搜索结果：Health care management science

Veterans are vulnerable to housing instability and/or homelessness (HUH) and may encounter unique challenges that affect their healthcare. While research has noted connections between major psychiatric disorders and HUH, few studies have examined personality disorders (PD) and their sex-specific relationships with HUH and healthcare use among aging veterans. We examined sex differences in the epidemiology of PD and their impact on healthcare service use among aging HUH veterans. A cross-sectional study involving 6,042,426 veterans (5,722,344 males and 320,082 females) was conducted using linked U.S. Department of Veterans Affairs (VA) Homeless Operations Management and Evaluation System and Corporate Data Warehouse among veterans&#x2009;&#x2265;&#x2009;50&#xa0;years who sought VA healthcare services over a twelve-month period between 2016 and 2024. Regression modeling was applied to identify predictors of PD and healthcare service use. PD prevalence was estimated at 0.46% (1.65% among females, and 0.39% among males). PD-diagnosed veterans experienced HUH more frequently than their counterparts, and this association was stronger in male vs. female veterans. Age&#x2009;<&#x2009;65y, non-Black race, unmarried status, military sexual trauma, and self-directed violence were associated with PD among HUH-experienced veterans. Among HUH-experienced veterans, those with vs. without PD had greater odds of using healthcare services, with higher average number of healthcare encounters, especially among females for primary care, and among males for acute care. Although more frequently diagnosed among female veterans, PD were more strongly related to HUH among male veterans. Sex-specific patterns of healthcare use emerged according to PD among aging HUH-experienced veterans.

Home mechanical ventilation (HMV) is an important form of support for the out-of-hospital management of patients with chronic respiratory failure and long-term ventilatory dependence. It plays an important role in prolonging life, relieving symptoms, and supporting home living. As the site of treatment extends from the hospital to the home, patients and caregivers must jointly face challenges related to treatment decision-making, technological adaptation, expansion of caregiving responsibilities, and insufficient support systems. Existing studies have often focused on a single disease, a single ventilation modality, or a single caregiving perspective, and a systematic synthesis of the experiences and support needs of patients receiving HMV and their caregivers remains lacking. This study aimed to systematically synthesize the experiences and support needs of patients receiving HMV and their caregivers during home treatment through a qualitative systematic review and meta-synthesis. It also explored core issues across different disease types, ventilation modalities, levels of dependence, and caregiving contexts to provide evidence for developing stratified and continuous care support pathways for the family as a unit. This study conducted a meta-synthesis using the Joanna Briggs Institute methodology for qualitative systematic reviews. PubMed, Web of Science, Embase, the Cochrane Library, and CINAHL were systematically searched from January 1, 2020, to April 30, 2026, and the reference lists of the included studies were manually searched. The methodological quality of the included studies was assessed using the JBI Critical Appraisal Checklist for Qualitative Research. Findings were categorized and synthesized using the JBI meta-aggregation approach, and confidence in the evidence for the synthesized themes was assessed using the ConQual framework. Thirteen qualitative studies were included, involving 129 patients receiving HMV and 121 family-caregiving-related participants, including family caregivers, relatives, and bereaved family members. Five synthesized themes and 17 subthemes were generated: (1) passive entry, repeated weighing, and active participation in HMV decision-making; (2) adapting to the integration of ventilation technology into everyday family life; (3) ongoing tensions among life support, quality of life, and autonomy; (4) expansion of family caregiving responsibilities and reconstruction of the boundaries of professional care; and (5) gaps in support systems and the need for continuous support for the whole family. The ConQual assessment showed that the final level of confidence was moderate for all five synthesized themes. HMV is not only a long-term respiratory support technology but also a continuous care process deeply embedded in disease progression, family life, and healthcare service systems. The experiences of patients and caregivers are jointly influenced by disease type, ventilation modality, level of ventilatory dependence, socioeconomic conditions, and healthcare system context. HMV nursing practice should shift from individual patient management and guidance on device use toward continuous support for the family as a unit. Particular attention should be given to strengthening shared decision-making, caregiver training, professional follow-up, remote monitoring and digital follow-up, psychosocial support, resource navigation, and integration of early palliative care to improve the sense of security, quality of life, and sustainability of care for both patients and caregivers.

