搜索结果：Journal of patient-reported outcomes

Patient-reported outcome measures (PROMs) are widely used in musculoskeletal rehabilitation to assess pain, physical function, disability, health-related quality of life, psychological status, and patient-perceived recovery. Although traditionally applied as outcome measures, PROMs may also provide prognostic information and contribute to prediction models of rehabilitation response. However, their dual role as both endpoints and predictors has not yet been sufficiently integrated within a unified methodological framework. This narrative review critically examines the role of PROMs in musculoskeletal rehabilitation, with particular emphasis on their use as endpoints of functional recovery, predictors of rehabilitation outcomes, longitudinal monitoring tools, and instruments supporting shared decision-making. A search of peer-reviewed literature was conducted across global databases, focusing on commonly used PROMs. The available evidence indicates that PROMs capture patient-centred domains that are not fully represented by objective clinical or performance-based measures. As endpoints, they permit evaluation of treatment effectiveness. As predictors, baseline and early-treatment PROMs may contribute to prognostic models, risk stratification, treatment matching, and identification of patients at risk of persistent disability or non-response. Their predictive value is influenced by measurement validity, construct overlap, baseline severity, regression to the mean, ceiling and floor effects, assessment timing, missing data, and validation strategy. The clinical utility of PROM-informed models depends on rigorous instrument selection, transparent modelling, calibration assessment, external validation, and adherence to recognised methodological and reporting standards. PROMs should be considered as potentially valuable components of personalised rehabilitation assessment and prognostic modelling.

Dental patient-reported outcomes (dPROs), which capture patients' subjective experiences of their oral health, promote more patient-centered, personalized, and effective dental care. This study aims to assess the types and frequency of dPROs and dental patient-reported outcome measures (dPROMs) reported in randomized controlled trials (RCTs) in periodontology for the period 2023-2025, and to explore variables associated with reporting of dPROs in these trials. A PubMed search was conducted on July 2, 2025, to identify eligible studies. RCTs in periodontology, involving human subjects, and published from 2023 onward were included. The reported dPROs and the corresponding dPROMs were extracted and summarized. Logistic regression analyses were performed to assess associations between various variables and reporting of dPROs. A total of 175 RCTs were included, of which 53 studies (30.3%) reported at least one dPRO. The most frequently reported dPROs were orofacial pain (N&#x202f;=&#x202f;23), discomfort (N&#x202f;=&#x202f;17), and oral health-related quality of life (N&#x202f;=&#x202f;13). The most commonly reported dPROM for both orofacial pain and discomfort was the Visual Analogue Scale, while the 14-item Oral Health Impact Profile was most commonly reported to assess oral health-related quality of life. The reporting of dPROs was statistically significantly associated with 4-year journal impact factor (odds ratio: 1.48; 95% confidence interval: 1.17-1.88; P&#x202f;<&#x202f;.01) and duration of follow-up of study subjects (odds ratio: 2.14; 95% confidence interval: 1.04-4.42; P&#x202f;=&#x202f;.04). dPROs were infrequently reported in the RCTs in periodontology. RCTs that reported dPROs were more likely to be published in journals with higher impact factors and have longer follow-up times.

Immunotherapeutic strategies for the treatment of lymphomas are rapidly expanding and can deliver durable remissions to patients with historically limited treatment options. Patient-reported outcomes (PROs) provide direct measurement of symptoms, functioning, and health-related quality of life (HRQoL), complementing physician-assessed toxicities and enabling a more comprehensive assessment of "treatment tolerability," defined as the willingness of patients to adhere to treatment dose and schedule based on symptom burden and functioning. In this review, we demonstrate that when PROs are incorporated into clinical research, we gain a better understanding of treatment tolerability, particularly of novel immunotherapies, which confer distinct toxicity profiles compared with traditional chemoimmunotherapy. As survival improves, we argue that PROs should be incorporated as a primary or co-primary endpoint in most modern clinical trials, rather than as a point of interest in exploratory analyses. In patients with lymphoma, baseline and longitudinal HRQoL are prognostic of progression-free and overall survival. However, persistent discordance between clinician-graded adverse events (AEs) and patient-reported symptomatic AEs suggests that current trial endpoints focused primarily on safety and survival incompletely capture the patient experience, particularly in the context of novel immunotherapy-related toxicities. PROs are essential for interpreting modern lymphoma immunotherapies, where acute and chronic toxicities coexist with the promise of long-term remissions. Despite broad consensus of their utility, PRO analysis from seminal lymphoma immunotherapy trials remains inconsistent, and there remain significant gaps in the literature regarding the true patient-reported tolerability of emerging therapeutic regimens. Future trials should adopt harmonized PRO strategies (including symptom and functional domains), define meaningful thresholds for minimally important differences, and integrate real-world PRO data prospectively to better align clinical trial data with patient-centered treatment tolerability.

