ObjectiveTo evaluate patient safety culture (PSC) and its associated factors and staff perceptions of adverse event reporting in Chinese nursing homes.DesignA mixed-methods study based on a secondary analysis of a multisite research program, integrating a 2021–2022 cross-sectional survey with a secondary thematic analysis of focus group interviews.Setting and participantsEleven nursing homes in South China, including 674 frontline staff (quantitative phase) and 35 managers, nurses, and caregivers (qualitative phase).MethodsPSC was assessed using the Nursing Home Survey on Patient Safety Culture. Quantitative data were analyzed using descriptive statistics, univariate analysis, and multiple linear regression. Interview data were analyzed using Braun and Clarke’s thematic analysis.ResultsThe overall positive response rate (PRR) for PSC was 86.5%, with lower PRRs for Adherence to Workflow (72.7%) and Staffing (67.0%). PSC was statistically associated with income satisfaction (B = 0.174, β = 0.189, p = 0.020), job satisfaction (B = 0.176, β = 0.208, p = 0.046), and years of work experience in nursing home care (B = −0.098, β = −0.113, p = 0.014). The model explained 35.0% of the variance (R2 = 0.350, adjusted R2 = 0.345). Thematic analysis identified four themes: workforce shortages and safety anxiety, non-standardized workflows and interprofessional role conflicts, cultural barriers to adverse event reporting, and staff-driven improvement strategies.Conclusions and implicationsDespite positive overall PSC, structural deficiencies were observed in staffing and adherence to workflow. Cultural factors and organizational pressures may be associated with the underreporting of adverse events. The findings suggest priorities for future intervention development, including resource optimization, workflow standardization, and non-punitive reporting systems. However, these findings require testing in longitudinal or interventional studies.

Much literature discusses the migration of linguistically, culturally, and ethnically diverse nurses. However, little is known about nurses’ perceptions of cross-border mobility within culturally homogenous contexts. This study explored the perceptions of Mainland Chinese nurses regarding cross-border mobility to Hong Kong and Macao Special Administrative Regions, using the capability, opportunity, motivation, and behavior (COM-B) model as a conceptual framework. Using a qualitative descriptive design, semi-structured interviews were conducted between March and June 2024 with 16 nurses in nine cities in Guangdong Province, Mainland China. The interviews followed a predetermined topic guide developed based on the COM-B model. Subsequently, interview transcripts were subjected to deductive content analysis. Within the three categories of the COM-B model, 9 key themes emerged, including capability (limited professional knowledge and skills, work language barriers), motivation (increasing income, greater career development opportunities, higher social status), and opportunity (government and healthcare organizational support, concerns about differences in nursing practices, consideration of family responsibilities, concerns about adaptation to life). Affected by differences in healthcare systems, Mainland Chinese nurses face certain adaptation challenges in cross-border mobility, but most hold positive attitudes and are willing to engage in short-term cross-border employment. Distinct from transnational nursing migration, language barriers to intra-China cross-border mobility among nurses mainly lie in language proficiency rather than cultural adaptation. Furthermore, the family-centered work ethic prevalent in Chinese society, underpinned by filial piety, constitutes an important factor influencing nurses’ cross-border mobility decisions. Chinese government authorities, healthcare institutions, and nursing managers should integrate these factors into management practices to provide targeted support for nurses’ cross-border mobility.

