46%) and low self-management behavior group (n = 58, 23.97%). The ANOVA and chi-square tests demonstrated significant differences among three groups concerning age and educational level. Multinomial logistic regression analysis indicated that employment condition, smoking and drinking history significantly predicted self-management behavior.ConclusionsThe statistical analysis indicated that the majority of patients fall into the moderate self-management group. Further regression analysis demonstrated significant associations between self-management proficiency and both age and educational level. These findings highlight the need for tailored interventions targeting specific patient profiles.

OBJECTIVES:To construct a systematic framework for college nursing teachers' lifelong learning ability guiding the professional development of college nursing teachers. METHODS:Twenty participants (including 12 nursing teachers, 3 educational administrators, and 5 nursing students) were selected through purposive sampling from a university between July and December 2024. Semi-structured in-depth interviews guided by the five nested systems of Ecological Systems Theory (EST) were conducted to collect data, which were then analyzed using NVivo 12 software and grounded theory coding. RESULTS:Grounded in the five nested systems of EST (individual, micro, meso, exo, macro), the "adaptation, planning, renovation, transformation, shaping (APRTS)" framework for college nursing teachers' lifelong learning ability was proposed for the first time, including 5 core dimensions and 15 sub-dimensions. A dynamic ecological cycle mechanism (adaptation→planning→renovation→transformation→shaping) emerged across these dimensions, reflecting the systematic and interactive nature of ability development. CONCLUSIONS:Grounded in EST, this framework systematically expounds the internal logic and development laws of college nursing teachers' lifelong learning ability, providing a theoretical basis and practical reference for responding to social changes, empowering educational transformation, and optimizing the educational ecosystem. It promotes a paradigm shift in teachers' career development from passive acceptance to active change.

Nursing assistants (NAs) are a key occupational group that provide daily living care and nursing support across medical and integrated healthcare settings. NAs have been introduced to alleviate nursing shortages and better meet patients’ care needs. In many countries, mandatory pre-employment training programs are tailored to the NAs’ role. However, China lacks a standardized pre-service training program, leading to fragmented content and variable training quality. In response to national policy priorities, this study aims to develop a standardized pre-service training program for NAs in China. A modified Delphi method and the Analytic Hierarchy Process (AHP) were used to establish a competency-based pre-service training program, guided by the Competency Iceberg Model, from June to October 2022. An expert panel (n = 12) from nine tertiary hospitals across eight provinces participated in two rounds of Delphi consultations to reach consensus on program content. Expert agreement was evaluated using consensus levels and Kendall’s W coefficient. The final training program comprises a three-level framework with three first-level indicators, 25 s-level indicators, and 100 third-level indicators, encompassing both practical care competencies and latent professional competencies. Expert consensus was achieved across all hierarchical indicators. Kendall’s W values for the second- and third-level indicators were 0.222 and 0.179, respectively, both of which were statistically significant (p < 0.001). The AHP results assigned the highest priority to skills (0.50), followed by professionalism (0.25) and knowledge (0.25). Within these domains, practical care skills, including mobility care, sputum management, and latent competencies, including emotional management and communication, received the highest priority weightings. These weightings can provide an evidence-informed rationale for prioritising training content, allocating instructional time, and further guiding practical implementation. This study established a structured, competency-based pre-service training program for NAs by integrating expert consensus with quantitative prioritization. The program provides a holistic framework and evidence-informed basis for developing NAs training and standardizing pre-service training in Chinese healthcare settings. Future research should examine its feasibility, effectiveness, and implementation across diverse clinical contexts.