Routine monitoring of patient-reported outcomes (PROs) during cancer treatment improves symptom control and quality of life, yet real-world uptake and sustained engagement with PRO monitoring remain suboptimal. Gamification has been shown to improve engagement with digital health interventions. User-centered design approaches are needed to ensure that gamified PRO tools are acceptable, usable, and responsive to patient and clinician needs, especially for older adult users. This study aimed to develop a gamified symptom monitoring web application for older adult patients with cancer using a multiphase, iterative, and user-centered approach. The overall study design was a mixed-methods user-centered design study involving 3 phases. From 2022 to 2026, participants were recruited across online and clinical settings using multiple strategies, including ResearchMatch (Vanderbilt University Medical Center), clinician referrals, professional networks, and outreach through the electronic health record at an academic medical center. Phase 1 was a survey of older adults with chronic health conditions. They reported on symptom severity, mobile health (mHealth) preferences, and gamification preferences, which were analyzed descriptively. Phases 2 and 3 involved semistructured interviews with older adult cancer survivors and clinicians, respectively, to identify actionable feedback, followed by iterative usability testing with older adult cancer survivors. In Phase 1, older adults (n=216) with chronic conditions reported high frequency of mobile phone use (across 11 mobile phone behaviors, mean 6.1, SD 1.63 where 6 indicates daily use) and generally favorable attitudes toward gamification (across 18 gameful design elements, means ranged from 2.8-4.3 on a 1-5 scale and SDs ranged from 0.75-1.12), with learning elements rated most appealing (mean 4.3/5, SD 0.75). Concerns about a gamified mHealth app included data privacy and perceived trivialization of health. Phase 2 interviews (n=7) demonstrated strong interest in longitudinal symptom visualization and clinician-sharable reports; gamified content was viewed as engaging by most participants but was preferred as optional. In Phase 3, iterative clinician interviews (n=5) and patient usability testing (n=9) led to substantial refinements, including simplified navigation, enhanced visual accessibility, further guidance on score interpretation with embedded educational videos, and de-emphasis of the gamified travel learning component. Across usability testing rounds, the number of user experience problems per interview decreased from 17 to 4, indicating improved usability. Using a multiphase, mixed methods, user-centered design process, we developed AthenaCompanion (Northwestern University with The Ohio State University), a gamified web application for PRO monitoring tailored to older adults undergoing cancer treatment. Across surveys and interviews, patients emphasized the importance of clinical utility, clarity of symptom feedback, and low-pressure, optional gamification elements. This work demonstrates the feasibility of integrating gamification into PRO monitoring and provides a foundation for future work evaluating long-term usability, engagement, and clinical effectiveness in real-world oncology care.

This study aimed to evaluate the short- to mid-term clinical outcomes following arthroscopic extensor carpi radialis brevis (ECRB) debridement in patients with chronic epicondylopathy humeri radialis (cEHR). We hypothesized that arthroscopic ECRB debridement would result in favorable short- to mid-term patient-reported outcomes, improving pain levels, strength, range of motion (ROM) and patient satisfaction. A retrospective case series was conducted on patients who underwent arthroscopic ECRB debridement for cEHR with symptoms&#x2009;>&#x2009;6 months. Patients were assessed at a minimum of 12 months postoperatively using the Mayo Elbow Performance Score (MEPS), Patient-Rated Tennis Elbow Evaluation (PRTEE), Disabilities of the Arm, Shoulder, and Hand (DASH) score, and Visual Analog Scale (VAS) for pain. Pre- and postoperative scores were compared using DASH and VAS. Maximum isometric wrist extension strength and postoperative ROM were measured bilaterally. Return to sport and work, patient satisfaction, and complications were documented. Of the 35 eligible patients, 30 completed follow-up (86% follow-up rate; mean age 48.4&#x2009;&#xb1;&#x2009;6.6 years; range: 36-65 years; 47% male). The mean duration of symptoms before surgery was 12 months (IQR 8-20, range 6-62). The mean follow-up duration was 28.13&#x2009;&#xb1;&#x2009;10.9 months (range 12-45). At final follow-up, median outcome scores were 100 (IQR 100-100; range 65-100) for the MEPS, 8.7 (IQR 0.8-13.9; range 0-39.2) for the DASH, 0 (IQR 0-1; range 0-7) for the VAS and 10.3 (IQR 0.8-26.8; 0-79.5) for the PRTEE. In comparison to preoperative values, VAS scores significantly improved (6 [IQR 2.75-7, range 9] vs. 0 [IQR 0-1, range 0-7], p&#x2009;<&#x2009;0.01), as did DASH scores (46.6&#x2009;&#xb1;&#x2009;20 vs. 10.3&#x2009;&#xb1;&#x2009;10.5, p&#x2009;<&#x2009;0.01). Post-operatively, all patients recovered full range of motion, with an arc of at least 140&#xb0;. The median wrist extension strength in the operated arm was 98.6% (IQR: 87.4-107%, range: 69.5-121%) when compared to the healthy side, with no significant differences (p&#x2009;=&#x2009;0.681). Overall, 80% of patients returned to sports at the same or a slightly reduced level, including 12% who achieved a higher activity level than before. The vast majority of patients (97%) successfully returned to their previous professional activities, while only a small proportion (3%) retired from a part-time manual labor position post-surgery, primarily due to age. Furthermore, 83% of patients indicated they would undergo the procedure again. One patient developed posterolateral rotational instability six months after index surgery and consequently required reconstruction of the lateral ulnar collateral ligament (LUCL). Arthroscopic ECRB debridement for cEHR was associated with improved pain and function and high rates of return to sport and work at short- to mid-term follow-up. IV Retrospective case series.

Post-COVID-19 condition (PCC) is a complication of acute COVID-19, which often presents with a variety of symptoms. It can also impact individuals' overall well-being, capacity to carry out daily activities, engage in physical exercise, maintain employment, and their general quality of life. Therefore, this review aimed to examine the role of patient-reported outcome measures (PROMs) questionnaires in assessing patients with PCC through prevalence of abnormal tests. We searched three databases. Two reviewers independently screened articles using Laser Al and extracted relevant data using a piloted Google Sheets. We performed a meta-analysis using OpenMeta and RevManWeb and conducted a subgroup analysis based on the setting of the patients during their acute COVID-19 infection. We assessed the risk of bias using a modified ROBINS-I tool and the certainty using the Grading of Recommendations Assessment, Development, and Evaluation approach. No studies reported diagnostic test accuracy measures for questionnaires in PCC. However, 23 comparative studies reported on the prevalence of abnormal questionnaire results in patients with PCC. Outcomes showed that patients with PCC have higher abnormal results than controls, regardless of their setting during acute COVID-19 infection. The overall certainty of the evidence was low due to the high risk of bias, indirectness, and imprecision. This review sheds light on the importance of testing PROMs in patients with PCC using these questionnaires and the need for further testing their validity in this condition.

