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Motivos que llevan a las mujeres a optar por el parto domiciliario planificado

Objetivo principal: conocer los motivos que llevan a las mujeres a optar por el parto domiciliário planificado. Metodología: estudio descrip-tivo, exploratorio, con un enfoque cualitativo. Participaron en la investigaciõn nueve mujeres que han optado por tener su parto en casa. Recolección de datos se produjo a través de entrevistas semiestructuradas, realizadas individualmente. Se utilizó la técnica de análisis de contenido de tipo temático. Resultados principales: del análisis emergieron los temas: Motivos que llevaron al parto domiciliário; Percep-ción de las mujeres sobre el parto domiciliário; Conductas de los profesionales de la salud en el parto domiciliário; y El enfermero frente a la asistencia al parto domiciliário. Conclusión principal: Las mujeres que optan por el parto domiciliario buscan una atención más humana sobre el parto, evitando una serie de intervenciones innecesarias, comunes en los hospitales.

Does obesity impact the outcome of severely burned patients?

Abstract

Although obesity appears to be an important predictor of mortality and morbidity, little data about the impact of body mass index (BMI) on the outcome of severely burned patients are available. Patients admitted to the General Hospital Vienna between 1994 and 2014, who underwent surgery because of burn injuries, were enrolled in this study. BMI was used to divide patients into five groups: BMI 18.5 to 24.9, 25 to 29.9, 30 to 34.9, 35 to 39.9, and > 40. The groups were compared in terms of difference of mortality and morbidity. Of 460 patients, 34.3% (n = 158) died. Mortality rates were the lowest in patients with obesity class III and the highest in patients with BMI 35 to 39.9 (BMI 18.5‐24.9: 30.5%, BMI 25‐29.9: 31.5%, BMI 30‐34.9: 41.3%, BMI 35‐39.9: 55.5%, BMI > 40: 30%; P = .031). BMI was not found to be an independent risk factor when corrected with age, percent total body surface area burned, full‐thickness burns, and inhalation injury. No significant differences in length of stay, inhalation trauma, pneumonia, wound infection, sepsis, and invasive ventilation were observed. BMI as an independent risk factor for severely burned patients could not be confirmed via multivariate analysis.

Using an Evidence-Based Approach for Electronic Health Record Downtime Education in Nurse Onboarding

imageElectronic health record systems have been widely implemented throughout healthcare settings over the last few years, and nurses rely on these systems to obtain information about patients, make clinical decisions, and deliver safe and appropriate care. Health information technology systems have electronic health record downtime episodes both due to scheduled maintenance and unforeseen circumstances. The ability to deliver safe and effective care during electronic health record downtime episodes is important, yet training on electronic health record downtime is rarely included for nursing staff. This quality improvement project implemented an electronic health record downtime training course and administered it to 50 onboarding nurses within the hospital facility. The participants indicated a positive perception of electronic health record downtime preparedness after the course offering related to ability to find and follow downtime procedures. However, no precourse metrics were obtained, and therefore it is uncertain if this positive perception is a direct result of the electronic health record downtime training course. While initial results are promising, further investigation will need to be conducted to determine training course effectiveness.

Biological approaches for hypertrophic scars

Abstract

Scar formation is usually the pathological consequence of skin trauma. And hypertrophic scars (HSs) frequently occur in people after being injured deeply. HSs are unusually considered as the result of tissue contraction and excessive extracellular matrix component deposition. Myofibroblasts, as the effector cells, mainly differentiated from fibroblasts, play the crucial role in the pathophysiology of HSs. A number of growth factors, inflammatory cytokines involved in the process of HS occurrence. Currently, with in‐depth exploration and clinical research of HSs, various creative and effective treatments budded. In here, we summarize the progress in the molecular mechanism of HSs, and review the available biotherapeutic methods for their pathophysiological characteristics. Additionally, we further prospected that the comprehensive therapy may be more suitable for HS treatment.