Background: Falls are a growing long-term care challenge in ageing societies. Intrinsic capacity provides a multidomain framework for conceptualising fall risk in later life. However, traditional analytic approaches are less well suited to capturing interdependence among intrinsic capacity indicators and identifying those most directly connected to short-term fall occurrence. Methods: We conducted a prospective observational study of 871 residents from four nursing homes in southern China. Ten baseline intrinsic capacity indicators were assessed, and falls were recorded over 6 months. Mixed graphical models with LASSO regularisation were used for network outcome analysis, with fall occurrence modelled as the prospective outcome node. Robustness was examined using non-parametric bootstrap resampling, conservative network estimation, a covariate network, conventional logistic regression, and exploratory age- and sex-stratified networks. Findings: During follow-up, 181 residents (20·8%) experienced at least one fall. Fall occurrence was directly connected with walking speed (edge weight=−0·215), balance (edge weight=−0·200), depressive symptoms (edge weight=0·136), handgrip strength (edge weight=−0·099), and chair standing (edge weight=−0·011). Bootstrap assessment of edge-weight accuracy and sensitivity analyses using conservative network estimation and conventional logistic regression generally supported the main findings. Interpretation: Intrinsic capacity indicators differed in their proximity to 6-month fall occurrence. Locomotor and psychological indicators may offer practical entry points for prioritising residents who require closer fall surveillance or more comprehensive geriatric assessment. These findings support the integration of brief intrinsic capacity-based assessment into long-term care quality improvement as a feasible approach to targeted fall surveillance within multidomain fall-risk evaluation and prevention.

INTRODUCTION:Motoric cognitive risk syndrome (MCR) is a screening syndrome that has been associated with increased dementia risk in prior studies. This study aimed to investigate the prevalence, associated factors, and adverse outcomes of MCR among community-dwelling older adults in China. METHODS:A cross-sectional analysis was conducted among 5,242 China Health and Retirement Longitudinal Study (CHARLS) participants aged ≥60 years to examine factors associated with prevalent MCR, and prospective outcomes were evaluated over a 3-year follow-up. The Boruta algorithm was used for feature selection. Multivariate logistic regression analysis was employed to assess associations, while XGBoost was applied as a complementary baseline classification approach to rank feature importance for distinguishing prevalent MCR. RESULTS:The prevalence of MCR was 12.9% among the study population, with higher rates in unmarried, illiterate, and older participants. Physical performance measures emerged as the strongest associated factors, with five-time sit-to-stand test (odds ratio [OR] = 1.05, 95% confidence interval [95% CI]: 1.03-1.07), handgrip strength (OR = 0.98, 95% CI: 0.97-0.99), and mobility score (OR = 1.12, 95% CI: 1.04-1.19) showing significant associations. Higher education level (OR = 0.67, 95% CI: 0.51-0.89) and social activity participation (OR = 0.69, 95% CI: 0.58-0.82) were inversely associated with prevalent MCR, while stroke (OR = 2.18, 95% CI: 1.43-3.24), visual impairment (OR = 1.40, 95% CI: 1.08-1.84), and poor self-reported health status (OR = 1.50, 95% CI: 1.13-2.00) were associated with higher odds of prevalent MCR. MCR was prospectively associated with activities of daily living disability (adjusted OR = 1.40, 95% CI: 1.12-1.73) but not hospitalization (adjusted OR = 1.08, 95% CI: 0.87-1.34). CONCLUSION:These findings underscore the importance of incorporating physical performance measures and social factors in MCR screening protocols and may inform screening and risk stratification in aging populations.

INTRODUCTION:Adverse childhood experiences (ACEs) may have long-term effects on cognitive and motor function in later life. This study examined the association between ACEs and motoric cognitive risk (MCR) syndrome among older adults in China and investigated whether depression and chronic pain mediate this relationship. METHODS:This cross-sectional study analyzed 3,983 adults aged ≥60 years from the China Health and Retirement Longitudinal Study (CHARLS). Twelve ACE indicators were assessed across conventional, expanded, and new categories. MCR was diagnosed based on cognitive complaints and slow gait speed. Depression was evaluated using the 10-item Center for Epidemiologic Studies Depression Scale, and chronic pain through standardized questionnaires. Multivariable logistic regression models and parallel mediation analyses examined associations between ACEs and MCR. RESULTS:The study included 3,983 older adults with a median age of 66 years (interquartile range: 63-71), of whom 59.3% were male. MCR was identified in 12.9% (n = 512) of participants, with emotional neglect (40.1%) and physical abuse (30.7%) being the most common ACEs. Participants with 1-3 ACEs (adjusted odds ratio [OR] = 1.41, 95% confidence interval [CI]: 1.05-1.93) and ≥4 ACEs (adjusted OR = 1.69, 95% CI: 1.19-2.43) showed significantly higher odds of MCR compared to those without ACEs. Depression and chronic pain mediated 14.3% and 21.4% of the total effect, respectively. CONCLUSION:ACEs demonstrated dose-dependent associations with MCR in Chinese older adults, partially mediated through depression and chronic pain. These findings suggest that screening for ACE exposure and addressing mental and physical health may be critical for preventing cognitive-motor decline in later life.