Teamwork has been recognized as a potentially important organizational factor associated with nurse- and patient-related outcomes. Previous studies have been conducted to examine the association between nurses' perceptions of teamwork and various outcomes in hospital settings. However, no systematic review has yet summarized this evidence. Therefore, this study aimed to summarize the available evidence on the association between nurses' perceptions of teamwork and nurse and patient outcomes in hospital settings. This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search was conducted using the keywords "teamwork," "group work," and "nurse," along with their synonyms, across PubMed, Scopus, Web of Science, CINAHL, and the Google Scholar search engine. The quality of selected studies was assessed using the Critical Appraisal Skills Programme (CASP) checklists. The narrative synthesis method was used to summarize and classify the results. A total of 33 studies met the inclusion criteria for this systematic review. The analysis identified two overarching themes: nurse-related outcomes and patient outcomes. Twenty-two studies (66.7%) reported that nurses' positive attitudes toward teamwork were associated with more favorable levels in 17 nurse outcomes, which were categorized into four groups: (1) job attitudes and retention; (2) patient safety attitudes and competency; (3) occupational stress, fatigue, and conflict; and (4) ethical values and moral practice. Additionally, fourteen studies (42.4%) reported that such attitudes were linked to more favorable patient-related outcomes, categorized as (1) nursing care processes; (2) adverse events reporting and occurrence; (3) quality and safety of care; and (4) patient-centered and caring behaviors. Teamwork may be considered an important factor associated with more favorable nurse and patient outcomes. To promote collaboration, hospital administrators and nursing educators may consider implementing strategies to support teamwork within clinical settings. Nevertheless, further research employing longitudinal and interventional designs is necessary to clarify causal pathways and better understand the relationship between teamwork and these outcomes.

Remote rehabilitation has become increasingly relevant after total knee arthroplasty (TKA). However, existing reviews have often pooled interventions with markedly different levels of clinician involvement, making it difficult to determine whether interactive, feedback-enabled models provide distinct clinical value. This systematic review and meta-analysis evaluated the effectiveness of interactive remote rehabilitation (IRR), defined as technology-enabled rehabilitation involving bidirectional communication between patients and health care providers, compared with conventional rehabilitation after TKA. PubMed, Cochrane CENTRAL, Embase, Web of Science, CINAHL, Scopus, and CNKI were searched from inception to May 5, 2026. Randomized controlled trials enrolling adults after TKA and comparing IRR with conventional rehabilitation were eligible. Outcomes included pain, patient-reported function, range of motion, quadriceps muscle strength, mobility, general health status, and health-related quality of life. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Random-effects meta-analyses used Hartung-Knapp-Sidik-Jonkman CIs and Nagashima-corrected 95% prediction intervals (PIs); analyses were stratified as short-, mid-, and long-term follow-up. The protocol was prospectively registered in PROSPERO (CRD420251049015). In total, 23 randomized controlled trials involving 2607 participants were included. A total of 7 studies were judged to be at low risk of bias, 7 raised some concerns, and 9 were at high risk of bias. Across most primary and secondary outcomes, IRR did not show statistically significant advantages over conventional rehabilitation, including pain, Western Ontario and McMaster Universities Osteoarthritis Index, Knee Injury and Osteoarthritis Outcome Score, Timed Up and Go test, and EQ-5D outcomes, across follow-up periods. A very small benefit was observed for short-term active extension range of motion (mean difference 0.26, 95% CI 0.04-0.48; 95% PI 0.00-0.52), which remained statistically significant after excluding high-risk studies but was of limited clinical magnitude. Short-term quadriceps muscle strength favored IRR in the primary analysis (standardized mean difference 0.60, 95% CI 0.01-1.19; 95% PI -0.63 to 1.87), but the effect was not robust after sensitivity analysis, and the PI crossed the null. Evidence for 36-Item Short Form Survey and 6-minute walk test outcomes was insufficient for quantitative synthesis. Heterogeneity was substantial for several outcomes, PIs were frequently wide, and certainty of evidence was generally low to very low. This review is innovative in focusing specifically on bidirectional, IRR rather than treating all remote or technology-assisted rehabilitation as a single category, and it differs from prior reviews by combining this conceptual distinction with time-stratified analyses and more conservative random-effects inference. This synthesis brings to the field a clearer and more clinically interpretable assessment of what IRR currently adds after TKA: available evidence does not establish superiority over conventional rehabilitation, although IRR may represent a feasible care model where access to in-person rehabilitation is limited. These findings can inform service planning and trial design while underscoring the need for higher-quality studies to identify which interactive features, patient groups, and contexts are most likely to benefit.

Depression and anxiety are prevalent in working-aged adults. Although treatment provided by health professionals can improve symptoms and functioning, many people experiencing mental ill-health do not seek help. There have been very few effective interventions to improve help seeking in adults, with none implemented across diverse workplaces through online delivery. The primary aim of this trial was to test the effectiveness of a co-designed program for increasing professional help seeking intentions in Australian employees, relative to an active control condition. A triple-blinded, 2-arm cluster randomized controlled trial (N=487; control workplaces: n=26 and intervention workplaces: n=25) was conducted to assess the relative effectiveness of Helipad, a fully automated co-designed single-session interactive program (intervention condition) with a standard psychoeducation program (active control condition). Eligible workplaces (those with &#x2265;50 employees and an employee assistance program; clusters) were recruited via advertising or invited directly by researchers. Eligible participants (employees in a participating Australian workplace, aged &#x2265;18 y, living in Australia, fluent in reading and understanding English, and had access to a device and a reliable internet connection) completed a pretest, immediate posttest, and 6-month follow-up survey sent via email assessing help seeking intentions (primary outcome); mental illness stigma; mental health literacy; help seeking attitudes and behavior; work and activity functioning; quality of life; and symptoms of depression, anxiety, and general psychological distress. A significant difference in change over time in professional help seeking intentions was found between the 2 conditions (F2,185.44=6.89; P=.001), with planned contrasts showing that the Helipad program was effective in increasing professional help seeking intentions compared with the control at the primary end point of immediate posttest (t359.35=-3.72; P<.001). This difference was not maintained at the 6-month follow-up (t119.76=-1.05; P=.30). Retention rates were 71.1% at posttest and 24.9% at follow-up. The Helipad program was also associated with improved mental health literacy and help seeking attitudes at posttest. Helipad was not significantly superior to the control in reducing mental illness stigma or improving professional help seeking behavior; functioning; quality of life; or symptoms of depression, anxiety, or general psychological distress (secondary outcomes) at the 6-month follow-up. A total of 15 people (control: n=9, 4.5%; intervention: n=6, 4.3%) reported adverse events at posttest. This study demonstrated that the co-designed online Helipad program was effective in improving the intentions of employees to seek help from a professional compared to an active control. The program also improved mental health literacy and help seeking attitudes, but these changes were not sustained and did not translate into observable differences in help seeking behaviors or mental health symptoms. This was the first trial of a co-designed intervention to improve mental health help seeking in general workplaces, with previous trials focusing primarily on specific high-risk work environments. Workplace programs that can be delivered at scale may lead to more appropriate engagement with professional mental health care to prevent poor mental health outcomes and increase productivity.

