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Effects of hospital‐family holistic care model on the health outcome of Patients with permanent enterostomy based on the theory of “Timing It Right”

Abstract

Aims and objectives

To explore the effects of hospital‐family holistic care model based on “Timing It Right” on the health outcome of Patients with permanent colostomy.

Background

Colorectal cancer is a common malignant tumor of digestive system, which seriously threatens human life and health. Colostomy is one of the main treatments for colorectal cancer, which effectively improves the 5‐year survival rate of patients. However, the postoperative psychological and physiological rehabilitation nursing is still faced with great challenges due to the change of body image and defecation pathway caused by colostomy.

Methods

A randomized controlled trial was conducted and 119 patients with permanent enterostomy were randomly divided into two groups, with 60 cases in the intervention group and 59 cases in the control group. The intervention group received routine care、follow‐up and hospital‐family holistic care intervention based on “Timing It Right”, while the control group received routine care and follow‐up. The resilience, self‐care ability, complications and life quality of Patients with permanent enterostomy were compared between two groups before intervention,at discharge , 3 months and 6 months after discharge. CONSORT checklist was applied as the reporting guideline for this study (See supplementary File 1).

Results

108 patients with permanent enterostomy completed the study (90.76%). At 3 months and 6 months after discharge, the resilience and quality of life in the intervention group were significantly better than those in the control group (t = 4.158 vs 7.406, t = 4.933 vs 8.611, P < 0.05); while the complications in the intervention group were significantly lower than that in the control group (25.5% vs 41.51%, 14.45% vs 30.19% ; P < 0.05). The self‐care ability of the intervention group was significantly better than that in the control group (t = 1.543 vs 3.656 vs 6.273, P < 0.05) at discharge, 3 months and 6 months after discharge. The interaction between time and grouping showed that the effect of time factor varied with the grouping. After intervention, there were significant differences in psychological resilience、 self‐care ability、complications and quality of life between the two groups at different observation points (P < 0.01). The three evaluation indices of intervention group increased with the migration of observation time points and were significantly better than those of control group, especially the quality of life (84.35±4.25 vs 60.45±8.42, P < 0.01).

Conclusions

The hospital‐family holistic care model based on “Timing It Right” can effectively improve the psychological resilience, self‐care ability, quality of life, reduce complications and improve the health outcomes of patients with permanent enterostomy.

Relevance to clinical practice

Patients with permanent enterostomy have different needs for nursing care at different stages of the disease, and they are dynamically changing. The hospital‐family holistic care model based on “Timing It Right” can effectively improve the health outcomes of patients with permanent enterostomy, which is worthy of clinical application.

Factors associated with quality of life in patients with diabetic hypoglycaemia

Abstract

Aims and Objectives

To identify determinants of quality of life among patients who had experienced hypoglycaemia and who were undergoing insulin treatment.

Background

Patients with diabetes receiving insulin treatment are at high risk for hypoglycaemia, which tends to affect their quality of life.

Design

With a cross‐sectional and observational study design (see the STROBE checklist and Appendix S1).

Methods

One hundred and fifty patients with type 2 diabetes who had received insulin treatment and had experienced hypoglycaemia (<70 mg/dl) in the last 6 months were recruited. Data were collected from May 2016–February 2018 using the Knowledge of Hypoglycaemia Scale, Fear of Hypoglycaemia Scale, Social Support Scale and the simplified Taiwanese version of the Quality of Life Scale developed by the World Health Organization.

Results

Factors found to be associated with quality of life in patients with hypoglycaemia included having an educational level of senior high school or above, being on an insulin regimen only, engaging in regular exercise, diabetes complications, fear of hypoglycaemia and greater social support, which accounted for 28.5% of the total variance.

Conclusions

During the process of glycaemic control, patients inevitably experience hypoglycaemic episodes. Therefore, healthcare providers should assist patients with disease management to improve their quality of life. Future studies should also recruit patients who claim to have experienced hypoglycaemic symptoms, rather than considering only those with blood glucose levels below 70 mg/dl, to expand the generalisability of the findings. Future studies may also focus on the management of hypoglycaemia in patients on an insulin regimen, and on examining the effect of health education programmes on prevention of hypoglycaemia.

Relevance to clinical practice

The present findings could provide a reference for healthcare providers to consolidate nursing care guidelines and to improve such patients' quality of life.

