Toward a Medication Information Literacy Indicator System for Older Adults: A Delphi Study.

BACKGROUND: The safety of medication use among older adults is a growing concern, given the aging population. Despite widespread attention, the exploration of medication literacy in older adults, particularly from the perspective of information literacy, is in its nascent stages. METHODS: This study utilized the existing literature to define medication information literacy (MIL) as a theoretical framework. A two-round Delphi survey was conducted to identify the essential components of a MIL indicator system for older adults. The analytic hierarchy process (AHP) was then used to assign weights to each indicator. RESULTS: The study observed relatively high response rates in both rounds of the questionnaire, which, along with expert authority coefficients (Cr) of 0.86 and 0.89, underscores the credibility and expertise of the panellists. Additionally, Kendall's coefficient of concordance (Kendall's W) ranging from 0.157 to 0.33 (p < 0.05) indicates a consensus among experts on the identified indicators. Utilizing the Delphi process, a MIL indicator system for older adults was developed, comprising five primary and 23 secondary indicators. These indicators were weighted, with medication information cognition and acquisition emerging as pivotal factors in enhancing medication literacy among older adults. CONCLUSIONS: This study developed a MIL indicator system tailored for older adults using the Delphi approach. The findings can inform healthcare professionals in providing customized medication guidance and assist policymakers in crafting policies to enhance medication safety among older adults. PATIENT OR PUBLIC CONTRIBUTION: Patient and public engagement played a pivotal role in the development of our medication information literacy indicator system for older adults. Their involvement contributed to shaping research questions, facilitating study participation, and enriching evidence interpretation. Collaborations with experts in geriatric nursing, medicine, and public health, along with discussions with caregivers and individuals with lived experience, provided invaluable insights into medication management among older adults. Their input guided our research direction and ensured the relevance and comprehensiveness of our findings.

Photoinduced Pd-Catalyzed Intramolecular 6-endo Heck Reaction of Alkyl Halides.

A novel photocatalytic palladium-induced 6-endo-selective alkyl Heck reaction of unactivated alkyl iodides and alkyl bromides has been described. This strategy facilitates the gentle and efficient synthesis of a variety of 5-phenyl-1,2,3,6-tetrahydropyridine derivatives. It demonstrates a broad substrate tolerance and excellent 6-endo selectivity. Unlike the high-temperature requirements of traditional alkyl Heck reactions, this transformation efficiently proceeds at room temperature and shows significant promise for industrial-scale applications. Mechanistic investigations reveal that this alkyl Heck reaction proceeds via a hybrid palladium-radical process.

Prevention and management of enteral nutrition-related diarrhea among adult inpatients: a best practice implementation project.

INTRODUCTION: Diarrhea, the most common complication for patients during enteral nutrition, poses a range of risks and care burdens. Medical staff are aware of the importance of proactively preventing and managing enteral nutrition-related diarrhea. However, clinical prevention and management methods are not standardized, and the scientific basis and effectiveness of these methods need to be further verified. OBJECTIVES: This project aimed to promote evidence-based practices for the prevention and management of enteral nutrition-related diarrhea among adult inpatients in a public tertiary hospital in China. METHODS: This project was guided by the JBI Evidence Implementation Framework and used the JBI Practical Application of Clinical Evidence System (PACES) and the JBI Getting Research into Practice (GRiP) tools. Twelve audit criteria were developed to conduct a baseline audit to measure compliance with best practices. A barrier analysis was conducted, and strategies were implemented to overcome the barriers. The project was finalized with a follow-up audit to determine any changes in compliance with best practices. RESULTS: The overall compliance rate for the audit criteria increased from 27.37% at baseline to 89.62% in the follow-up audit, with six criteria achieving a compliance rate of 100%. CONCLUSIONS: The implementation of evidence-based practices can effectively narrow the gap between current practice and best practice. This project improved the ability of medical staff to prevent and manage enteral nutrition-related diarrhea, as well as promoting evidence-based practice in the hospital. SPANISH ABSTRACT: http://links.lww.com/IJEBH/A168.

Design and Implementation of an Inpatient Fall Risk Management Information System.

