COVID-19 can create a viral-induced myopathy resulting in dyspnea. Respiratory muscle strength training has recently been reported to reduce persistent dyspnea in individuals with post-COVID-19 symptomology. This study aimed to determine the effectiveness of a 12-week home-based, respiratory muscle strength training program in reducing dyspnea and to determine its feasibility and acceptability. This single-group trial included adults > 4 weeks beyond the acute COVID illness. Participants were assessed in person at baseline, 6, and 12 weeks for dyspnea, pulmonary symptoms, quality of life, pulmonary function, and functional capacity. Participants received inspiratory and expiratory respiratory muscle strength trainers, diaries, weekly phone calls, and were shown how to perform the exercises using a return demonstration during the baseline appointment. Statistical analyses included descriptive statistics and the Friedman test to evaluate changes over time. There was a significant reduction in dyspnea (2.04-1.39,  = .005), pulmonary symptoms (17.6-11.7,  < .001), and a significant increase in the quality-of-life index score (0.682-0.752,  = .013) and visual analog scale (63.1-71.57,  = .004). Significant improvements in peak inspiratory flow (111.24-195.77 l,  < .001), forced expiratory volume over 1 s (291.29-345.42 l,  < .001), thoracic expansion (2.71-3.88 cm,  < .001) and the 6 min walk test (300.22-391.57 m,  < .001) were also found. Study adherence was >95% and feasibility and acceptability scores were high. Home-based respiratory muscle strength training may be an effective, acceptable strategy that can be used as a standalone treatment to reduce persistent dyspnea in post-COVID-19 survivors. This study was pre-registered with Clinical Trials.gov [NCT06091280]. Clinical Trial URL/ClinicalTrials.gov PRS: Record Summary NCT06091280. IRB approval was provided by the University of South Florida (006272).

This research was conducted to determine the effects of preoperative fasting durations on blood glucose levels, dehydration, and anxiety in patients. This cross-sectional study was conducted in the General Surgery Clinic of a university hospital. The study included 92 patients undergoing elective laparoscopic cholecystectomy. Data collection forms such as the Sociodemographic Characteristics Questionnaire and the State Anxiety Inventory were administered in the preoperative period, while the Dehydration and Blood Glucose Monitoring Form and Visual Analog Scale were applied a total of three times: in the preoperative period, at the second hour postoperatively, and at the 8th hour postoperatively. Necessary permissions were obtained for the study. The patients' mean solid and liquid fasting time was 16.65 (2.80) and 15.85 (2.95) hr. The prolongation of the preoperative mean solid fasting time showed a negative correlation with blood glucose levels and a positive correlation with some dehydration symptoms, skin turgor return time, and the nausea score. The prolongation of the preoperative mean liquid fasting time showed a positive correlation with prominence of lingual fissures, nausea scores, thirst scores, heart rate, skin turgor return time and heart rate. In addition, prolonged solid fasting time was associated with higher anxiety levels. Prolonged fasting before surgery negatively affected patients' anxiety and blood glucose levels and led to dehydration symptoms. Prolonged fasting and fluid restriction before surgery had negative effects on patients' anxiety and blood glucose levels, while also leading to the emergence of some dehydration symptoms.

Pulse oximetry is a widely used, noninvasive method for estimating arterial oxygen saturation (SaO2). However, emerging evidence suggests that skin pigmentation may affect its accuracy, potentially leading to occult hypoxemia in individuals with darker skin tones. This systematic review examines the impact of skin pigmentation on pulse oximeter accuracy by comparing pulse oximetry (SpO2) readings with arterial blood gas-measured SaO2 across diverse populations. A systematic search of PubMed and Embase was conducted following PRISMA 2020 guidelines. Eligible studies included those comparing SpO2 to SaO2 while stratifying results by skin pigmentation or race/ethnicity. Data extraction focused on bias in SpO2 readings, study design, and population characteristics. Risk of bias was assessed using the QUADAS-2 tool. Forty-two studies met the inclusion criteria. Consistent evidence indicated that pulse oximeters overestimate SaO2 in individuals with darker skin tones, particularly at lower oxygen saturations. This overestimation may delay recognition of hypoxemia and critical interventions. Methodological variability was noted, including inconsistent racial classifications and skin tone assessment methods. Pulse oximeters exhibit a systematic bias in individuals with darker skin tones. Standardized skin pigmentation assessment and improved device calibration are needed to enhance accuracy and ensure equitable patient care.