Associations of occupational stress, workplace violence and organizational support on chronic fatigue symptoms among nurses

Abstract

Aims

Chronic fatigue syndrome is an agnogenic disease worldwide. Nurses are at a high risk of chronic fatigue syndrome. However, no research has been done to examine the associations of workplace violence, organizational support and occupational stress with chronic fatigue syndrome among Chinese nurses. This study aimed to examine effects of these factors on chronic fatigue syndrome in this occupational group.

Desine

Cross‐sectional. All participants voluntarily completed a questionnaire survey.

Methods

The study was conducted in Liaoning province from December 2017 to January 2018. Self‐administered questionnaires were distributed to 1200 nurses, including Effort‐Reward‐Imbalance, Workplace Violence Scale, Survey of Perceived Organizational Support, together with age, gender, marital status, education levels, physical activities, job rank, monthly income and weekly working hours. Complete responses were obtained from 1080 (90%) participants. Chronic fatigue syndrome was diagnosed by doctors according to the Centers for Disease Control and Prevention criteria. Multivariable logistic regression was performed to examine these independent risk factors.

Results

The prevalence of chronic fatigue syndrome was 6.76%. The results of logistic regression analysis showed that nurses who experienced serious higher levels of overcommitment, workplace violence and less organizational support were more likely to be classified as chronic fatigue syndrome.

Conclusion

There was a high prevelence of chronic fatigue syndrome. Lower workplace violence, more organizational support and lower overcommitment could be effective resources for reducing chronic fatigue syndrome.

Impact

Workplace violence, organizational support and occupational stress were related to chronic fatigue syndrome, which helped to explain why Chinese nurses suffered higher prevelance of chronic fatigue syndrome. Overcommitment explained chronic fatigue syndrome better than Effort/Reward Ratio, so intrinsic stress played a more critical role than extrinsic stress in chronic fatigue syndrome. Chinese nurses suffered serious sleep disorders and impairment of concentration and memory. These symptoms might also atributed to serious occupational stress, unsafe and unsupportive working environment. Creating a safe and supportive working emvironment, releiving intrinsic occupational stress should be considered as an institutional strategy to early prevent chronic fatigue syndrome.

Effect of stay in a postpartum care institution on postpartum depression in women

Childbirth is a major life experience for women. From conception to arrival of the newborn, the physical and mental experience has a great impact and influence on mothers (Swanson et al., 2011), which may lead to emotional or mental disorders post partum (Dolatian et al., 2013; Roy-Byrne et al., 2016). Postpartum depression is a common problem in women (Motzfeldt et al., 2013). In the 6 weeks after birth, serious intentions or behaviours that can harm the mother or baby may have adverse effects on child growth and development (O'Hara and McCabe, 2013; Bennett et al., 2016).

Sex difference in incidence of gastric cancer: an international comparative study based on the Global Burden of Disease Study 2017

Por: Lou · L. · Wang · L. · Zhang · Y. · Chen · G. · Lin · L. · Jin · X. · Huang · Y. · Chen · J.
Objectives

To investigate sex difference in global gastric cancer incidence by year, age and socioeconomical status.

Design

An international comparative study.

Setting

We obtained the global and national sex-specific incidence of gastric caner by year and age from the Global Burden of Disease Study 2017. The human development index (HDI) in 2017 as an indicator of national socioeconomical status was extracted from the Human Development Report.

Main outcome measures

Sex-specific incidence of gastric cancer was compared by year and age at the global level. Linear regression analyses were performed to explore socioeconomic-associated sex difference in gastric cancer incidence.

Results

Despite declining incidence of global gastric cancer in both sexes between 1990 and 2017, relative sex difference showed an increasing trend, with male to female ratios of age-standardised incidence rates (ASRs) rising from 1.86 to 2.20. Sex difference was almost negligible under 45 years of age and relative difference maximised in the age range of 65–69 years with male to female ratios of ASRs being 2.74. Both absolute sex difference (standardised β=0.256, p

Conclusions

This study revealed that decreasing incidence of global gastric cancer was accompanied by widening sex difference in the past few decades. Men always had higher incidence than women. Greater sex difference was found in older age and in more developed countries. These findings highlight the importance of making sex-sensitive health policy to cope with the global gastric cancer burden.