BACKGROUND: Falls had been identified as one of the nursing-sensitive indicators for nursing care in hospitals. With technological progress, health information systems make it possible for health care professionals to manage patient care better. However, there is a dearth of research on health information systems used to manage inpatient falls. OBJECTIVE: This study aimed to design and implement a novel hospital-based fall risk management information system (FRMIS) to prevent inpatient falls and improve nursing quality. METHODS: This implementation was conducted at a large academic medical center in central China. We established a nurse-led multidisciplinary fall prevention team in January 2016. The hospital's fall risk management problems were summarized by interviewing fall-related stakeholders, observing fall prevention workflow and post-fall care process, and investigating patients' satisfaction. The FRMIS was developed using an iterative design process, involving collaboration among health care professionals, software developers, and system architects. We used process indicators and outcome indicators to evaluate the implementation effect. RESULTS: The FRMIS includes a fall risk assessment platform, a fall risk warning platform, a fall preventive strategies platform, fall incident reporting, and a tracking improvement platform. Since the implementation of the FRMIS, the inpatient fall rate was significantly lower than that before implementation (P<.05). In addition, the percentage of major fall-related injuries was significantly lower than that before implementation. The implementation rate of fall-related process indicators and the reporting rate of high risk of falls were significantly different before and after system implementation (P<.05). CONCLUSIONS: The FRMIS provides support to nursing staff in preventing falls among hospitalized patients while facilitating process control for nursing managers.

Climates and associated factors for evidence-based practice implementation among nurses: a cross-sectional study.

BACKGROUND: The organizational climate that fosters and supports the implementation of evidence is a key factor influencing the effective implementation of evidence-based practice (EBP). Nurses, being the largest group of medical staff, play a crucial role in EBP implementation. The perception of the climate for EBP implementation among nurses in their organizations is unknown, especially among Chinese nurses. AIMS: To clarify the implementation climate of EBP among Chinese nurses and identify the factors associated with the implementation and development of evidence-based nursing practices. METHODS: This study employed a descriptive cross-sectional study design. From March 2023 to April 2023, a sample of nurses (n = 1260) from two Tertiary care hospitals in central China were selected and surveyed by self-designed social-demographic questionnaire and Implementation Climate Scale. Multiple linear stepwise regression analysis was conducted to determine the predictors of implementation climate. RESULTS: The nurses achieved a mean ICS score of 59.10 ± 11.22, with mean scores exceeding 3 points for each sub-dimension and item. In the results of multiple linear regression, income satisfaction, implementation of evidence-based nursing practice project(s) within the unit, experience of evidence-based nursing practice during working life, and specific training or courses in evidence-based nursing practice were predictors of ICS. Of these, income satisfaction was the most significant predictor. These factors could explain 17.5% of the total variance in implementation climate. CONCLUSION: The climate for implementing EBP in Chinese nursing organizations was relatively strong. Nursing managers can enhance the climate for implementing EBP in their organizations by actively improving salary and enhancing EBP-related trainings and practices. RELEVANCE TO CLINICAL PRACTICE: Understanding nurses' perceptions of the EBP implementation climate in their organizations can help to identify specific barriers and facilitators to the development of EBP and facilitate its successful implementation. PATIENT OR PUBLIC CONTRIBUTION: Clinical nurses were involved in data collection and completed the questionnaires on EBP implementation climate.

Developing a Quality Evaluation Index System for E-Consultation Doctor-Patient Communication Using the Delphi Method.

Background: E-consultation medical services have become popular globally, which offers patients more options, regardless of time or location. However, research indicates a prevalent issue with the communication quality in e-consultations, leading to sub-optimal patient experiences. Objective: This study aims to design an evaluation system for e-consultation quality. The developed scale guides operators in improving services and users in assessing their experience. It aids in selecting e-consultation services, saving costs, and assisting doctors in making informed decisions. Methods: This study combines existing scales, literature analysis, and expert consultation to form preliminary evaluation indicators. Fourteen experts were invited using stratified purposive sampling. Two rounds of Delphi method were conducted to exclude indicators that did not meet basic conditions. The final evaluation system was determined through expert discussions and revisions. The Analytic Hierarchy Process (AHP) quantified indicator weights. Results: Both rounds of the questionnaire saw compelling response rates of 100% (14 out of 14) and 92.86% (13 out of 14), respectively. Meanwhile, the Expert Authority Coefficient (Cr) was recorded at 0.89 and 0.88, respectively, while the Kendall Consistency Coefficient (Kendall W) for all level indicators fluctuated between 0.133 and 0.37 (P<0.05). The ultimate indicator system formulated includes three primary indicators, ten secondary indicators, and thirty-two tertiary indicators. The highest to lowest weighted first-level indicators were 'Joint Decision-Making between Doctors and Patients' (0.6232), 'Patient Responsiveness' (0.2395), and "Interpersonal Relationship between Doctors and Patients" (0.1373). Weights for the second-level and third-level indicators were also determined. Conclusion: A scientific scale for e-consultation quality evaluation has been created, which effectively captures the essence of online medical communication and patient experiences. It enriches the theoretical framework for evaluating e-consultation quality, broadens perspectives in Internet medicine, provides practical guidance for network medical service managers and users and the development of the "Internet + medical health" service model.