The readiness of essential equipment like airway trolleys is critical in pediatric cardiac intensive care units (PCICUs). Kaizen, a Lean management principle, has been increasingly applied in healthcare to enhance efficiency and patient care. This study investigates the transformative impact of Kaizen principles on airway trolley preparation in a 10-bedded PCICU. A 12-month prospective observational study was conducted between January 1, 2024 and December 31, 2024. Kaizen was introduced in the system on July 1, 2024. Pre-and post-Kaizen data were compared to evaluate its impact on response times, preparation efficiency, error reduction, resource utilization, and nursing satisfaction. We demonstrated remarkable reduction in response times during pediatric cardiac emergencies, from 4.82 to 2.14 min, post-Kaizen ( < .001). Time spent on airway trolley preparation decreased significantly from 12.5 to 7.3 min ( < .001). The frequency of errors in preparation decreased significantly from 4.2 to 1.1 errors per month. Waste reduction was achieved through streamlined processes, with nurses reporting a 30% reduction in preparation time. Nursing staff expressed heightened confidence and preparedness during high-stress situations. The application of Kaizen principles significantly optimized airway trolley preparation processes, highlighting their potential for broader healthcare applications.

The purpose of this study was to investigate the prevalence and risk factors of delirium in children receiving mechanical ventilation (MV) admitted to the pediatric intensive care unit. A prospective observational study was conducted, enrolling 160 critically ill children aged 29 days to 18 years who received MV for more than 24 hr between August 2021 and August 2023. Delirium was assessed using the Cornell Assessment of Pediatric Delirium. Demographic, disease-related, and treatment-related characteristics were collected from electronic medical records by staff nurses. The incidence of delirium in children with MV was 83.8%. The median duration of MV at the onset of delirium was 1.5 (interquartile range: 0.5, 3.0) days, and according to the day of extubation, 74.6% of delirium cases first occurred ≥ 24 hr before extubation. Binary logistic regression analyses revealed that the independent risk factors of delirium in critically ill children with MV included age ≤ 5 years, physical restraints, pediatric sequential organ failure assessment score, and lower pulse oximetry oxygen saturation (SpO). This study may help develop intervention strategies to reduce the incidence of delirium in critically ill children with MV by targeting related risk factors.

Social drivers of health (SDOH) play a critical role in influencing health outcomes, including those related to cognitive dysfunction in patients with cirrhosis. Cognitive dysfunction, which can significantly impact the quality of life and health outcomes in patients with cirrhosis, may be influenced by various SDOH factors. This scoping review aims to synthesize current evidence on the association between SDOH and cognition among patients with cirrhosis. A systematic search of the literature was conducted from inception through March 2024 using PubMed, Cochrane Library, and Embase databases. Studies that examined the relationship between SDOH and cognition, as measured by neuropsychological tests, were identified. SDOH were categorized into the five Healthy People 2030 SDOH domains. A total of 31 studies were included in the review; however, many of the studies did not primarily focus on examining the relationship between SDOH and cognition. Cognition was primarily assessed using the Psychometric Hepatic Encephalopathy Score. Education was the most frequently investigated SDOH, followed by employment. Higher levels of education and employment were generally associated with better cognitive performance. The SDOH domains of social and community context and healthcare access and quality were not addressed in the included studies. This review highlights the potential link between SDOH and cognition among patients with cirrhosis but also reveals that existing research is limited, especially beyond education. Future research should address these understudied SDOH factors to inform strategies to identify at-risk patients and improve health outcomes in patients with cirrhosis.