Postoperative intravenous parecoxib sodium followed by oral celecoxib post total knee arthroplasty in osteoarthritis patients (PIPFORCE): a multicentre, double-blind, randomised, placebo-controlled trial

Por: Zhuang · Q. · Tao · L. · Lin · J. · Jin · J. · Qian · W. · Bian · Y. · Li · Y. · Dong · Y. · Peng · H. · Li · Y. · Fan · Y. · Wang · W. · Feng · B. · Gao · N. · Sun · T. · Lin · J. · Zhang · M. · Yan · S. · Shen · B. · Pei · F. · Weng · X.
Objectives

To evaluate the morphine-sparing effects of the sequential treatment versus placebo in subjects undergoing total knee arthroplasty (TKA), the effects on pain relief, inflammation control and functional rehabilitation after TKA and safety.

Design

Double-blind, pragmatic, randomised, placebo-controlled trial.

Setting

Four tertiary hospitals in China.

Participants

246 consecutive patients who underwent elective unilateral TKA because of osteoarthritis (OA).

Interventions

Patients were randomised 1:1 to the parecoxib/celecoxib group or the control group. The patients in the parecoxib/celecoxib group were supplied sequential treatment with intravenous parecoxib 40 mg (every 12 hours) for the first 3 days after surgery, followed by oral celecoxib 200 mg (every 12 hours) for up to 6 weeks. The patients in the control group were supplied with the corresponding placebo under the same instructions.

Primary and secondary outcome measures

The primary endpoint was the cumulative opioid consumption at 2 weeks post operation (intention-to-treat analysis). Secondary endpoints included the Knee Society Score, patient-reported outcomes and the cumulative opioid consumption.

Results

The cumulative opioid consumption at 2 weeks was significantly smaller in the parecoxib/celecoxib group than in the control group (median difference, 57.31 (95% CI 34.66 to 110.33)). The parecoxib/celecoxib group achieving superior Knee Society Scores and EQ-5D scores and greater Visual Analogue Scale score reduction during 6 weeks. Interleukin 6, erythrocyte sedation rate and C-reactive protein levels were reduced at 72 hours, 2 weeks and 4 weeks and prostaglandin E2 levels were reduced at 48 hours and 72 hours in the parecoxib/celecoxib group compared with the placebo group. The occurrence of adverse events (AEs) was significantly lower in the parecoxib/celecoxib group.

Conclusions

The sequential intravenous parecoxib followed by oral celecoxib regimen reduces morphine consumption, achieves better pain control and functional recovery and leads to less AEs than placebo after TKA for OA.

Trial registration number

ClinicalTrials.gov (ID: NCT02198924).

Association between H. pylori infection and health Outcomes: an umbrella review of systematic reviews and meta-analyses

Por: Li · L. · Tan · J. · Liu · L. · Li · J. · Chen · G. · Chen · M. · Xie · J. · Song · Q. · Huang · X. · Xie · S.
Objective

Systematic reviews and meta-analyses have revealed the associations between H. pylori infection and various health outcomes. We aimed to evaluate the strength and breadth of evidence on the associations.

Design

Umbrella review of systematic reviews and meta-analyses.

Setting

No settings.

Participants

No patients involved.

Data sources

Embase, PubMed, Web of Science, Cochrane Library Databases, CNKI, VIP database and Wangfang database from inception to February 1, 2019.

Outcomes measures

Diverse diseases (such as cancer and ischaemic heart disease).

Results

Sixty articles reporting 88 unique outcomes met the eligible criteria. 74 unique outcomes had nominal significance (p2=50%–75%) and 24 had high heterogeneity (I2>75%). Moreover, 20% exhibited publication bias (pH. pylori infection may be associated with an increased risk of five diseases and a decreased risk of irritable bowel syndrome.

Conclusion

Although 60 meta-analyses explored 88 unique outcomes, moderate quality evidence only existed for six outcomes with statistical significance. H. pylori infection may be associated with a decreased risk of irritable bowel syndrome and an increased risk of hypertriglyceridemia, chronic cholecystitis and cholelithiasis, gestational diabetes mellitus, gastric cancer and systemic sclerosis.

Trial registration

CRD42019124680.

Efficacy of adjunctive azithromycin versus single-dose cephalosporin prophylaxis for caesarean scar defect: study protocol for a randomised controlled trial

Por: Cai · Y. · Pan · H. · Zhang · J. · Cheng · W. · Shi · Y. · Zeng · M. · Shi · L. · Yu · J. · Shen · Y. · Chen · S. · Zhu · Q. · Mol · B. W. · Huang · D.
Introduction

Perioperative infections may be considered predictors of caesarean scar defect (CSD), and multidose antibiotics have a protective effect against CSD. However, the ability of adjunctive azithromycin combined with cephalosporin to reduce the prevalence of CSD remains unclear. The planned study aims to clarify the protective effect of antibiotics against CSD and to assess the effectiveness of adjunctive azithromycin prophylaxis for CSD.