Hypertension Treatment in Frail Older Adults: A Systematic Review and Appraisal of Guidelines.

BACKGROUND: Managing hypertension in frail older patients is challenging. Several institutions and organizations have published up-to-date hypertension guidelines suggesting frailty screening among older hypertensive patients, with new recommendations for blood pressure-lowering treatment among the frail population. However, the quality of current hypertension guidelines and the consistency of antihypertension treatment recommendations for frail older patients and their supporting evidence remain unknown. OBJECTIVE: In this review, we aimed to systematically collect guidelines with antihypertension treatment recommendations for frail older patients, examine and compare these recommendations, and critically assess reporting and methodology quality of these guidelines. METHODS: A literature search was conducted on two databases and three major websites of guideline development organizations. The AGREE instrument and RIGHT checklist were used to evaluate the methodology and reporting quality of the guidelines, respectively. The consistency of recommendations within the guidelines were compared using descriptive analysis. RESULTS: We identified 13 hypertension guidelines. The overall methodology quality scores (range 23.35-79.07%) and reporting rates (range 10/35-29/35) varied among these guidelines. Four guidelines provided an explicit definition of frailty. Considering treatment tolerability or increased likelihood of adverse effects while using pharmacotherapy in frail older patients was mentioned in all guidelines. Ten guidelines recommended adjusting blood pressure targets or specific pharmacotherapy programs. Four guidelines recommended using clinical judgment when prescribing. However, the specific recommendations lacked clarity and unity without sufficient evidence. CONCLUSIONS: There were considerable variations in methodology and reporting quality across the 13 included hypertension guidelines. Furthermore, the depth and breadth of antihypertension treatment recommendations for frail older patients were varied and inconsistent. Further trials exploring optimal treatment are urgently required to promote the development of specific guidelines for managing frail older hypertensive patients.

Roles of conserved active site residues in the IscS cysteine desulfurase reaction.

Escherichia coli cysteine desulfurase (CD), IscS, modifies basal metabolism by transferring sulphur (S) from L-cysteine to numerous cellular pathways, whereas NFS1, a human CD, is active only in the formation of the [Acp]2:[ISD11]2:[NFS1]2 complex. Despite the accumulation of red-coloured IscS in E. coli cells as a result of the deficiency of accessible iron, as revealed in our previous studies, the mechanism of the potential enzymatic reaction remains unclear. In this study, the N-terminus of IscS was fused with the C-terminus of NFS1, which was reported to be almost fully active as IscS and exhibits a pyridoxal 5'-phosphate (PLP) absorption peak at 395 nm. Moreover, SUMO-EH-IscS exhibited significant growth recovery and NADH-dehydrogenase I activity in the iscS mutant cells. Furthermore, through in vitro and in vivo experiments combined with high-performance liquid chromatography and ultra-performance liquid chromatography-tandem mass spectrometry, it was shown that the new absorption peaks of the IscS H104Q, IscS Q183E, IscS K206A, and IscS K206A&C328S variants at 340 and 350 nm may correspond to the enzyme reaction intermediates, Cys-ketimine and Cys-aldimine, respectively. However, after mutation of the conserved active-site residues, additional absorption peaks at 420 and 430 nm were associated with PLP migration in the active-site pocket. Additionally, the corresponding absorption peaks of Cys-quinonoid, Ala-ketimine, and Ala-aldimine intermediates in IscS were 510, 325, and 345 nm, respectively, as determined by site-directed mutagenesis and substrate/product-binding analyses during the CD reaction process. Notably, red IscS formed in vitro by incubating IscS variants (Q183E and K206A) with excess L-alanine and sulphide under aerobic conditions produced an absorption peak similar to the wild-type IscS, at 510 nm. Interestingly, site-directed mutation of IscS with hydrogen bonds to PLP at Asp180 and Gln183 resulted in a loss of enzymatic activity followed by an absorption peak consistent with NFS1 (420 nm). Furthermore, mutations at Asp180 or Lys206 inhibited the reaction of IscS in vitro with L-cysteine (substrate) and L-alanine (product). These results suggest that the conserved active site residues (His104, Asp180, and Gln183) and their hydrogen bond with PLP in the N-terminus of IscS play a key role in determining whether the L-cysteine substrate can enter the active-site pocket and regulate the enzymatic reaction process. Therefore, our findings provide a framework for evaluating the roles of conserved active-site residues, motifs, and domains in CDs.