Canada's health workforce crisis is placing sustained pressure on primary care, particularly in the management of chronic pain, mental health conditions and substance use disorders. Mentoring is a compelling response to workforce, educational and well-being challenges in healthcare, and Adaptive Mentorship Networks (AMNs) have emerged in Canada as an interprofessional model to strengthen provider capacity, psychological safety and compassionate care. Despite widespread interest and demonstrable effectiveness, the determinants that influence successful implementation, spread, adaptation and sustainability of AMNs remain insufficiently understood. This 3-year mixed-methods protocol will evaluate implementation of 11 AMNs that are established or in development across Canada. The study will focus on two complementary levels: (1) implementation of AMNs within healthcare ecosystems; and (2) capabilities, opportunities and motivations that contribute to adaptive mentorship between mentors and mentees. The overarching approach to understand the determinants of successful implementation and behavioural influences on adaptive mentorship uses implementation science and systems thinking methodologies to support a pan-Canadian Learning Health System. Work will proceed in three phases. Phase I will explore determinants of implementation (phase Ia) and behavioural influences on adaptive mentorship (phase Ib) through document review, interviews, systems mapping and readiness assessment. Phase II will use a Learning Alliance to identify, select and operationalise fit-for-purpose implementation strategies. Phase III will co-develop AMN-specific logic models and evaluate the feasibility, acceptability and initial utility of selected strategies. The study will be guided by the Active Implementation Framework, the Consolidated Framework for Implementation Research, the Consolidated Framework for Sustainability Constructs, the Capabilities, Opportunities and Motivation for Behaviour model, the Theoretical Domains Framework and the Health Equity Implementation Framework. Outputs from phase Ia will provide a compendium of determinants critical for the implementation of mentorship networks within healthcare arranged by stage of implementation, and the activities that current networks have taken to influence such determinants. Outputs from phase Ib will identify the capabilities, opportunities and motivations deemed critical for facilitating engagement in the act of clinical mentorship. Phase II will identify a contextualised understanding of strategies that are optimally suited to influence critical determinants of implementing AMNs and engaging in clinical mentorship. Our outputs from phases I and II will be pilot tested with each AMN and inform the development of site-specific logic models and a cross-site implementation blueprint that will be evaluated in phase III. This protocol advances a systems-informed approach to implementing AMNs across diverse Canadian health systems, with implications for mentorship-enabled workforce development. Ethics approval has been obtained from the Bruy&#xe8;re Health Research Ethics Board (M16-25-001 and M16-25-002) and the Newfoundland and Labrador Health Research Ethics Board (Ref# 2025.047). Participants provide informed consent prior to participating in study interviews acknowledging potential risks and benefits to participation. Findings will be mobilised through integrated knowledge mobilisation with participating AMNs, members of the Learning Alliance, policy and practice partners, conference presentations, publications, AI-enabled knowledge sharing tools and plain-language resources.

Internet healthcare has become a key part of China's hospital-centered health system. Driven by "Internet Plus Healthcare", Healthy China 2030, and public-hospital high-quality development policies, it has evolved from remote consultation experiments into regulated online-offline care pathways. This review traces its development from the first documented remote medical practice in 1986 to the present, focusing on policy, institutional models, clinical evidence, governance challenges, and reform. We conducted a structured narrative review of English- and Chinese-language sources on internet healthcare in Chinese public hospitals. PubMed/MEDLINE, Web of Science Core Collection, China National Knowledge Infrastructure (CNKI), and official policy sources were searched. Eligible sources addressed internet hospitals, telemedicine, online follow-ups, remote monitoring, e-prescriptions, insurance payments, digital governance, clinical outcomes, patient safety, equity, or implementation barriers in mainland China. Internet healthcare progressed through early telemedicine, institutional network expansion, internet-hospital development, and pandemic-driven normalization. The 2018 regulatory framework positioned internet hospitals as extensions of licensed physical medical institutions, thereby permitting online follow-ups for common and chronic diseases while preserving offline accountability. During COVID-19, online consultation, e-prescriptions, drug delivery, and insurance payments rapidly expanded. Evidence suggests benefits for chronic disease management, medication adherence, cardiovascular secondary prevention, and reduced travel burden. However, evidence remains limited for diagnostic accuracy, adverse events, emergency escalation, and long-term outcomes. Persistent barriers include quality variation, workload, cybersecurity, data fragmentation, artificial intelligence (AI) accountability, reimbursement design, regional inequity, and digital exclusion among older adults. China's model may be understood as a hospital-centered extension of public-hospital functions rather than a stand-alone virtual-care system. Future development should prioritize outcome-based evaluations, safety governance, equitable access, data interoperability, and accountability for internet-based and AI-assisted care.

