Multicenter Cross-sectional Study Research Articles

The non-linear associations between blood manganese level and sarcopenia in patients undergoing maintenance hemodialysis: A multicenter cross-sectional study

Background and aimsManganese (Mn), a vital element in energy metabolism, is predominantly stored in skeletal muscles and plays a crucial role in muscle function and strength. Patients on maintenance hemodialysis (MHD) often experience muscle wasting due to metabolic disruption and inflammation. This study aimed to explore the relationship between blood Mn levels and sarcopenia in a patient population. MethodsIn this multicenter cross-sectional study, conducted from March 2021 to March 2022, 386 patients on MHD from three medical centers were included. Blood Mn levels were measured using inductively coupled plasma mass spectrometry, and body composition was assessed post-dialysis using bioelectrical impedance analysis. Grip strength was measured using a digital dynamometer. The patients were categorized into groups with and without sarcopenia. Using a generalized additive model to fit a smooth curve, we employed a generalized linear model to identify the optimal inflection point and explore the threshold effect after discovering a segmented relationship. Subsequently, a binary logistic regression analysis was conducted to investigate the relationship between blood manganese levels and the risk of sarcopenia, with adjustments made for potential confounding factors. ResultsA negative correlation was observed between blood Mn levels and sarcopenia-related parameters (Appendicular Skeletal Muscle Mass Index and grip strength) in Spearman’s correlation analysis (both P < 0.05). After adjusting for confounding factors, a nonlinear association was identified. When blood Mn was ≤ 10.6 μg/L, the increase in sarcopenia was not statistically significant (P > 0.05). Conversely, when blood Mn exceeded 10.6 μg/L, each 1 μg/L increase raised the risk of sarcopenia by 0.1 times. Considering confounders, multivariate binary logistic regression confirmed an independent association between elevated blood Mn levels and sarcopenia. ConclusionThis study revealed an independent association between elevated blood Mn levels (> 10.6 μg/L) and sarcopenia in patients undergoing MHD. These findings emphasize the importance of understanding the Mn metabolism in the context of muscle health in this patient population. Further research is warranted to explore the underlying mechanisms and potential interventions for mitigating sarcopenia in patients with elevated blood Mn levels undergoing MHD.

Chinese Healthcare Workers' Knowledge, Attitudes, and Practices in Diabetic Kidney Management: A Multi-Centered Cross-Sectional Study.

Given the importance of diabetic kidney disease (DKD) management, this study aims to explore the knowledge, attitudes, and practices in disease management demonstrated by healthcare workers from the nephrology department. This study is a multi-centered cross-sectional study, and adopts snowball sampling, with 530 healthcare workers being recruited to complete a questionnaire covering areas such as demographic characteristics, knowledge, attitude, and practices (KAP) of DKD management. This data was analyzed using descriptive statistics and binary logistics analysis. In this study, 530 healthcare workers were studied, including 94 doctors and 436 nurses. The participants were mainly from general tertiary hospitals in 14 provinces. For Chinese nurse, the results indicate that both poor knowledge level (Odds Ratio (OR) =0.63, 95% Confidence Interval (CI): 0.42-0.94) and having experience in further medical training in nephrology (OR=1.92, 95% CI: 1.20-3.08) are associated with the practice levels. For Chinese doctors, having not experience in further medical training in nephrology (OR=0.36, 95% CI: 0.15-0.83) are associated with their practice levels. In summary, Chinese doctors and nurses in this study showed positive attitudes towards DKD management, but their knowledge and practical skills were lacking. This underscores a notable gap in achieving optimal DKD care. Notably, nurses' knowledge influenced their management practices, and additional nephrology training correlated with better engagement. To improve patient care, enhancing nephrology healthcare professional training and addressing knowledge-practice disparities are recommended.

Community-acquired pneumonia: use of clinical characteristics of acutely admitted patients for the development of a diagnostic model – a cross-sectional multicentre study

ObjectivesThis study aimed to describe the clinical characteristics of adults with suspected acute community-acquired pneumonia (CAP) on hospitalisation, evaluate their prediction performance for CAP and compare the performance of the...