Validity and reliability of the Chinese version of the Normalization MeAsure Development(NoMAD).

BACKGROUND: The Normalization MeAsure Development (NoMAD) is a brief quantitative tool based on the Normalization Process Theory (NPT), which can measure the implementation process of new technologies and complex interventions. The aim of our study was to translate and culturally adapt the NoMAD into Chinese, and to evaluate the psychometric properties of the Chinese version of NoMAD. METHODS: According to the NoMAD translation guideline, we undertook forward translation, backward translation, and compared these translations to get a satisfactory result, then we performed cognitive interviews to achieve cross-culture adaptation. And the psychometric properties of the final version were evaluated among clinical nurses who used the pressure injuries management system via WeChat mini-program at a tertiary hospital in northwestern China. RESULTS: A total of 258 nurses were enrolled in our study, and the response rate was 92.1%. The Cronbach's alpha of four dimensions were as follow: Coherence (0.768), Cognitive Participation (0.904), Collective Action (0.820), and Reflexive Monitoring (0.808). The overall internal consistency was 0.941. The confirmatory factor analysis results showed a good fit for its theoretical structure (CFI = 0.924, TLI = 0.910, RMSEA = 0.0079, SRMSR = 0.046, χ2/df = 2.61). The item-level content validity index ranged from 0.857 to 1, and the scale-level content validity index was 0.95. There were positive correlations between four constructs scores and three general normalization scores. CONCLUSIONS: The Chinese version of NoMAD is a reliable and valid tool to evaluate the implementation process of innovations.

[Study on the changes of cartilage metabolites in patients with knee osteoarthritis before and after fibula osteotomy].

OBJECTIVE: To explore changes of C-terminal cleavage epitope of type Ⅱ collagen 3/4 fragment in cartilage metabolism (Col2-3/4Clong mono or C2C), carboxyl-terminal telopeptide of type Ⅱ collagen (CTX-Ⅱ) and knee joint function before and after osteotomy of fibula in patients with knee osteoarthritis. METHODS: From January 2019 to March 2020, 65 patients with knee osteoarthritis who underwent fibular osteotomy treatment accompanied with medial pain were selected, including 25 males and 40 females, aged from 44 to 70 years old with an average of (56.20±10.05) years old;25 patients were gradeⅠ, 19 patients with gradeⅡ, 17 patients with grade Ⅲ, and 4 patients with grade Ⅳ according to Kellgren-Lawrence grading. The content of CTX-Ⅱ and C2C in knee joint fluid, serum interleukin 1ß ( IL-1ß), tumor necrosis factor-α (TNF-α) before osteotomy and 6 months after osteotomy were detected. Visual analogue scale(VAS) was used to evaluate degree of pain relief, American Knee Society Score (KSS) and Hospital for Special Surgery (HSS) were applied to evaluate recovery of knee joint function. RESULTS: Sixty-five patients were followed up from 6 to 18 months with an average of(12.4±3.6) months. VAS, KSS and HSS score at 6 months after osteotomy were better than that of before osteotomy(P<0.05). Serum IL-1ß, TNF-α and content of CTX-Ⅱand C2C of knee joint fluid at 6 months after osteotomy were lower than those before osteotomy(P<0.05). CONCLUSION: Fibula osteotomy could relieve pain of knee osteoarthritis, maintain balance of joint stress, reduce organism inflammatory response, improve cartilage metabolism, reduce decomposition of articular cartilage, and reduce level of CTX-Ⅱand C2C, which is benefit for regeneration of articular cartilage and promote recovery of knee joint function.

Textual Features and Risk Preference Effects on Mental Health Education Among Teenager Students in Chongqing, China.