This study aimed to evaluate the effects of pelvic floor rehabilitation on the prevention and treatment of bowel symptoms in patients with rectal cancer. PubMed, Embase, Web of Science, The Cochrane Library, CINAHL Plus with Full Text, and ProQuest were searched from inception to August 31, 2025. Eligible randomized controlled trials (RCTs) investigating pelvic floor rehabilitation for the prevention or treatment of bowel symptoms were included. Risk of bias was evaluated using the Cochrane Risk of Bias tool version 2, and the certainty of evidence was assessed with the GRADE approach. Statistical analyses were performed using RevMan 5.4. A total of 12 RCTs were included. For prevention, pelvic floor rehabilitation was associated with significantly lower Wexner incontinence scores at 1 month (MD − 2.78, 95

This study aimed to examine disordered eating attitudes and their associated factors among hospitalized patients with schizophrenia. The primary objective was to identify sociodemographic, clinical, and psychological factors associated with eating attitudes. The secondary objective was to explore, as an exploratory analysis, whether a statistically significant indirect association through insight was present between depressive symptoms and eating attitudes within the framework of the Common Sense Model of Self-Regulation, while acknowledging that the cross-sectional design does not allow causal inference. In this cross-sectional study, 300 Chinese long-term hospitalized patients with schizophrenia were recruited by convenience sampling method in South China from October 2022 to May 2023. The patients completed a questionnaire, including socio-demographics, Eating Attitudes Test-26, Insight and Treatment Attitudes Questionnaire, Hamilton Rating Scale for Depression, and Hamilton Rating Scale for Anxiety. The factors associated with eating attitudes were analyzed by multiple linear regression, and the exploratory mediating role of insight between depressive symptoms and eating attitudes was examined through the Bootstrap mediating effect. Given the positive skewness of the EAT-26 scores, a sensitivity analysis was additionally performed using a generalized linear model with a normal distribution, identity link function, and robust covariance estimator to assess the robustness of the primary regression findings. 22

BackgroundGiven the globalization of the nursing workforce, psychological empowerment represents a critical intrinsic determinant of nurses' mobility intentions, specifically regarding cross-border work.AimTo identify latent profiles of nurses' psychological empowerment, examine associated factors, and explore the relationship between these profiles and cross-border working intention.MethodsA cross-sectional multicenter study was conducted from March to September 2023. Using convenience sampling, clinical nurses were recruited through liaisons from nursing societies in nine cities of Guangdong Province. Data were collected through questionnaires covering sociodemographic questionnaire, psychological empowerment, and cross-border working intention, with analyses including chi-square tests, logistic regression, and latent profile analysis (LPA) performed using SPSS 23.0 and Mplus 8.3.ResultsA total of 3671 valid questionnaires were collected, and 39.5% of the respondents reported cross-border intentions. LPA identified three psychological empowerment profiles among nurses, ranked from high to low: the core-driven empowerment profile (16.94%), the adaptive empowerment profile (70.42%), and the constrained empowerment profile (12.64%). The nurses with lower salary, intermediate title, and without specialist nurse qualification were more likely to fall into the constrained empowerment profile. Psychological empowerment was positively correlated with nurses' cross-border work intention. The core-driven profile showed the highest cross-border work intention (50.6%), followed by the adaptive (38.2%) and constrained profiles (31.7%). For cross-border work, the constrained profile prioritized salary (87.1%) as the key concern, while the core-driven profile focused more on good promotion opportunities (70.3%).ConclusionPsychological empowerment exerts a positive impact on clinical nurses' cross-border work intention, with the three identified empowerment profiles exhibiting divergent motivational priorities and decision logics. These findings highlight the need for subgroup-specific strategies to balance nursing workforce mobility and stability.Implications for Nursing ManagementThe findings support a differentiated human resource strategy based on nurses' psychological empowerment profiles. For core-driven nurses, institutions should provide international career development channels to strengthen their domestic job embeddedness. For adaptive nurses, tailored skill training and decision-making autonomy should be offered to guide their mobility aspirations. For constrained nurses, competitive compensation and family support services should be prioritized to address their stability needs and rebuild professional confidence. These targeted measures balance talent mobility and domestic workforce stability.