Methods and analysis

This study is a double-blind, parallel-control randomised clinical trial that will be carried out at the International Peace Maternity and Child Health Hospital. A total of 220 eligible patients will be randomised (1:1) to receive either adjunctive azithromycin or single-dose cephalosporin 30 min before the incision. The evaluation criteria are the prevalence and characteristics of CSD as assessed by transvaginal ultrasound (TVU) and saline infusion sonohysterography (SIS) at 42 days, 6 months and 12 months after delivery. The primary outcome will be the prevalence of CSD, and the characteristics of CSD will be assessed by TVU and SIS 42 days after delivery; all other outcomes are secondary.

Ethics and dissemination

This protocol received authorisation from the Medical Research Ethics Committee of International Peace Maternity and Child Health Hospital on 25 April 2018 (approval no. GKLW2017-84). The findings will be reported in peer-reviewed publications and presentations at international scientific meetings.

Trial registration number

ChiCTR-INR-17013272.

Core competencies in neurocritical care training in China: consensus developed by a national Delphi consensus survey combined with nominal group technique

Objectives

To define the core competencies essential for specialist training in neurocritical care in China.

Design

Modified Delphi method and nominal group (NG) technique.

Setting

National.

Participants

A total of 1094 respondents from 33 provinces in China participated in the online survey. A NG of 11 members was organised by the Neuro-Critical Care Committee affiliated with the Chinese Association of Critical Care Physicians and the National Center for Healthcare Quality Management in Neurological Diseases.

Results

1094 respondents from 33 provinces in China participated in the online survey. A formal list containing 329 statements was generated for the rating by a NG. After five rounds of NG meetings and one round of comments and iterative review, 198 core competencies (54 on neurological diseases, 64 on general medical diseases, 42 on monitoring of practical procedures, 20 on professionalism and system management, five on ethical and legal aspects, three on the principles of research and certification and 10 on scoring systems) formed the final list.

Conclusion

By using consensus techniques, we have developed a list of core competencies for neurocritical care training, which may serve as a reference for future specialist training programmes in China.

Metabolic syndrome in native populations living at high altitude: a cross-sectional survey in Derong, China

Por: Huang · X. · Hu · Y. · Du · L. · Lin · X. · Wu · W. · Fan · L. · Li · L. · Zhong · X. · Gong · Q. · Gao · L. · Kuang · W.
Objective

The metabolic syndrome is a major risk factor for cardiovascular disease. Little information exists on the prevalence of the metabolic syndrome at high-altitude areas in China. We aimed to estimate the prevalence of metabolic syndrome and its individual components at high altitude.

Methods

A cross-sectional survey of 5053 adults living in Derong from elevation of 2060 to 3820 m was carried out in 2013. Metabolic syndrome was defined according to the Chinese Diabetes Society criteria.

Results

The overall prevalence of metabolic syndrome was 3.6% (5.9% in men and 1.8% in women) in Derong, China. Obesity and hypertension were more prevalent among adults than dyslipidaemia and hyperglycaemia at high altitude. The prevalence of metabolic syndrome was higher in township than countryside residents (6.6%, 11.9% in men and 1.5% in women vs 3.0%, 4.6% in men and 1.8% in women). Men with age 30–59 years old had a much higher prevalence of metabolic syndrome than women. Men, township, middle and old age residents had a higher risk of metabolic syndrome. The risk of obesity and dyslipidaemia decreased and the risk of hypertension increased in very high altitude (≥3000 m) residents.

Conclusion

In Derong, despite the relatively low prevalence of metabolic syndrome, hypertension and obesity are more prevalent in adult residents. And metabolic syndrome is more concentrated in township and male residents. These people also have a higher risk of metabolic syndrome. Therefore, it is necessary to develop a national strategy for the prevention and treatment of metabolic syndrome for high-risk population at high altitude in China.