Objective This study aimed to characterize the multidimensional self-health management needs of patients undergoing bariatric surgery, to provide a basis for optimizing the care continuum across the pre-admission, perioperative, and follow-up phases. Methods This study employed a descriptive qualitative design incorporating patient-journey mapping. Through purposive sampling, 19 patients from mainland China who underwent bariatric surgery between November 2024 and April 2025 were recruited for semi-structured interviews. Inductive thematic analysis was subsequently applied to distill core experiences and needs themes and construct the patient-journey map. Results The finalized patient-journey map employed the clinical timeline (pre-admission, perioperative, and follow-up management) as the horizontal axis and five vertical dimensions—medical/behavioral management, role management, emotional management, dietary management, and exercise management. Across these phases, 32 core experience themes were identified, capturing the dynamic evolution of needs. The pre-admission phase was marked by fragmented information, decisional delay, internalized weight stigma, and disrupted eating and activity rhythms. The perioperative phase revealed expectation–reality gaps in symptom experience, ambivalent fear–anticipation emotions, and barriers rooted in generic dietary and exercise guidance. The follow-up phase was characterized by plateau anxiety, suboptimal medication adherence, dietary misconceptions constrained by real-world contexts, and monotonous exercise patterns. Collectively, the trajectory illuminates a shift from informational empowerment and destigmatization toward expectation calibration and symptom adaptation, ultimately demanding sustained behavioral reinforcement and identity reconstruction through continuous, stage-tailored support. Conclusions This patient-journey map delineated dynamic, stage-specific self-management experiences and needs in bariatric surgery, providing a practical framework for comprehensive, patient-centered, and precision interventions aimed at optimizing recovery, adherence, and long-term quality of life.

BACKGROUND:More than 1 billion people globally live with obesity. Individuals who have undergone metabolic and bariatric surgery (MBS) face identity reconstruction challenges linked to poor dietary adherence and psychological distress. Few studies analyze the mechanism of dissonance between preoperative identity expectations and postoperative reality, leaving a psychosocial support gap for long-term recovery. OBJECTIVES:To explore the dynamic collision between preoperative identity expectations and postoperative reality and identify key turning points in identity reconstruction among patients who have undergone MBS, guided by Social Identity Theory and Narrative Identity Theory. SETTING:Metabolic and Bariatric Surgery Department, University Hospital (June 2023-June 2024). METHODS:Purposive sampling of 18 patients who have undergone MBS (1-2 years postsurgery). Interpretive narrative design with semi-structured interviews; data triangulation (diaries, social media, and clinical records). Analysis used Riessman's framework integrated with Social Identity and Narrative Identity Theories. RESULTS:Preoperative expectations covered 4 dimensions (body image, social role, self-identity, and health function). Postoperative conflicts occurred across these dimensions, leading to a 3-stage identity reconstruction process: Conflict Adaptation (0-6 mo), Cognitive Adjustment (6-12 mo), and Identity Reconstruction (12-24 mo). Key turning points included successful social experiences, athletic breakthroughs, and family support. CONCLUSIONS:This study provides a theoretically grounded model of MBS identity reconstruction, highlighting the role of social group dynamics and narrative storytelling in navigating expectation-reality dissonance. The findings provide preliminary insights that may inform future development of clinical psychological support and psychosocial adaptation interventions.

BackgroundOccupational fatigue is a complex and widespread issue among healthcare workers, yet its heterogeneous manifestations remain inadequately studied. This study aimed to identify distinct fatigue profiles and examine the multifaceted determinants that differentiate these profiles.MethodsA cross-sectional survey was conducted among 734 healthcare workers. The assessment was conducted using the newly developed Healthcare Worker Occupational Fatigue Scale that has undergone reliability and validity tests. Latent profile analysis was used to identify occupational fatigue subgroups, and multiple logistic regression analysis was conducted to explore the influencing factors of each subgroup.ResultsLatent profile analysis identified four distinguishable occupational fatigue subgroups: the compensated group (17.97%), the prodromal-symptomatic group (35.29%), the decompensated diffuse group (37.87%), and the systemic crisis group (8.86%). Multivariate logistic regression analysis revealed that perceived workload, department affiliation, number of night shifts per month, low intention to stay, noisy environment, commuting time, and individual-level factors, including gender and health status, were significant risk factors for occupational fatigue.ConclusionOccupational fatigue among healthcare workers exhibits substantial heterogeneity and can be categorized into four distinct profiles, with multiple contributing factors. It is necessary to adopt hierarchical and personalized intervention strategies based on precise subgroup characteristics, such as systematically reducing the workload and optimizing the acoustic environment for the severe fatigue group, in order to effectively alleviate the occupational fatigue of healthcare workers.