Effects of photoelectric therapy on proliferation and apoptosis of scar cells by regulating the expression of microRNA‐206 and its related mechanisms

Abstract

Human skin fibroblast (HSF) cells were irradiated with different energy lasers to detect cell proliferation, apoptosis, and expression of microRNA‐206 and protein, and to further summarise the therapeutic effect of laser on scar cells. Human scar cell line HSF cells were cultured in three groups. The control group was not irradiated by laser, the low‐energy group was irradiated by 10 J/cm2 laser, and the high‐energy group was irradiated by 20 J/cm2 laser. After irradiation, HSF cells were cultured for 20 hours. Cell proliferation was detected by MTT assay. Cell cycle and apoptosis were detected by flow cytometry. Transwell migration assay was used to detect cell migratory ability. Reverse transcription polymerase chain reaction (RT‐PCR) was used to detect miR‐206 and mTOR gene levels. The levels of MMP‐9, Bax, Bcl‐2, cyclin D1, and mTOR signalling pathway proteins were detected by Western blotting assays. The results showed that after laser irradiation, the proliferation of cells decreased, and the difference between the control group and the experimental group was significant (P < .05). The higher the energy was, the greater the upregulation of apoptosis was. Apoptosis and cell migration increased (P < .05). The expressions of microRNA‐206, MMP‐9, and Bax were upregulated, while the expressions of mTOR, Bcl‐2, and cyclin D1 were downregulated. To sum up, laser irradiation can significantly inhibit the proliferation of HSF cells, affect cell cycle, and increase cell apoptosis and migratory ability.

Patient-reported improvement in pain with pregabalin for painful diabetic neuropathy and postherpetic neuralgia is promising but needs further investigation

Por: Cox · F.

Commentary on: Derry S, Bell RF, Straube S, et al. Pregabalin for neuropathic pain in adults. Cochrane Database Syst Rev 2019:CD007076. doi: 10.1002/14651858.CD007076.pub3.

Implications for practice and research

  • There is moderate quality evidence that pregabalin is more effective than placebo for postherpetic neuralgia, painful diabetic neuropathy and post-traumatic neuropathic pain.

  • There is no evidence to support its use in HIV neuropathy nor central neuropathic pain.

  • Future studies require greater sample sizes and clearer methodology.

  • There is a need to identify patients who would benefit from pregabalin therapy.

  • Context

    Pregabalin is licensed to treat neuropathic pain which is defined as pain caused by a lesion or disease of the somatosensory nervous system.1 Neuropathic pain effects up to 10% of the population2 and includes postherpetic neuralgia (PHN) and painful diabetic neuropathy (PDN). The impact can be disabling and lead to higher healthcare...

    Vacuum‐assisted closure therapy combined with bi‐pectoral muscle flap for the treatment of deep sternal wound infections

    Abstract

    Deep sternal wound infection (DSWI) is a fatal complication after median sternotomy. This study was to assess the effect of vacuum‐assisted closure (VAC) combined with bi‐pectoral muscle advancement flap therapy on rehabilitation for the treatment of DSWI. Fifty‐two patients with DSWI underwent treatment of VAC and bi‐pectoral muscle flap. These patients were followed‐up 12 months postoperation. The patient characteristics, duration of VAC therapy, the mean hospital stay, and postoperative complications were retrospectively analysed. All patients underwent 1 to 3 VAC treatment sessions before closure. Fifty‐one of 52 DSWI patients were cured to discharge; the mean hospital stay was 26.5 days. The drainage tube continued to drain a large amount of bloody fluid in three patients after the wound was closed. Respiratory failure occurred in one patient with severe mediastinal and pulmonary infections and died eventually in hospital. One patient died of acute cerebral haemorrhage during the12‐month follow‐up. VAC therapy combined with bi‐pectoral muscle flap is a simple and effective treatment for DSWIs with short hospital stays and few complications. However, this is a retrospective case series presentation with no comparison group; further large‐scale controlled studies are needed.