To evaluate whether alcohol use severity, as measured by the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C), is associated with postoperative complications, hospital utilisation and opioid prescribing among adult surgical inpatients. Retrospective cohort study. Single tertiary academic hospital in the USA, using data from inpatient surgical admissions between April 2021 and September 2023. Adult patients (&#x2265;18 years) admitted for inpatient surgery with a completed AUDIT-C screening during their admission. AUDIT-C scores were categorised as at-risk (&#x2265;5 for men, &#x2265;4 for women) or low risk (other non-zero scores). Patients with AUDIT-C scores of 0 were described in the cohort but excluded from the primary comparative analyses to account for potential J-shaped associations between abstinence and health outcomes. The primary outcome was a composite of surgical complications, emergency department visits, hospital readmissions or mortality within 30 days of surgery. Secondary outcomes included hospital length of stay and postoperative opioid prescribing from discharge through 6&#x2009;months. Univariable and multivariable logistic regression models were used to evaluate associations between AUDIT-C scores and postoperative outcomes. Additional analyses included Kaplan-Meier survival analysis, receiver operating characteristic curves and feature importance modelling. 9538 (31.1%) of 30&#x2009;708 eligible surgical patients completed the AUDIT-C, and screening was more common among younger, healthier patients. Among screened patients, 5440 (57.0%) were female and 7405 (77.6%) identified as non-Hispanic White. A total of 805 (8.4%) of screened patients reported at-risk alcohol use. The primary outcome, composite adverse postoperative outcomes, occurred in 13.9% of low-risk patients and 14.5% of at-risk patients (p=0.637). In unadjusted analyses, no significant differences were observed between alcohol risk groups for individual postoperative outcomes, including complications, 30-day readmissions, emergency department visits or mortality. Multivariable logistic regression confirmed no association between AUDIT-C category and the primary composite outcome (average marginal effect 0.01, 95%&#x2009;CI -0.02 to 0.03). Median hospital length of stay differed slightly between groups (3.0&#x2009;days (IQR 4.0) vs 3.0&#x2009;days (IQR 5.0); p=0.01). In adjusted Cox proportional hazards modelling, at-risk alcohol use was associated with a slightly lower hazard of discharge compared with low-risk alcohol use, corresponding to a modestly longer time to discharge (HR=0.92, p=0.041). Time to readmission did not differ significantly. Opioid prescribing at discharge was similar across groups (58.4% vs 58.9%, p=0.763). In this real-world surgical cohort, observed AUDIT-C risk category among patients who completed screening was not significantly associated with short-term postoperative outcomes or opioid prescribing. While small differences in length of stay reached statistical significance, their clinical relevance is uncertain. Limitations include limited number of at-risk patients, non-response bias and the absence of standardised follow-up for at-risk patients, which may have contributed to null findings. Future efforts should focus on improving screening through workflow integration, surgical team engagement and follow-up interventions to fully realise benefits from alcohol screening.

To review the content, characteristics, and current application status of patient-reported outcomes (PROs) for non-surgical treatment of pelvic organ prolapse (POP), providing information for future research. In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) guidelines, a systematic search of PubMed, Web of Science, Embase, CINAHL, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Database, VIP Database, and Chinese Biomedicine Literature Database (CBM-SinoMed) was conducted. The search period covered the inception of each database through January 16, 2025. A total of 1548 studies were identified, of which 19 were included in the review. In the context of non-surgical POP, PROs were primarily used to evaluate clinical effectiveness, quality of life, and symptoms. Across the included literature, 29 PRO instruments were described, covering aspects such as patients' physiological and psychological status, treatment satisfaction, and treatment goals. PROs application in non-surgical POP management remains limited. Future efforts should expand its scope, implement dynamic assessment across treatment stages, and utilize digital technology to improve the convenience and efficiency of assessment. Revisar o conte&#xfa;do, as caracter&#xed;sticas e o status atual da aplica&#xe7;&#xe3;o dos resultados relatados pelo paciente (PROs) para o tratamento n&#xe3;o cir&#xfa;rgico do prolapso de &#xf3;rg&#xe3;os p&#xe9;lvicos (POP), fornecendo informa&#xe7;&#xf5;es para pesquisas futuras. Em conformidade com a extens&#xe3;o das Diretrizes Preferred Reporting Items for Systematic Reviews and Meta-Analyses para revis&#xf5;es de escopo (PRISMA-ScR), uma busca sistem&#xe1;tica no PubMed, Web of Science, Embase, CINAHL, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Database, VIP Database e Chinese Biomedicine Literature Database (CBM-SinoMed) foi realizada. O per&#xed;odo de pesquisa abrangeu o in&#xed;cio de cada banco de dados at&#xe9; 16 de janeiro de 2025. Um total de 1548 estudos foram identificados, dos quais 19 foram inclu&#xed;dos na revis&#xe3;o. No contexto do POP n&#xe3;o cir&#xfa;rgico, os PROs foram usados principalmente para avaliar a efic&#xe1;cia cl&#xed;nica, a qualidade de vida e os sintomas. Em toda a literatura inclu&#xed;da, 29 instrumentos de PRO foram descritos, abrangendo aspectos como o estado fisiol&#xf3;gico e psicol&#xf3;gico dos pacientes, a satisfa&#xe7;&#xe3;o com o tratamento e os objetivos do tratamento. A aplica&#xe7;&#xe3;o de PROs no manejo n&#xe3;o cir&#xfa;rgico do POP permanece limitada. Esfor&#xe7;os futuros devem expandir seu escopo, implementar a avalia&#xe7;&#xe3;o din&#xe2;mica em todas as fases do tratamento e utilizar a tecnologia digital para melhorar a conveni&#xea;ncia e a efici&#xea;ncia da avalia&#xe7;&#xe3;o.