Azithromycin as an add-on treatment for persistent uncontrolled asthma in adults: protocol of a systematic review and meta-analysis

Por: Liu · W. · Mu · W. · Zhang · H. · Zhai · J. · Li · X. · Guan · P. · Lian · F. · Feng · J. · Yu · S. · Wang · X. · Si · J. · Sun · Z. · Huang · Y.
Introduction

Clinical management of asthma remains a public challenge. Despite standard treatment with inhaled corticosteroids (ICS) and long-acting beta-agonists (LABAs), asthma remains uncontrolled in a substantial number of chronic asthma patients who risk reduced lung function and severe exacerbations. Azithromycin could have add-on effects for these patients. This study is proposed to systematically evaluate the efficacy of azithromycin as an add-on treatment for adults with persistent uncontrolled symptomatic asthma.

Methods and analysis

Two reviewers will perform a comprehensive search of PubMed, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL) and four Chinese electronic databases including China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), WanFang Data and VIP Database from inception to May 2019. Only randomised controlled trials will be included. There is no restriction on language or publication status. Combined oral azithromycin and an ICS or/and a LABA will be compared with standard treatment alone or with a placebo. The primary outcomes are the number or frequency of asthma exacerbations, changes in asthma symptoms and lung function. Secondary outcomes include the number or frequency of inhalations of beta-agonists with or without corticosteroids for rescue use, eosinophil counts in blood or sputum, adverse events and others. A meta-analysis will be attempted to provide an estimate of the pooled treatment effect. Otherwise, qualitative descriptions of individual studies will be given.

Ethics and dissemination

Ethical approval is not required because no primary data will be collected. Study findings will be presented at scientific conferences or published in a peer-reviewed journal.

PROSPERO registration number

CRD42019117272.

In vitro evaluation of the hyaluronic acid/alginate composite powder for topical haemostasis and wound healing

Abstract

The use of haemostatic agents can provide life‐saving treatment for patients who suffer from massive bleeding in both prehospital and intraoperative conditions. However, there are still urgent demands for novel haemostatic materials that exhibit better haemostatic activity, biocompatibility, and biodegradability than existing products. In the present study, we aim to evaluate the feasibility of new wound dressing, RapidClot, for treating uncontrolled haemorrhage through a series of in vitro assessments to determine the swelling ratio, clotting time, enzymatic degradation, haemolytic activity, cytotoxicity, cell proliferation, and migration. The results indicated that the RapidClot revealed better water adsorption capacity and shorter blood clotting time (132.7 seconds) than two commercially available haemostatic agents Celox (378.7 seconds) and WoundSeal (705.3 seconds). Additionally, the RapidClot dressing exhibited a similar level of degradability in the presence of hyaluronidase and lysozyme as that of Celox, whereas negligible degradation of WoundSeal was obtained. Although both Celox and RapidClot revealed a similar level in cell viability (above than 90%) against NIH/3 T3 fibroblasts, improved cell proliferation and migration could be obtained in RapidClot. Taking together, our results demonstrated that RapidClot could possess a great potential for serving as an efficient healing dressing with haemorrhage control ability.

Path analysis from physical activity to quality of life among dementia patients: A dual‐path mediating model 痴呆症患者体力活动到生活质量的路径分析:双路径中介模型

Abstract

Aims

To clarify the specific impact paths among physical activity, activity of daily living, depression and quality of life among dementia patients.

Design

A descriptive, cross‐sectional design.

Methods

Dementia patients and their caregivers from five tertiary general hospitals and one dementia patients’ club were recruited. A total of 216 valid questionnaires were collected from November 2018 ‐ March 2019. Path analysis was performed by Mplus 7.0 to test the casual relationship among physical activity, activity of daily living, depression and quality of life.

Results

Most patients with dementia presented a low level of physical activity and suffered from impaired quality of life. The modified model presented a good model fit and revealed that physical activity had indirect positive effects on quality of life mediated by activity of daily living and depression.

Conclusion

The results showed that physical activity was a promising non‐pharmacological method to improve the performance of activity of daily living and reduce depressive symptoms and then enhance the quality of life among dementia patients.

Impact

The findings were beneficial to elevate the awareness of physical activity among patients and professionals. This study was helpful to understand how physical activity exerted effects on life quality of dementia patients. This study provided a new perspective for researchers to elucidate the causal relationship of variables among dementia patients.