    Selective debridement of burn wounds using hydrosurgery system

    Abstract

    In recent years, hydrosurgery is a technology that has been applied more and more in debridement procedures. However, the selectivity of hydrosurgery to cutaneous necrotic tissues has not been proved. This study was designed to investigate the possible tissue selectivity of hydrosurgery in the debridement in burn wounds. Deep partial‐thickness burns were produced on the back of porcine, and 48 hours later, both burn wounds and normal skin were debrided using the hydrosurgery system. Then tissue samples were taken, and histological staining was performed and observed under microscope. Burn wound resection rates and the normal skin damaged rates were measured. Our result indicated that the burn wounds were significantly more sensitive than the normal skin when the water pressure produced by the hydrosurgery system was set between 3000 and 5000 psi (pounds per square inch), that is, the necrotic tissue portions were debrided more easily than the normal skin tissue. Based on these data, we suggest that 3000 to 5000 psi of water pressure in the hydrosurgery system has a skin tissue selectivity in burn wounds.

    En la calle por ellas y por ellos: relato de experiencia en zonas de prostitución de un municipio del sur de Brasil

    Objetivo principal: relatar a experiência das práticas de educação em saúde, por um grupo de profissionais, integrantes da Atenção Primária em Saúde, em zonas de prostituição de Rio Grande/RS. Metodologia: Trata-se de um relato de experiência, realizado em 2016, por um grupo de profissionais (Enfermeira, Assistente Social, Educador Social e motorista), vinculados a secretaria de saúde de um município do extremo sul do Brasil. Em uma unidade móvel de saúde, o grupo percorreu as zonas de prostituição (postos de gasolina, ruas e boates). De abril a agosto de 2016, os profissionais de saúde desenvolveram ações de conscientização sobre a importância dos riscos inerentes a profissão, sobre o cuidado de si, através da oferta de testes rápidos, distribuição de preservativos masculinos e femininos e lubrificantes íntimos. Resultados: Vinte zonas de prostituição foram encontradas pela equipe, concentrados em ruas, boates e postos de combustíveis espalhados pela cidade. Cerca de 200 profis-sionais do sexo, foram atendidas pelo grupo, sendo ofertados mensalmente 40 exames de testes rápidos e 40 carteiras sociais. Quanto a pre-venção as ISTs, foram distribuídos 1500 preservativos masculinos, 200 preservativos femininos e 500 lubrificantes íntimos. Conclusão: A equipe, de forma itinerante, atuou de forma exitosa na busca, não somente de orientá-las quanto aos riscos inerentes a profissão, mas também de conhecer um pouco da sua história, do resgate a cidadania e da autoestima, a uma população que tem seus direitos frequentemente violados. Percebe-se nessa vivência a importância da educação em saúde como um instrumento de promoção e prevenção, na busca pela valorização dessas pessoas.

    Antimicrobial photodynamic therapy in skin wound healing: A systematic review of animal studies

    Abstract

    Bacterial infection is a common wound complication that can significantly delay healing. Classical local therapies for infected wounds are expensive and are frequently ineffective. One alternative therapy is photodynamic therapy (PDT). We conducted a systematic review to clarify whether PDT is useful for bacteria‐infected wounds in animal models. PubMed and Medline were searched for articles on PDT in infected skin wounds in animals. The language was limited to English. Nineteen articles met the inclusion criteria. The overall study methodological quality was moderate, with a low‐moderate risk of bias. The animal models were mice and rats. The wounds were excisional, burn, and abrasion wounds. Wound size ranged from 6 mm in diameter to 1.5 × 1.5 cm2. Most studies inoculated the wounds with Pseudomonas aeruginosa or methicillin‐resistant Staphylococcus aureus. Eleven and 17 studies showed that the PDT of infected wounds significantly decreased wound size and bacterial counts, respectively. Six, four, and two studies examined the effect of PDT on infected wound‐cytokine levels, wound‐healing time, and body weight, respectively. Most indicated that PDT had beneficial effects on these variables. PDT accelerated bacteria‐infected wound healing in animals by promoting wound closure and killing bacteria.