Anti-TB treatment non-adherence predictors: A multi-center cross-sectional study in Kandahar, Afghanistan

BackgroundAdherence to anti-TB treatment in low- and middle-income countries (LMICs), including Afghanistan, is critical for global TB control. ObjectivesWe aimed to determine anti-TB treatment non-adherence prevalence and its predictors in Kandahar, Afghanistan. MethodsWe conducted a multi-center cross-sectional study of 579 TB patients in Kandahar, using a systematic random sampling method, and collected their data on sociodemographic attributes, clinical factors, and mental health. The eight-item Tuberculosis Medication Adherence Questionnaire (TBMAQ) was used for labeling TB patients as adherent or non-adherent. We assigned a score of ≤4 (the cut-off) as non-adherence. We performed the multivariable logistic regression to probe significant predictors of non-adherence. ResultsThe non-adherence rate in this study was 66.8% (95% CI: 62.9–70.5). Being uneducated (AOR = 1.66, 95 % CI: 1.09–2.53), having a comorbid medical condition (AOR = 2.57, 95 % CI: 1.39–4.74), feeling stigmatized for having TB (AOR = 9.25, 95 % CI: 4.72–18.1), and having a comorbid depression (AOR = 1.77, 95 % CI: 1.16–2.71) were associated with non-adherence. ConclusionAnti-TB treatment adherence needs to be prioritized among TB patients overall, particularly in those with a low level of education, comorbidity, perceived TB-related stigma, and comorbid depression with consistent evidence of increased non-adherence.

Perceived stress and coping strategies after unsuccessful cardiopulmonary resuscitation among pre-hospital emergency technicians: A multicenter cross-sectional study

BackgroundEffective stress management after unsuccessful cardiopulmonary resuscitation (CPR) requires the determination of perceived stress and identification and reinforcement of effective coping strategies. Therefore, the present study was conducted to determine perceived stress and coping strategies after unsuccessful CPR for the first time among Iranian pre-hospital emergency technicians. MethodsA cross-sectional, descriptive, correlational, multicenter study was conducted in 2022. The research population included all pre-hospital emergency technicians working in 44 urban, road, and aerial pre-hospital emergency stations in 22 counties of Ilam Province, west of Iran. A total of 374 technicians worked in these stations, which were included in the study by census method according to the inclusion criteria. The data collection tools were the Questionnaire of perceived stress after unsuccessful CPR and Brief Coping Orientation to Problems Experienced (COPE) Inventory. The collected data were analyzed with SPSS software version 27 using descriptive and analytical statistics (Pearson correlation test, multiple linear regression analysis, independent sample T-test, and ANOVA) at a significance level of p ≤ 0.05. ResultsThe perceived stress was at a moderate level with a mean score of 65.56 ± 14.21. Among six coping strategies, problem-focused coping had the highest (3.01 ± 0.59) and denial had the lowest mean value (1.94 ± 0.79). Perceived stress had a significant direct relationship with 5 coping strategies, including problem-focused coping, support-focused coping, emotion-focused coping, self-distraction, and religion (p < 0.05). The strongest relationship was found between perceived stress and self-distraction followed by emotion-focused coping. According to the results of multiple regression analysis, emotion-focused coping and self-distraction had predictive roles. ConclusionThe participants used different coping strategies to cope with the stress of unsuccessful CPR. The most common coping mechanisms used by the participants were problem-focused, emotion-focused, and support-focused coping. Pre-hospital emergency officials can assist pre-hospital emergency technicians in coping with occupational stress, including the stress of unsuccessful CPR, through organizing educational courses, teaching effective coping strategies, and offering support programs.

The current status and challenges of perioperative management of patients with a BMI of greater than or equal to 50kg/m 2 undergoing bariatric surgery in China: a multicenter cross-sectional study.

Performing bariatric surgery on patients with a BMI of over 50kg/m 2 is challenging. This study aimed to explore the status and challenges related to the perioperative management of such patients in China. A prospective survey was designed to investigate the perioperative management of patients with a BMI of greater than or equal to 50kg/m 2 undergoing bariatric surgery in China. The questionnaire of our survey included general information, preoperative management measures, surgical procedures performed, technical details regarding anaesthesia, and postoperative management measures. A response from only one attending physician per bariatric centre was accepted. Physicians from a total of 101 hospitals responded to the questionnaire, and the questionnaire data from 98 hospitals were complete. These centres had completed a total of 44702 bariatric surgeries since the launch of such surgery to December 2021. A total of 3280 patients had a BMI exceeding 50kg/m 2 . The preferred surgical procedures for patients with super obesity were sleeve gastrectomy by 62 centres, Roux-en-Y gastric bypass by 11 centres, sleeve gastrectomy plus jejunojejunal bypass by 19 centres, one anastomosis gastric bypass by 1 centre, and duodenal switch by 1 centre. The most worrying issues were cardiopulmonary failure and difficulty in extubation. 91 centres believed that preoperative weight loss was beneficial. A low-calorie diet was the specific measure mainly implemented, only three centres considered using intragastric balloon placement. Postoperative management measures varied greatly. Bariatric surgery has seen rapid development. Chinese physicians show significant differences regarding the perioperative management for patients with a BMI of over 50kg/m 2 . The perioperative risks of these patients remain relatively high, making further development of clinical pathways is necessary.