To evaluate the effects of a dyadic symptom management intervention on health outcomes of postoperative esophageal cancer patients and their caregivers. A quasi-experimental study was conducted involving 84 esophageal cancer patients and their caregivers at a cancer center in Southern China. Participants in the control group received standard perioperative care, whereas those in the intervention group underwent four structured educational sessions and received symptom management consultations during the first postoperative month. Primary outcomes included patients’ symptom burden and difference in symptom assessment between patients and their caregivers. Secondary outcomes included dyadic communication, depression, anxiety, and quality of life. Generalized estimating equation models were applied for data analysis. Semi-structured interviews were conducted for the process evaluation. Statistically significant differences were observed between groups in dyadic symptom severity assessments, patient symptom severity and interference, the 31-day unplanned readmission rate, as well as dyadic anxiety, depression, and the mental component summary. No significant differences were found in dyadic symptom interference assessments, family communication, or the physical component summary of the dyads. Qualitative process evaluation identified three main themes: (1) security and gratitude, (2) adapting together, healing together, and (3) sustainable support and resources. Our findings suggest that the nurse-led dyadic symptom management intervention may improve symptom management and psychological outcomes (e.g., anxiety and depression) among postoperative esophageal cancer patients and their family caregivers. Registration: This study was retrospectively registered with the Chinese Clinical Trial Registry on 10 June 2025 (ChiCTR2500104063).

BACKGROUND:Falls are a common geriatric syndrome in older adults and are associated with functional decline, disability, hospitalization, and increased mortality. Exercise has been shown to improve fall-related outcomes, but the comparative effectiveness across different exercise modalities remains to be clarified. OBJECTIVE:This study aimed to assess the comparative effectiveness of different exercise interventions on the number of fallers, recurrent fallers, fall-related injuries, and fall-related fractures in older adults. DESIGN:Network meta-analysis of randomized controlled trials. METHODS:Systematic searches were conducted in five databases, including PubMed, Web of Science, Embase, the Cochrane Library, and CINAHL Plus with Full Text, from database inception to October 21, 2025, and were updated to April 18, 2026. Risk of bias was assessed using the Cochrane Risk of Bias tool 2.0 for randomized controlled trials. A frequentist network meta-analysis was performed using Stata 17 and R 4.2.1. Heterogeneity was assessed using τ2, Q statistics, and I2, and interventions were ranked according to the surface under the cumulative ranking curve. RESULTS:A total of 45 randomized controlled trials involving 16,240 older adults were included, evaluating five types of exercise interventions. Compared with usual care, multicomponent exercise (OR = 0.78, 95% CI: 0.67 to 0.91) and mind-body exercise (OR = 0.62, 95% CI: 0.46 to 0.85) were associated with fewer fallers among older adults (Q = 89.27, P < 0.05, I2 = 55.2%, τ2 = 0.08), while mind-body exercise (OR = 0.57, 95% CI: 0.38 to 0.85) was also associated with fewer recurrent fallers (Q = 32.95, P = 0.02, I2 = 45.4%, τ2 = 0.06). In addition, mind-body exercise (OR = 0.68, 95% CI: 0.47 to 0.99) and balance training (OR = 0.76, 95% CI: 0.61 to 0.96) may reduce the risk of fall-related injuries (Q = 4.03, P = 0.67, I2 = 0%, τ2 = 0). No statistically significant differences were observed between exercise interventions and usual care for fall-related fractures. Sensitivity analyses indicated that the results were stable. CONCLUSION:Multicomponent exercise, mind-body exercise, and balance training may reduce fall-related outcomes in older adults and may inform clinical decision-making regarding exercise interventions. However, these findings should be interpreted with caution because the certainty of evidence ranged from moderate to very low across outcomes. Further high-quality randomized controlled trials are needed to confirm these findings.