    Ischemia and reperfusion injury in superficial inferior epigastric artery-based vascularized lymph node flaps

    by David P. Perrault, Gene K. Lee, Antoun Bouz, Cynthia Sung, Roy Yu, Austin J. Pourmoussa, Sun Young Park, Gene H. Kim, Wan Jiao, Ketan M. Patel, Young-Kwon Hong, Alex K. Wong

    Vascularized lymph node transfer (VLNT) is a promising treatment modality for lymphedema; however, how lymphatic tissue responds to ischemia has not been well defined. This study investigates the cellular changes that occur in lymph nodes in response to ischemia and reperfusion. Lymph node containing superficial epigastric artery-based groin flaps were isolated in Prox-1 EGFP rats which permits real time identification of lymphatic tissue by green fluorescence during flap dissection. Flaps were subjected to ischemia for either 1, 2, 4, or 8 hours, by temporarily occluding the vascular pedicle. Flaps were harvested after 0 hours, 24 hours, or 5 days of reperfusion. Using EGFP signal guidance, lymph nodes were isolated from the flaps and tissue morphology, cell apoptosis, and inflammatory cytokines were quantified and analyzed via histology, immunostaining, and rtPCR. There was a significant increase in collagen deposition and tissue fibrosis in lymph nodes after 4 and 8 hours of ischemia compared to 1 and 2 hours, as assessed by picrosirius red staining. Cell apoptosis significantly increased after 4 hours of ischemia in all harvest times. In tissue subject to 4 hours of ischemia, longer reperfusion periods were associated with increased rates of CD3+ and CD45+ cell apoptosis. rtPCR analysis demonstrated significantly increased expression of CXCL1/GRO-α with 2 hours of ischemia and increased PECAM-1 and TNF-α expression with 1 hour of ischemia. Significant cell death and changes in tissue morphology do not occur until after 4 hours of ischemia; however, analysis of inflammatory biomarkers suggests that ischemia reperfusion injury can occur with as little as 2 hours of ischemia.

    Detection of posttraumatic pneumothorax using electrical impedance tomography—An observer-blinded study in pigs with blunt chest trauma

    by Felix Girrbach, Tobias Landeck, Dominic Schneider, Stefan U. Reske, Gunther Hempel, Sören Hammermüller, Udo Gottschaldt, Peter Salz, Katharina Noreikat, Sebastian N. Stehr, Hermann Wrigge, Andreas W. Reske

    Introduction

    Posttraumatic pneumothorax (PTX) is often overseen in anteroposterior chest X-ray. Chest sonography and Electrical Impedance Tomography (EIT) can both be used at the bedside and may provide complementary information. We evaluated the performance of EIT for diagnosing posttraumatic PTX in a pig model.

    Methods

    This study used images from an existing database of images acquired from 17 mechanically ventilated pigs, which had sustained standardized blunt chest trauma and had undergone repeated thoracic CT and EIT. 100 corresponding EIT/CT datasets were randomly chosen from the database and anonymized. Two independent and blinded observers analyzed the EIT data for presence and location of PTX. Analysis of the corresponding CTs by a radiologist served as reference.

