Clinical Nursing Research最新文献

The increasing prevalence of diabetes mellitus (DM) and patients' lack of self-management awareness have led to a decline in health-related quality of life (HRQoL). Studies identifying potential risk factors for HRQoL in DM patients and presenting generalized models are relatively scarce. The study aimed to develop and evaluate a machine learning (ML)-based model to predict the HRQoL in adult diabetic patients and to examine the important factors affecting HRQoL. This study extracted factors from the Korea National Health and Nutrition Examination Survey database (2016-2020) based on situation-specific theory, and using data from 2,501 adult DM patients. We developed five ML-based HRQoL classifiers (logistic regression, naïve Bayes, random forest, support vector machine, and extreme gradient boosting (XGBoost) in DM patients. The developed ML model was evaluated using six evaluation metrics to determine the best model, and feature importance was computed based on Shapley additive explanations (SHAP) value. The XGBoost model showed the best performance, with an accuracy of 0.940, a recall of 0.943, a precision of 0.940, a specificity of 0.919, an F1-score of 0.942, and an area under the curve score of 0.984. Based on SHAP values, the top five significant predictors of HRQoL were self-rated health (1.898), employment (0.822), triglycerides (0.781), education level (0.618), and aspartate transaminase/alanine transaminase ratio (0.611). The findings confirmed that the ML-based prediction model achieved high accuracy (over 90%) in distinguishing stable and at-risk groups in terms of HRQoL among adult DM patients. The XGBoost model's superior performance supports its potential integration into routine diabetes care as a decision-support tool. Identifying high-risk individuals early can help healthcare providers implement targeted interventions to improve long-term health outcomes.

The prevalence of poor sleep quality tends to increase progressively as renal function deteriorates. Patients with declining kidney function frequently encounter both physical and psychological discomfort. However, research investigating the factors influencing sleep quality in individuals with early-stage chronic kidney disease (CKD) has been limited. This study aims to identify specific factors associated with early-stage CKD that may contribute to poor sleep quality and to elucidate the relationship between these factors and sleep quality. A hundred and six patients completed the assessment, including the renal function test, Pittsburgh Sleep Quality Index, Beck Depression Inventory-Second Edition, and fatigue severity scale. Logistic regression analyses and partial least squares structural equation modeling were used to analyze the data. Poor sleep quality was reported in 59.43% of patients with early-stage CKD. Significant associations were found between poor sleep quality and age (p < .01; 95% confidence interval: [1.03, 1.17]), severity of depression (p = .01, [1.05, 1.48]), and severity of fatigue (p = .02, [1.09, 2.71]). By contrast, estimated glomerular filtration rate (eGFR) (p = 0.53, [0.96, 1.02]) did not demonstrate a significant association with poor sleep quality. Further analysis revealed that fatigue and depression are key contributors to poor sleep quality and may be influenced by declining renal function, even though the eGFR is not directly related to sleep outcomes. Addressing psychological factors, particularly fatigue and depression, is crucial for the improvement of sleep quality in patients with early-stage CKD. Future strategies should be focused on comprehensive care approaches that specifically target fatigue and depression to enhance sleep quality in this patient population.

The identification of traumatic birth is becoming a major global health concern. Evaluating the existing research can help shape future directions for traumatic birth studies. This study aimed to provide a comprehensive and up-to-date summary of research articles on traumatic birth. We performed a bibliometric analysis using the Science Citation Index Expanded of the Web of Science Core Collection database, covering the period from January 1, 1985, to June 30, 2023. A total of 1,568 original articles were found, indicating a significant increase in traumatic birth research. The United States was the most prolific country, followed by Australia and Canada. The University of Sydney, the University of Toronto, and the University of Pittsburgh were the top 3 institutions in terms of published documents. The terms "infants," "perceptions," and "birth injuries" had the highest burst strengths. MeSH Bibliographic Item Co-Occurrence Matrix Builder analysis identified six major research topics, with birth injuries and their prevention and control, as well as brachial plexus/shoulder injuries and surgery, being the most concentrated areas. While traumatic birth is not yet universally recognized and its scope remains under discussion, it is increasingly becoming a significant issue. Understanding the priorities and trends of research can guide future academic endeavors, highlighting areas that require further investigation and development.