Background: Mental health is a public health problem of great concern. Previous studies show that textual features and individual psychological characteristics can influence the effect of receiving information. Purpose: This study explores whether textual features influence the persuasiveness of teenager students' mental health education while considering the influence of risk preference. Methods: From November to December 2021, a cross-sectional study was conducted among 1,869 teenager students in grade 7-12 in Chongqing, China. Wilcoxon signed-rank test, multiple logistic regression, and subgroup analysis were used to analyze the data. Results: Among the four textual features mentioned in this study, a significant difference was reported in the persuasive effects of information with and without numerical features (p < 0.001), and such information tended to include digital features. The result for the symbolic features (p < 0.001) was consistent with the numerical features. The persuasive effects of positive and negative emotional information significantly differed (p < 0.001), with the former showing a better performance. No significant differences were observed between the persuasive effects of information with and without emotional conflicts (p > 0.05). Combined with those from the risk preference analysis, results showed that the regulatory effect of risk preference was only reflected in emotional conflicts. Students who prefer having no emotional conflict in the text showed the characteristics of risk avoidance, or lower grades, or rural or school accommodation. Most teenager students are also risk averse, especially females (or = 2.223, 95%CI:1.755-2.815) and juniors (or = 1.533, 95%CI: 1.198-1.963). Conclusion: The numbers, symbols, and positive emotions in the text generate an active effect on teenager students receiving mental health education. Students avoiding risk are inclined to read texts without emotional conflicts. The probability of male choosing texts with positive emotional polarity is 33.5% lower than that of female. Female students and those from lower grades also demonstrate a higher inclination to risk avoidance compared with their male and higher grade counterparts. Therefore, educational materials with different text characteristics should be developed for teenager students with varying characteristics.

ISCA2 deficiency leads to heme synthesis defects and impaired erythroid differentiation in K562 cells by indirect ROS-mediated IRP1 activation.

Iron­sulfur (Fe-S) clusters have been shown to play important roles in various cellular physiological process. Iron­sulfur cluster assembly 2 (ISCA2) is a vital component of the [4Fe-4S] cluster assembly machine. Several studies have shown that ISCA2 is highly expressed during erythroid differentiation. However, the role and specific regulatory mechanisms of ISCA2 in erythroid differentiation and erythroid cell growth remain unclear. RNA interference was used to deplete ISCA2 expression in human erythroid leukemia K562 cells. The proliferation, apoptosis, and erythroid differentiation ability of the cells were assessed. We show that knockdown of ISCA2 has profound effects on [4Fe-4S] cluster formation, diminishing mitochondrial respiratory chain complexes, leading to reactive oxygen species (ROS) accumulation and mitochondrial damage, inhibiting cell proliferation. Excessive ROS can inhibit the activity of cytoplasmic aconitase (ACO1) and promote ACO1, a bifunctional protein, to perform its iron-regulating protein 1(IRP1) function, thus inhibiting the expression of 5'-aminolevulinate synthase 2 (ALAS2), which is a key enzyme in heme synthesis. Deficiency of ISCA2 results in the accumulation of iron divalent. In addition, the combination of excessive ferrous iron and ROS may lead to damage of the ACO1 cluster and higher IRP1 function. In brief, ISCA2 deficiency inhibits heme synthesis and erythroid differentiation by double indirect downregulation of ALAS2 expression. We conclude that ISCA2 is essential for normal functioning of mitochondria, and is necessary for erythroid differentiation and cell proliferation.

Co-expression Mechanism Analysis of Different Tachyplesin I-Resistant Strains in Pseudomonas aeruginosa Based on Transcriptome Sequencing.

Tachyplesin I is a cationic antimicrobial peptide with 17 amino acids. The long-term continuous exposure to increased concentrations of tachyplesin I induced resistance in Pseudomonas aeruginosa. The global gene expression profiling of tachyplesin I-resistant P. aeruginosa strains PA-60 and PA-99 and the sensitive strain P. aeruginosa CGMCC1.2620 (PA1.2620) were conducted by transcriptome sequencing to analyze the common underlying mechanism of resistance to tachyplesin I in low- or high-resistance mutants. The co-expression patterns, gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment, sRNA target genes, and single-nucleotide polymorphism (SNP) change were analyzed for the co-expressed genes in this study. A total of 661 differentially co-expressed genes under treatments of PA1.2620 vs. PA-99 and PA1.2620 vs. PA-60 (HL) were divided into 12 kinds of expression patterns. GO and KEGG pathway enrichment analyses indicated that the enrichment of co-expressed genes was mainly associated with oxidoreductase activity, mismatched DNA binding, mismatch repair, RNA degradation of GO terms, aminoacyl-tRNA biosynthesis, and aminobenzoate degradation pathways, and so forth. The co-expressed resistance-related genes were mainly involved in antibiotic efflux and antibiotic inactivation. Seven co-expressed genes had SNP changes. Some co-expressed sRNAs were involved in P. aeruginosa resistance to tachyplesin I by regulating target genes and pathways related to resistance. The common resistance mechanism of P. aeruginosa among different mutants to tachyplesin I was mainly associated with the expression alteration of several genes and sRNA-regulated target genes related to resistance; few genes had base mutations. The findings of this study might provide guidance for understanding the resistance mechanism of P. aeruginosa to tachyplesin I.