    Results

    87/100 cases had at least one PTX detected by CT. Fourty-two cases showed a PTX > 20% of the sternovertebral diameter (PTXtrans20), whereas 52/100 PTX showed a PTX>3 cm in the craniocaudal diameter (PTXcc3), with 20 cases showing both a PTXtranscc and a PTXcc3. We found a very low agreement between both EIT observers considering the classification overall PTX/noPTX (κ = 0.09, p = 0.183). For PTXtrans20, sensitivity was 59% for observer 1 and 17% for observer 2, with a specificity of 48% and 50%, respectively. For PTXcc3, observer 1 showed a sensitivity of 60% with a specificity of 51% while the sensitivity of observer 2 was 17%, with a specificity of 89%. By programming a semi-automatized detection algorithm, we significantly improved the detection rate of PTXcc3, with a sensitivity of 73% and a specificity of 70%. However, detection of PTXtranscc was not improved.

    Conclusion

    In our analysis, visual interpretation of EIT without specific image processing or comparison with baseline data did not allow clinically useful diagnosis of posttraumatic PTX. Multimodal imaging approaches, technical improvements and image postprocessing algorithms might improve the performance of EIT for diagnosing PTX in the future.

    Assessment of dynamic cerebral autoregulation in humans: Is reproducibility dependent on blood pressure variability?

    by Jan Willem Elting, Marit L. Sanders, Ronney B. Panerai, Marcel Aries, Edson Bor-Seng-Shu, Alexander Caicedo, Max Chacon, Erik D. Gommer, Sabine Van Huffel, José L. Jara, Kyriaki Kostoglou, Adam Mahdi, Vasilis Z. Marmarelis, Georgios D. Mitsis, Martin Müller, Dragana Nikolic, Ricardo C. Nogueira, Stephen J. Payne, Corina Puppo, Dae C. Shin, David M. Simpson, Takashi Tarumi, Bernardo Yelicich, Rong Zhang, Jurgen A. H. R. Claassen

    We tested the influence of blood pressure variability on the reproducibility of dynamic cerebral autoregulation (DCA) estimates. Data were analyzed from the 2nd CARNet bootstrap initiative, where mean arterial blood pressure (MABP), cerebral blood flow velocity (CBFV) and end tidal CO2 were measured twice in 75 healthy subjects. DCA was analyzed by 14 different centers with a variety of different analysis methods. Intraclass Correlation (ICC) values increased significantly when subjects with low power spectral density MABP (PSD-MABP) values were removed from the analysis for all gain, phase and autoregulation index (ARI) parameters. Gain in the low frequency band (LF) had the highest ICC, followed by phase LF and gain in the very low frequency band. No significant differences were found between analysis methods for gain parameters, but for phase and ARI parameters, significant differences between the analysis methods were found. Alternatively, the Spearman-Brown prediction formula indicated that prolongation of the measurement duration up to 35 minutes may be needed to achieve good reproducibility for some DCA parameters. We conclude that poor DCA reproducibility (ICC 0.6) values when cases with low PSD-MABP are removed, and probably also when measurement duration is increased.

    Reduction of visual and auditory stimuli to reduce pain during venipuncture in premature infants. Study protocol for a randomized controlled trial

    Abstract

    Aim

    To evaluate the efficacy of the reduction of visual and auditory stimuli on pain during venipuncture in premature newborns of 32–36 weeks of gestation.

    Design

    Open, randomized, non‐blind parallel clinical trial.

    Method

    Study to take place at the neonatal intensive care unit of a University Hospital in 2019–2021. Fifty‐six recently born babies between 32‐36 weeks of gestation will participate. The dependent variable is the level of pain determined using the premature infant pain profile instrument. The intervention will be assigned randomly using the random.org software. Data analysis will be carried out using the IBM SPSS v.25 software assuming a level of significance of 5%.

    Discussion

    The evidence for the efficacy of reducing sensory stimulation and its effect on pain in minor procedures has not been studied in depth. There are no studies that evaluate the reduction of visual and auditory stimuli in a combined way.

    Impact

    It is easy to incorporate the reduction of visual and auditory stimuli into nursing practice. The results of this study could have a direct impact on clinical practice.