目的

阐明痴呆症患者体力活动、日常生活活动、抑郁与生活质量的具体影响路径。

设计

描述性横向设计。

方法

从五所三级综合医院和一家痴呆症患者俱乐部招募痴呆症患者及其看护人员。自2018年11月至2019年3月,共收集到216份有效问卷。采用Mplus 7.0进行路径分析,以验证体力活动、日常生活活动、抑郁与生活质量之间的因果关系。

结果

大多数痴呆症患者的体力活动水平较低,生活质量较差。改进后的模型与情况相符,并表明体力活动对生活质量有间接的积极影响,其中介作用是日常生活活动和抑郁。

结论

结果表明,体力活动是一种改善痴呆症患者日常生活活动表现、减轻抑郁症状、提高生活质量的非药理学方法,具有广阔的前景。

影响

本项研究结果有助于提高患者和专业人士对体力活动的认识。本项研究有助于了解体力活动对痴呆症患者生活质量的影响。此外,这项研究还为研究人员明确痴呆症患者各影响变量之间的因果关系提供了新的研究角度。

Factors influencing self‐management behaviours among patients with type 2 diabetes mellitus in the Solomon Islands

Abstract

Aims and objectives

This study aims to explore the current state of self‐management behaviours among persons with type 2 diabetes mellitus in the Solomon Islands and to discuss the factors influencing these behaviours.

Background

The prevalence of diabetes and diabetes complications is increasing in the Solomon Islands. However, the effective diabetes prevention and care are not provided in the country.

Design

This is a cross‐sectional study.

Methods

A convenience sample of 150 persons with type 2 diabetes mellitus was recruited from a hospital in the Solomon Islands from August 2017–September 2017. Self‐report questionnaires were used to measure the self‐management behaviours, diabetes knowledge and illness perception. In addition, the study adhered to the EQUATOR checklist, STROBE (see Appendix #jocn15139-sup-0001S1).

Results

The overall score for self‐management was 56.9 ± 13.2 and diabetes knowledge and illness perception, as influencing factors of self‐management, earned total scores of 13.3 ± 4.0 and 55.8 ± 12.0, respectively. Stepwise regression analysis identified illness perception, diabetes knowledge and smoking as significant influencing factors, explaining 20.8% of the total variance in self‐management.

Conclusions

The level of diabetes self‐management behaviours demonstrated by persons with type 2 diabetes mellitus in this study was rated as less than ideal. Diabetes knowledge and illness perception were the two main factors influencing patient self‐management in the Solomon Islands.

Relevance to clinical practice

The study addressed the current state of the self‐management behaviours of persons with diabetes and discussed the factors influencing these behaviours. The findings indicated that knowledge and illness perception of diabetes were the two main factors and provided baseline information for policymakers, health planners and healthcare providers highlighting diabetes as an important issue in Solomon Islands.

Predictors for self‐management in older adults with type 2 diabetic nephropathy

Abstract

Aim and Objectives

To investigate factors related to self‐management and predictors of self‐management in older adult patients with type 2 diabetic nephropathy.

Background

Diabetic patients suffer many comorbidities during their lifetime, and the process of self‐management is complex. Self‐management and an integrated care experience are extremely important for older adults with diabetic nephropathy.

Design

A cross‐sectional correlation design was adopted.

Methods

A total of 123 older patients were enrolled in the study from June 2016 to November 2017. Data collection involved a demographic questionnaire, the Patients' Experience of Integrated Care Questionnaire and the Partners in Health Scale to measure the integrated care experience and self‐management. Data analysis included descriptive statistics, independent t tests, Pearson product‐moment correlation and multiple linear regression. The methods are consistent with the STROBE criteria (Data #jocn15154-sup-0001S1).

Results

The results showed that the majority of the sample was female (56.9%). The average age was 77 years old. Stepwise regression analysis showed that re‐admission during the past year (p < .001), physical function (p < .001) and integrated care experience (p < .001) are predictors of self‐management in older adult patients with type 2 diabetic nephropathy and explained 42.8% of the variation in self‐management behaviour.

Conclusion

The results can be used to enhance the awareness of clinicians of the importance of an integrated care experience and self‐management among older patients with type 2 diabetic nephropathy. Clinicians also should pay attention to physical function and the integrated care experience to promote self‐management.

Relevance to Clinical Practice

Studies on the integrated care experience and self‐management of diabetic neuropathy in older adults are limited in Taiwan. The results of this study provide valuable information to support the importance of integrated care among this specific population.

Factors Associated with Spiritual Care Competencies in Taiwan's Clinical Nurses: A Descriptive Correlational Study

Abstract

Aims and objectives

To determine factors associated with nurses' spiritual care competencies.