BackgroundHospital restrooms are a weak link in infection control due to high pathogen loads, poor ventilation, and limitations of conventional disinfection. This study developed a smart toilet featuring a novel electrolytic disinfection technology to assess its clinical efficacy in decontaminating restroom surfaces and air, while exploring its potential for microbial control within hospital settings.MethodsA prospective controlled experimental study was conducted in four inpatient public restrooms at Zhongnan Hospital of Wuhan University between July and August 2025. The intervention utilized an onsite electrolysis device that electrolyzed a diluted sodium chloride solution to produce neutral electrolyzed water containing hypochlorous acid as the primary biocidal agent. Bench tests confirmed that a concentration of 40 mg/L achieved a 100% kill rate against E. coli within 9 min. The system was integrated into smart toilets. Surface samples (n = 216) and air samples (n = 72) were collected at 0, 5, and 30 min after use. Disinfection qualification rate, bactericidal efficacy, and natural microbial decay were compared against routine cleaning.ResultsThe surface qualification rate was 53.7% before and 61.1% after the intervention, a difference that was not statistically significant (p > 0.05). The toilet seat (5 min after use) and inner bowl (30 min after use) both reached 100% compliance, whereas the flush button demonstrated limited and inconsistent bactericidal efficacy. The air sterilization rate reached 89.7% at 30 min, which was significantly higher than the natural decay rate of 49.8% in the control group (p < 0.05).ConclusionThis smart toilet with novel electrolytic disinfection technology improves environmental hygiene in hospital restrooms and overcomes key limitations of manual cleaning. Nevertheless, the flush button remains a high risk site because it is not directly subjected to disinfection, thereby necessitating design optimization.

A family history of colorectal cancer among first-degree relatives is recognized as one of the most significant and prevalent risk factors for colorectal cancer in China. Colonoscopy remains the most crucial screening method, as early colonoscopy screening can effectively reduce the risk of advanced colorectal cancer. However, the factors influencing the decision-making behavior of first-degree relatives regarding colonoscopy screening have predominantly been examined through quantitative studies, while mixed-methods research remains scarce. This study aimed to evaluate the decision-making behaviors of first-degree relatives of patients with colorectal cancer and to identify the factors influencing these behaviors. An explanatory sequential design was adopted within a mixed-methods framework. For the quantitative phase, convenience sampling was used to select 272 first-degree relatives of colorectal cancer patients who were treated at a tertiary hospital’s gastrointestinal surgery department in Wuhan, China from March to December 2023, for a questionnaire survey. For the qualitative component, a maximum variation purposive sampling method, guided by the Protection Motivation Theory, was employed to select 16 participants from the initial survey group for semi-structured interviews. Our findings revealed that participants had a high health belief score. Key factors influencing their decision to undergo colonoscopy screening included marital status, average monthly household income, medical payment method, and perceived severity. The qualitative study identified six core themes: perceived susceptibility, perceived severity, internal and external rewards, response efficacy, response costs, and self-efficacy. Medical staff should focus on first-degree relatives of colorectal cancer who are unmarried or widowed, have lower family income, have lower reimbursement rate of medical insurance, and lack of disease severity perception. Through establishing social support system, issuing subsidies for colonoscopy screening, increasing reimbursement rate of medical insurance, emphasizing the severity of colorectal cancer, to enhance their health belief level and promote colonoscopy screening decision-making behavior. Not applicable.