Framing Effects and Evidence Type: Influence on the Persuasive Effect of Myopia Prevention Messages Among Elementary School Students in China.

Background: The myopia is a public health issue that attracts much attention. However, limited attention has been paid to the effect of primary school students' acceptance of health messages. Previous studies have found that framing effects and evidence types influence the persuasive effect of messages. Purpose: This study explored whether framing effects and evidence type influence the persuasive effect of myopia prevention messages among elementary school students and the influence of children's myopia prevention cognition was considered. Methods: A cross-sectional study was conducted among 1,493 elementary school students aged 9 to 13 in China from May to July 2020 by convenience sampling. Wilcoxon signed-rank test and multinomial logistic regression were used for data analysis. Results: Significant differences were found in the persuasive effect between statistical and non-statistical evidence messages (p < 0.001). Among non-statistical evidence messages, gain-framed messages showed a greater persuasive effect than loss-framed messages (p < 0.001). Among statistical evidence messages, loss-framed messages performed better than gain-framed messages (p < 0.001). Children's myopia prevention cognition exerted no significant effect on the persuasive effect of the messages (p > 0.05). Conclusion: This study demonstrated the influence of framing effect on the persuasive effect of myopia prevention messages among children aged 9 to 13 in China. Non-statistical evidence messages showed a better persuasive effect than statistical evidence messages. Different types of evidence influenced the persuasive effect of gain- and loss- framed messages. These findings have implications for strategies more or less likely to work in making myopia prevention messages for children.

Association of Diabetic Retinopathy With Stroke: A Systematic Review and Meta-Analysis.

Background: The population-based studies conducted thus far do not provide conclusive evidence of the link between diabetic retinopathy (DR) and stroke. The aim of the present systematic review was to determine whether DR is specifically associated with stroke. Methods: MEDLINE, Embase, and Web of Science were systematically searched from their inception to July 31, 2020. All cohort studies that reported associations between the presence of DR and incident stroke were included. The pooled hazard ratios (HRs), pooled risk ratios (RRs), and 95% confidence intervals (CIs) were calculated. Results: The meta-analysis included 19 cohort studies involving 81,452 diabetic patients. The pooled effect size of any DR related to stroke was 1.25 for HR (95% CI: 1.12-1.39; P < 0.0001) and 1.96 for RR (95% CI: 1.60-2.39; P < 0.0001). Subgroup analysis for the type of diabetes yielded pooled HR of 1.29 (95% CI: 1.10-1.50; P = 0.001) in patients with type 2 diabetes mellitus (T2DM). The pooled RR was 2.29 (95% CI: 1.77-2.96; P < 0.0001) in patients with T2DM. Two studies addressed the DR-related stroke among type 1 diabetes mellitus (T1DM) patients. One study found a significant association between DR and stroke (OR: 1.6; 95% CI: 1.1-2.3; P < 0.01), while the other did not identify an association between these two conditions (RR: 1.40; 95% CI: 0.62-2.18; P = 0.178). Conclusions: The presence of DR is associated with an increased risk of stroke in diabetic patients. This correlation is robust in T2DM patients but uncertain in T1DM patients. Our findings indicate that DR is an important biomarker for the prediction of stroke. To further validate the role of DR in stroke-risk stratification, additional research is required on the association between the stage of DR and stroke risk, and more studies including T1DM patients are necessary.

Using Machine Learning Technologies in Pressure Injury Management: Systematic Review.