    Trial registered at clinicaltrials.gov: NCT04041635

    Intra‐individual variability in sleep is related to glycaemic control in adults with type 2 diabetes

    Abstract

    Aims

    To examine whether there were significant differences in sleep during weekdays/weekends and whether the intra‐individual variability in sleep was related to glycaemic control in patients with type 2 diabetes.

    Design

    Correlational, longitudinal design.

    Methods

    Data were collected between February 2017–January 2018. In all, 56 adults with type 2 diabetes were included (60.7 years, 55.4% female). Sleep was measured using the Consensus Sleep Diary over 8 days. Intra‐individual variability of sleep was calculated as the standard deviation of sleep variables. Standard deviations of sleep duration, sleep efficiency, sleep quality, and mid‐sleep time were obtained. Glycaemic control was measured by haemoglobin A1C. Paired t test and multiple regression analysis were used.

    Results

    Overall, there were no differences in sleep parameters between weekdays and weekends. Participants slept 20 min more over the weekends than during weekdays. The mid‐sleep time during weekends was about 35 min later than during weekdays. Intra‐individual variability of sleep duration and mid‐sleep ranged from 27.6–167.4 min and 13–137 min, respectively. Controlling for covariates (e.g., distress, symptoms, and self‐care), larger variability in sleep duration, and mid‐sleep were significantly related to higher A1C levels.

    Conclusion

    Diabetes educators are recommended to include the assessment of intra‐individual variability in sleep. Maintaining a regular sleep habit (e.g., sleep duration and sleep timing) should be highlighted during patient education.

    Impact

    Intra‐individual variability in sleep is an alternative dimension for sleep assessment. This study examined whether intra‐individual variability in sleep was related to glycaemic control in an older sample of type 2 diabetes patients using a sleep diary across 8 days. This sample had a similar sleep pattern during weekdays and weekends. Larger intra‐individual variabilities in sleep duration and mid‐sleep time were independently related to worse glycaemic control. Diabetes patients are recommended to maintain a regular sleep routine.

    Do emotional labour strategies influence emotional exhaustion and professional identity or vice versa? Evidence from new nurses 情绪劳动策略是否会对情绪枯竭和职业认同产生影响,反之亦然?源自新聘护士的证据

    Abstract

    Aims

    The aim was to examine the reciprocal relationships of emotional labour strategies with emotional exhaustion and professional identity.

    Design

    This study adopted a four‐wave cross‐lagged panel design.

    Methods

    Survey data were collected in 2018 from a sample of 171 newly hired nurses from 58 hospitals in 11 provinces of China. Nurses’ emotional labour (i.e., deep acting and surface acting), emotional exhaustion and professional identity were repeatedly measured. Cross‐lagged panel analyses were conducted to examine the reciprocal relationships we hypothesized.

    Results

    We found that emotional exhaustion was positively related to surface acting (but not vice versa); deep acting was negatively related to emotional exhaustion (but not vice versa); professional identity was positively related to deep acting (but not vice versa).

    Conclusion

    Our findings suggest that deep acting and professional identity may decrease the level of emotional exhaustion, whereas emotionally exhausted nurses are more likely to employ surface acting strategies.

    Impact

    This research finding will have an impact on the nursing management. Healthcare managers may consider workshops or training and development programs that promote nurses’ professional identify to promote nurses’ use of deep acting and consequently reduce their level of emotional exhaustion, which has been associated with a variety of negative consequences, such as low quality of patient service, high medical accidents, and turnover rate.