BACKGROUND:Standardized guidelines for optimal tunnel length in tunneled peripherally inserted central catheters (PICCs) are lacking. OBJECTIVES:The objective of this study was to evaluate the real-world impact of tunnel length on clinical outcomes. METHODS:This retrospective cohort study included 207 cancer patients who received tunneled PICCs, categorized into a control group (tunnel length > 4 cm, n = 134) and an observation group (tunnel length ≤ 4 cm, n = 73). Propensity score matching (PSM) was used to address baseline heterogeneity. Cox regression analyses were used to assess the risk of complication during a 120-day follow-up. RESULTS:Compared to the control group (tunnel length > 4 cm), the observation group (tunnel length ≤ 4 cm) had a significantly higher adjusted overall complication risk (HR = 2.92, 95% CI: 1.07-7.94, P = 0.036) and unplanned catheter removal rate (4.4% vs. 0.0%, P = 0.027), confirming the safety of longer tunnels despite comparable comfort levels between groups. After PSM, Cox regression analysis showed results consistent with those from the unmatched cohort. Subgroup analyses revealed a reduced risk of complications with longer tunnels in patients with BMI ≤ 25 kg/m² (HR = 0.29, 95% CI: 0.11-0.82), without hypertension (HR = 0.36, 95% CI: 0.13-1.00), without diabetes (HR = 0.38, 95% CI: 0.15-0.97), and with solid tumors (HR = 0.31, 95% CI: 0.11-0.85). CONCLUSION:The results show that tunnel lengths > 4 cm reduce overall complications and prolong catheter retention, supporting the implementation of standardized protocols while advocating for personalized adjustments based on BMI, comorbidities, and cancer type.

BACKGROUND:Frequent hand hygiene is essential for infection control among health care workers (HCWs) but may cause adverse skin effects. PURPOSE:To assess the relationships between frequent hand hygiene practices, skin symptoms, and microbiota alterations in HCWs. METHODS:A comprehensive search of 7 databases was conducted to identify articles published between January 2014 and July 2024 in English and Chinese. RESULTS:A total of 24 studies were included in the review. Frequent hand hygiene was associated with reduced microbial flora in 2 studies and high incidences of skin dryness, itching, peeling, erythema, fissures, burning, and pain in 18 studies. Fifteen studies linked frequent hand hygiene to eczema, dermatitis, acne, and folliculitis, while 1 study found higher Staphylococcus aureus detection in severe eczema cases. CONCLUSIONS:Prolonged frequent hand hygiene alters hand microbiota and induces various skin symptoms, necessitating attention to chronic occupational exposure among HCWs.

Healthcare workers are at high risk of occupational fatigue. However, the lack of a specific assessment tool hinders understanding of the prevalence of fatigue and the effectiveness of interventions, posing a significant threat to physical and mental well-being. This study aimed to develop and preliminarily validate a scale specifically designed to assess occupational fatigue among healthcare workers, thereby providing a practical tool for self-assessment and occupational health management. An initial item pool was generated through a comprehensive review of literature related to this topic and existing fatigue scales. Content and face validity were assessed via a two-round Delphi expert consultation and a pilot survey, resulting in a preliminary scale version. Psychometric properties were evaluated using data from 475 healthcare workers recruited through convenience sampling from a tertiary Grade A general hospital in Wuhan, Hubei Province. The structural validity was examined using exploratory factor analysis and confirmatory factor analysis. Reliability was assessed using Cronbach’s alpha and Guttman Split-Half reliability. Data analysis was performed using SPSS 26.0 and AMOS 23.0. The final Healthcare Worker Occupational Fatigue Scale (HWOFS) comprises 35 items across five dimensions: physical, cognitive and emotional, social, sleep-related, and auditory fatigue. The scale demonstrates excellent internal consistency (Cronbach’s alpha = 0.973, Guttman Split-Half reliability coefficient = 0.924). Content validity was strong, with item-level content validity indices ranging from 0.867 to 1.000 and a scale-level content validity index of 0.925. The confirmatory factor analysis supported the five-factor structure, showing good model fit. All standardized factor loadings were ≥ 0.532 (all p < 0.01). This study demonstrated the robust reliability and validity of the newly developed HWOFS. These initial findings support the potential of HWOFS as a tool for healthcare institutions to establish fatigue warning systems, optimize human resource allocation, and develop occupational health protection policies. However, further validation in larger healthcare populations is required before broader application.