PURPOSE:To explore the postoperative psychosocial adaptation challenges of young and middle-aged lung cancer survivors, with a focus on their lived experiences, perceptions, and underlying cultural influences, including social roles, etiquette, and family expectations, to guide the development of more precise and culturally sensitive psychosocial support. METHODS:A qualitative descriptive design was conducted. A total of 21 young and middle-aged lung cancer survivors were purposively recruited and interviewed using a semi-structured guide. The data were organized by NVivo 11.0 and qualitatively analyzed using thematic analysis. RESULTS:We generated an overarching theme, "psychosocial adaptation challenges: striving for a new normal". Four themes were identified: (1) unbearable threat of death, including inability to endure death, and fear of cancer recurrence; (2) symptom distress, including clearly stated symptoms and subjectively ambiguous symptoms; (3) restrictions on daily life, including activity intolerance, imposed dietary restriction, withdrawal from social activities, and adjusted work engagement; and (4) being treated differently, including feeling isolated or discriminated against, a burden of goodwill, and longing for normal. CONCLUSION:Young and middle-aged survivors following lung cancer surgery experienced severe psychosocial adaptation challenges, including challenges specific to this life stage. This study emphasizes the need for postoperative care to attend to physical recovery, psychological adjustment, and social-role reconstruction among lung cancer survivors.

PURPOSE:This cross-sectional study aimed to examine the level of psychosocial adjustment among young and middle-aged patients with lung cancer, explore the influencing factors of psychosocial adjustment, and identify the mediating role of resilience between stigma and psychosocial adjustment. METHODS:Between October 2022 and October 2023, data were collected using a self-designed demographic and disease-related questionnaire, the Psychosocial Adjustment to Illness Scale-Self-Report (PAIS-SR), Social Impact Scale (SIS), and Connor-Davidson Resilience Scale (CD-RISC). The sample comprised 245 patients with lung cancer recruited from a tertiary grade A cancer center in southern China. To analyze the data, hierarchical multiple regression analyses were used, and the mediation Model 4 of the PROCESS macro in SPSS was implemented. RESULTS:Participants (42.9%) had moderate or severe psychosocial maladjustment. Financial stress, cancer stage, time since treatment completion, dyspnea, stigma, and resilience were included in the final regression model and explained 46.2% of the variance of psychosocial adjustment. The total and direct effects of stigma on psychosocial adjustment were significant, and a positive indirect effect was identified for stigma on psychosocial adjustment via resilience. CONCLUSIONS:Stigma had a negative impact on psychosocial adjustment among young and middle-aged lung cancer patients, while resilience had a partial mediating effect on the relationship between stigma and psychosocial adjustment. IMPLICATIONS FOR CANCER SURVIVORS:Targeted psychosocial interventions should be developed to alleviate stigma, enhance psychological resilience, and ultimately support patients' reintegration into society and their return to normal life.

