Lingli Li

Background: To ensure smooth surgical procedures, patient safety, and quality of perioperative care, perceived perioperative competence (PPC) is a daily and urgent requirement for operating room (OR) nurses. Understanding the status of PPC among OR nurses and its associated factors is essential for OR nurses/people in charge/researchers to pinpoint weaknesses and formulate interventions. Therefore, we aim to investigate the status of PPC and its associated factors. Furthermore, we explore the relationship between PPC, self-efficacy, and job burnout among OR nurses. Methods: Tertiary-A hospitals in various districts of Chengdu, China, were recruited using a stratified convenience sampling method. A cross-sectional survey was then administered to OR nurses in the selected hospitals. Data analysis included descriptive analysis, T-tests, one-way analysis of variance (ANOVA), multiple linear regression analysis, correlation analysis, and mediation analysis. Results: A survey of 640 OR nurses across 18 hospitals (with a 98.00% valid response rate) revealed an average PPC score of 3.66 ± 1.12/124.55 ± 26.54. Marital status, OR specialty education, and age significantly influenced PPC levels (p < 0.05). Self-efficacy was positively correlated with PPC, while job burnout was negatively correlated with PPC. Self-efficacy fully mediated the relationship between these two variables. Conclusions: The performances of PPC among Chinese OR nurses were acceptable. Marital status, OR specialty education, and age significantly influenced PPC levels. Self-efficacy fully mediates the relationship between job burnout and PPC.

Background: This updated meta-analysis aimed to compare the efficacy, safety, and treatment adherence of mirabegron and vibegron in patients with overactive bladder with head-to-head trials. Methods: A systematic literature search was conducted in PubMed, Embase, ClinicalTrials.gov, and the Cochrane Library from January 1, 2016 to July 6, 2025. Comparative studies evaluating mirabegron versus vibegron were included. Study selection followed the PICOS framework, and quality assessment was performed using the Cochrane Handbook for randomized controlled trials (RCTs) and the Newcastle–Ottawa Scale for non-RCTs. Outcomes included changes in voiding diary parameters, urodynamic measures, overactive bladder symptom scores, adverse events, and treatment adherence. Statistical analyses were conducted using Review Manager 5.3. Results: Six studies met the inclusion criteria. Vibegron was associated with a greater reduction in daily urgency episodes (standardized mean difference [SMD] = 0.37, P = .0006) and urinary urge incontinence (UUI) episodes (SMD = 0.33, P = .006) compared to mirabegron. However, no significant differences were found in other efficacy parameters or overall safety profiles. Vibegron demonstrated better adherence, with a higher continuation rate and lower discontinuation rate. Conclusion: Recent data indicated that vibegron demonstrated superior efficacy in reducing urgency and UUI episodes while maintaining a safety profile comparable to mirabegron. Furthermore, vibegron is associated with improved treatment adherence. However, additional RCTs are necessary to confirm these findings.

Objective: Positive attitudes and strong confidence toward oral healthcare among nursing students are essential prerequisites for providing quality oral healthcare, which directly impacts the likelihood and effectiveness of their post-training care practices. However, no validated scale is currently available in China to measure nursing students’ attitudes toward oral healthcare and confidence. This study aims to adapt the original English version of the attitude and confidence with oral healthcare among nursing students (ACORN) scale into Chinese culture and assess its psychometric properties. Methods: This study followed the Brislin Translation Model, including forward translation, back translation, and expert consultation (consultation of the differences between the original English version and the synthesized back-translated version of the ACORN scale with the original author, pilot testing, expert consultation, and bilingual testing). The formal experiment was conducted across eight universities offering bachelor’s nursing programs in China (Chengdu and Shenyang City), involving 536 nursing students who had completed oral healthcare courses. Item analysis, exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and reliability testing (internal consistency and test–retest reliability) were conducted. The data were divided into two equal sets using the random number table function in SPSS, one for EFA and the other for CFA. Results: The EFA extracted three dimensions: attitudes toward oral care (8 items), confidence in oral care practices (4 items), and confidence in diagnosing oral diseases (10 items), with a cumulative variance contribution rate of 66.33%. The CFA confirmed the three-factor structure with excellent model fit indicators. The overall Cronbach’s alpha for the Chinese version of the ACORN scale was 0.95, with the three dimensions having values of Cronbach’s alphas of 0.92, 0.85, and 0.94, respectively. Twenty nursing students participated in a test–retest survey after a two-week interval, resulting in a test–retest value of 0.76. Conclusion: The Chinese version of the ACORN scale exhibits strong reliability and validity performances and can be used to assess the oral care-related attitudes and confidence of nursing students in China.