Self-management empowers non-communicable disease (NCDs) patients to improve health, enhance quality of life (QoL), and reduce adverse outcomes. This study aims to synthesize empirical evidence on the effectiveness of self-management interventions in improving QoL and health outcomes among patients with NCDs. Following the PRISMA guidelines, a systematic search of PubMed/MEDLINE, Scopus, CINAHL, Web of Science, ScienceDirect, and OVID databases was conducted to identify relevant studies published between 2019 and 2024. Studies were included if they evaluated the impact of self-management interventions on QoL among adults with NCDs using randomized controlled trials or experimental designs. Risk of bias was assessed using the RoB 2 and ROBINS-I tools. A random-effects meta-analysis was performed to calculate pooled standardized mean differences using Hedges' g. Heterogeneity was assessed using Cochran's Q test and the I&#xb2; statistic. Sensitivity analyses and publication bias assessments were also conducted. Eleven studies involving 1,591 participants were included in the systematic review, and 10 studies were eligible for the meta-analysis. The pooled analysis demonstrated that self-management interventions significantly improved QoL compared with standard care (Hedges' g&#x2009;=&#x2009;0.58; 95% CI: 0.34-0.81). Moderate-to-substantial heterogeneity was observed across studies (I&#xb2; = 69.3%). Subgroup analysis indicated that intervention effects varied by country income level, with larger effect sizes observed in upper-middle-income countries. Sensitivity analysis confirmed the robustness of the findings. Funnel plot inspection and Egger's test indicated no statistically significant evidence of publication bias. Self-management interventions are associated with significant improvements in QoL among individuals with NCDs. These findings highlight the importance of integrating structured self-management programs into chronic disease care. Given the observed heterogeneity across studies, future research should focus on standardized intervention components, rigorous study designs, and evaluation across diverse healthcare settings to better understand the long-term effectiveness of self-management strategies. Not applicable.

To evaluate the effectiveness of nurse-led telehealth compared with usual care on glycemic control and body mass index in adults with type 2 diabetes mellitus (T2DM). Nurse-led telehealth may support diabetes self-management between clinic visits, but its effectiveness for adults with T2DM remains uncertain. Five databases were searched from September 2015 to January 2026. Randomized controlled trials comparing nurse-led telehealth with usual/conventional care in adults with T2DM were included. Two reviewers independently screened studies, extracted data, and assessed risk of bias. Random-effects meta-analyses pooled mean differences (MDs) with 95% confidence intervals (CIs). The primary outcome was change in HbA1c. Secondary outcomes included BMI and FPG. PROSPERO registration: CRD420251149835. Eleven RCTs were included in the systematic review; 10 contributed to meta-analysis, while 1 was synthesized narratively due to non-extractable outcome data. Nurse-led telehealth significantly reduced HbA1c compared with usual care (MD&#x2009;=&#x2009;-0.62%, 95% CI -0.90 to -0.34; p&#x2009;<&#x2009;0.0001). BMI showed a borderline but non-significant reduction favouring nurse-led telehealth (MD&#x2009;=&#x2009;-0.61&#x2009;kg/m2, 95% CI -1.23 to 0.01; p&#x2009;=&#x2009;0.05). FPG did not differ significantly between groups (MD&#x2009;=&#x2009;-0.62&#x2009;mmol/L, 95% CI -2.10 to 0.86; p&#x2009;=&#x2009;0.41). Nurse-led telehealth improves HbA1c compared with usual care and appears to be a promising adjunct to routine diabetes care delivered by nurses. Further trials should clarify intervention intensity and fidelity and evaluate longer-term outcomes relevant to nursing practice. This review supports integrating structured nurse-delivered remote follow-up into clinical pathways to strengthen ongoing diabetes self-management between clinic visits. The complexity of symptom burden, treatment workload and patient engagement should be considered, underscoring the importance of tailoring and ongoing support in nurse-led telehealth programmes. PROSPERO (CRD420251149835).

The increasing volume and complexity of orthopedic surgery have expanded the involvement of ward-based registered nurses in postoperative wound care. Although registered nurses receive foundational wound care education as part of their professional preparation, those without specialist wound care credentials may encounter challenges when managing complex orthopedic surgical wounds. Their experiences, role boundaries, and perceived support needs remain insufficiently explored. This study aimed to explore ward-based registered nurses' perceptions of their roles and professional boundaries in orthopedic surgical wound management and to identify perceived strategies for supporting their practice. A descriptive qualitative study was conducted in an orthopedic ward of a tertiary hospital in China. Fourteen ward-based registered nurses were purposively recruited and participated in semi-structured interviews. Data were analysed using Braun and Clarke's thematic analysis approach. Four themes were identified: negotiating professional boundaries within clinical hierarchies, evolving role identity in orthopedic surgical wound care, developing professional capacity for safe and responsive wound management, and sustaining practice development through continuing education and organizational support. Participants described surgical wound care as an expanding but ambiguously defined area of nursing practice. Their accounts highlighted a mismatch between foundational wound care education and the demands of complex orthopedic surgical wounds, variability in physicians' treatment preferences and local ward routines, limited decision-making authority, and inconsistent interprofessional collaboration. Participants also emphasized the importance of timely nursing involvement, clinically relevant continuing education, standardized protocols, and clearer escalation pathways for supporting safe and coordinated wound care. Ward-based registered nurses without specialist wound care credentials make important contributions to orthopedic surgical wound management through ongoing assessment, timely dressing care, patient education, and communication with physicians and wound care specialists. However, their expanding role is shaped by unclear professional boundaries, variable local practices, limited authority in wound-related decision-making, and uneven access to continuing education. Clearer role delineation, standardized protocols, structured continuing education, and collaborative escalation pathways are needed to support safe and consistent wound care.

