Objective:To explore the barriers to nurses applying the best evidence for non-pharmacologic prophylactic management of venous thromboembolism (VTE) in patients with multiple myeloma (MM), and to provide a basis for the development of clinical responses.Methods:A parallel mixed-methods study was conducted in January 2024 to facilitate the selection of nurses from the hematology department of Affiliated Hospital of Jiangsu University to conduct semi-structured in-depth interviews. Concurrently, convenience sampling was employed to select nursing staff from the same departineat for a quantitative questionnaire survey. The interview outlines based on the theoretical domains framework and the questionnaires based on the Barriers to the Application of the Evidence and Facilitators Scale. The questionnaire was developed based on the Barriers and Facilitators to Evidence Application Scale and combined with qualitative and quantitative analyses to derive barriers to nurses' implementation of best evidence.Results:The qualitative study conducted interviews with 9 female nurses in the hematology department, aged 25-49. The quantitative study surveyed 17 female nurses in the hematology department with an average age of (33.18 ± 9.09) years. Nurses scored high overall in evidence application (156.65 ± 20.09) points, with high scores on the organizational form dimension (34.47 ± 1.48) points, the evidence application leader dimension (44.24 ± 1.30) points, the nurses' team dimension (42.53 ± 1.41) points, and the implementation scenario dimension (11.18 ± 0.61) points, which suggests that nurses were process was well supported overall. Low scores on the evidence dimension (11.94 ± 0.91) points and patient dimension (12.41 ± 1.03) points indicated that nurses had barriers in knowledge acquisition and practical application. The results of qualitative interviews further revealed that nurses encourter multiple challenges when applying best evidence, including insufficient knowledge base, low professional identity within societym, absence of standardized departmental protocols, negative outcome expectations, and inadequate motivation coupled with ulcear objectives.Conclusions:There are multiple clinical factors affecting nurses' application of best evidence, and departments should propose targeted coping strategies based on the barrier factors to ensure the successful implementation of evidence-based practice changes, and thus advance the clinical application of best evidence for non-pharmacological prevention of VTE in MM patients.

Objective:To investigate the incidence of shoulder work-related musculoskeletal disorders (WMSDs) among occupational population in China, and to explore their intrinsic association with personal and work-related factors.Methods:In April 2024, 73497 valid questionnaires of the Chinese version of the Musculoskeletal Disorders Electronic Questionnaire were retrospectively analyzed from June 2018 to December 2023 in 22 provinces and 29 key industries in China, and the general information, occurrence of WMSDs and related risk factors of key occupational populations in different regions in China were collected. By using Chi-square test and confirmatory factor analysis, the relationship between shoulder fatigue and pain in key occupational groups and individual factors, work type, work posture and work organization was discussed, and the internal relationship was analyzed based on structural equation model.Results:Higher incidence of shoulder fatigue and pain were associated with female, lack of physical exercise, uncomfortable working posture and neck leaning forward ( P<0.05). Structural equation model analysis showed that work type, work posture and work organization were strongly correlated ( r=0.58, 0.55). Work organization and work type were strongly correlated with shoulder fatigue ( r=0.65) and moderately correlated with shoulder fatigue ( r=0.21). Shoulder fatigue was moderately associated with shoulder pain ( r=0.40). Individual factors, work type, work posture and shoulder fatigue could directly affect shoulder pain ( OR=0.07, -0.09, 0.17 and 0.40), and work type and work posture could also indirectly affect shoulder pain through shoulder fatigue ( OR=0.08, 0.03). Work organization only indirectly affected shoulder pain through shoulder fatigue ( OR=0.26) . Conclusion:The main influencing factor of shoulder pain is shoulder fatigue, followed by work posture and individual factors. Structural equation model can better reflect the complex relationship between work type, work posture and work organization and shoulder WMSDs. Improving work posture and work organization may be an effective way to control the influence of shoulder fatigue on shoulder pain.