Importanc: Large language models (LLMs) with retrieval-augmented generation (RAG) show promise for clinical decision support. However, their application is constrained by limited & outdated vector databases, suboptimal evidence retrieval and poor contextual continuity. Objective: To develop and evaluate a novel LLM-based agent that integrates Evidence-Based Medicine (EBM) principles and contextual conversation capabilities in answering clinical questions. Design, Setting and Participants: The agent for clinical decision making was developed and evaluated between July 1, 2024, and July 31, 2025. The system incorporated an EBM-enabled workflow, a memory module and Thought-Action-Observation (TAO) loops. Evaluation 1 assessed the system’s performance on 150 initial clinical questions across 15 cancer types. Evaluation 2 involved 45 multi-turn dialogue tasks (across 3 types). Baselines were state-of-the-art traditional RAG method and commercial LLMs with plugins. All generated responses across both evaluations were independently rated by 3 experts with over five years of clinical experience. The study was performed at West China Medical Center. Main Outcomes and Measures: Each response in evaluation 1 was classified into one of three predefined categories—correct, inaccurate, or wrong. As for evaluation 2, tasks were deemed successful when previous conversation is remembered and answer is correct, otherwise the task was considered unsuccessful. Results: In evaluation 1, EBMChat generated the highest proportion of accurate responses (89% vs 78% for the best baseline method). The superior performance of EBMChat was associated with its ability to retrieve optimal evidence, demonstrated by significantly higher evidence hierarchy (100% vs 17.5% RCT-level or above), stricter evidence timeliness (within 5 years vs from the 1980s onwards), and more comprehensive retrieval (median of 693 vs 267 items/question). Regarding evaluation 2, EBMChat successfully completed 93% of the tasks. In contrast, GPT-4.1 with plugins (Web Search) achieved a success rate of only 31%. This performance gap was attributed to EBM-enabled workflow, memory module and TAO loops, which ensure robust contextual conversation capabilities. Conclusion and Relevanc: EBMChat identifies appropriate evidence by effectively balancing timeliness, hierarchy, and relevance. Meanwhile, its enhanced conversational capabilities facilitate the preservation of contextual data, enabling users to explore clinical problems more deeply or comprehensively in multi-turn dialogues. Our findings underscore that the effective promotion of clinical practice by AI requires deeper integration of core medical principles into the technology itself, rather than direct application of general-purpose AI tools.

Efficient wound assessment is essential for healthcare teams to facilitate prompt diagnosis, optimize treatment plans, reduce workload, and enhance patients' quality of life. In recent years, non‐invasive techniques for aiding wound assessment, such as digital photography, 3D modelling, optical imaging, fluorescence and thermography, as well as artificial intelligence, have been gradually developed. This paper aims to review the various methods of measurement and diagnosis based on non‐invasive wound imaging, and to summarize their application in wound monitoring and assessment. The goal is to provide a foundation and reference for future research on wound assessment.

Objective: To clarify the effectiveness and safety of psycho-behavioral intervention combined with a non-benzodiazepine to improve perioperative sleep quality in patients undergoing knee arthroplasty, and also to explore the optimal dosage of non-benzodiazepine (oral zolpidem tartrate) to form a standardized sleep quality management process to promote accelerated recovery of patients.Methods: 240 patients undergoing initial unilateral total knee arthroplasty between January and December 2016 were prospectively included and randomly divided into blank control group (group A), psycho-behavioral intervention group (group B), zolpidem tartrate 10 mg group (group C), and psycho-behavioral intervention + zolpidem tartrate 5 mg group (group D). Sleep, pain, psychological, and knee function scores were compared.Results: There were significant differences between the four groups with respect to Pittsburgh sleep quality index scores, sleep efficiency, Epworth Sleepiness Scale scores, inflammatory indices, pain, and enhanced recovery after surgery indices during hospitalization (P < 0.05).Conclusion: Psychological behavioral intervention combined with non-benzodiazepine can improve the perioperative quality of sleep. Compared with drug intervention alone, it reduces the dosage of non-benzodiazepine, alleviates anxiety, improves patient satisfaction, and enhances the quality of life.