Background

Holistic nursing care includes biopsychosocial and spiritual care. However, nurses are limited by a lack of knowledge, time constraints and apprehension of assessing spiritual issues, which leaves them unable to assess and meet patients' spiritual needs. Thus, when patients experience spiritual distress, clinical nurses lose the opportunity to support spiritual growth and self‐actualization. In Taiwan, spiritual care, religion, and culture are unique compared to those in other countries. Overall, factors associated with Taiwanese nurses' spiritual care competencies lack comprehensive exploration.

Methods

This study adopted a descriptive correlational design using cross‐sectional survey (see Supplementary File 1). Cluster sampling was used to select clinical nurses from fourteen units of a medical center and a regional hospital. Data were collected from January to June 2018 with a 97.03% response rate. Clinical nurses completed a background questionnaire, spiritual care practice questionnaire, spirituality and spiritual care related scales. Data were analyzed using descriptive and linear regression. This report followed the STROBE checklist.

Results

Spiritual care competence ranged from 44‐123 (mean 84.67±12.88; range 27‐135) . The majority of clinical nurses rated their spiritual care competence as moderate (64‐98). The significant factors associated with nurses' spiritual care competence were education, religion, interest in spiritual care, having role models, past life events, barriers to providing spiritual care of the spiritual care practice score, and spiritual attitude and involvement score. The overall model was significant (p<.001) and accounted for 55.0% of variance (adjusted R 2=.488).

Conclusions

Most clinical nurses have moderate spiritual care competence. Objective factors identified affect clinical nurses' spiritual care competencies.

Relevance to clinical practice

To improve nurses' spiritual care competencies, objective factors that affect clinical nurses' spiritual care competencies must be emphasized. Multiple strategies for enhancing nurses' own spiritual well‐being can be provided via employee health promotion projects and activities, and promoting nurses' spirituality and spiritual care competencies can be explored in clinical settings through bedside teaching, situational simulation, objective structured clinical examinations, and self‐reflection.

Development of a core outcome set for myocardial infarction in clinical trials of traditional Chinese medicine: a study protocol

Por: Qiu · R. · Zhong · C. · Han · S. · He · T. · Huang · Y. · Guan · M. · Hu · J. · Li · M. · Lin · Y. · Chen · J. · Shang · H.
Introduction

Myocardial infarction (MI) is the most dangerous complication in patients with coronary heart disease. In China, there is an increasing number of randomised controlled trials (RCTs) of traditional Chinese medicine (TCM) for treating MI. However, the inconsistency of outcome reporting means that a large number of clinical trials cannot be included in systematic reviews to provide the best evidence for clinical practice. The aim of this study is to develop a core outcome set (COS) for future TCM clinical trials of MI, which may improve the consistency of outcome reporting and facilitate the synthesis of data across studies in systematic reviews.

Methods and analysis

We will conduct a systematic review of MI clinical trials with any intervention. Semistructured interviews will be conducted to obtain the perspectives of patients with MI. The outcomes from the systematic review and semistructured interviews will be grouped and used to develop a questionnaire. The questionnaire will be developed as a supplement for the TCM syndromes of MI and will be constructed from the results of a systematic review, existing medical records and a cross-sectional study. Then two rounds of the Delphi survey will be conducted with different stakeholders (TCM experts and Western medicine experts in cardiovascular disease, methodologists, magazine editors and patients) to determine the importance of the outcomes. Only the TCM experts will need to response to the questionnaire for core TCM syndromes. A face-to-face consensus meeting will be conducted to create a final COS and recommend measurement time for each outcome.

Ethics and dissemination

This project has been approved by the Ethics Committee of Dongzhimen Hospital, Beijing University of Chinese Medicine. The final COS will be published and freely available.

Trial registration number

This study is registered with the Core Outcome Measures in Effectiveness Trials database as study 1243 (available at: http://www.comet-initiative.org/studies/details/1243).

Establishment and assessment of the hepatic venous pressure gradient using biofluid mechanics (HVPGBFM): protocol for a prospective, randomised, non-controlled, multicentre study

Por: Lin · J.-Y. · Zhang · C.-H. · Zheng · L. · Li · H.-J. · Zhu · Y.-M. · Fan · X. · Li · F. · Xia · Y. · Huang · M.-Z. · Yang · S.-H. · Qi · X.-L. · Huo · H.-Z. · Chen · H.-S. · Lou · X.-L. · Luo · M.
Introduction

Portal hypertension (PH) is a severe disease with a poor outcome. Hepatic venous pressure gradient (HVPG), the current gold standard to detect PH, is available only in few hospitals due to its invasiveness and technical difficulty. This study aimed to establish and assess a novel model to calculate HVPG based on biofluid mechanics.