With the growing adoption of mobile technologies, mHealth applications have emerged as valuable tools for enhancing maternal healthcare by providing accessible and flexible support throughout pregnancy and postpartum period. Despite their widespread use, limited evidence exists on how these apps are designed and evaluated for self-care, highlighting the need for a structured review. A rapid review was conducted using a structured search in PubMed, Scopus, and Web of Science to identify studies focusing on digital applications delivered through mobile or web-based platforms that support self-care during pregnancy and postpartum. Eligible studies included randomized controlled trials, study protocols, and development papers published from 2015 to 2025. Data were extracted and narratively synthesized to examine app features, theoretical foundations, and evaluation strategies. A total of 13 studies were included, primarily evaluating mobile health (mHealth) interventions during pregnancy and postpartum period. The applications predominantly targeted mental health, lifestyle behaviors, and health literacy. Randomized controlled trials were the most common study design. Although several studies applied behavioral theories such as Cognitive Behavioral Therapy and Social Cognitive Theory, many lacked explicit theoretical frameworks. mHealth applications show promise in supporting maternal self-care, particularly for postpartum mental health. However, many interventions lack theoretical grounding and long-term evidence. Future efforts should prioritize scalable, theory-based, and culturally tailored designs to enhance effectiveness and sustainability.

Chronic Inflammatory Demyelinating Polyradiculoneuropathy (CIDP), a rare autoimmune disorder affecting peripheral nerves, is associated with substantial societal costs. This study assesses healthcare utilization and productivity losses across varying levels of patient disability. Data were obtained from Adelphi's CIDP Disease Specific Programme&#x2122; (September 2022-April 2023), a digital, international, real-world survey involving neurologists and their patients (UK, France, Germany, Italy, Spain). Disability was measured using the Inflammatory Neuropathy Cause and Treatment (INCAT; range: 0-10), and categorized as mild (&#x2264;2), moderate (3-4), or severe (&#x2265;5). Neurologists provided data on treatment, informal care, hospitalizations, mobility aids, and home modifications for 542 patients, while lost productivity was reported by a subset of patients (n&#x202f;=&#x202f;199). Associations between disability level and healthcare utilization and lost productivity were evaluated using linear regression, adjusting for age and time since diagnosis. Of the 542 patients, 236 (43.5%) had mild, 189 (34.9%) moderate, and 117 (21.6%) severe disability. Treatment rates increased with severity (receiving treatment: mild 78.4%, moderate 89.9%, severe 92.3%; p&#x202f;<&#x202f;0.001). The proportion of patients receiving informal care rose sharply with increasing disability (mild 7.2%, moderate 31.2%, severe 62.9%; p&#x202f;<&#x202f;0.001). Hospitalizations in the 12&#x202f;months prior to the survey were more frequent with greater disability (mild 7.0%, moderate 14.5%, severe 21.6%; p&#x202f;<&#x202f;0.001), as were emergency admissions (1.0, 9.9, 13.7% respectively; p&#x202f;<&#x202f;0.001) and ICU stays (0.0, 0.7, 3.9% respectively; p&#x202f;=&#x202f;0.001). The use of mobility aids (19.1, 56.1, 89.7% respectively) and home modifications (12.8, 45.8, 74.2% respectively) also rose significantly with severity (p&#x202f;<&#x202f;0.001 for both). Finally, work productivity losses among employed patients and activity impairment rose as disability increased (average percentage of productivity loss: mild 21.8%, moderate 44.0%, severe: 67.3%, p&#x202f;<&#x202f;0.001; average daily activity impairment: mild 28.6%, moderate: 44.6%, severe: 68.1%, p&#x202f;<&#x202f;0.001). CIDP is associated with substantial healthcare utilization that increases with increasing disability, highlighting the progressive functional decline associated with more severe disease. In addition to direct healthcare demands, CIDP imposes considerable caregiver support needs, changes in living conditions, and productivity losses. Together, these findings underscore the wide-ranging impact of CIDP and the need for comprehensive management strategies.