To compare clinical, operative, patient-reported, and economic outcomes of robotic versus laparoscopic inguinal hernia repair in adults. We conducted a PRISMA 2020-compliant systematic review and meta-analysis of PubMed, Web of Science, and Google Scholar through June 13, 2025. The protocol was retrospectively registered in PROSPERO (CRD420251075296). Comparative randomized and observational studies of elective robotic versus laparoscopic inguinal hernia repair in adults were eligible. Random-effects meta-analyses used restricted maximum-likelihood estimation with Hartung-Knapp confidence intervals; risk of bias was assessed using RoB 2 and MINORS, and certainty was evaluated using GRADE. Nineteen reports representing 18 unique cohorts and 78,940 participants were included. Nine reports (3,200 participants) contributed recurrence data; robotic repair was associated with a lower observed recurrence risk (RR 0.32, 95% CI 0.17-0.59; I2&#x2009;=&#x2009;0%), although certainty was low and the randomized evidence was imprecise. Robotic repair required longer operative time (11 studies; MD&#x2009;+&#x2009;30.04 min, 95% CI 9.87-50.20; I2&#x2009;=&#x2009;99.6%); after excluding the influential Holleran 2022 cohort, the estimate was&#x2009;+&#x2009;22.09 min (95% CI 8.87-35.30). Pooled immediate and postoperative-day-1 pain estimates did not show a statistically significant difference. Length of stay was not significantly different in the primary analysis (MD&#x2009;+&#x2009;0.33 days, 95% CI -0.03 to 0.70), while an influence analysis suggested a small increase after robotic repair (+&#x2009;0.18 days). Overall complication estimates were unstable, and no clear differences were found for hematoma, surgical-site infection, or urinary retention. Robotic repair was consistently more expensive across heterogeneous healthcare settings. Robotic inguinal hernia repair was associated with lower observed recurrence in predominantly non-randomized evidence, but this finding should not be interpreted as proof of causal superiority. Robotic repair generally required approximately 22-30 additional operative minutes and incurred higher costs, while pooled pain, length-of-stay, and complication findings were uncertain or clinically small. Technique selection should therefore consider patient and hernia characteristics, surgeon experience, institutional resources, and the low to very low certainty of the available evidence.

Rectal prolapse (RP) and pelvic organ prolapse (POP) frequently coexist, yet are often evaluated and treated separately. This study aimed to compare patient-reported outcomes and cost-effectiveness of combined versus isolated robotic prolapse repair. We conducted a prospective multicentre cohort study across three tertiary pelvic floor centres. Women undergoing robotic rectal prolapse repair (rRP), robotic pelvic organ prolapse repair (rPOP) or combined robotic repair (rRP&#x2009;+&#x2009;rPOP) were included. Validated patient-reported outcome measures were collected at baseline and 12&#x2009;months. Health utility was derived from EQ-5D-3L and used to calculate quality-adjusted life years (QALYs). A trial-based cost-effectiveness analysis was performed from the healthcare sector perspective. A theoretical cohort was modelled to examine staged versus combined repair in patients with multicompartment prolapse. Forty-seven patients were included (rRP n&#x2009;=&#x2009;14, rPOP n&#x2009;=&#x2009;16, rRP&#x2009;+&#x2009;rPOP n&#x2009;=&#x2009;17). All groups demonstrated significant improvement in pelvic floor symptoms and quality of life at 12&#x2009;months. Improvements across bowel, bladder and prolapse-related domains were greatest in the combined repair group. Health utility gains were observed in all cohorts. In patients with multicompartment prolapse, combined robotic repair was cost-effective, whereas staged procedures were associated with higher cumulative costs without proportional gains in QALYs. Within robotic prolapse surgery, combined rectal and pelvic organ prolapse repair provides the most comprehensive symptom improvement and represents a cost-effective strategy when both compartments are symptomatic. These findings support systematic evaluation for multicompartment prolapse and multidisciplinary surgical planning.

Sleep and rest are fundamental to recovery during hospitalisation and are highly sensitive to nursing care. However, they are rarely assessed systematically in a way that captures patients' experiences and care-sensitive dimensions within routine nursing practice. To develop and psychometrically evaluate a patient-reported, nursing-informed instrument of hospitalised patients' experiences of sleep and rest, derived from selected Nursing Outcomes Classification (NOC) indicators. A multicentre, cross-sectional psychometric study was conducted in two phases. First, a panel of experts reached consensus on relevant NOC outcomes and indicators related to sleep and rest. Second, the resulting instrument was administered to 1060 adult patients hospitalised in Internal Medicine units across eight hospitals. Psychometric evaluation included factor analyses, internal consistency assessment, hierarchical latent structure analysis and convergent validity testing. Analyses supported a three-dimensional structure encompassing physiological, contextual and emotional domains, explaining 70.6% of the total variance. The confirmatory model showed good overall fit, and reliability estimates indicated high internal consistency for both the total instrument and individual dimensions. Hierarchical modelling revealed a strong general latent factor underlying the three domains, supporting the primary interpretation of an overall score, with dimension-specific information considered supplementary. The findings support the validity and reliability of a multidimensional, nursing-informed instrument to assess patients' experiences of sleep and rest during hospitalisation. The instrument provides a clinically meaningful framework informed by nursing theory and operationalised using selected NOC indicators, facilitating systematic nursing assessment of sleep and rest during hospitalisation.