Pain is highly prevalent among older adults with cardiovascular disease (CVD) and may compromise functional independence. However, the nature of this relationship in different cultural and healthcare contexts is not well understood. We examined the association between pain and functional limitations among adults aged 60 years and older with self-reported cardiovascular disease (CVD) using nationally representative data from the Longitudinal Aging Study in India (LASI, n = 11,247), the China Health and Retirement Longitudinal Study (CHARLS, n = 3733) and the Mexican Health and Aging Study (MHAS, n = 5108). Pain was assessed through self-report, and functional status was evaluated across activities of daily living (ADL), instrumental activities of daily living (IADL), and mobility. Cross-sectional associations were estimated using multivariable logistic regression, and longitudinal analyses examined the effect of baseline pain on incident disability at 3-year follow-up in the Chinese and Mexican cohorts. Pain was reported by 43.7%, 36.2%, and 43.6% of participants in India, China, and Mexico, respectively. After adjustment for covariates, pain was significantly associated with ADL disability in all three countries (India OR=1.86, China OR=2.22, Mexico OR=2.32), with similar associations observed for IADL and mobility limitations. Strong dose-response relationships were identified between pain frequency or severity and functional limitations. Longitudinal analyses further showed that baseline pain predicted new-onset ADL and IADL disability at follow-up. These findings demonstrate that pain is consistently associated with functional decline among older adults with CVD, underscoring the importance of pain assessment and management in geriatric cardiovascular care globally. PERSPECTIVE: This study reveals consistent cross-national associations between pain and functional disability among older adults with cardiovascular disease. Pain independently predicts future functional decline, underscoring its value as a clinical marker for early intervention and as a modifiable target in integrated cardiovascular and geriatric care programs.

The incidence of adverse events (AEs) among older adults in nursing homes increases annually. This study explored the real experience of managing AEs among nursing-home staff. Six semistructured focus group discussions were held in two nursing homes with a diverse sample of 35 nursing-home staff, including 11 managers, 12 nurses, and 12 nursing assistants. The thematic analysis approach was used to analyze the data, revealing three principal themes: (1) AE awareness: definition, attribution, and avoidance; (2) AE reporting: benefits vs. barriers; and (3) improvement measures for AE management. The management of AEs in nursing homes was a multidimensional issue requiring a comprehensive consideration of individual, organizational, and systematic factors. By enhancing staff's understanding of AEs, optimizing the reporting mechanism, and implementing effective management improvement measures, the safety management of nursing homes can be significantly improved. Our research emphasized as well the importance of establishing a positive safety culture.

Purpose This study aims to investigate return to work (RTW) status and identify its predictors in the early post-treatment period among nasopharyngeal carcinoma (NPC) survivors. Methods A prospective observational study was conducted. A convenience sample of 209 NPC survivors were recruited from a tertiary cancer center in Southern China between July 2021 and March 2022. The research instruments comprised the Readiness for Return to Work Scale, M.D. Anderson Symptom Inventory - Head and Neck, Work Motivation Scale, and demographic, disease-related, and work-related questionnaire. Return to work status and current job characteristics were assessed via telephone interview three months after completing treatment. Logistic regression analysis was conducted to determine the predictive factors. Results Approximately 31.1% of NPC survivors returned to work in the early post-treatment period. Logistic regression analysis showed that NPC survivors who were male, had one child, had higher family monthly income per capita, were in the stages of prepared for action-self-evaluation/prepared for action-behavior, and had stronger work motivation were more likely to return to work in the early post-treatment period. Conclusions The RTW is low among NPC survivors in the early post-treatment period. Factors predicting RTW are complex under Chinese culture context. Healthcare professionals should prioritize the early identification of survivors with low RTW intention and provide culturally sensitive interventions to enhance their work motivation and readiness. These efforts are crucial to supporting NPC survivors in achieving successful early RTW.