Nurses' Personality Traits and Perceived Work Environments During Public Health Emergencies: Implications for Nursing Workforce Planning.

The nursing workforce faces substantial challenges, particularly in the aftermath of the COVID-19 era. Developing an effective strategy for workforce maintenance and the strategic deployment of nurses is crucial. This study aimed to explore and categorize nurses' personality traits, with a focus on analyzing differences in their perceptions of the nursing work environment. Between January 2023 and February 2023, a multi-center cross-sectional study was carried out involving nurses from 12 tertiary hospitals actively engaged in frontline COVID-19 response duties. Through cluster sampling, surveys were distributed among eligible nursing staff, comprising a general information questionnaire, the Chinese Big Five Personality Questionnaire-Short Form, subjective evaluations of emergency nursing management, and the Chinese Nursing Work Environment Scale for Public Health Emergencies. Various statistical analyses, such as descriptive analysis, cluster analysis, non-parametric tests, and general linear model analysis, were employed to investigate the correlation between personality types and the perception of nursing work environments. The analysis encompassed 1059 valid questionnaires, reflecting the experiences of frontline nurses. The majority of these nurses possessed 1-5 years of experience, held junior professional titles, volunteered for their roles, and served as attending nurses. Categorization based on personality traits revealed three groups: resilient (35.60%), ordinary (16.15%), and distressed (48.25%) types. Significantly distinct perceptions of nursing work environments emerged among these categories, with resilient and ordinary types expressing notably higher satisfaction compared to the distressed group (H value = 256.487, p < 0.001). This study illustrates the connection between nurses' perceived working environment and their personality traits. Nursing managers should factor in nurses' personality traits when choosing and deploying frontline responders during public health emergencies. Prioritizing resilient-type nurses and crafting a supportive work environment that aligns with nurses' characteristics is indispensable for an effective emergency response.

Knowledge level and health information-seeking behavior of people with diabetes in rural areas: a multicenter cross-sectional study.

There is a lack of research on the current level of diabetes knowledge and health information-seeking behaviors among patients with diabetes in rural areas of China's economically underdeveloped regions during COVID-19, as well as a lack of up-to-date evidence on glycemic control and the incidence of complications among rural patients with diabetes. To investigate the prevalence of glycemic control and complications among patients with diabetes in rural areas, to explore the current status and correlation of diabetes knowledge level and health information-seeking behavior, and to analyze the factors affecting diabetes knowledge level. From January 2022 to July 2022, we conducted a screening on diabetic complications and a questionnaire survey among 2,178 patients with diabetes in 15 county hospitals in rural areas of Guangxi Zhuang Autonomous Region. The patients' knowledge level and health information-seeking behavior were investigated. Spearman correlation analysis was used to assess the correlation between diabetes knowledge and health information-seeking behavior. Multiple linear regression analysis was used to test how demographic information and health information-seeking behavior influenced the level of diabetes knowledge. Of 2,178 patients with diabetes in rural areas, 1,684 (77.32%) had poor glycemic control, and the prevalence of diabetic complications was estimated to be 72.13%. Patients with diabetes had poor diabetes knowledge and health information-seeking behavior, and there is a strong positive correlation between them. Diabetes knowledge level was influenced by per capita household disposable income, occupational status, gender, age, ethnicity, family history of diabetes, insulin use, glycated hemoglobin, education level, number of complications and health information-seeking behavior. Patients with diabetes in rural areas have poor glycemic control and a high incidence of diabetic complications. Patients with diabetes in rural areas have poor knowledge and inadequate health information-seeking behavior. Systematic and standardized education should be provided to improve patients' diabetes knowledge and thus improve their self-management ability.