Stroke is a major global health concern, often resulting in depression, anxiety, and disability. Effective management strategies, particularly nurse-led interventions, are essential for enhancing health-related quality of life (HRQoL) in stroke patients. This study evaluates the impact of these interventions on post-stroke HRQoL outcomes. To evaluate nurse-led interventions on HRQoL in stroke patients, this systematic review followed PRISMA guidelines. Searches were conducted across multiple databases, including Cochrane Central, Scopus, PubMed, Web of Science, and PsycINFO, to identify relevant randomized controlled trials (RCTs) while applying strict inclusion and exclusion criteria. Data extraction and risk of bias (ROB) assessments using the ROB-2 tool were performed independently by two investigators, with statistical analyses executed using Stata 17 software. From the initial 4,834 studies, nine studies were included for final analysis. Nine studies with 1,135 stroke patients (572 intervention, 563 control) assessed nurse-led interventions on HRQoL. Results showed a significant positive effect of nurse-led interventions (standardized mean difference (SMD): 5.26 [2.09, 8.42], I2: 99.72). Subgroup analysis revealed that Asian countries had a higher effect (SMD: 6.75 [3.45, 10.04]) compared to American and European countries (SMD: 0.08 [-0.87, 1.04]), and interventions over 10 weeks showed greater impact (SMD: 8.55 [5.56, 11.55]) compared to shorter ones (SMD: 3.59 [-0.35, 7.53]). Differences between assessment tools were also significant (p < .001). This meta-analysis shows that nurse-led interventions significantly improve stroke patients' HRQoL, with variations based on geography, intervention duration, and assessment tools. Further research is needed to optimize these interventions in clinical practice.

Health problems associated with post-acute COVID-19, also known as "Long COVID," range from mild to severe. The best defense against this potentially serious condition is to prevent COVID-19 infection and reinfection. The same preventive measures for COVID-19 may be used to help prevent the spread of Long COVID. This study used the Health Belief Model (HBM) to examine whether and how public understanding and awareness of Long COVID and its prevention shape the adoption of COVID-19 preventive behaviors. N = 605 English-speaking U.S.-based adults were recruited via Qualtrics. Predictors of intention to carry out COVID-19 preventive behaviors were investigated. Outcomes included behaviors relevant to preventing both acute and Long COVID. Across all models, except the one examining intent to get a vaccine booster, Black respondents were more likely than White respondents to express intent to carry out COVID-19 preventive behaviors. In addition, HBM constructs added significantly to the regression models. Susceptibility to Long COVID was significant for all behavioral outcomes (all ps < .05), self-efficacy for wearing a mask (p < .001), and self-efficacy for testing for COVID-19 after exposure and before a social event (ps < .001). In addition, perceived benefits for Long COVID prevention predicted intent of mask-wearing (p < .001), testing before a social event (p = .002), and getting a vaccine booster (p = .001). Perceived severity of Long COVID did not significantly predict adherence to preventive behaviors. U.S. adults are more likely to express intent to carry out COVID-19 preventive behaviors, such as masking and receiving booster vaccines, when they report feeling greater susceptibility to Long COVID as well as greater self-efficacy for engaging in these preventive behaviors. Public health messaging about Long COVID with incorporation of HBM constructs may be an effective means of increasing continued recommended COVID-19 preventive behaviors, which also hold co-benefits for prevention of infections, such as influenza and measles, as well as emerging viruses such as avian flu.

Limited studies have explored the effects of individual and environmental factors on sleep disturbance in individuals with inflammatory bowel disease (IBD), which is vital for informing future sleep interventions. Thus, the purpose of this study was to explore the possible mediated effects of potential precipitating and/or perpetuating factors on the relationship between sleep disturbance and symptoms in adults with IBD. This is a correlational study of adults with IBD recruited from ResearchMatch. Survey questions asked about demographics, clinical characteristics, sleep hygiene, sleep beliefs and attitudes, sleep environment, sleep control, and symptoms (sleep disturbance, abdominal pain, anxiety, depression, fatigue). Data analysis included descriptive statistics, Pearson correlations, and mediation analysis. We included 250 adults with IBD (M = 37.9 years old, 64.8% female, 72.4% white). Fifty-four percent of the sample self-reported having a diagnosed sleep disorder. Sleep hygiene and sleep beliefs and attitudes significantly mediated the relationship between sleep disturbance and symptoms (i.e., fatigue, depression, anxiety, and abdominal pain). Whereas the sleep environment and sleep control did not significantly mediate the relationship between sleep disturbance and symptoms. Individuals with IBD experience sleep disturbances, alongside symptoms of anxiety, depression, abdominal pain, and fatigue. Mediation analysis identified sleep hygiene and sleep beliefs, and attitudes as partial mediators. Considering cognitive-behavioral therapy for insomnia is recommended for restructuring these mediating factors. Participants also faced moderate environmental disturbances, suggesting a need for further investigation in this population.

Implantable Cardioverter Defibrillators (ICDs) are essential for managing life-threatening arrhythmias but can impact patients' quality of life (QoL), mood, and sexual health. Although QoL may improve shortly after implantation, factors such as age, psychological state, and ICD shocks can influence long-term outcomes. Anxiety, depression, and fears around physical and sexual activity are common among ICD patients, yet the depth of these effects remains underexplored. This cross-sectional, correlational study examined associations between QoL, mood, and sexual health in 30 adult ICD patients (ages 27-83) within 3 years postimplantation, recruited from a Southeastern U.S. academic medical center. Participants completed the SF-36, Profile of Mood States, and Multidimensional Sexuality Questionnaire. Spearman's correlations indicated that lower QoL was significantly associated with higher mood disturbance (rho = -0.645, p < .001) and lower sexual health (rho = 0.535, p = .005), though no significant link was found between mood disturbance and sexual health (rho = -0.279, p = .168). Multiple linear regression confirmed that QoL was influenced by both mood and sexual health. Post-hoc power analysis using EpiData verified that the sample size (n = 30) provided 90% power with a 5% error rate. These findings underscore the importance of addressing emotional and sexual well-being in ICD patient care. Targeted interventions could improve outcomes, but further research with larger samples is needed to deepen understanding of these relationships.