Background: Frequent hand hygiene is essential for infection control among health care workers (HCWs) but may cause adverse skin effects. Purpose: To assess the relationships between frequent hand hygiene practices, skin symptoms, and microbiota alterations in HCWs. Methods: A comprehensive search of 7 databases was conducted to identify articles published between January 2014 and July 2024 in English and Chinese. Results: A total of 24 studies were included in the review. Frequent hand hygiene was associated with reduced microbial flora in 2 studies and high incidences of skin dryness, itching, peeling, erythema, fissures, burning, and pain in 18 studies. Fifteen studies linked frequent hand hygiene to eczema, dermatitis, acne, and folliculitis, while 1 study found higher Staphylococcus aureus detection in severe eczema cases. Conclusions: Prolonged frequent hand hygiene alters hand microbiota and induces various skin symptoms, necessitating attention to chronic occupational exposure among HCWs.

BackgroundThe discharge readiness for metabolic and bariatric surgery (MBS) patients are designed to facilitate their transition from hospital to home and support early rehabilitation, ultimately improving discharge quality and outcomes.ObjectivesThis study aimed to describe the experiences and discharge readiness of patients undergoing MBS.SettingA Tertiary hospital, China.MethodsAn empirical phenomenological approach was used. Eighteen participants were recruited in Wuhan using convenience sampling. Semi-structured, in-depth, face-to-face interviews were conducted in May 2024. Each interview was transcribed verbatim, and Colaizzi’s method was used to analyze the data.ResultsFive themes emerged from data analysis: post-surgical adaptation and expectations; negative emotions and stigma; knowledge gaps and ongoing education needs; post-discharge self-management and support needs; navigating physical recovery and long-term life planning. Patients faced both physiological and psychological discomfort. Insufficient social support was due to gaps in self-management knowledge and biased perceptions of reintegration. The surgery also impacted their reintegration into society and family life, while the long-term effect encouraged patients to adopt positive coping strategies and seek external support. Family provided primary support, but ongoing professional medical guidance was crucial for successful recovery and reintegration.ConclusionThe discharge readiness of the patient needs to be appreciated and improved. Developing a specific scale to assess readiness for MBS patients are crucial. A multidisciplinary, patient-centered discharge support system, supported by an information platform, should provide real-time, practical guidance for rehabilitation. Furthermore, establishing an effective post-discharge linkage mechanism will enhance self-management and ensure access to appropriate medical and social support.

Background: Despite numerous studies assessing bundled interventions to enhance hand hygiene compliance (HHC), compliance rates persist at suboptimal levels. Our objective was to employ Kotter's Change Model (KCM) to enhance HHC and conduct a comprehensive process evaluation among medical staff within the intensive care unit (ICU). Methods: KCM was implemented at the ICU of Zhongnan Hospital of Wuhan University from March 2018 to August 2021, with a 41-month longitudinal monitoring of HHC. The primary outcome focused on the absolute monthly change in HHC. Secondary outcomes encompassed the HHC characteristics across different phases, varying trends in HHC concerning different hand hygiene opportunities and occupations, quarterly incidences of central line-associated bloodstream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI). Results: This study included 20,222 hand hygiene actions and 24,195 opportunities. The overall HHC was 83.58 % (95 %CI, 83.11 %-84.04 %). Following the KCM implementation, HHC surged from 35.71 % (95 % CI, 22.99 %-50.83 %) to 87.75 % (95 % CI, 85.53 %-89.67 %), reflecting a notable increase of 145.73 %. The most rapid growth in HHC occurred post-patient contact, elevating from 35.29 % to 89.8 %. Despite escalating patient numbers and treatment complexities annually, the quarterly rates of CLABSI (0 %o -3.53 %o ) and CAUTI (0.96 %o-4.26 %o ) remained consistently low. Conclusion: Utilizing KCM systematically alters healthcare providers' perception of hand hygiene, fostering an environment that advocates for and sustains improved HHC among ICU personnel. Implications for clinical practice: The Kotter's change model can be an effective framework for healthcare organizations to systematically improve and maintain hand hygiene compliance among healthcare providers, which can in turn help reduce healthcare-associated infections.