使用logistic回归构建适合于关节置换术患者术后睡眠障碍（postoperative sleep disturbance, PSD）的风险预测模型。 回顾性收集四川省成都市某三甲医院2017年1月1日–2021年9月30日行关节置换术的4286例患者资料，其中3001例作为训练集，1285例作为测试集，在Matlab中使用逻辑回归算法筛选预测因子建模，采用列线图展示术后睡眠障碍预测风险。使用受试者工作特征曲线下面积（area under the curve, AUC）、准确率、精度、召回率、F1值和校准曲线进行模型效果评价。 本研究最终纳入入院后术前是否睡眠障碍、病房类型、体质量指数、是否吸烟、疾病范围、关节活动度（屈曲）、关节活动度（伸）、术前末次血红蛋白以及手术类型等9个预测因子进入模型构建。预测模型的AUC值为0.708（95%置信区间：0.677～0.740），准确率为75.20%，精度为65.80%，召回率为43.70%，F1值为0.525，校准曲线显示预测概率与实际一致性较好。 本研究构建的模型预测效能良好，且列线图简便易操作，医护人员可根据预测因子在关节置换术患者术前预测PSD的发生风险，便于及早进行预防，降低患者发生PSD的风险。

Background: Hemiarthroplasty is the standard treatment for patients with femoral neck fractures (FNFs). Controversy exists over the use of bone cement in hip fractures treated with hemiarthroplasty.Objective: We performed an updated systematic review and meta‐analysis to compare cemented and uncemented hemiarthroplasty in patients with femoral neck fractures.Methods: A literature review was conducted using Cochrane Library, ScienceDirect, PubMed, Embase, Medline, Web of Science, CNKI, VIP, Wang Fang, and Sino Med databases. Studies comparing cemented with uncemented hemiarthroplasty for FNFs in elderly patients up to June 2022 were included. Data were extracted, meta‐analyzed, and pooled as risk ratios (RRs) and weighted mean differences (WMDs) with a 95% confidence interval (95% CI).Results: Twenty‐four RCTs involving 3471 patients (1749 cement; 1722 uncemented) were analyzed. Patients with cemented intervention had better outcomes regarding hip function, pain, and complications. Significant differences were found in terms of HHS at 6 weeks (WMD 12.5; 95% CI 6.0–17.0; P < 0.001), 3 months (WMD 3.3; 95% CI 1.6–5.0; P < 0.001), 4 months (WMD 7.3; 95% CI 3.4–11.2; P < 0.001), and 6 months (WMD 4.6; 95% CI 3.3–5.8; P < 0.001) postoperatively. Patients with cemented hemiarthroplasty had lower rates of pain (RR 0.59; 95% CI 0.39–0.9; P = 0.013), prosthetic fracture (RR 0.24; 95% CI 0.16–0.38; P < 0.001), subsidence/loosening (RR 0.29; 95% CI 0.11–0.78; P = 0.014), revisions (RR 0.59; 95% CI 0.40–0.89; P = 0.012), and pressure ulcers (RR 0.43; 95% CI 0.23–0.82; P = 0.01) at the expense of longer surgery time (WMD 7.87; 95% CI 5.71–10.02; P < 0.001).Conclusion: This meta‐analysis demonstrated that patients with cemented hemiarthroplasty had better results in hip function and pain relief and lower complication rates at the expense of prolonged surgery time. Cemented hemiarthroplasty is recommended based on our findings.

Femoral nerve blocks (FNB) can provide effective pain relief but result in quadriceps weakness with increased risk of falls following total knee arthroplasty (TKA). Adductor canal block (ACB) is a relatively new alternative providing pure sensory blockade with minimal effect on quadriceps strength. The meta-analysis was designed to evaluate whether ACB exhibited better outcomes with respect to quadriceps strength, pain control, ambulation ability, and complications. PubMed, Embase, Web of Science, Wan Fang, China National Knowledge Internet (CNKI) and the Cochrane Database were searched for RCTs comparing ACB with FNB after TKAs. Of 309 citations identified by our search strategy, 12 RCTs met the inclusion criteria. Compared to FNB, quadriceps maximum voluntary isometric contraction (MVIC) was significantly higher for ACB, which was consistent with the results regarding quadriceps strength assessed with manual muscle strength scale. Moreover, ACB had significantly higher risk of falling versus FNB. At any follow-up time, ACB was not inferior to FNB regarding pain control or opioid consumption, and showed better range of motion in comparison with FNB. ACB is superior to the FNB regarding sparing of quadriceps strength and faster knee function recovery. It provides pain relief and opioid consumption comparable to FNB and is associated with decreased risk of falls.