Just-in-time adaptive interventions (JITAIs) use real-time data to deliver personalized support at moments of heightened need and may improve dietary behaviors in real-world settings. The aim of this study is to systematically review the application, characteristics, and effectiveness of JITAIs in dietary health management. We included human studies evaluating JITAIs-based dietary interventions delivered through digital platforms that used real-time or near-real-time data to tailor intervention content, timing, or intensity. Eligible studies reported at least one behavioral, engagement, physiological, or clinical outcome; reviews, protocols, editorials, commentaries, and studies without outcome data were excluded. We searched PubMed, Embase, Scopus, CINAHL, Web of Science, ClinicalTrials.gov, WHO ICTRP (International Clinical Trials Registry Platform), and ISRCTN (International Standard Randomized Controlled Trial Number) from inception. The initial search was conducted on August 20, 2025, and updated on March 16, 2026; reference lists were also screened manually. Two reviewers independently screened studies and extracted data. Methodological quality was assessed using the 2018 Mixed Methods Appraisal Tool, and reporting quality was assessed using the Mobile Health Evidence Reporting and Assessment checklist. Because of substantial heterogeneity, findings were synthesized narratively. The review was registered in PROSPERO (International Prospective Register of Systematic Reviews; CRD420261285292). Twenty studies involving 2948 participants were included. Target populations comprised individuals with overweight or obesity, chronic conditions, and eating disorders and the general population engaged in dietary management. Interventions were mainly delivered via smartphone apps, SMS text messaging, wearable-device feedback, and context-triggered notifications. More consistent benefits were observed for proximal behavioral and process outcomes, including fruit and vegetable intake, sodium-restriction behaviors, drinking automaticity, self-monitoring, eating-related behaviors, and responsiveness to prompts. Some studies also reported improvements in distal clinical outcomes, such as body weight, BMI, waist circumference, blood pressure, blood glucose, and selected biochemical indicators. However, these findings were inconsistent, and most studies did not show clear between-group advantages. Common implementation barriers included device incompatibility, variability in digital literacy, geolocation or signal limitations, and burden from frequent prompts. JITAIs-based dietary interventions appear promising for supporting timely and individualized dietary behavior change, particularly for proximal behavioral outcomes, although evidence for sustained clinical effects remains inconsistent. This review contributes to the JITAIs literature by examining dietary health management as a distinct application domain and by synthesizing evidence that has otherwise been dispersed across broader reviews of digital behavior change and weight management. By integrating intervention characteristics, delivery approaches, triggering mechanisms, and effects across diverse populations, it clarifies methodological and implementation gaps and informs more standardized intervention design and reporting. These findings support the development of scalable, context-sensitive digital dietary interventions for clinical care, chronic disease self-management, weight management, and public health nutrition.

Engaging knowledge users, including patient partners and health-system partners, in embedded health services research is increasingly recognized as essential for strengthening the relevance of research and improving the quality and equity of health services and is foundational to the success of team science. Existing engagement frameworks, however, often capture experiences at single time points and do not fully reflect relational dimensions over time such as trust, reciprocity, shared decision-making, and equity which can impact the outputs and outcomes of partnered research. There remains limited evidence describing how engagement unfolds or what conditions support or hinder meaningful, equitable partnerships in research. This study will address this gap by examining the ripple effects of a long-standing researcher-knowledge user partnership and identifying the relational and structural factors that sustain it. This qualitative, participatory study will be guided by critical patient-oriented research (cPOR), an approach that centres equity, shares power, and structurally situates lived/living experiences throughout the research process. In alignment with cPOR principles, patient partners and health-system partners are co-researchers across all stages of the study from inception through to development of data collection tools and will partner in analysis and interpretation. The study will be conducted within the Lung Health Equity Advisory Committee, a partnership co-established to address inequities in lung health, where patient partners, clinicians, policymakers, program implementers, and researchers have worked together since 2020. Data collection will be informed by patient engagement tools, such as the Engaging with Purpose Patient Engagement Framework, to assess experiences across five pillars: Co-Build, Support, Mutual Respect, Inclusiveness, and Impact, using document analysis and annual surveys. Analysis will be guided by the theoretical concept of ripple effects, to explore how engagement processes, outputs, and outcomes accumulate and influence subsequent phases of work. Data will be analysed using combined deductive-inductive content analysis, with triangulation across all data sources. Preliminary findings will be synthesized with partners through Ripple Effects Mapping (REM), a participatory approach that supports collective interpretation, visualization of impact pathways, and opportunities for continuous improvement. This study offers a novel approach to understanding the experiences and impact of long-standing research-knowledge user partnerships that are not bound by a specific project or timeline. By exploring this relational approach to engagement, we will generate nuanced insights into how knowledge-user engagement is built, experienced, and adapted over time within an equity-oriented partnership. The exploration of ripple effects is expected to strengthen real-time learning and partnership dynamics while offering a transferable model for other research teams seeking to embed iterative, partner-guided improvement into engagement practices that are sustained over time. Working closely with patients, community members, and people who plan and deliver healthcare helps make research more useful and can improve the quality and fairness of care. However, most ways of exploring engagement practices capture people&#x2019;s experiences as snapshots at different points in time, and do not adequately unpack how aspects such as trust, shared decision-making, and fairness may impact long-standing relationships. This study will help fill this gap by looking at how engagement is experienced over time in a long-standing partnership and by identifying the relationship and system factors that help support meaningful and impactful partnerships.This study will use an approach that focuses on equity, shared decision-making, and lived/living experiences. Patient partners and health-system partners who have been working together since 2020 in the Lung Health Equity Advisory Committee to improve lung health outcomes for all have co-designed this study and research approach. They will help analyse and understand the results. We will collect information from project documents and surveys and work together to create a ripple effects map that visually traces how engagement activities, relationships, and collective decision-making contribute to outcomes and development of novel projects over time.This study will help us better understand how sustained partnerships are built, experienced, and can be improved over time. It will also provide a model that other research teams can use to understand and sustain how they work with partners for greater impact.