Severe illness and intensive care treatment pose significant challenges not only for the patients but also for their relatives, known as post-intensive care syndrome in family members (PICS-F). Not much is known about psychosocial outcomes in relatives of former severely ill COVID-19 patients who were hospitalized under pandemic-related challenges. This study aimed to investigate long-term psychosocial outcomes of relatives of formerly hospitalized COVID-19 patients in relation to patient and relative characteristics. Longitudinal data on psychosocial outcomes of relatives of COVID-19 patients, admitted to the general ward or intensive care unit (ICU) in 2020 and enrolled in the multicenter prospective cohort NeNeSCo study, were collected via questionnaires, 9 and 15 months post-hospital discharge of the patient. Outcomes of interest were anxiety, depression, post-traumatic stress symptoms (PTSS), caregiver burden, and quality of life. In general, relatives scored high on PTSS, especially in the ICU group (22.5%). Relatives of ICU patients had higher levels of anxiety and caregiver burden than those of general ward patients. Over time, anxiety decreased while caregiver burden increased in the total group. Factors associated with less favorable outcomes in terms of anxiety, depression, PTSS, and caregiver burden were associated with both relative and patient variables, with relatives' passive coping showing the strongest association across all outcome variables and time. Admission to the ICU increased the level of anxiety in relatives, while patient cognitive complaints were predictive of more severe symptoms in relatives (anxiety, depression, and caregiver burden). In conclusion, nurses providing follow-up care should be aware of the impact of severe COVID-19 on the psychosocial outcomes of relatives, comparable to other severe conditions, and offer guidance, especially to those who will not seek help themselves. Early screening for and psychoeducation on the emotional consequences of severely ill patients can guide nurses in their supportive care.

The COVID-19 pandemic necessitated a triad of therapies for patients: oxygen, nutrition, and patient positioning. In the progressive care units, patients were placed in a prone position while receiving continuous enteral nutrition (EN) to optimize healing and oxygenation. The study aimed to identify the rate of aspiration pneumonia in non-ventilated COVID-19 patients placed in a prone position while receiving continuous EN. This was a single-group, descriptive retrospective study. The study was conducted at a two-time Magnet designated academic medical and health science center in the Southwestern United States. The sample included 97 electronic health records (EHRs) of patients diagnosed with COVID-19, receiving continuous EN, and placed in a prone position from March 15, 2020 to June 1, 2022. Data were extracted from EHRs using ICD-10 codes, including patient demographics, EN frequency, gastric tube placement, patient positioning, and incidence of aspiration pneumonia. Descriptive statistics and non-parametric tests were used. The Kruskal-Wallis rank sum test and Fisher's exact test were employed for comparisons. Statistical significance was set at  ≤ .05. Out of 97 patients, 8 (8.25%) developed aspiration pneumonia. The majority of patients (75%) had post-pyloric feeding tubes. All patients who developed aspiration pneumonia had post-pyloric tubes. Placing COVID-19 patients in a prone position while receiving continuous EN may be a safe practice. Diligent nursing assessment is crucial to minimize aspiration risk and optimize patient outcomes.

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 ( < .01; 95% confidence interval: [1.03, 1.17]), severity of depression ( = .01, [1.05, 1.48]), and severity of fatigue ( = .02, [1.09, 2.71]). By contrast, estimated glomerular filtration rate (eGFR) ( = 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.

Many patients, especially those with long-term conditions, face significant challenges in managing their health. Burden of treatment is the effort required for self-managing health. This burden is often intensified by social determinants of health, such as limited access to care and financial instability. Burden of treatment is understudied in socially and medically complex patients, particularly in the critical period of transitioning home after hospital discharge. To address this gap, this study analyzed data from telephone interviews with urban primary care patients who had been recently hospitalized and were identified by an algorithm as having complex medical and social needs, and received a nurse-led outreach call intervention to examine the following areas: (a) how patients with complex health and social needs experience burden of treatment following hospitalization; (b) the individual, interpersonal, and healthcare system factors that patients perceive as impacting burden of treatment; and (c) the impact of an outreach phone call on burden of treatment. The study team completed telephone interviews with 22 patients who received the outreach call intervention, using a semi-structured interview guide based on established treatment burden measurement tools. Interview data were analyzed using rapid qualitative data analysis techniques to identify key themes to answer the research questions. Findings indicated that most participants reported minimal treatment burden across key domains, such as understanding diagnoses, scheduling appointments, managing medications, and engaging in self-care. A minority experienced substantial difficulties, such as frustration with appointment scheduling and challenges with activities of daily living due to their conditions. Several factors were identified as influencing treatment burden, including health condition complexity, family support, and provider communication. Patients generally responded positively to the outreach calls, finding them reassuring and informative. Treatment burden is variable among medically and socially complex patients following hospitalization and is shaped by a number of individual, interpersonal, and healthcare system factors. Further research is needed to develop and evaluate interventions to build healthcare system capacity to serve this population, to minimize treatment burden.

