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Development of a tool for assessing the clinical competency of Chinese masters nursing students based on the mini-CEX: a Delphi method study

Por: Peng · Q. · Gao · Y. · Liu · N. · Gan · X.
Objective

To construct a scientific and systematic competency evaluation tool for master of nursing specialists (MNS) and to provide a reference for the training, assessment and competency evaluation of MNS.

Methods

A first draft of the indicators for assessing MNS core competencies was developed on the basis of published research and group discussions. Between June and December 2020, the indicators were revised using two rounds of the Delphi expert consultation method, with questionnaires completed by 16 experts from five provinces in China.

Results

The valid retrieval rate of the two questionnaires was 100.00%, and the coefficient of expert authority was 0.931. The Kendall’s concordance coefficients of the two rounds of questionnaires were 0.136 (p

Conclusions

The MNS competency assessment tool constructed in this study is focused and highly credible. The findings can be used as a guide for the training, assessment and competence evaluation of MNS in the future.

Relationship between social isolation and glycaemic control of people previously diagnosed with diabetes: secondary analysis from the CHARLS

Por: Lu · Q. · Qu · L. · Xie · C. · Shu · Y. · Gao · F. · Zou · M. · Fan · X. · Luo · X. · Meng · J. · Xue · Y. · Cao · Y.
Objectives

Social isolation may affect diabetes self-management. This study aimed to explore the relations between social isolation and glycaemic control in patients with diabetes and to explore lifestyle differences among individuals with different levels of social isolation.

Methods

The relevant data of 665 people previously diagnosed with diabetes included in the China Health and Retirement Longitudinal Study from 2011 to 2015 were extracted and analysed. The study included patient general information, blood glucose, lipids, glycosylated haemoglobin, social isolation index, health-related lifestyle factors and diabetes-related factors. Differences in metabolic abnormalities and modifiable lifestyles were compared among patients with varying levels of social isolation.

Results

Multiple linear regression analysis demonstrated that among men aged 45–64 years, the high social isolation group had significantly higher glycosylated haemoglobin levels compared with the low isolation group (7.29±1.81 vs 6.59±1.63, p=0.026). A positive correlation was observed between social isolation and blood glucose (β=14.16; 95% CI 2.75 to 25.57; p=0.015) and glycosylated haemoglobin (β=0.35; 95% CI 0.10 to 0.60; p=0.006), indicating that higher social isolation was associated with higher fasting blood glucose and glycosylated haemoglobin levels. However, no significant associations were observed in other age groups. Notably, men aged 45–65 years with high social isolation had higher depression rates (44.10% vs 24.60%, p=0.024), lower engagement in moderate exercise (5.70% vs 23.50%, p=0.019) and shorter 10-minute walks (17.10% vs 36.80%, p=0.027). Differences in other health-related and diabetes-related factors were not statistically significant.

Conclusion

Middle-aged men with diabetes with higher social isolation tend to have higher blood glucose and glycosylated haemoglobin levels. This subset of patients requires targeted attention to provide social support from family and friends for improved glycaemic control. If necessary, education on diabetes should be made available to family members and friends.

Inhaled Nitric Oxide ReDuce postoperatIve pulmoNAry complicaTions in patiEnts with recent COVID-19 infection (INORDINATE): protocol for a randomised controlled trial

Por: Zheng · Z. · Wang · L. · Wang · S. · Fan · Q. · Zhang · H. · Luo · G. · Gao · B. · Yang · X. · Zhao · B. · Wang · X. · Dong · H. · Nie · H. · Lei · C.
Background

A history of SARS-CoV-2 infection has been reported to be associated with an increased risk of postoperative pulmonary complications (PPCs). Even mild PPCs can elevate the rates of early postoperative mortality, intensive care unit (ICU) admission and prolong the length of ICU and/or hospital stays. Consequently, it is crucial to develop perioperative management strategies that can mitigate these increased risks in surgical patients who have recently been infected with SARS-CoV-2. Accumulating evidence suggests that nitric oxide (NO) inhalation might be effective in treating COVID-19. NO functions in COVID-19 by promoting vasodilation, anticoagulation, anti-inflammatory and antiviral effects. Therefore, our study hypothesises that the perioperative use of NO can effectively reduce PPCs in patients with recent SARS-CoV-2 infection.