Objective:To explore the structural equation model to explore the levels of work-related musculoskeletal disorders (WMSDs) and various risk factors in the feet and ankle of China's occupational population, providing scientific basis for for preventing WMSDs in feet and ankles.Methods:Data of 73497 national occupational epidemiological cases were selected from June 2018 to December 2023 used the Chinese version of the Electronic Questionnaire on Musculoskeletal Disorders. The adverse ergonomic factors and their source classification standard and confirmatory factor analysis were used to investigate foot and ankle WMSDs and their related risk factors (including individual factors, work organization, work posture, work type, fatigue, etc.) in key occupational groups in China, and structural equation model hypothesis, fitting, verification, and path and intermediary effect analysis were carried out. The model fit evaluation indexes included Chi-square specific degrees of freedom ( χ2/ df), gauge fit index (NFI), Tucker Lewis index (TLI), goodness of Fit index (GFI), adjusted Goodness of Fit index (AGFI) and approximate root mean square error (RMSEA) . Results:A total of 73497 occupational workers were surveyed, with local muscle fatigue and WMSDs incidence rates in the feet and ankles being 17.17% and 12.06%, respectively. The fitting index of the adjusted structural equation model basically meets the standard (GFI=1, AGFI=1, RMESA=0.042, NFI=0.716, TLI=0.663). The top three factors affecting feet and ankle WMSDs are feet and ankle muscle fatigue, work type, and work organization, with standardized path coefficients of 0.221, 0.105, and 0.095, respectively. The top two factors affecting feet and ankle muscle fatigue are work organization and work type, with standardized path coefficients of 0.548 and 0.383, respectively. Feet and ankle muscle fatigue, work type, work organization, and work posture have a direct effect on feet and ankle WMSDs, with effect values of 0.221, 0.105, 0.095, and 0.077, respectively. The organization and type of work can also have indirect effects through feet and ankle muscle fatigue, with effect values of 0.121 and 0.084, respectively.Conclusion:Feet and ankle muscle fatigue has a direct impact on WMSDs, and plays a mediating role between ankle and ankle WMSDs caused by work organization and work type. Feet and ankle muscle fatigue is an important pathway leading to feet and ankle WMSDs. It is recommended that employers and managers detect job fatigue early and take corresponding prevention and intervention measures, which can play a key role in preventing feet and ankle WMSDs.

Objective:To explore the structural relationship between WMSDs in the upper limbs and various risk factors in the occupational population in China, based on a large sample epidemiological survey and structural equation analysis, and to establish a structural equation model, so as to lay a foundation for the prevention and control of such diseases.Methods:The Chinese version of the Musculoskeletal Disorders Electronic Questionnaire was used to conduct a nationwide survey on the prevalence of WMSDs in the upper extremity. Six factors related to WMSDs in the upper extremity were extracted by the classification standard of adverse ergonomic factors and their source and confirmatory factor analysis, including work organization, work type, upper extremity work posture, individual factors, upper extremity fatigue and upper extremity WMSDs. The structural equation analysis was carried out and the structural equation model was established.Results:The incidence of WMSDs and fatigue in the upper limbs was 24.44% and 43.76%, respectively. The adjusted structural equation model fitting indicators were generally up to the standard (GFI=1.000, AGFI=1.000, RMSEA=0.043, NFI=0.808, TLI=0.784) . The four exogenous latent variables of work organization, work type, upper limb work posture and individual factors were correlated. There was a strong positive correlation between job type and upper limb work posture ( r=0.865) , a moderate positive correlation between work organization and job type and upper limb work posture ( r=0.570, 0.490) , and a weak negative correlation between individual factors and the other three exogenous latent variables. Upper limb work posture and individual factors had direct effects on upper limb WMSDs, and the effect coefficients were 0.10 and 0.06, respectively. Upper limb fatigue played a mediating role between work organization, work type, upper limb work posture and upper limb WMSDs. The effect coefficient was 0.46, and the composition ratios of indirect effects were 100.0%, 100.0%, and 38.3%, respectively. The direct path effect of upper limb work posture, individual factors and upper limb WMSDs was weaker than the mediating path through upper limb fatigue. Conclusion:When carrying out the prevention and control of upper limbWMSDs, it is necessary to comprehensively consider the pathogenesis path of upper limb muscle fatigue and upper limb WMSDs caused by work organization, work type, and upper limb work posture, so as to provide theoretical reference for improving the prevention and control level of such diseases.