This study aimed to develop and validate a machine learning-based predictive model for assessing the risk of fear of childbirth in pregnant women during late pregnancy. A cross-sectional observational study was conducted from November 2022 to July 2023, involving 406 pregnant women. Six machine learning algorithms, including Lasso-assisted logistic regression (LR), random forest (RF), eXtreme Gradient Boosting (XGB), support vector machine (SVM), Bayesian network (BN), and k-nearest neighbors (KNN), were used to construct the models with 10-fold cross-validation. The results showed that the XGB model achieved the best performance, with an area under the receiver operating characteristic curve (AUC) of 0.874, accuracy of 0.795, sensitivity of 0.764, and specificity of 0.878. The LR model also performed well (AUC = 0.873). Key predictors of fear of childbirth included pain catastrophizing, expectation for painless childbirth, childbirth delivery preferences, medication use during pregnancy, and use of birth-related apps. The LR model was used to create a nomogram for clinical use. These machine learning models can help healthcare professionals identify and intervene early in cases of fear of childbirth.

With aging, female older adults experience biochemical changes such as drop in their sex hormones and biomarkers and often encounter stress, which can be manifested in psychological symptoms. Previous literature has confirmed that racial/ethnic differences exist in the interactive relationship between sex hormones, biomarkers, and psychological symptoms. Yet, the racial/ethnic differences in their interactive relationship have not yet been examined. This is a secondary data analysis using the cross-sectional data of Wave II (2010-2011) from the National Social Life, Health, and Aging Project (NSHAP), and included 1,228 female older adults without moderate to severe cognitive impairment. Moderated network analysis was conducted with race as a moderator to examine the interactive relationship among sex hormones, biomarkers, and psychological symptoms and to compare the differences between the White and non-White group. The White group had a more positive relationship between total hemoglobin and cognition (edge weight = 0.18; moderated edge weight = 0.22). The non-White group had a positive relationship between progesterone and anxiety (edge weight = 0.05; moderated edge weight = 0.04) and between estradiol and cognition (edge weight = 0.03; moderated edge weight = 0.03), both of which were not present in the White group. We found a small moderated effect of race, and the strength of relationship among sex hormones, biomarkers, and psychological symptoms was different between the White and non-White group. Our study offers important preliminary findings to understand the potential racial/ethnic disparities that exist among sex hormones, biomarkers, and psychological symptoms in female older adults and the need to take an interactive approach.

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 ( < .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.

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.

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 ( = 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.

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.  = 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 s < .05), self-efficacy for wearing a mask ( < .001), and self-efficacy for testing for COVID-19 after exposure and before a social event (s < .001). In addition, perceived benefits for Long COVID prevention predicted intent of mask-wearing ( < .001), testing before a social event ( = .002), and getting a vaccine booster ( = .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.

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 (, 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 (, 3.76), 29.52 (, 7.03), and 3.51 (, 0.67), respectively. Regression analysis showed that fear of progression positively predicted poor sleep quality ( = .539,  < .001) and social connectedness negatively predicted poor sleep quality ( = -.301,  < .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.

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,  < .001) and lower sexual health (rho = 0.535,  = .005), though no significant link was found between mood disturbance and sexual health (rho = -0.279,  = .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 ( = 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.

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 ( = 2.03, 95% CI [1.13, 3.65],  = .02), readmission ( = 8.17, [4.70, 14.21],  < .001), stroke recurrence rate ( = 2.66, [1.51, 4.69],  < .001), and adverse outcomes rate ( = 2.07, [1.18, 3.61],  < .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 ( = 1.12, [-0.62, 2.86],  = .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.