Fever is one of the most common symptoms in children and a leading cause of their hospitalisation. Nurses, as primary caregivers in paediatric wards, play a pivotal role in the assessment and management of children with fever. However, nurses' perceptions and experiences of fever management are influenced by cultural contexts, psychological and social factors, as well as prevailing health system policies. The aim of the study was to explore nurses' perceptions influencing their management of childhood fever, including barriers and facilitators to evidence-based practice. A qualitative descriptive design using a conventional content analysis approach. Nineteen nurses working in paediatric wards participated in individual semi-structured interviews conducted between March 20, 2024 and May 20, 2025. Purposive sampling was used to recruit participants with direct experience in managing fever in children. Data were audio-recorded, transcribed verbatim and analysed inductively using qualitative content analysis as described by Graneheim and Lundman. The study adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. Data analysis resulted in the extraction of one main theme titled 'Navigating Uncertainty and Psychological Strain in Pediatric Fever Management' and five main categories. Nurses described challenges related to the absence of locally adapted clinical guidelines, lack of continuous education, hierarchical dependence on physicians, fever phobia and misconceptions, which led to non-evidence-based decision-making and unnecessary interventions. The findings underscore the need for developing culturally appropriate local clinical guidelines, implementing evidence-based continuous educational programmes, enhancing nurses' professional autonomy and providing effective family education. These interventions can improve care quality, reduce nurses' occupational anxiety and ultimately enhance child health outcomes. Understanding nurses' experiences and challenges may inform the development of educational interventions, localised clinical guidelines and organisational strategies to improve the quality and consistency of fever management in children. What problem did the study address? &#x25e6;The study addressed the gap between evidence-based fever management guidelines and actual nursing practice in paediatric settings. What were the main findings? &#x25e6;Nurses' clinical decision-making was influenced by fear of complications, parental expectations, organisational factors and contextual factors. Where and on whom will the research have an impact on? &#x25e6;The findings may impact paediatric nurses, healthcare administrators and policymakers by informing strategies to support evidence-based fever management in hospital settings. This study was reported in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. No patient or public contribution: Patients or members of the public were not involved in the design, conduct, reporting or dissemination plans of this research, as the study focused on nurses' professional experiences.

Adults with major lower limb amputation (LLA) due to dysvascular etiology often experience diverse health outcomes. However, the absence of standardized outcome reporting limits the ability to synthesize evidence, evaluate care models, and develop consistent clinical pathways. This review updates a systematic review on outcome measures and indicators reported in this population. A systematic review update was conducted across six databases (MEDLINE, EMBASE, EBM Reviews, PsycINFO, Web of Science, and CINAHL) from 20 April 2017 to 1 December 2022. All study designs were eligible; however, the articles needed to report outcome measures and indicators on at least 50% of the adult population with major dysvascular LLAs. The extracted outcome measures and indicators were organized according to Dodd's framework and then reclassified alongside those reported in the study by Ambler and colleagues. The pilot phase of data extraction was carried out independently by multiple reviewers, after which a single reviewer completed the data extraction. Of the 12,557 articles, 160 studies reporting data on 228,116 individuals with major dysvascular LLA met the inclusion criteria. Combining these with the 440 studies from the previous review, 2,466 outcome measures and indicators were categorized in five core areas: life impact (25.7%), physiological/clinical (23.4%), death (18.7%), resource use (17.6%), and adverse events (14.6%). In terms of the outcome domains, mortality/survival was the most commonly reported domain, followed by physical functioning (e.g. prosthesis fit, use), skin (e.g., stump wound healing), nervous system outcomes (e.g., residual limb pain), need for further interventions (e.g., prescription of medications), hospital outcomes (e.g., duration of stay, discharge), and adverse events. This study builds on a previous review by identifying and categorizing outcome measures and indicators in adults with major dysvascular LLA, highlighting inconsistencies in outcome reporting across studies. The absence of a standardized set of outcome measures and indicators limits the ability to conduct meta-analyses or systematic reviews, evaluate the effectiveness of care models, and establish clinical pathways. Developing a core outcome set tailored to the needs of individuals with dysvascular LLA could help address these challenges by promoting consistency in outcome reporting and enabling meaningful comparisons across studies. Ultimately, this could contribute to improving the quality, efficiency, and person-centeredness of care. PROSPERO (CRD42023388570).

Amyotrophic Lateral Sclerosis (ALS) is a rapidly progressive, fatal neurodegenerative disease. Patients with ALS are at increased risk of developing depressive symptoms. A clearer understanding of the associations between depressive symptoms, disease progression, health-related quality of life and perceived social support is needed to advance intervention-oriented research and improve psychosocial care in ALS. In a multicenter cross-sectional study, patients with ALS were asked to complete patient-reported outcomes (PROs) to evaluate depressive symptoms (ALS-Depression-Inventory, ADI-12), health-related quality of life (ALS-Assessment-Questionnaire, ALSAQ-5/ALSAQ-40), physical functioning (ALS-Functional Rating Scale-Extension, ALSFRS-EX) and perceived social support (Multidimensional Scale of Perceived Social Support, MSPSS). To evaluate associations between demographic/clinical variables and PROs, we performed Pearson's, Spearman's, and partial correlation analyses. In addition, a multiple regression was run to identify predictors of depressive symptoms. Comparisons of patient groups were performed with chi-squared tests for categorical variables and Student t-tests or one-way analysis of variance (ANOVA) for continuous variables, followed by post-hoc tests. Out of the 150 patients examined, 60% reported depressive symptoms, with half of them exhibiting clinically relevant depressive symptoms. Depressive symptoms were significantly associated with disease progression (r&#x2009;=&#x2009;.466, p&#x2009;<&#x2009;.001), various aspects of health-related quality of life (mobility: r&#x2009;=&#x2009;.394, activities of daily living: r&#x2009;=&#x2009;.268 and emotional well-being: r&#x2009;=&#x2009;.793, all p&#x2009;<&#x2009;.001), the MSPSS sum score (partial r&#x2009;=&#x2009;-.234, p&#x2009; =&#x2009;.007), and the ALSFRS-EX sum score (r&#x2009;=&#x2009;-.352, p&#x2009;<&#x2009;.001). Patients with depressive symptoms reported significantly more physical impairments (p&#x2009;=&#x2009;.002) and less perceived social support by their families (p&#x2009;=&#x2009;.016) and friends (p&#x2009;<&#x2009;.001) compared to patients without depressive symptoms. Depressive symptoms are prevalent in patients with ALS and are closely associated with faster disease progression, reduced physical functioning, poorer health-related quality of life, and lower perceived social support. Further studies, particularly using qualitative methods, are needed to elucidate protective factors, clarify psychosocial mechanisms, and support the conceptualization of specialized and integrated psychosocial care for patients with ALS in Germany.