BackgroundAdverse events in nursing homes, which are unintended incidents causing unnecessary harm to older residents. Previous studies in Chinese populations often focused on adverse events in hospitals, rather than residents in nursing homes. Additionally, they tended to focus on single incident rather than multiple types of adverse events. This study aims to assess the occurrence and contributing factors of multiple adverse events perceived by staff in Chinese nursing homes.MethodsA cross-sectional survey was conducted among 691 frontline staff from 11 nursing homes in Southern China (August 2021–January 2022). Data were collected using a General Information Questionnaire, the Adverse Event Reporting Awareness Scale, and the Adverse Event Reporting Habit Scale. Logistic regression models were employed to analyze the contributing factors of adverse events.ResultsA total of 13 types of adverse events were screened out in nursing homes, and 477 (69.0%) participants reported that the adverse events “had happened” in the past year. The most common events were falls, unplanned extubation, and pressure sores. Clinical staff were 2.06 times more likely than frontline workers to report adverse events (95% CI = 1.13–3.76). Increased awareness (OR = 1.24, 95% CI = 1.15–1.34) and habitual reporting of adverse events (OR = 1.04, 95% CI = 1.01–1.08) were positively associated with higher reporting rates.ConclusionA significant proportion of staff reported adverse events, with clinical staff and those with better reporting habits noting higher occurrences. To enhance resident safety, nursing homes must prioritize preventing high-risk adverse events. Targeting frontline workers with lower reporting awareness and habits is crucial for effective interventions.

PURPOSE:To assess the stigma levels among colorectal cancer (CRC) survivors, identify determinants, examine correlations with CRC knowledge and self-efficacy, and quantify the relative influence of various contributing factors. METHODS:In total, 301 CRC survivors were enrolled from a tertiary oncology center in southern China. The participants completed the Social Impact Scale (SIS), Bowel Cancer Awareness Measure (Bowel CAM), General Self-Efficacy Scale (GSES), and a demographic and disease-related questionnaire. The analytical framework included multiple linear regression to identify the factors influencing stigma, LASSO regression for variable refinement, and random forest modeling to construct hierarchies of factor importance. RESULTS:Participants demonstrated moderate levels across all measures: stigma (54.63 ± 8.37), CRC knowledge (8.25 ± 4.74), and self-efficacy (26.81 ± 5.95). Multiple linear regression identified type of medical insurance, support from peers, unwillingness to accept colonoscopy, CRC knowledge, and self-efficacy as significant factors influencing stigma. Random forest analysis ranked factor importance by Gini index: self-efficacy (4366.41), support from peers (1618.03), CRC knowledge (1029.04), type of medical insurance (886.66), and unwillingness to accept colonoscopy (750.16). CONCLUSIONS:Healthcare providers should pay more attention to stigma among CRC patients. Effective stigma reduction necessitates culturally-sensitive psychosocial interventions, including enhancing patients' confidence in managing their disease, strengthening professional-driven online popularization of science campaigns, and facilitating social support networks.

PURPOSE:Cervical cancer patients undergoing 3D external beam radiotherapy plus brachytherapy face significant physical and psychological burdens. This study aimed to explore their experiences across the treatment journey to improve care. METHODS:Semi-structured interviews and participant observation with 20 Chinese cervical cancer radiotherapy patients gathered data on psychological, behavioral, social support, and needs aspects. Thematic analysis informed the creation of user personas and journey maps. Clinical applicability and accuracy were assessed via questionnaires completed by 60 patients. RESULTS:Patients exhibited substantial physical, psychological, and social needs throughout treatment, with variations across groups and stages. Four distinct treatment stages were defined: initial intervention, external beam radiotherapy, 3D brachytherapy, and long-term follow-up, each with stage-specific and cross-journey needs. Five typical patient profiles were identified and mapped to stage-specific needs. Questionnaire validation confirmed the profiles effectively captured patients' emotional fluctuations and evolving needs across stages. CONCLUSIONS:Combining user personas and journey mapping successfully depicted cervical cancer radiotherapy patients' needs and emotional changes across treatment phases, validated for clinical use. This framework provides a basis for personalized interventions to optimize patient experience and outcomes.