Status of the midwifery workforce and childbirth services and the impact of midwife staffing on birth outcomes in China: a multicentre cross-sectional study

ObjectiveTo investigate the status of the midwifery workforce and childbirth services in China and to identify the association between midwife staffing and childbirth outcomes.DesignA descriptive, multicentre cross-sectional survey.SettingMaternity hospitals from...

Epidemiological predictors of quality of life and the role of early markers in children with cerebral palsy: A multi-centric cross-sectional study

BackgroundMore than 100 million children in the world have at least one type of disability. Among disabled children, approximately 25% of chronic disabilities are of neurological origin. Cerebral Palsy is the leading cause of chronic disability in children, making them not only physically and mentally handicapped but also socially aloof. MethodsThis study was conducted among 200 eligible participants from three centers with Child Guidance or Cerebral Palsy clinics in the outpatient department. All the participants were included in the analysis of the epidemiological profile and the role of early markers. Of these, 70 participants were assessed for quality of life according to the age criteria of a pre-tested Cerebral Palsy Quality of Life questionnaire (CP-QOL). ResultsMean ± S.D. age in years was 3.7 ± 2.8. Birth history included 182 (39%) neonatal etiopathology, followed by 173 (38%) perinatal, and 106 (23%) antenatal causes. Mean ± S.D. birth weight was 2.3 ± 1.2 kg. The positive predictors of various domains of Quality of Life were an absence of any associated sensory, neurological, communication, or psychological disorder or disability. While, the negative predictors were decreasing functional capacity, involvement of number of limbs in increasing order, high therapeutic requirements, and dependency. ConclusionThe association between early diagnosis of cerebral palsy and improved functional capacity, involvement of a lesser number of limbs, better quality of life, and absence of associated disabilities is established from the findings of our study.

Risk-adjusted trend in national inpatient fall rates observed from 2011 to 2019 in acute care hospitals in Switzerland: a repeated multicentre cross-sectional study

ObjectivesThis study aimed to investigate whether a significant trend regarding inpatient falls in Swiss acute care hospitals between 2011 and 2019 could be confirmed on a national level, and whether...

Paediatric off-label use of drugs in Gansu, China: a multicentre cross-sectional study

ObjectiveTo examine the current prevalence and cost of paediatric off-label drug prescriptions in Gansu, China, and the potential influencing factors.DesignThe prevalence of off-label prescriptions in paediatrics was evaluated according to...

Prevalence of smoking and its associated factors among students of the University of Dongola, Northern State, Sudan: a cross-sectional study.

Smoking is one of the leading causes of morbidity and mortality worldwide, and its prevalence has increased globally, particularly among university students. The study aimed to assess the smoking prevalence and its associated factors among students at University of Dongola, Northern State, Sudan. A multi-centred cross-sectional study was conducted among students of University of Dongola. Data was collected via an online Google form questionnaire. Descriptive and comparative analyses were performed using SPSS, version 26. Statistical significance was considered at p less than or equal to 0.05. A total of 642 students participated in the study, of which 51.9% were females. Most of the students (73.6%) were aged 20-25 years and came from health & medical faculties (60.7%). The overall prevalence of smoking was 11.7%. The determined risk factors for smoking included male gender (P≤0.001), older age (P≤0.001), non-health and non-medical faculties (P≤0.001), uneducated fathers (P=0.032), and low socio-economic status (P=0.001). The most common reason for smoking was stress (36%), with cigarettes being the most commonly used type (88%). Personal savings were the main source of smoking expenses (73.3%). Most smokers (88%) were aware of the harmful effects of smoking. The overall smoking prevalence was relatively low among students at University of Dongola. Male gender, older age, non-health and non-medical faculties, uneducated fathers, and low socio-economic status were significant risk factors for smoking. The majority of smokers were aware of the harmful effects of smoking.

Self-reported competence among advanced practice nursing students in Denmark, Finland and Norway: a cross-sectional multicentre study.