BACKGROUND: Pressure injury (PI) is a common and preventable problem, yet it is a challenge for at least two reasons. First, the nurse shortage is a worldwide phenomenon. Second, the majority of nurses have insufficient PI-related knowledge. Machine learning (ML) technologies can contribute to lessening the burden on medical staff by improving the prognosis and diagnostic accuracy of PI. To the best of our knowledge, there is no existing systematic review that evaluates how the current ML technologies are being used in PI management. OBJECTIVE: The objective of this review was to synthesize and evaluate the literature regarding the use of ML technologies in PI management, and identify their strengths and weaknesses, as well as to identify improvement opportunities for future research and practice. METHODS: We conducted an extensive search on PubMed, EMBASE, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, China National Knowledge Infrastructure (CNKI), the Wanfang database, the VIP database, and the China Biomedical Literature Database (CBM) to identify relevant articles. Searches were performed in June 2020. Two independent investigators conducted study selection, data extraction, and quality appraisal. Risk of bias was assessed using the Prediction model Risk Of Bias ASsessment Tool (PROBAST). RESULTS: A total of 32 articles met the inclusion criteria. Twelve of those articles (38%) reported using ML technologies to develop predictive models to identify risk factors, 11 (34%) reported using them in posture detection and recognition, and 9 (28%) reported using them in image analysis for tissue classification and measurement of PI wounds. These articles presented various algorithms and measured outcomes. The overall risk of bias was judged as high. CONCLUSIONS: There is an array of emerging ML technologies being used in PI management, and their results in the laboratory show great promise. Future research should apply these technologies on a large scale with clinical data to further verify and improve their effectiveness, as well as to improve the methodological quality.

Predictive validity of the braden scale for pressure injury risk assessment in adults: A systematic review and meta-analysis.

AIM: Pressure injuries are common adverse events in clinical practice, affecting the well-being of patients and causing considerable financial burden to healthcare systems. It is therefore essential to use reliable assessment tools to identify pressure injuries for early prevention. The Braden Scale is a widely used tool to assess pressure injury risk, but the literature is currently lacking in determining its accuracy. This study aimed to evaluate the accuracy of the Braden Scale in assessing pressure injury risk. DESIGN: Systematic review and meta-analysis. METHODS: Articles published between 1973-2020 from periodicals indexed in the PubMed, EMBASE, CINAHL, Web of Science and the Cochrane Library were selected. Two reviewers independently selected the relevant studies for inclusion. Data were analysed by the STATA 15.0 and the RevMan 5.3 software. RESULTS: In total, 60 studies involving 49,326 individuals were eligible for this meta-analysis. The pooled SEN, SPE, PLR, NLR, DOR and AUC were 0.78 (95% CI: 0.74 to 0.82), 0.72 (95% CI: 0.66 to 0.78), 2.80 (95% CI: 2.30 to 3.50), 0.30 (95% CI: 0.26 to 0.35), 9.00 (95% CI: 7.00 to 13.00) and 0.82 (95% CI: 0.79 to 0.85), respectively. Subgroup analyses indicated that the AUC was higher for prospective design (0.84, 95% CI: 0.81 to 0.87), mean age <60 years (0.87, 95% CI: 0.84 to 0.90), hospital (0.82, 95% CI: 0.79 to 0.86) and Caucasian population (0.86, 95% CI: 0.82 to 0.88). In addition, 18 was found to be the optimal cut-off value. CONCLUSION: The evidence indicated that the Braden Scale had a moderate predictive validity. It was more suitable for mean age <60 years, hospitalized patients and the Caucasian population, and the cut-off value of 18 might be used for the risk assessment of pressure injuries in clinical practice. However, due to the different cut-off values used among included studies, the results had a significant heterogeneity. Future studies should explore the optimal cut-off value in the same clinical environment.

Inconsistencies in study eligibility criteria are common between non-Cochrane systematic reviews and their protocols registered in PROSPERO.

The author should give careful consideration to the study eligibility criteria of systematic reviews (SRs) and follow it after review protocol development to reduce the possibility of manipulation of inclusion. Our aim was to investigate the prevalence of differences in study eligibility criteria between non-Cochrane SRs and their pre-registered protocols on PROSPERO, and determined what changes were involved as well as whether those changes were explained. We searched the protocols registered on PROSPERO platform in the year of 2018 and then selected these protocols which full-text have been published up to June 9, 2020. A random sample (n = 100) was included. Published full-texts were identified through the protocol's final publication citation. The following five key components of study eligibility criteria were compared: participants, intervention(s)/exposure(s), comparator(s), types of study design, and outcome(s). A total of 90% of included SRs exhibited differences in study eligibility criteria, and 59/90 altered in no less than two key components. Only one SR reported and explained the rationale for changes to the individual key component (the definition of exposure). The "Outcome(s)" exhibited the greatest variation, with changes in 61% of the SRs. The "Comparator(s)/control" exhibited the smallest variation, with changes in 20% of the SRs. Differences in study eligibility criteria between the non-Cochrane SRs and their protocols registered on PROSPERO were widespread but were seldom explained. Authors themselves, PROSPERO platform, as well as peer-review journals and their peer-reviewers should play a role in further improving transparency.