OBJECTIVE:To explore the true needs of patients awaiting kidney transplantation in China through the language used by them. We addressed the literature gap concerning this critical aspect of patient care and counselling. METHODS:We interviewed 32 individuals-22 who were on the waiting list for a kidney transplant and 10 were kidney transplant recipients. The obtained data were analysed using Colaizzi seven-step method. RESULTS:Four themes encompassing 86 coded statements were identified and crosschecked with each participant for validation.The waiting period needs of the participants fell into four distinct categories: emotional support, informational, medical support, and social support needs. CONCLUSION:We can determine the needs of patients by interpreting their linguistic cues with a nuanced understanding.Transplant professionals must (1) understand patients' needs from their perspective; (2) recognise the dynamic changes in their emotional support demands; and (3) determine each patient's informational needs, their willingness to receive medical support, and the current state of their social support. PRACTICE IMPLICATIONS:Our results offer insights for transplant professionals to better support patients awaiting kidney transplantation, highlighting the need to routinely attend to their unmet emotional, informational, medical and social support needs. This will enable patients to better prepare for transplantation while anticipating the arrival of a matched kidney.

Infectious respiratory particles (IRPs) exhaled by infected patients significantly influence the safety of susceptible patients in fever clinic waiting areas. Understanding the impact of occupancy density (OD) on the IRPs transmission is essential. This study employed real-time CO2 monitoring to assess fever clinic ventilation performance. The findings revealed an average air change per hour (ACH) of 2.2, below the recommended 6 ACH for infection control. The effects of high, medium, and low OD on the IRPs transmission were analyzed using computational fluid dynamics at 2.2 ACH, considering scenarios where the infected patient was located upstream, downstream and in the seating area of the waiting area. The results showed that IRPs released from the upstream infector had the highest suspension rates, ranging from 14 % to 20 %, while IRPs from other locations had suspension rates below 5 %. Further analysis indicated that the maximum and upper quartile intake fraction (IF) in susceptible populations caused by upstream infectors decreased as OD decreased. At high OD, the upper quartile IF was 0.1 %, which was 1.5 and 2.1 times higher than at medium and low OD, respectively. This decreasing trend was not observed for downstream and seating area infectors. Significance test revealed that IF at high OD was significantly higher than at medium OD only at seating area infectors, with no significant difference in other scenarios. In conclusion, fever clinics with insufficient ventilation should prioritize increasing ventilation rates over merely reducing OD to control infection risks.

To explore the psychological status and experiences of head nurses as second victims in nursing adverse events. A mixed-method explanatory sequential study design was employed to collect both quantitative and qualitative data. A total of 220 head nurses were recruited from six hospitals using convenient sampling to complete a questionnaire assessing perceived stress, anxiety, coping styles, and social support in managing nursing adverse events. A subset of participants from the quantitative study was randomly selected for semi-structured interviews to explore their feelings and experiences. A total of 192 valid questionnaires were included in the analysis. The results revealed that 39.1% of head nurses experienced severe stress, while 62.5% reported moderate to severe anxiety. Positive coping styles scored higher than negative coping styles (p < 0.001). The overall perceived social support level was high among participants. Through semi-structured interviews with 12 head nurses, three themes emerged: "positive coping," "multiple negative emotions," and "desire for external help." Head nurses often experience elevated stress and moderate to severe anxiety when confronted with nursing adverse events, accompanied by multiple negative emotions, and addressing the negative emotions of head nurses and enhancing social support systems is crucial for their well-being.