Methods and analysis

This is a prospective, randomised, non-controlled, multicentre trial. A total of 248 patients will be recruited in this study, and each patient will undergo CT, blood tests, Doppler ultrasound and HVPG measurement. The study consists of two independent and consecutive cohorts: original cohort (124 patients) and validation cohort (124 patients). The researchers will establish and improve the HVPG using biofluid mechanics (HVPGBFM)model in the original cohort and assess the model in the validation cohort.

Ethics and dissemination

The study was approved by the Scientific Research Projects Approval Determination of Independent Ethics Committee of Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine (approval number 2017–430 T326). Study findings will be disseminated through peer-reviewed publications and conference presentations.

Trial registration number

NCT03470389.

Integration of Different Sensory Interventions From Mother’s Breast Milk for Preterm Infant Pain During Peripheral Venipuncture Procedures: A Prospective Randomized Controlled Trial

Abstract

Purpose

To compare the effects of integrating mother’s breast milk (BM) with three different combinations of sensory stimuli on preterm infant pain during peripheral venipuncture procedures.

Design

A prospective, repeated‐measures randomized controlled trial.

Methods

Preterm infants (gestational age between 28 and 37 weeks, and in stable condition) needing venipuncture were recruited by convenience sampling (N = 140) and randomly assigned to four treatment conditions: (a) routine care (condition 1); (b) BM odor or taste (condition 2); (c) BM odor or taste + heartbeat sounds (HBs; condition 3), and (d) BM odor or taste + HBs + non‐nutritive sucking (NNS; condition 4). Pain scores were assessed based on the Premature Infant Pain Profile‐Revised (PIPP‐R) over nine phases: baseline (phase 0, 5 min without stimuli before venipuncture), disinfecting (phase 1), during venipuncture (phase 2), and a 10‐min recovery (phases 3–8).

Findings

Infants who received BM odor or taste + HBs + NNS had significantly lower increases in pain scores from baseline compared with controls across phases 1 through 8. Infants treated with either condition 2 or 3 demonstrated significant reductions in mild pain during disinfecting and recovery phases, as compared with the controls. When condition 2 was used as the reference, there were no significant differences in pain scores between the infants receiving condition 3 across the nine phases, suggesting mothers’ HBs have only mild analgesic effects on venipuncture pain.

Conclusions

Integration of mother’s BM odor or taste, HBs, and tactile NNS should be considered as an intervention for alleviation of procedural pain for preterm infants.

Clinical Relevance

Clinicians should incorporate the integrated sensory intervention into caregiving support for preterm infants undergoing short painful procedures.

Liver Health Literacy and Health Status Among Adults With Hepatitis C: Implications for the Nursing Profession as Part of the 2030 Global Elimination Goal

Abstract

Purpose

To explore the prevalence of hepatitis C virus (HCV) infection as well as the levels of liver health literacy and association with the health status of people with HCV through the nurse‐led community health development goal of global elimination.

Methods

A community‐based, cross‐sectional study was conducted between July 2018 and June 2019 in coastal Western Yunlin County, Taiwan. This study was conducted at five townships, and serum HCV antibody (anti‐HCV) screening was used for the identification of potentially infected people by a collaborating local hospital.

Results

Of the 1,963 adults from rural areas enrolled in this study, 321 (16.4%) were anti‐HCV positive, 237 (73.8%) reported that they were unaware of their HCV positivity, and none of them were provided information on direct‐acting antiviral agent therapy. The levels of anti‐HCV positivity were higher among female patients (p < .05), elderly people (p < .001), those with a low education level (p < .001), and those from the Sihu Township within Yunlin County (p < .001). Participants with anti‐HCV positivity tended to have lower intakes of vegetables (p < .01) and fruit (p < .05), a greater number of comorbidities (p < .05), as well as a greater incidence of abnormal liver (p < .001) and renal function (p < .001) compared to those with anti‐HCV negativity. Multivariable linear regression analysis showed that the presence of HCV infection and a greater number of metabolic syndrome components were associated with poor liver and renal function.

Conclusions

These findings showed a high prevalence of HCV infection among adults living in rural areas, who had low literacy levels on hepatitis, unhealthy lifestyles, and abnormal liver and renal function.

Clinical Relevance

Clinicians and primary healthcare providers should initiate efforts to increase the levels of liver health literacy by increasing the accessibility to infection confirmation tests and reducing the number of barriers to the reception of antiviral treatment.

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