Association between Frailty and Mortality, Falls, and Hospitalization among Patients with Hypertension: A Systematic Review and Meta-Analysis.

OBJECTIVE: Chronological age alone does not adequately reflect the difference in health status of a patient with hypertension. Frailty is closely associated with biological age, and its assessment is clinically useful in addressing the heterogeneity of health status. The purpose of our study is to comprehensively examine the predictive value of frailty for negative health outcomes in hypertensive patients through a systematic review and meta-analysis. METHODS: Multiple English and Chinese databases were searched from inception to 04.11.2020. All cross-sectional and longitudinal studies that examined the association between frailty and relevant clinical outcomes among hypertensive patients were included. The NOS was used to assess the risk of bias of studies included in the analysis. Hazard ratios (HRs), odds ratios (ORs), and 95% confidence intervals (CIs) were pooled for outcomes associated with frailty. RESULTS: Six longitudinal studies and one cross-sectional study involving 17403 patients with hypertension were included in the meta-analysis. The risk of bias of all included studies was rated as low or moderate. The pooled HR of frailty related to mortality was 2.45 (95% CI: 2.08-2.88). The pooled HR of prefrailty and frailty-related injurious falls was 1.07 (95% CI: 0.83-1.37) and 1.89 (95% CI: 1.56-2.27), respectively. The pooled HR of prefrailty and frailty-related hospitalization was 1.54 (95% CI: 1.38-1.71) and 1.94 (95% CI: 1.17-3.24), respectively. CONCLUSIONS: This systematic review suggests that frailty was a strong predictor of mortality, hospitalization, and injurious falls among patients with hypertension. Our findings indicate that assessment of frailty in patients with hypertension to guide their management may be necessary in clinical setting. However, our finding was based on very limited amount studies; thus, future studies are required to further validate the role of frailty in prediction of negative health outcomes in hypertensive patients as well as pay more attention to the following knowledge gaps: (1) the association between frailty and hypertension-related outcomes, (2) the significance of the association between different frailty models and relevant clinical outcomes, and (3) the predictive value of prefrailty for the negative health outcomes in people with hypertension.

Effect of clinical teaching behaviours on transition shock in graduate nurses.

AIM: This study aimed to explore the impact of preceptor clinical teaching behaviours on transition shock in graduate nurses using bi-directional feedback between graduate nurses and clinical preceptors and to assess preceptor clinical teaching behaviours. DESIGN: This was a descriptive cross-sectional study. METHODS: This study was conducted from January-February 2019. Participants included graduate nurses (N = 117) and clinical preceptors (N = 908) from a major public tertiary hospital in Western China. RESULTS: Overall level of transition shock of graduate nurses was moderate (mean = 89 SD  17.54). Transition shock level of graduate nurses rose with the increasing of time in clinical work. Intensive care unit graduate nurses suffered the strongest transition shock, whereas surgery graduate nurses suffered the least. Graduate nurses thought that clinical preceptors were best at evaluation and feedback, whereas clinical preceptors thought they were best at showing concern and support. The primary factors associated with transition shock in graduate nurses were the time admitted to the hospital, feedback, and evaluation, use of appropriate teaching strategies, and showing concern and support, explaining 63.5% of the total variation in transition shock in graduate nurses. CONCLUSION: In Western China, where the development of economic and medical conditions lag, transition shock is a major obstacle to the professional development of graduate nurses and clinical teaching behaviours is the key to overcoming transition obstacles. However, the serious shortage of nurses makes it difficult to not only complete heavy clinical nursing work but also to undertake the teaching of students and graduate nurses. The clinical teaching system is influenced by many factors. Focusing on clinical teaching behaviours and transition shock in graduate nurses will provide valuable data for future intervention studies. IMPLICATION: The findings of this study will be of interest to managers at all levels and will enable them to support graduate nurses by engaging in excellent clinical teaching behaviours. In the clinical teaching process, giving more feedback and evaluation, improving the ability of using appropriate teaching strategies and focusing on the physical and mental health of graduate nurses may effectively decrease transition shock of graduate nurses and reduce the turnover rate.