The health care systems in the Nordic countries and worldwide are under pressure due to increased longevity and a shortage of nurses. Providing nurses with a high level of education, such as advanced practice nursing, is of great importance to ensure effective, safe and high-quality care. The aim of this study was to investigate self-reported competence using the Nurse Professional Competence Scale Short-Form for the first time among master's students of advanced practice nursing in the Nordic countries and to relate the findings to age, work obligations, child-rearing responsibilities, level of education and clinical nursing experience. A multicentre, cross-sectional design was used in this study conducted at five universities in Denmark, Finland and Norway. The Nurse Professional Competence Scale Short-Form consisting of six competence areas was used with a maximum score of 7 per item for the analysis of single items and a transformed scale from 14.3 to 100 for analysing the competence areas (higher score equals higher self-reported competence). Descriptive and comparative statistics were used to analyse the data. The highest mean score was found for the competence area 'Value-based nursing care'. Students living with home-dwelling children (≤ 18 years) reported significantly higher competence in 'Nursing care', while students ≥33 years reported significantly higher competence in 'Nursing care' and 'Value-based nursing care'. No significant differences were found between students working and those not working alongside their studies, between students with and without further nursing-related education, or between students with long and short experience as nurses. The findings from this study might help to further develop curricula in advanced practice nursing master's programmes to ensure high-quality nursing and sustainable health care in the future. Future high-quality master's programmes might benefit from systematic collaboration between Nordic higher education institutions as also Sweden is planning master's programme. Higher age, having children at home and working while studying should not be considered causes for concern.

Development and Validation of an Automatic Ultrawide-Field Fundus Imaging Enhancement System for Facilitating Clinical Diagnosis: A Cross-Sectional Multicenter Study

In ophthalmology, the quality of fundus images is critical for accurate diagnosis, both in clinical practice and in artificial intelligence (AI)-assisted diagnostics. Despite the broad view provided by ultrawide-field (UWF) imaging, pseudocolor images may conceal critical lesions necessary for precise diagnosis. To address this, we introduce UWF-Net, a sophisticated image enhancement algorithm that takes disease characteristics into consideration. Using the Fudan University ultra-wide-field image (FDUWI) dataset, which includes 11 294 Optos pseudocolor and 2415 Zeiss true-color UWF images, each of which is rigorously annotated, UWF-Net combines global style modeling with feature-level lesion enhancement. Pathological consistency loss is also applied to maintain fundus feature integrity, significantly improving image quality. Quantitative and qualitative evaluations demonstrated that UWF-Net outperforms existing methods such as contrast limited adaptive histogram equalization (CLAHE) and structure and illumination constrained generative adversarial network (StillGAN), delivering superior retinal image quality, higher quality scores, and preserved feature details after enhancement. In disease classification tasks, images enhanced by UWF-Net showed notable improvements when processed with existing classification systems over those enhanced by StillGAN, demonstrating a 4.62% increase in sensitivity (SEN) and a 3.97% increase in accuracy (ACC). In a multicenter clinical setting, UWF-Net-enhanced images were preferred by ophthalmologic technicians and doctors, and yielded a significant reduction in diagnostic time ((13.17 ± 8.40) s for UWF-Net enhanced images vs (19.54 ± 12.40) s for original images) and an increase in diagnostic accuracy (87.71% for UWF-Net enhanced images vs 80.40% for original images). Our research verifies that UWF-Net markedly improves the quality of UWF imaging, facilitating better clinical outcomes and more reliable AI-assisted disease classification. The clinical integration of UWF-Net holds great promise for enhancing diagnostic processes and patient care in ophthalmology.

Management Reality of Female Patients with COPD: A Multicenter Cross-Sectional CAP Study in Japan.

Reports from Europe and North America suggest that female chronic obstructive pulmonary disease (COPD) patients have a higher symptom burden and mortality than male patients. However, little is known about the management reality of female patients with COPD in Japan. We compared the clinical characteristics of female COPD patients with those of male using the cohort of the COPD Assessment in Practice study, which is a cross-sectional multicenter observational study. Of the 1168 patients, 133 (11.4%) were female. A history of never smoking was higher in females than males (p<0.01). Although there was no difference in age or forced expiratory volume in one second (FEV1) % predicted between the groups, modified medical research council dyspnea scale (mMRC) and number of frequent exacerbators were higher in females (mMRC≥2: p<0.01; number of exacerbations≥2: p=0.011). The mean forced vital capacity and FEV1 values in females were lower than those in males (p<0.0001 and p<0.0001, respectively). Females were more likely to use long-term oxygen therapy and inhaled corticosteroids than males (p=0.016 and p<0.01, respectively). The prevalence of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) groups B, C, D (ABCD GOLD 2017 classification), and E (ABE GOLD 2023 classification) was higher in females than in males. The disease burden of female patients with COPD is higher than that of male patients in Japan, suggesting the importance of interventions considering female-dominant features such as lower absolute FVC and FEV1, respiratory failure, and asthma-like conditions.