The global population is ageing, and chronic kidney disease is becoming more common. As a result, increasing numbers of older adults with multimorbidity and frailty are progressing to kidney failure. This requires all healthcare professionals involved in the care of people with kidney failure to be able to provide careful guidance with regards to available treatment options. Choosing a treatment pathway for frail patients may be challenging, particularly for those considered ineligible for kidney transplantation. For such individuals, the remaining options are dialysis and conservative kidney management (CKM). However, these treatments have not been compared in randomized trials, which often makes it difficult to determine which treatment best aligns with the needs and preferences of people living with kidney failure. In this narrative review, we discuss CKM as a valuable treatment approach for old and frail people with kidney failure, and those considered ineligible for kidney transplantation. We compare clinical outcomes between CKM and dialysis, such as health-related quality of life and survival. We guide the identification of people who may benefit from CKM and when discussions on CKM should be initiated. We discuss shared decision-making and consider the perspectives of patients, caregivers, and clinicians. Lastly, we embed CKM within the broader context of kidney supportive care, a palliative approach that includes advance care planning, symptom management, and lifestyle modifications that can be considered irrespective of treatment modality. Regardless of whether CKM or dialysis is chosen in the end, careful consideration of treatment options can help to ensure that people with kidney failure receive care that aligns with their values, preferences, and goals.

There is growing evidence that routinization in nursing care is a concerning issue that directly affects the quality of nursing care and nurses' ability to be creative and innovative in care, flexibility, and ability to provide individualized care, and comprehensiveness in care at the global level. This study aimed to identify factors associated with routinization in nursing care. The method of Whittemore and Knafl was employed to conduct this integrated review, which consisted of five stages: identification and determination of the purpose, search for sources, data evaluation, data analysis, and results presentation. Evidence search was conducted using the keywords nursing care, routine, routines, routinization, and their Persian equivalents separately or in combination using the AND and OR operators in the databases PubMed, Web of Science, CINAHL, Scopus, SID, Medex, Magiran, and IranDoc from the beginning to October 2024. After screening and checking for eligibility, the articles were evaluated using the Joanna Briggs Institute's critical appraisal tools. A total of 23 articles met the inclusion criteria and were included in the final review. The most important factors affecting routinization were categorized into 4 categories: individual factors, organizational factors, communication factors, and patient-related factors. The results of this study indicate the need for critical interventions to address factors that can influence routinization in nursing care. Overall, studies highlight the complexity and dependence of routinization in care on various factors, including workload, work environment, and nurse characteristics.