Objective:To explore the barriers to nurses applying the best evidence for non-pharmacologic prophylactic management of venous thromboembolism (VTE) in patients with multiple myeloma (MM), and to provide a basis for the development of clinical responses.Methods:A parallel mixed-methods study was conducted in January 2024 to facilitate the selection of nurses from the hematology department of Affiliated Hospital of Jiangsu University to conduct semi-structured in-depth interviews. Concurrently, convenience sampling was employed to select nursing staff from the same departineat for a quantitative questionnaire survey. The interview outlines based on the theoretical domains framework and the questionnaires based on the Barriers to the Application of the Evidence and Facilitators Scale. The questionnaire was developed based on the Barriers and Facilitators to Evidence Application Scale and combined with qualitative and quantitative analyses to derive barriers to nurses' implementation of best evidence.Results:The qualitative study conducted interviews with 9 female nurses in the hematology department, aged 25-49. The quantitative study surveyed 17 female nurses in the hematology department with an average age of (33.18 ± 9.09) years. Nurses scored high overall in evidence application (156.65 ± 20.09) points, with high scores on the organizational form dimension (34.47 ± 1.48) points, the evidence application leader dimension (44.24 ± 1.30) points, the nurses' team dimension (42.53 ± 1.41) points, and the implementation scenario dimension (11.18 ± 0.61) points, which suggests that nurses were process was well supported overall. Low scores on the evidence dimension (11.94 ± 0.91) points and patient dimension (12.41 ± 1.03) points indicated that nurses had barriers in knowledge acquisition and practical application. The results of qualitative interviews further revealed that nurses encourter multiple challenges when applying best evidence, including insufficient knowledge base, low professional identity within societym, absence of standardized departmental protocols, negative outcome expectations, and inadequate motivation coupled with ulcear objectives.Conclusions:There are multiple clinical factors affecting nurses' application of best evidence, and departments should propose targeted coping strategies based on the barrier factors to ensure the successful implementation of evidence-based practice changes, and thus advance the clinical application of best evidence for non-pharmacological prevention of VTE in MM patients.

Objective:To investigate the incidence of shoulder work-related musculoskeletal disorders (WMSDs) among occupational population in China, and to explore their intrinsic association with personal and work-related factors.Methods:In April 2024, 73497 valid questionnaires of the Chinese version of the Musculoskeletal Disorders Electronic Questionnaire were retrospectively analyzed from June 2018 to December 2023 in 22 provinces and 29 key industries in China, and the general information, occurrence of WMSDs and related risk factors of key occupational populations in different regions in China were collected. By using Chi-square test and confirmatory factor analysis, the relationship between shoulder fatigue and pain in key occupational groups and individual factors, work type, work posture and work organization was discussed, and the internal relationship was analyzed based on structural equation model.Results:Higher incidence of shoulder fatigue and pain were associated with female, lack of physical exercise, uncomfortable working posture and neck leaning forward ( P<0.05). Structural equation model analysis showed that work type, work posture and work organization were strongly correlated ( r=0.58, 0.55). Work organization and work type were strongly correlated with shoulder fatigue ( r=0.65) and moderately correlated with shoulder fatigue ( r=0.21). Shoulder fatigue was moderately associated with shoulder pain ( r=0.40). Individual factors, work type, work posture and shoulder fatigue could directly affect shoulder pain ( OR=0.07, -0.09, 0.17 and 0.40), and work type and work posture could also indirectly affect shoulder pain through shoulder fatigue ( OR=0.08, 0.03). Work organization only indirectly affected shoulder pain through shoulder fatigue ( OR=0.26) . Conclusion:The main influencing factor of shoulder pain is shoulder fatigue, followed by work posture and individual factors. Structural equation model can better reflect the complex relationship between work type, work posture and work organization and shoulder WMSDs. Improving work posture and work organization may be an effective way to control the influence of shoulder fatigue on shoulder pain.

Objective:To explore the structural equation model to explore the levels of work-related musculoskeletal disorders (WMSDs) and various risk factors in the feet and ankle of China's occupational population, providing scientific basis for for preventing WMSDs in feet and ankles.Methods:Data of 73497 national occupational epidemiological cases were selected from June 2018 to December 2023 used the Chinese version of the Electronic Questionnaire on Musculoskeletal Disorders. The adverse ergonomic factors and their source classification standard and confirmatory factor analysis were used to investigate foot and ankle WMSDs and their related risk factors (including individual factors, work organization, work posture, work type, fatigue, etc.) in key occupational groups in China, and structural equation model hypothesis, fitting, verification, and path and intermediary effect analysis were carried out. The model fit evaluation indexes included Chi-square specific degrees of freedom ( χ2/ df), gauge fit index (NFI), Tucker Lewis index (TLI), goodness of Fit index (GFI), adjusted Goodness of Fit index (AGFI) and approximate root mean square error (RMSEA) . Results:A total of 73497 occupational workers were surveyed, with local muscle fatigue and WMSDs incidence rates in the feet and ankles being 17.17% and 12.06%, respectively. The fitting index of the adjusted structural equation model basically meets the standard (GFI=1, AGFI=1, RMESA=0.042, NFI=0.716, TLI=0.663). The top three factors affecting feet and ankle WMSDs are feet and ankle muscle fatigue, work type, and work organization, with standardized path coefficients of 0.221, 0.105, and 0.095, respectively. The top two factors affecting feet and ankle muscle fatigue are work organization and work type, with standardized path coefficients of 0.548 and 0.383, respectively. Feet and ankle muscle fatigue, work type, work organization, and work posture have a direct effect on feet and ankle WMSDs, with effect values of 0.221, 0.105, 0.095, and 0.077, respectively. The organization and type of work can also have indirect effects through feet and ankle muscle fatigue, with effect values of 0.121 and 0.084, respectively.Conclusion:Feet and ankle muscle fatigue has a direct impact on WMSDs, and plays a mediating role between ankle and ankle WMSDs caused by work organization and work type. Feet and ankle muscle fatigue is an important pathway leading to feet and ankle WMSDs. It is recommended that employers and managers detect job fatigue early and take corresponding prevention and intervention measures, which can play a key role in preventing feet and ankle WMSDs.