    目的

    研究情绪劳动策略与情绪枯竭和职业认同的相互关系。

    设计

    本研究采用四波交叉滞后组设计。

    方法

    2018年,对我国11个省份58家医院的171名新聘护士进行问卷调查,收集数据。反复测量护士的情绪劳动(即深层伪装和表层伪装)、情绪枯竭和职业认同。采用交叉滞后组分析来检验我们先前假设的相互关系。

    结果

    我们发现,情绪枯竭与表层伪装呈显著正相关(反之不成立);深层伪装与情绪枯竭呈显著负相关(反之不成立);职业认同与深层伪装呈显著正相关(反之不成立)。

    结论

    我们的研究结果表明,深层伪装和职业认同可能会降低情绪枯竭的程度,而面临情绪枯竭的护士更有可能采用表层伪装策略。

    影响

    本项研究发现将对护理管理工作产生影响。医疗保健管理人员可能会考虑举办研讨会或开展培训和发展计划,以提高护士的职业认同感,从而促进护士采用深层伪装策略,降低他们的情绪枯竭程度。同时情绪枯竭还与各种负面影响有关,如患者服务质量低,医疗事故频发,人员流动率高。

    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。

    The relationship of workplace violence and nurse outcomes: Gender difference study on a propensity score matched sample 工作场所暴力与护士结局的关系:倾向性评分匹配样本的性别差异研究

    Abstract

    Aims

    To investigate workplace violence and nurse outcomes by comparing gender differences.

    Design

    A secondary analysis of cross‐sectional survey data.

    Methods

    Workplace violence was measured by four items from the International Hospital Outcome Study. Nurse outcomes were measured by tools including burnout, job satisfaction and intention to stay. We used propensity score matching to generate a sociodemographic balanced dataset of 108 male and 288 female nurses. A hypothetical relationship model was derived from the affective events theory. Comparative statistics and multi‐group structural equation modelling were conducted to analyze gender differences. Data were collected in China from December 2013 – August 2014.

    Results

    Male nurses reported more workplace violence from staff and less intention to stay than females. Besides finding the mediation of burnout sharing with female nurses consistent with the affective events theory, workplace violence was directly linked to less intention to stay in male nurses.

    Conclusion

    Male nurses experience more workplace violence by staff than female nurses. Besides responding emotionally to workplace violence like female nurses, male nurses also respond behaviourally.

    Impact

    What problem did the study address? Gender differences in workplace violence and its relationship to nurse outcomes. What were the main findings? Male nurses experienced more workplace violence than female nurses, linked directly to less intention to stay. Workplace violence linked to less job satisfaction and intention to stay in nurses was mediated by burnout. Where and on whom will the research have impact? Gender‐based prevention of and coping with workplace violence should be included in nursing training.

    目的

    通过比较性别差异,探讨工作场所暴力与护士结局的关系。

    设计

    横向调查数据的二次分析。

    方法

    通过国际医院结局研究中的四个项目对工作场所暴力进行衡量研究。护士结局以工作倦怠、工作满意度和留任意愿为衡量指标。我们采用倾向性评分匹配,生成一个由108名男性护士和288名女性护士组成的社会人口平衡数据集。基于情绪事件理论提出了一个假设关系模型。通过利用好比较统计方法和多组结构方程建模来分析性别差异。数据于2013年12月至2014年8月在中国收集。

    结果

    相比于女护士,男护士更容易遭受工作场所暴力,留任意愿较低。除了通过与女护士分享工作倦怠的调解作用(与情绪事件理论一致)外,工作场所暴力与男护士的留任意愿降低直接相关。

    结论

    男护士比女护士更容易遭受工作场所暴力。除了像女护士一样对工作场所暴力做出情绪反应外,男护士还会做出行为上的反应。

    影响

    本项研究解决了哪些问题?工作场所暴力的性别差异及其与护士去留的关系。主要结果是什么?男护士比女护士更容易遭受工作场所暴力,这与其留任意愿较低直接相关。工作场所暴力与工作满意度和留任意愿降低相关,且通过工作倦怠调解。本项研究将适用于何处且对哪些人产生影响?护理培训应包括基于性别的工作场所暴力预防和应对措施。

    Controlled trial of an mHealth intervention to promote healthy behaviours in adolescence (TeenPower): Effectiveness analysis

    Abstract

    Aim

    To evaluate the effectiveness on lifestyle change of an mHealth intervention to promote healthy behaviours in adolescence (TeenPower) and to analyse the predictors of the mHealth intervention effectiveness.