Assessing satisfaction in simulation among nursing students: psychometric properties of the Satisfaction with Simulation Experience - Italian Version scale

BackgroundThe Satisfaction with Simulation Experience scale is a 5-point Likert scale that measures students’ satisfaction in medium and high-fidelity simulation scenarios. This study aims at investigating the psychometric properties of the Satisfaction with Simulation Experience - Italian Version scale.MethodsA multi-centre cross-sectional study was conducted. The scale was administered to a sample of 266 undergraduate nursing students from two Italian universities after attending a medium- and high-fidelity simulation session in November 2022 and March 2023. Cronbach’s alpha coefficient and item-total correlation were sorted out to assess internal consistency and reliability. The test-retest method was used as a measure of scale stability over time as well as the confirmatory factor analysis to verify construct validity.ResultsThe Cronbach’s alpha value was 0.94 for the overall scale, indicating excellent reliability, and it was 0.84 or higher for each subscales, indicating good reliability. A large correlation coefficient of 0.60 or higher was found between each item and its subscale and between each item and the overall scale score. A medium test-retest correlation coefficient was found for most items (r > 0.30). The confirmatory factor analysis confirmed the factorial structure found in the original study.ConclusionsSatisfaction is an important teaching and learning quality indicator along with the achievement of learning outcomes in simulation. The Satisfaction with Simulation Experience - Italian Version scale showed good reliability and validity; therefore, it could be a useful tool to assess simulation impact in Italian nursing students. The extensive utilization of the Satisfaction with Simulation Experience scale, along with its various validated versions, could facilitate assessing satisfaction in simulation across diverse contexts and enable comparisons of findings across studies in different countries.

Molecular characterization of carbapenemase and extended spectrum beta-lactamase producing Acinetobacter baumannii isolates causing surgical site infections in Ethiopia

BackgroundAcinetobacter baumannii is an opportunistic pathogen that can cause a variety of nosocomial infections in humans. This study aimed to molecularly characterize extended-spectrum beta-lactamase (ESBL) producing and carbapenem-resistant Acinetobacter species isolated from surgical site infections (SSI).MethodsA multicentre cross-sectional study was performed among SSI patients at four hospitals located in Northern, Southern, Southwest, and Central parts of Ethiopia. The isolates were identified by microbiological methods and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). Antibiotic susceptibility was determined using disk diffusion. The presence of phenotypic ESBL and carbapenemase production was detected by employing standard microbiological tests, including combined disk diffusion (CDT). ESBL and carbapenem resistance determinants genes were studied by polymerase chain reaction (PCR) and sequencing.ResultsA total of 8.7% Acinetobacter species were identified from 493 culture-positive isolates out of 752 SSI wounds. The species identified by MALDI-TOF MS were 88.4% A. baumannii, 4.7% Acinetobacter pittii, 4.7% Acinetobacter soli, and 2.3% Acinetobacter lactucae. Of all isolates 93% were positive for ESBL enzymes according to the CDT. Using whole genome sequencing 62.8% of the A. baumannii harbored one or more beta-lactamase genes, and 46.5% harbored one or more carbapenemase producing genes. The distribution of beta-lactamases among Acinetobacter species by hospitals was 53.8%, 64.3%, 75%, and 75% at JUSH, TASH, DTCSH, and HUCSH respectively. Among ESBL genes, blaCTX−M alleles were detected in 21.4% of isolates; of these 83.3% were blaCTX−M−15. The predominant carbapenemase gene of blaOXA type was detected in 24 carbapenem-resistant A. baumannii followed by blaNDM alleles carried in 12 A. baumannii with blaNDM−1 as the most common.ConclusionsThe frequency of Acinetobacter species that produce metallobetalactamases (MBLs) and ESBLs that were found in this study is extremely scary and calls for strict infection prevention and control procedures in health facilities helps to set effective antibiotics stewardship.

The role of nurse-patient mutuality on self-care behaviours in patients with chronic illness.