Objective:To explore the structural relationship between WMSDs in the upper limbs and various risk factors in the occupational population in China, based on a large sample epidemiological survey and structural equation analysis, and to establish a structural equation model, so as to lay a foundation for the prevention and control of such diseases.Methods:The Chinese version of the Musculoskeletal Disorders Electronic Questionnaire was used to conduct a nationwide survey on the prevalence of WMSDs in the upper extremity. Six factors related to WMSDs in the upper extremity were extracted by the classification standard of adverse ergonomic factors and their source and confirmatory factor analysis, including work organization, work type, upper extremity work posture, individual factors, upper extremity fatigue and upper extremity WMSDs. The structural equation analysis was carried out and the structural equation model was established.Results:The incidence of WMSDs and fatigue in the upper limbs was 24.44% and 43.76%, respectively. The adjusted structural equation model fitting indicators were generally up to the standard (GFI=1.000, AGFI=1.000, RMSEA=0.043, NFI=0.808, TLI=0.784) . The four exogenous latent variables of work organization, work type, upper limb work posture and individual factors were correlated. There was a strong positive correlation between job type and upper limb work posture ( r=0.865) , a moderate positive correlation between work organization and job type and upper limb work posture ( r=0.570, 0.490) , and a weak negative correlation between individual factors and the other three exogenous latent variables. Upper limb work posture and individual factors had direct effects on upper limb WMSDs, and the effect coefficients were 0.10 and 0.06, respectively. Upper limb fatigue played a mediating role between work organization, work type, upper limb work posture and upper limb WMSDs. The effect coefficient was 0.46, and the composition ratios of indirect effects were 100.0%, 100.0%, and 38.3%, respectively. The direct path effect of upper limb work posture, individual factors and upper limb WMSDs was weaker than the mediating path through upper limb fatigue. Conclusion:When carrying out the prevention and control of upper limbWMSDs, it is necessary to comprehensively consider the pathogenesis path of upper limb muscle fatigue and upper limb WMSDs caused by work organization, work type, and upper limb work posture, so as to provide theoretical reference for improving the prevention and control level of such diseases.

Background Shoemaking industry workers are prone to work-related musculoskeletal disorders (WMSDs) due to long-term awkward postures during the work process. There is little research on the prevalence and influencing factors of WMSDs in the knee region of this industry, and it should be taken seriously. Objective To estimate the prevalence of work-related knee pain among shoemaking workers and analyze the related influencing factors. Methods A total of 6982 shoemaking workers were selected from 26 shoemaking factories in Guangdong, Hubei, Fujian, Chongqing, Shandong, Zhejiang, and Jingxi by convenience sampling. Prevalence of work-related knee pain in past year, demographic characteristics, occupational related factors, and work posture were collected by a cross-sectional survey using the electronic version of Musculoskeletal Disorder Questionnaire. Logistic regression analysis was used to analyze the influencing factors that may lead to work-related knee pain. Results This survey collected 6982 valid questionnaires with a recovery rate of 98.3%. The prevalence of work-related knee pain of shoemaking workers in the past 12 months was 13.0% (908/6982). According to the results of logistic regression analysis, compared with workers with less than 5 years of service, workers with 5-10 years of service (OR=1.21, 95%CI: 1.02, 1.45) and more than 10 years (1.53, 95%CI: 1.27, 1.83) showed a higher risk of knee WMSDs; sometimes, often and very frequent (reference : rarely or never) long-term standing (OR=1.33, 95%CI: 1.08, 1.64; OR=2.67, 95%CI: 2.10, 3.39; OR=2.75, 95%CI: 2.08, 3.63) and sometimes, often and very frequent (reference: rarely or never) long-term squatting or kneeling (OR=1.80, 95%CI: 1.47, 2.21; OR=2.43, 95%CI: 1.58, 3.75; OR=3.22, 95%CI: 1.66, 6.24) increased the risk of knee pain: long-term bending (OR=1.59, 95%CI: 1.34, 1.89) and often repeated movement of lower limbs and ankles (OR=1.48, 95%CI: 1.25, 1.75) were also risk factors for knee WMSDs among shoemaking industry workers (P<0.05). Adequate rest time (OR=0.58, 95%CI: 0.49, 0.68) and able to stretch or change leg posture (OR=0.75, 95%CI: 0.64, 0.88) reduced the risk of knee WMSDs (P<0.05). Conclusion In the shoemaking industry, length of service and awkward postures are risk factors for knee pain. The shoemaking enterprises should ensure that workers have sufficient rest time, reduce long-term standing, squatting, kneeling, and bending postures, as well as lower limbs repetition in order to reduce the occurrence of knee WMSDs of workers.