Effective patient education is critical to an individual's treatment plan when living with diabetes, a debilitating disease requiring extensive knowledge and skills to effectively manage and prevent future morbidity. This descriptive, cross-sectional study assessed the appropriateness of commercially developed patient education materials for rural adults with diabetes. Using electronic health record data from patients (n = 132) with documented health literacy levels (HLL), their HLL scores were reviewed for suitability of educational materials provided by a single rural-border hospital. HLL was measured using the Newest Vital Sign, while educational materials were assessed by two independent reviewers using the Patient Education Materials Assessment Tool for Printable Materials to measure understandability and actionability, and the Simple Measure of Gobbledygook to measure the readability level of documents in both English and Spanish. The mean HLL for Spanish speakers (n = 77) was 2.01 (±1.56), while the mean HLL for English speakers (n = 55) was 2.09 (±1.46), indicating a high likelihood of low health literacy. The materials were evaluated with the English materials achieving an understandability score of 83.33% and an actionability score of 60.00%. By contrast, the Spanish materials scored lower, 61.54% and 20.00%, respectively. In addition, the readability of the materials measured a 9.0 grade level for English materials and a slightly higher 10.8 for Spanish materials. These findings highlight a significant discrepancy between the HLL and the appropriateness of educational materials for the sample population. Although commercially available educational products may provide a budget-concise solution to patient education, particularly in low-resourced organizations, they fail to address the health education needs of the individuals who receive them. Despite the project's limited sample size and single geographical location, it underscores the importance for healthcare organizations to address the health education needs of their communities.

Poor sleep quality is prevalent among patients with chronic heart failure (HF), with fear of progression being one of its independent predictors. However, the pathways through which it exerts its influence have not been fully elucidated. A total of 246 patients with chronic HF, hospitalized in the cardiology department of a hospital from January to June 2024, were selected for this study using a convenience sampling method. Data were collected using the General Information Questionnaire, Social Connectedness Scale, the Fear of Progression Questionnaire-Short Form, and the Pittsburgh Sleep Quality Index. Stratified regression analysis was conducted to assess the effects of fear of progression and social connectedness on sleep quality. The mediating effect of social connectedness in fear of progression and sleep quality was tested by SPSS PROCESS. The mean age of the patients in this study was 73.84 years (SD, 11.53), with 52.4% being female. The study revealed that patients with chronic HF had sleep quality, fear of progression, and social connectedness had mean scores of 11.83 (SD, 3.76), 29.52 (SD, 7.03), and 3.51 (SD, 0.67), respectively. Regression analysis showed that fear of progression positively predicted poor sleep quality (β = .539, p < .001) and social connectedness negatively predicted poor sleep quality (β = -.301, p < .001). Furthermore, fear of progression exerted an indirect effect on sleep quality through its influence on social connectedness. Social connectedness exerts a significant influence on the relationship between fear of progression (FoP) and sleep quality among chronic HF patients. Enhancing social connectedness potentially offers an effective intervention to ameliorate sleep quality in chronic HF patients exhibiting a high level of FoP.

The influence of patient delay on prognosis in patients with ischemic stroke remains unclear. We conducted a systematic review and meta-analysis to determine the association of patient delay with the prognostic outcome of ischemic stroke. PubMed, Web of Science, Embase, Cochrane Library, CNKI, CBM, Wanfang Database, and VIP Database were comprehensively searched from inception to July 24, 2022. All case-control studies, cohort studies, and randomized controlled trials that met the inclusion criteria were retrieved; additionally, manual retrieval and literature tracing were performed. Two reviewers independently screened literature, extracted data, and evaluated the risk of bias in the included studies. Revman 5.3.5 software was used for meta-analysis. We included 14 studies (11 cohort studies and 3 case-control studies) involving 25,337 patients. The results of meta-analysis revealed that the delayed visit group of patients with ischemic stroke had a higher mortality rate, readmission rate, stroke recurrence rate, and adverse outcomes rate than the timely visit group. Among them, mortality (OR = 2.03, 95% CI [1.13, 3.65], p = .02), readmission (OR = 8.17, [4.70, 14.21], p < .001), stroke recurrence rate (OR = 2.66, [1.51, 4.69], p < .001), and adverse outcomes rate (OR = 2.07, [1.18, 3.61], p < .001), respectively. There was no statistical difference in the National Institute of Health Stroke Scale score difference between the delayed visit group and the timely visit group (MD = 1.12, [-0.62, 2.86], p = .21). Patient delay affects the prognosis of patients with ischemic stroke and increases the risk of death, readmission, stroke recurrence, and adverse outcomes. In the future, more in-depth research is needed to verify and expand our research results.