Background Sepsis is a critical global health issue, particularly affecting older adults. Despite advances in acute sepsis management, the long-term outcomes for survivors, particularly those transitioning to skilled nursing facilities (SNFs), remain poorly characterized. Aim To evaluate the prognostic value of the age-adjusted Charlson Comorbidity Index (ACCI) in predicting 6-month mortality among older adult sepsis survivors discharged to SNFs. Study Design An observational cohort study of older adult sepsis patients in the intensive care unit (ICU) of a tertiary academic medical centre in Boston from 2008 to 2019 was performed. Patients were stratified into low (<= 5), intermediate (6, 7) and high (>= 8) ACCI score groups. Using the Cox proportional hazards model, we determined the association between ACCI scores and 6-month mortality, calculating hazard ratios (HR) and 95% confidence intervals (CIs). The predictive performance was assessed using ROC curve analysis and compared with Sequential Organ Failure Assessment (SOFA) scores. Results The study included 3713 sepsis survivors aged 65 and older discharged to SNFs. The median age was around 80 years, and 52.6% of the participants were female. The analysis revealed that each one-point increase in the ACCI was associated with an 18% higher risk of mortality within 6 months (HR 1.18; 95% CI 1.14-1.22; p < 0.001). Furthermore, compared with individuals with low ACCI scores, those in the moderate ACCI score group had a HR of 1.55 (95% CI: 1.26-1.91, p < 0.001), and those in the high ACCI score group had a HR of 2.43 (95% CI: 1.96-3.03, p < 0.001). ACCI demonstrated superior predictive performance compared with SOFA scores (area under the curve [AUC] 0.65 vs. 0.53, p < 0.001). Conclusions ACCI serves as an independent predictor of 6-month mortality in older adult sepsis survivors discharged to SNFs. Relevance to Clinical Practice Critical care nurses can use ACCI as a risk stratification tool to identify high-risk older sepsis survivors, inform discharge planning and improve interprofessional communication for tailored post-acute care interventions in SNFs.

PURPOSE:To synthesize the prevalence and risk factors for critical weight loss (CWL) in head and neck cancer (HNC) patients during radiotherapy. METHODS:PubMed, Embase, Web of Science, the Cochrane Library, China National Knowledge Infrastructure, Weipu database, and Chinese Biomedical database were searched from their inception to April 2025. The quality of the included studies was assessed using the Newcastle-Ottawa Scale. The prevalence of CWL was analyzed with a random effects model. Subgroup analysis was conducted to investigate possible sources of heterogeneity. The odds ratios and their 95 % confidence intervals were calculated for the analysis of risk factors. RESULTS:A total of 25 studies were included. The pooled prevalence of CWL was 57 % (95 % CI: 52 %-63 %), ranging from 25.2 % to 86 %. Subgroup analysis revealed a higher prevalence of CWL among the following patient groups: those with oropharyngeal cancer (69 %), tumor staging III/IV (59 %), undergoing chemoradiotherapy (58 %), and individuals from developing countries (62 %). The identified factors were chemoradiotherapy (OR = 2.52, 95 % CI: 1.86-3.43), smoking (OR = 2.02, 95 % CI: 1.12-3.65), high pre-treatment BMI (kg/m2) (OR: 1.10, 95 % CI: 1.04-1.17), and high performance status (OR: 0.49, 95 % CI: 0.34-0.72). CONCLUSIONS:CWL is a common problem in HNC patients during radiotherapy. Chemoradiotherapy, smoking, higher pretreatment BMI (kg/m2), and lower performance status may increase the risk of CWL. Healthcare professionals should identify risk factors for CWL to enable precision interventions and ultimately improve clinical outcomes.