Objective:To investigate the influencing factors of cardiac autonomic dysfunction in maintenance hemodialysis (MHD) patients by recording 48 h heart rate variability.Methods:It was a single-center cross-sectional study. MHD patients at the Hemodialysis Center of Peking University People's Hospital between October 1, 2021 and December 31, 2022 were enrolled in the study. These patients initiated hemodialysis for more than three months and were older than 18 years old, and patients with tachyarrhythmia, implanted cardiac pacemaker and the recording time less than 48 h were excluded. Demographic data, comorbidity, laboratory data, hemodialysis session data and heart rate variability were collected. Multivariate linear regression model was used to analyze the influencing factors for cardiac autonomic dysfunction in MHD patients.Results:A total of 110 patients were enrolled in the study, including 37 females (33.6%) and 36 diabetic patients (32.7%). The age of the patients was (57.8±14.8) years old, and the median dialysis vintage was 73.00(27.75±130.25) months. At baseline, the serum phosphate level was (1.6±0.4) mmol/L, and the N-terminal pro B-type natriuretic peptide (NT-proBNP) after ln transformed {ln[NT-proBNP(ng/L)]} was 8.4±1.2. The standard deviation of all normal R-R interval (SDNN) was (90.6±27.9) ms, ln[root mean square of successive differences in R-R interval (RMSSD, ms)] 3.2±0.8, ln[low frequency (ms 2)] 3.4±1.3, ln[high frequency (ms 2)] 3.1±1.4, and ln[low frequency/high frequency ratio] 0.28±0.64. After adjusting the age, coronary heart disease, diabetes, hemoglobin, serum phosphate and 25-hydroxy-vitamin D, serum natrium ( β=2.042, 95% CI 0.021–4.064, P=0.048) and ln[NT-proBNP (ng/L)] ( β=-7.027, 95% CI -12.247–-1.808, P=0.009) were independently correlated with SDNN (adjusted R2=0.218). Univariate linear regression model showed that diabetes was correlated with ln[low frequency(ms 2)] of MHD patients ( β=-0.659, 95% CI -1.171–-0.146, P=0.012), but in the multivariate linear regression model, significant correlation between diabetes and low frequency was not found. After adjusting the diabetes, coronary heart disease, dialysis vintage, hemoglobin, serum phosphate, serum albumin, pre-dialysis systolic blood pressure, post-dialysis systolic blood pressure, pre-dialysis diastolic blood pressure, increasing age ( β=-0.011, 95% CI -0.019–-0.003, P=0.007) and ln[NT-proBNP(ng/L)] ( β=-0.151, 95% CI -0.253–-0.048, P=0.004) were independently correlated with a decrease in the ln[low frequency/high frequency ratio]. In the multivariate linear regression model with ln[high frequency(ms 2)] or ln[RMSSD(ms)] as dependent variable, after adjusting the relevant factors, serum phosphate level was independently correlated with ln[RMSSD(ms)] ( β=-0.421, 95% CI -0.777–-0.065, P=0.021) or ln[high frequency(ms 2)] ( β=-0.752, 95% CI -1.325–-0.180, P=0.010). Conclusions:Hyperphosphatemia is an independent influencing factor of parasympathetic nervous system in MHD patients. Higher NT-proBNP is associated with lower SDNN and lower ratio of low frequency/high frequency, so serum phosphate control and volume control should be highlighted. Age is associated with autonomic dysfunction in MHD patients, so more attention should be paid to elder patients.