To examine the role of nurse-patient mutuality on three self-care behaviours in chronic illness patients. A cross-sectional multi-centre study was conducted. Mutuality was measured with the Nurse-Patient Mutuality in Chronic Illness scale which has the dimensions of developing and going beyond, being a point of reference and deciding and sharing care, and self-care was measured with the Self-care of Chronic Illness Inventory (SC-CII). Multivariable linear regression analyses were used to assess the contribution of three dimensions of mutuality on self-care maintenance, monitoring and management behaviours controlling for patient gender, age, education, number of medications, and presence of a family caregiver. The sample included 465 inpatients and outpatients with at least one chronic illness. The three dimensions of mutuality had different roles in their influence on the three dimensions of self-care. Developing and going beyond was significantly associated with self-care maintenance and self-care monitoring behaviours. Point of reference was significantly associated with self-care maintenance behaviour. Deciding and sharing care was significantly associated with self-care monitoring and self-care management behaviours. The mutuality between nurse and patient may be a novel area of research to support and improve patient self-care behaviours with implications for clinical practice and education. Mutuality between nurse and patient increases patient engagement, symptom recognition, decision-making process and patient-centred approach favouring the development of self-care behaviours. Mutuality between nurse and patient is a new concept and its association with the patient outcomes could bring relevance to the nursing profession. Self-care behaviours are important in the management of chronic diseases, but are difficult to perform. Mutuality between nurse and patient influences the three different behaviours of self-care in chronic illness, for this reason it is important to increase the level of mutuality in this dyad. STROBE checklist for cross-sectional studies was followed in this study. Patients were involved in the sample of the study.

Nursing Students' Attitudes Toward Technology: Multicenter Cross-Sectional Study.

The growing presence of digital technologies in health care requires the health workforce to have proficiency in subjects such as informatics. This has implications in the education of nursing students, as their preparedness to use these technologies in clinical situations is something that course administrators need to consider. Thus, students' attitudes toward technology could be investigated to assess their needs regarding this proficiency. This study aims to investigate attitudes (enthusiasm and anxiety) toward technology among nursing students and to identify factors associated with those attitudes. Nursing students at 2 universities in Sweden and 1 university in Poland were invited to answer a questionnaire. Data about attitudes (anxiety and enthusiasm) toward technology, eHealth literacy, electronic device skills, and frequency of using electronic devices and sociodemographic data were collected. Descriptive statistics were used to characterize the data. The Spearman rank correlation coefficient and Mann-Whitney U test were used for statistical inferences. In total, 646 students answered the questionnaire-342 (52.9%) from the Swedish sites and 304 (47.1%) from the Polish site. It was observed that the students' technology enthusiasm (techEnthusiasm) was on the higher end of the Technophilia instrument (score range 1-5): 3.83 (SD 0.90), 3.62 (SD 0.94), and 4.04 (SD 0.78) for the whole sample, Swedish students, and Polish students, respectively. Technology anxiety (techAnxiety) was on the midrange of the Technophilia instrument: 2.48 (SD 0.96), 2.37 (SD 1), and 2.60 (SD 0.89) for the whole sample, Swedish students, and Polish students, respectively. Regarding techEnthusiasm among the nursing students, a negative correlation with age was found for the Swedish sample (P<.001; ρSwedish=-0.201) who were generally older than the Polish sample, and positive correlations with the eHealth Literacy Scale score (P<.001; ρall=0.265; ρSwedish=0.190; ρPolish=0.352) and with the perceived skill in using computer devices (P<.001; ρall=0.360; ρSwedish=0.341; ρPolish=0.309) were found for the Swedish, Polish, and total samples. Regarding techAnxiety among the nursing students, a positive correlation with age was found in the Swedish sample (P<.001; ρSwedish=0.184), and negative correlations with eHealth Literacy Scale score (P<.001; ρall=-0.196; ρSwedish=-0.262; ρPolish=-0.133) and with the perceived skill in using computer devices (P<.001; ρall=-0.209; ρSwedish=-0.347; ρPolish=-0.134) were found for the Swedish, Polish, and total samples and with the semester only for the Swedish sample (P<.001; ρSwedish=-0.124). Gender differences were found regarding techAnxiety in the Swedish sample, with women exhibiting a higher mean score than men (2.451, SD 1.014 and 1.987, SD 0.854, respectively). This study highlights nursing students' techEnthusiasm and techAnxiety, emphasizing correlations with various factors. With health care's increasing reliance on technology, integrating health technology-related topics into education is crucial for future professionals to address health care challenges effectively. RR2-10.2196/14643.