Maternal mortality remains a major public health challenge in Indonesia, with Papua province experiencing the highest provincial maternal mortality ratio. Evidence on how both individual- and community-level factors contribute to maternal deaths in this context remains limited. This study analyzed data from the 2020 Indonesian Population Census, including 18,886 women aged 15-49 years in Papua, of whom 169 experienced maternal death. Maternal deaths were identified using the census mortality module. Descriptive statistics and &#x3c7;2 tests examined bivariate associations. Multilevel logistic regression models were applied to estimate the effects of individual- and community-level determinants, accounting for district-level clustering. Sensitivity analysis using modified Poisson regression with robust variance was conducted to assess robustness of estimatesResults: Maternal mortality was significantly associated with advanced maternal age (>35 years, adjusted odds ratio (aOR) 2.92, 95% confidence interval (CI): 2.45-3.47), nulliparity (aOR 5.94, 95%CI: 4.74-7.44), unmarried status (aOR 2.79, 95%CI: 2.19-3.56), low education (aOR 2.03, 95%CI: 1.38-3.00), and rural residence (aOR 1.95, 95%CI: 1.56-2.45). None of the community-level variables were statistically significant. Substantial between-regency variation persisted in the final multilevel model (intraclass correlation coefficient = 0.61; median odds ratio = 8.95), indicating strong contextual disparities. Maternal mortality in Papua is driven primarily by sociodemographic disadvantage and rural residence, while community-level health system factors alone did not explain between-regency variation. Policies should prioritize improving access and quality of care for first-time and unmarried mothers, enhancing youth-friendly health services, and addressing rural barriers through referral strengthening, maternity waiting homes, and integration of traditional birth attendants. Long-term investments in education and health workforce retention in remote areas remain critical to reducing maternal deaths in Papua.

Pediatric hantavirus cardiopulmonary syndrome/hantavirus pulmonary syndrome (HCPS/HPS) is rare but can progress rapidly from a nonspecific febrile prodrome to respiratory failure, shock, and multiorgan dysfunction. Pediatric-specific evidence is limited, and a comprehensive map of the clinical literature is lacking. We conducted a systematic scoping review per Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR) guidance (protocol registered at DOI:10.17605/OSF.IO/MZDN4). PubMed/MEDLINE, Embase, Scopus, Web of Science, and Cochrane CENTRAL were searched from inception to May 2026. Eligible reports described children or adolescents (age &#x2264;18 years) with HCPS/HPS and extractable pediatric clinical data. Two reviewers independently screened records, assessed overlap, extracted data, and appraised reporting quality using Joanna Briggs Institute tools. Of 2208 database records, 20 reports were included in the core pediatric synthesis after removal of 976 duplicates and screening. Reports were concentrated in the Americas. Recurrent features included fever, gastrointestinal symptoms, myalgia, thrombocytopenia, hemoconcentration, pulmonary edema, respiratory failure, and shock. Severe cases required mechanical ventilation, vasoactive support, extracorporeal membrane oxygenation, and in some cases renal replacement therapy. Larger pediatric case series and surveillance-level reports reported mortality of approximately 33% to 37%. Evidence was predominantly case-based with variable reporting completeness. Pediatric HCPS/HPS is rare but potentially rapidly fatal. Early suspicion in endemic regions or after rodent exposure, with prompt supportive critical care and timely consideration of advanced cardiopulmonary support, is central to management.

Postoperative nausea and vomiting (PONV), as a common complication in laparoscopic surgery, significantly delays patients' recovery and increases the incidence of unplanned readmission. Although drug prevention is widely used, nurse-led non-pharmacological interventions can provide safe and effective collaborative management. However, the current evidence is fragmented and there is a lack of guidelines specific to laparoscopic surgery, resulting in significant differences in clinical practice. This study aimed to integrate the best evidence and establish standardized non-pharmacological nursing strategies for the prevention and treatment of PONV in adults undergoing laparoscopic surgery. Following the standard methodology of the Fudan University Center for Evidence-based Nursing (registration number: ES20257623) and guided by the "5S" evidence pyramid model, we systematically searched multiple databases and guideline repositories from inception to December 4, 2025. We included evidence summary, clinical decision, guidelines, expert consensus statements, systematic reviews and meta-analyses. Literature screening, quality appraisal, and evidence extraction were performed independently by two reviewers. Methodological quality was assessed using validated screening tools. A summary of findings table was constructed to present the synthesized evidence. From 1,564 initial records, 39 publications were included: 5 evidence summaries, 1 clinical decision, 8 guidelines, 4 expert consensuses and 21 systematic reviews. We synthesized 28 best practice recommendations across five key domains: pre-operative risk assessment (identification of risk factors, risk quantification tools, stratified PONV prophylaxis), intraoperative preventive interventions (fluid management, acupoint stimulation, high-concentration oxygen), post-operative symptom management (symptom assessment tool, non-pharmacological management), follow-up care (health education, prevention and control of PDNV), system support (organizational management). This evidence summary provided a comprehensive, clinically actionable framework for nurses to lead proactive, evidence-based PONV care for laparoscopic surgery patients. Effective nursing interventions directly reduced PONV incidence, decreased antiemetic requirements, and improved patient comfort and satisfaction. In addition, nursing practice can shift from reactive management to proactive prevention, thereby delivering patient-centered benefits. The findings should be adapted to local contexts to develop standardized nursing procedures, thereby translating evidence into clinical practice. Not applicable.