AimsTo identify the contaminated areas of the hand collection and analyse the distribution characteristics of bacteria in the hand after swab collection.DesignThis study used a cross-sectional design.MethodsA cross-sectional study sampling 50 pairs of hands (sampling hand and auxiliary hand) of healthcare workers was performed. Ten samples were collected from each participant. The optimal hand hygiene rates and bacterial colony counts of the whole hand and different hand sections without hand hygiene were identified as the primary outcomes.ResultsThe optimal hand hygiene rates of the sampling hand and auxiliary hand were 88.8% (222/250) and 91.6% (229/250), respectively. The lowest optimal hand hygiene rates for the sampling hand and the auxiliary hand were both on the dorsal side of the finger and the dorsum of the hand (86.0%, 86.0% vs. 90.0%, 86.0%); the optimal hand hygiene rates for both sites of the sampling hand were 86.0% (43/50), and the optimal hand hygiene rates for the auxiliary hand were 90.0% (45/50) and 86.0% (43/50). The bacteria colony counts did not differ between the sampling hands and auxiliary hand.ConclusionsThe dorsal side of the finger and dorsum of the hand were the most likely to be contaminated during oropharyngeal swab collection. Therefore, it is essential to pay extra attention to hand hygiene care of these two sites during the collection process to minimize the risk of cross-contamination.Reporting MethodThe Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines were adopted in this study.

BackgroundPsychological distress is common among patients with acute coronary syndrome (ACS) and has considerable adverse impacts on disease progression and health outcomes. Mindfulness-based intervention is a promising complementary approach to address patients’ psychological needs and promote holistic well-being. ObjectiveThis study aims to examine the effects of a social media–based mindfulness psycho-behavioral intervention (MCARE) on psychological distress, psychological stress, health-related quality of life (HRQoL), and cardiovascular risk factors among patients with ACS. MethodsThis study was a 2-arm, parallel-group randomized controlled trial. We recruited 178 patients (mean age 58.7, SD 8.9 years; 122/178, 68.5% male) with ACS at 2 tertiary hospitals in Jinan, China. Participants were randomly assigned to the MCARE group (n=89) or control group (n=89). The 6-week intervention consisted of 1 face-to-face session (phase I) and 5 weekly WeChat (Tencent Holdings Ltd)–delivered sessions (phase II) on mindfulness training and health education and lifestyle modification. The primary outcomes were depression and anxiety. Secondary outcomes included psychological stress, HRQoL, and cardiovascular risk factors (ie, smoking status, physical activity, dietary behavior, BMI, blood pressure, blood lipids, and blood glucose). Outcomes were measured at baseline (T0), immediately after the intervention (T1), and 12 weeks after the commencement of the intervention (T2). ResultsThe MCARE group showed significantly greater reductions in depression (T1: β=–2.016, 95% CI –2.584 to –1.449, Cohen d=–1.28, P<.001; T2: β=–2.089, 95% CI –2.777 to –1.402, Cohen d=–1.12, P<.001) and anxiety (T1: β=–1.024, 95% CI –1.551 to –0.497, Cohen d=–0.83, P<.001; T2: β=–0.932, 95% CI –1.519 to –0.346, Cohen d=–0.70, P=.002). Significantly greater improvements were also observed in psychological stress (β=–1.186, 95% CI –1.678 to –0.694, Cohen d=–1.41, P<.001), physical HRQoL (β=0.088, 95% CI 0.008-0.167, Cohen d=0.72, P=.03), emotional HRQoL (β=0.294, 95% CI 0.169-0.419, Cohen d=0.81, P<.001), and general HRQoL (β=0.147, 95% CI 0.070-0.224, Cohen d=1.07) at T1, as well as dietary behavior (β=0.069, 95% CI 0.003-0.136, Cohen d=0.75, P=.04), physical activity level (β=177.542, 95% CI –39.073 to 316.011, Cohen d=0.51, P=.01), and systolic blood pressure (β=–3.326, 95% CI –5.928 to –0.725, Cohen d=–1.32, P=.01) at T2. The overall completion rate of the intervention (completing ≥5 sessions) was 76% (68/89). Positive responses to the questions of the acceptability questionnaire ranged from 93% (76/82) to 100% (82/82). ConclusionsThe MCARE program generated favorable effects on psychological distress, psychological stress, HRQoL, and several aspects of cardiovascular risk factors in patients with ACS. This study provides clues for guiding clinical practice in the recognition and management of psychological distress and integrating the intervention into routine rehabilitation practice. Trial RegistrationChinese Clinical Trial Registry ChiCTR2000033526; https://www.chictr.org.cn/showprojEN.html?proj=54693