The Patient-Reported Outcomes Measurement Information System-29 (PROMIS-29) is widely used to measure health-related quality of life and common symptoms, but it has not yet been validated in patients receiving kidney replacement therapy (KRT). This study aims to evaluate the psychometric properties of the Chinese version of PROMIS-29 in patients receiving KRT. A cross-sectional survey was conducted from November 2023 to January 2024 among adult patients receiving KRT. Participants completed a clinical information questionnaire, PROMIS-29, and conventional measurement questionnaires through an online survey platform. Evaluation indicators included internal consistency, ceiling and floor effects, structural validity, convergent and discriminant validity, and criterion validity, and measurement invariance. Item characteristic curves and item information curves were also plotted. A total of 500 participants were included, with a age of (48.76&#xb1;12.59) years. Cronbach's &#x3b1; coefficients for the 7 domains of PROMIS-29 ranged from 0.75 to 0.96. Confirmatory factor analysis demonstrated good model fit: Comparative fit index (CFI)=0.975, Tucker-Lewis index (TLI)=0.971, root mean square error of approximation (RMSEA)=0.046, and standardized root mean square residual (SRMR)=0.056. All dimensions met the assumption of unidimensionality. No differential item functioning was detected for the majority of items across subgroups, indicating good measurement invariance. Most items showed ideal item characteristic curves and acceptable item information curves. The Chinese version of PROMIS-29 has good reliability, validity, and measurement invariance among Chinese patients receiving KRT and can be used to assess health-related quality of life and symptoms in this population. &#x76ee;&#x7684;: &#x60a3;&#x8005;&#x62a5;&#x544a;&#x7ed3;&#x5c40;&#x6d4b;&#x91cf;&#x4fe1;&#x606f;&#x7cfb;&#x7edf;-29(Patient-Reported Outcomes Measurement Information System-29&#xff0c;PROMIS-29)&#x5e7f;&#x6cdb;&#x5e94;&#x7528;&#x4e8e;&#x5065;&#x5eb7;&#x76f8;&#x5173;&#x751f;&#x6d3b;&#x8d28;&#x91cf;&#x548c;&#x5e38;&#x89c1;&#x75c7;&#x72b6;&#x7684;&#x6d4b;&#x91cf;&#xff0c;&#x4f46;&#x5c1a;&#x672a;&#x5728;&#x63a5;&#x53d7;&#x80be;&#x810f;&#x66ff;&#x4ee3;&#x6cbb;&#x7597;&#x7684;&#x60a3;&#x8005;&#x4e2d;&#x8fdb;&#x884c;&#x9a8c;&#x8bc1;&#x3002;&#x672c;&#x7814;&#x7a76;&#x65e8;&#x5728;&#x8bc4;&#x4f30;&#x4e2d;&#x6587;&#x7248;PROMIS-29&#x5728;&#x80be;&#x810f;&#x66ff;&#x4ee3;&#x6cbb;&#x7597;&#x60a3;&#x8005;&#x4e2d;&#x7684;&#x5fc3;&#x7406;&#x6d4b;&#x91cf;&#x5b66;&#x7279;&#x6027;&#x3002;&#x65b9;&#x6cd5;: &#x91c7;&#x7528;&#x6a2a;&#x65ad;&#x9762;&#x8c03;&#x67e5;&#x7814;&#x7a76;&#xff0c;&#x4e8e;2023&#x5e74;11&#x6708;&#x81f3;2024&#x5e74;1&#x6708;&#x62db;&#x52df;&#x6210;&#x4eba;&#x80be;&#x810f;&#x66ff;&#x4ee3;&#x6cbb;&#x7597;&#x60a3;&#x8005;&#x3002;&#x60a3;&#x8005;&#x901a;&#x8fc7;&#x5728;&#x7ebf;&#x8c03;&#x67e5;&#x5e73;&#x53f0;&#x586b;&#x5199;&#x4e34;&#x5e8a;&#x8d44;&#x6599;&#x95ee;&#x5377;&#x3001;PROMIS-29&#x548c;&#x4f20;&#x7edf;&#x6d4b;&#x91cf;&#x95ee;&#x5377;&#x3002;&#x8bc4;&#x4ef7;&#x6307;&#x6807;&#x5305;&#x62ec;&#x5185;&#x90e8;&#x4e00;&#x81f4;&#x6027;&#x3001;&#x5929;&#x82b1;&#x677f;&#x548c;&#x5730;&#x677f;&#x6548;&#x5e94;&#x3001;&#x7ed3;&#x6784;&#x6548;&#x5ea6;&#x3001;&#x805a;&#x5408;&#x548c;&#x533a;&#x5206;&#x6548;&#x5ea6;&#x3001;&#x6548;&#x6807;&#x6548;&#x5ea6;&#x548c;&#x6d4b;&#x91cf;&#x7b49;&#x4ef7;&#x6027;&#x3002;&#x540c;&#x65f6;&#x7ed8;&#x5236;&#x9879;&#x76ee;&#x7279;&#x5f81;&#x66f2;&#x7ebf;&#x548c;&#x6d4b;&#x8bd5;&#x4fe1;&#x606f;&#x66f2;&#x7ebf;&#x3002;&#x7ed3;&#x679c;: &#x6700;&#x7ec8;&#x7eb3;&#x5165;500&#x4f8b;&#x7814;&#x7a76;&#x5bf9;&#x8c61;&#xff0c;&#x5e74;&#x9f84;&#x4e3a;(48.76&#xb1;12.59)&#x5c81;&#x3002;PROMIS-29&#x4e2d;7&#x4e2a;&#x9886;&#x57df;&#x7684;&#x514b;&#x9f99;&#x5df4;&#x8d6b;&#x3b1;&#x7cfb;&#x6570;&#x4e3a;0.75~0.96&#x3002;&#x9a8c;&#x8bc1;&#x6027;&#x56e0;&#x5b50;&#x5206;&#x6790;&#x7ed3;&#x679c;&#x663e;&#x793a;&#x6a21;&#x578b;&#x62df;&#x5408;&#x826f;&#x597d;:&#x6bd4;&#x8f83;&#x62df;&#x5408;&#x6307;&#x6570;(comparative fit index&#xff0c;CFI)=0.975&#xff0c;&#x5854;&#x514b;-&#x5218;&#x6613;&#x65af;&#x6307;&#x6570;(Tucker-Lewis index&#xff0c;TLI)=0.971&#xff0c;&#x8fd1;&#x4f3c;&#x8bef;&#x5dee;&#x5747;&#x65b9;&#x6839;(root mean square error of approximation&#xff0c;RMSEA)=0.046&#xff0c;&#x6807;&#x51c6;&#x5316;&#x5747;&#x65b9;&#x6839;&#x6b8b;&#x5dee;(standardized root mean square residual&#xff0c;SRMR)=0.056&#xff0c;&#x4e14;&#x5404;&#x7ef4;&#x5ea6;&#x5747;&#x7b26;&#x5408;&#x5355;&#x7ef4;&#x6027;&#x5047;&#x8bbe;&#x3002;&#x5927;&#x591a;&#x6570;&#x6761;&#x76ee;&#x672a;&#x68c0;&#x6d4b;&#x5230;&#x9879;&#x76ee;&#x529f;&#x80fd;&#x5dee;&#x5f02;&#xff0c;&#x5177;&#x6709;&#x826f;&#x597d;&#x7684;&#x6d4b;&#x91cf;&#x7b49;&#x4ef7;&#x6027;&#x3002;&#x5927;&#x90e8;&#x5206;&#x6761;&#x76ee;&#x62df;&#x5408;&#x51fa;&#x7406;&#x60f3;&#x7684;&#x9879;&#x76ee;&#x7279;&#x5f81;&#x66f2;&#x7ebf;&#x548c;&#x53ef;&#x63a5;&#x53d7;&#x7684;&#x6d4b;&#x8bd5;&#x4fe1;&#x606f;&#x66f2;&#x7ebf;&#x3002;&#x7ed3;&#x8bba;: &#x4e2d;&#x6587;&#x7248;PROMIS-29&#x5728;&#x4e2d;&#x56fd;&#x80be;&#x810f;&#x66ff;&#x4ee3;&#x6cbb;&#x7597;&#x60a3;&#x8005;&#x4e2d;&#x5177;&#x6709;&#x826f;&#x597d;&#x7684;&#x4fe1;&#x6548;&#x5ea6;&#x548c;&#x6d4b;&#x91cf;&#x7b49;&#x4ef7;&#x6027;&#xff0c;&#x53ef;&#x7528;&#x4e8e;&#x80be;&#x810f;&#x66ff;&#x4ee3;&#x6cbb;&#x7597;&#x60a3;&#x8005;&#x5065;&#x5eb7;&#x76f8;&#x5173;&#x751f;&#x6d3b;&#x8d28;&#x91cf;&#x548c;&#x75c7;&#x72b6;&#x7684;&#x8bc4;&#x4f30;&#x3002;.