Artificial intelligence (AI)-based nursing interventions are increasingly being used to manage chronic illnesses; however, their definitive impact on clinical outcomes remains inconclusive, necessitating a comprehensive evidence synthesis. This umbrella review aimed to synthesize the evidence regarding the effectiveness of AI-based nursing interventions for chronic illness care and their subsequent impact on health care outcomes in clinical settings. We conducted an umbrella review and prospectively registered the protocol. A systematic search of 5 electronic databases (PubMed, CINAHL, Cochrane Library, Scopus, and Web of Science) was performed to identify systematic reviews and meta-analyses published in English between 2021 and 2025. The methodological quality of the included studies was evaluated using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist. Eight high-quality systematic reviews were included, with machine learning identified as the predominant technology. Three primary outcome domains emerged: predictive, psychosocial, and hospital utilization. Due to measurement heterogeneity, the results were synthesized narratively. Our findings demonstrated that AI-based nursing interventions are effective in predicting adverse clinical events, unplanned hospital utilization, and health care costs. However, evidence regarding psychosocial outcomes remains insufficient. This review provides systematic evidence supporting the utility of AI in chronic illness management, particularly for improving predictive and utilization outcomes. These findings offer actionable insights for nursing leaders to integrate AI into clinical practice and education. Future research should prioritize rigorous empirical designs to further strengthen the evidence base for AI-driven nursing care.

China introduced the Supplementary High-Cost Illness Insurance (SHCII) to strengthen financial protection against medical impoverishment. This study assesses its effectiveness and, critically, examines the distribution of its benefits across population subgroups to identify who benefits more. We used 2013 and 2018 survey data from Shandong Province and a difference&#x2011;in&#x2011;differences design, restricting the sample to hospitalized patients (n&#x2009;=&#x2009;3,136). The treatment group comprised patients whose out&#x2011;of&#x2011;pocket expenses exceeded city&#x2011;specific 2018 SHCII thresholds; the control group comprised those below the thresholds. The outcome was Vulnerability to Expected Poverty (VEP). Subgroup analyses were performed by income, urban&#x2011;rural residence, healthcare access, and age. Patients who benefit from SHCII experienced a significant reduction in VEP relative to those below the threshold (OR&#x2009;=&#x2009;0.624; average marginal effect = -0.064). The protective effect was statistically significant for low&#x2011;income individuals, rural residents, those with healthcare access within 15&#xa0;min, and adults aged 45 years and above. No significant effect was found for urban residents or for those with poorer geographical access to care. Patients who benefit from SHCII experienced a greater reduction in poverty vulnerability relative to those below the threshold, with effects concentrated among low&#x2011;income, rural, older, and well&#x2011;accessed populations. No significant association was observed for urban residents. The findings from Shandong, where policy parameters are broadly consistent with national guidelines, are likely generalizable to other provinces with similar policy designs and rural healthcare infrastructure. Future research is needed to test how different policy parameters affect the results. Not applicable.

Alzheimer's disease (AD) is a progressive neurodegenerative disorder characterized by cognitive decline, behavioral disturbances, and loss of functional independence. As the global prevalence of AD continues to rise, traditional episodic care models are increasingly inadequate for providing continuous and individualized support. Wearable electronic devices offer a potential alternative by enabling non-invasive, real-time monitoring in everyday settings. This systematic review synthesizes current evidence on the applications, reported outcomes, and implementation challenges of wearable and wearable-adjacent technologies in AD care. A systematic literature search was conducted in September 2025 across five databases: PubMed, Scopus, Web of Science, Cochrane Library, and Google Scholar, using keywords and MeSH terms related to wearable electronic devices, smart glasses, smartwatches, and Alzheimer's disease. The review protocol was prospectively registered in PROSPERO (CRD420251158703). Two independent reviewers screened records and extracted data in accordance with PRISMA 2020 guidelines. Methodological quality was assessed using a validated 10-item appraisal tool. Of 1399 identified records, ten studies met the eligibility criteria. For structured synthesis, the included technologies were organized into four architectural categories: body area network-based sensor systems, augmented reality smart glasses, hybrid wearable-mobile platforms, and wearable-adjacent assistive technologies. Across studies, the included technologies were applied to physiological monitoring, mobility and gait assessment, cognitive and spatial support, and caregiver communication. Findings suggest preliminary feasibility across these domains; however, small sample sizes, heterogeneous outcome measures, and predominantly early-phase study designs limit the strength of available evidence. Current evidence suggests that wearable and wearable-adjacent technologies may contribute to multiple aspects of AD care, particularly in home-based settings. Translation into routine practice requires prospective, adequately powered studies with standardized outcome frameworks, alongside regulatory alignment and patient-caregiver co-design to address persistent usability barriers.