    Design

    This study is designed as a non‐randomized controlled trial with a two‐arm structure.

    Methods

    Adolescents of 12–16‐year old were recruited from three school districts, with access to the Internet and smartphone/tablet devices. The intervention group was invited to engage in the mHealth intervention (TeenPower) for 6 months in addition to a school‐based intervention. The control group only followed the school‐based intervention. A repeated measures factorial ANOVA was used and the main effectiveness outcome was the lifestyle change measured by the adolescent lifestyle profile.

    Results

    The outcomes of the mHealth intervention (TeenPower) show a significant effect on nutrition (ƞ 2p = 0.03, p = .03), positive life perspective (ƞ 2p = 0.04, p = .01), and global lifestyle (ƞ 2p = 0.02, p = .05), with a dropout rate of 62.1%. The analysis of the effectiveness predictors of the mHealth intervention suggested that older adolescents tended to show a significant increase in the rates of stress management (r = .40; p < .05).

    Conclusions

    Although the considerable dropout rate, the mHealth intervention presented significant impact on multiple lifestyle domains, providing support for the effectiveness of mHealth interventions for health promotion as an add‐on to standard interdisciplinary interventions.

    Impact

    Adolescents must have the necessary and appropriate knowledge for the correct and responsible decision‐making regarding their health and lifestyle. Innovative strategies (mHealth intervention) were used to promote healthy behaviours. This study evaluates the effectiveness of an mHealth intervention (TeenPower) specifically designed for adolescents. We found a significant impact in several lifestyle domains such as health responsibility, nutrition, positive life perspective, and global lifestyle.

    Improving the quality of bowel preparation through an app for inpatients undergoing colonoscopy: A randomized controlled trial

    Abstract

    Aims

    To explore whether educational information delivered via a medical smartphone app in conjunction with verbal and written instructions, compared with traditional booklet‐based and verbal instructions, could improve the quality of bowel preparation for hospitalized patients undergoing colonoscopy.

    Design

    A prospective, single‐blinded, randomized controlled trial.

    Methods

    We performed a prospective, endoscopist‐blinded, randomized, controlled trial at Qilu Hospital of Shandong University in China between October 2017–March 2018. Inpatients who are eligible, based on the inclusion criteria, were randomized into two groups. Both groups received oral and written instructions for bowel preparation. In addition, the smartphone app group received instructions through a medical smartphone app. The primary outcome was the rate of adequate bowel preparation according to the Boston bowel preparation scale score. The secondary outcomes included patient compliance with instructions on how to take laxatives, side effects and rates of adenoma detection.

    Results

    A total of 293 patients were enrolled in this study. Demographic characteristics were comparable between the two groups. The χ2 test showed that the medical smartphone app group showed significant improvement in the rate of adequate bowel preparation compared with the control group (77.2% vs. 56.8%, p < .001). The adenoma detection rate (ADR) was significantly higher in the smartphone app group than in the control group (21.4% vs. 12.8%, p = .029) based on the χ2 test. The rates of incomplete compliance with instructions were 15.17% in the smartphone app group and 33.11% in the control group (p < .001) based on the χ2 test. The overall adverse events were 23.45% and 37.84% in the smartphone app and control groups, respectively (p = .008), based on the χ2 test.

    Conclusion

    Instructions provided via a mobile social media app in conjunction with traditional verbal and written methods could improve the quality of bowel preparation, increase the ADR and decrease adverse effects. App instructions could be an effective addition to oral and written instructions for inpatients undergoing colonoscopy.

    Impact

    This study suggested that clinical personnel could deliver information via smartphone as a powerful addition to traditional educational methods that could improve work efficiency and help patients increase the success rate of bowel preparation.

    Trial registration: Chinese clinical trial registration number: ChiCTR1900024666.

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