Quality of life (QoL) and bowel function are key outcomes in mid- and low rectal cancer. The comparative impact of laparoscopic total mesorectal excision (LaTME) versus transanal total mesorectal excision (TaTME) on patient-reported outcomes and long-term oncological results in randomized trials remains unclear. This prospective multicentre randomized trial enrolled patients with resectable mid-low rectal adenocarcinoma. QoL was assessed using the 30- and 29-item European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaires EORTC QLQ-C30 and QLQ-CR29, respectively) and bowel dysfunction was assessed using the Low Anterior Resection Syndrome (LARS) score before surgery and at the long-term follow-up (&#x2265; 12 months after index surgery). The sample size calculation was based on the primary endpoint from the original randomized clinical trial (composite conversion outcome), for which 116 patients were required. The minimum oncological follow-up was 5 years. Modified intention-to-treat (mITT) and per-protocol analyses were prespecified. In all, 116 patients were randomized (LaTME, 57; TaTME, 59); 105 patients were included in the mITT analysis. Sixty-seven valid QoL questionnaires were obtained (63.8%). Postoperative global health status (EORTC QLQ-C30) was high in both groups (median score 83.3) with no significant differences between them, and functional scales remained near maximum, with improved emotional functioning after LaTME only. Using the EORTC QLQ-CR29 score, TaTME showed higher postoperative stool frequency, flatulence, and faecal incontinence, with similar body image and sexual function. LARS scores (assessed only in patients without a permanent stoma) were comparable between LaTME and TaTME (median 24 versus 27, respectively), with major LARS (score 30-42) in 30 and 44% of LaTME and TaTME patients respectively. There were no significant differences between LaTME and TaTME in local recurrence (6.4% versus 3.7%, respectively), distant recurrence (14.9% versus 18.5%, respectively), disease-free survival, and overall survival. Overall QoL and bowel function remained high, with no detectable between-group differences. TaTME was associated with a higher burden of specific evacuatory symptoms on the EORTC QLQ-CR29. Long-term oncological outcomes did not differ significantly between techniques. Registration number: NCT02550769 (http://www.clinicaltrials.gov).