Method and analysis

A prospective, double-blind, single-centre, randomised controlled trial is proposed. The trial aims to include participants who are planning to undergo surgery with general anaesthesia and have been recently infected with SARS-CoV-2 (within 7 weeks). Stratified allocation of eligible patients will be performed at a 1:1 ratio based on the predicted risk of PPCs using the Assess Respiratory Risk in Surgical Patients in Catalonia risk index and the time interval between infection and surgery.

The primary outcome of the study will be the presence of PPCs within the first 7 days following surgery, including respiratory infection, respiratory failure, pleural effusion, atelectasis, pneumothorax, bronchospasm and aspiration pneumonitis. The primary outcome will be reported as counts (percentage) and will be compared using a two-proportion 2 test. The common effect across all primary components will be estimated using a multiple generalised linear model.

Ethics and dissemination

The trial is approved by the Institutional Review Board of Xijing Hospital (KY20232058-F1). The findings, including positive, negative and inconclusive results, will be published in scientific journals with peer-review processes.

Trial registration number

NCT05721144.

Association between socioeconomic status and hypertension among adults in Fujian province and the mediating effect of BMI and cooking salt intake: a cross-sectional study

Por: Li · Y. · Ge · W. · Wu · M. · Gao · M. · Peng · Z. · Han · Y. · Hu · X. · Li · L.
Objectives

This study aimed to investigate the association between socioeconomic status (SES) and the prevalence of hypertension in Fujian province, China, and to evaluate the mediating effect of body mass index (BMI) and cooking salt intake between SES and hypertension.

Design

Community-based cross-sectional survey was conducted between June 2018 and December 2019.

Setting

Fujian province, China.

Participants

A total of 26 500 participants aged >18 years completed the survey.

Outcome measures

The primary outcome was the prevalence of hypertension. Education, income and occupation were used as SES indicators. Meanwhile, certain health behaviours and metabolic risk factors were used as secondary indicators of SES.

Results

The prevalence of hypertension was relatively high among participants who finished primary education (34.8%), had the lowest annual income (46.0%), were unemployed or retired (34.7%). Education and income levels were negatively associated with the prevalence of hypertension (p

Conclusions

SES was associated with the prevalence of hypertension among adults in Fujian province, China. BMI and cooking salt intake were partial mediators of the association between SES and hypertension.

Adverse birth outcomes and childhood overweight at age of 3-8 years in a prospective cohort study in Tianjin, China

Por: Zhang · R. · Gao · M. · Li · W. · Liu · H. · Wang · S. · Wang · H. · Li · N. · Li · J. · Yu · Z. · Hu · G. · Leng · J. · Yang · X.
Objectives

To explore associations between adverse birth outcomes and childhood overweight at 3–8 years of age.

Design

A prospective cohort study.

Setting

Six central urban districts of Tianjin, China.

Participants

1681 woman–child pairs.

Methods

1681 woman–child pairs were followed up for 8 years in Tianjin, China. Demographic and clinical information including birth outcomes was collected longitudinally, commencing from first antenatal care visit till postpartum period. Offspring height and weight were measured at 3–8 years of age. High and low weight/length ratios (WLR) at birth were, respectively, defined as ≥90th and ≤10th gestational week and sex-specific percentiles. Overweight for children at 3–5 and 6–8 years of age were, respectively, defined as body mass index (BMI)-for-age and -sex above the 2 z-score and 1 z-score curves of the WHO’s child growth standards. Binary logistic regression analysis was used to obtain ORs and 95% CI with a stepwise backward selection method to select independent predictors.

Primary outcomes measures

Childhood overweight.

Results

Of 1681 children, 10.7% (n=179) and 27.8% (n=468) developed overweight at 3–5 and 6–8 years of age, respectively. Large for gestational age (LGA) was associated with increased risk of overweight at 3–5 years of age (aOR: 1.86, 95% CI: 1.27 to 2.72) while high WLR at birth was associated with increased risk of overweight at 6–8 years of age (1.82, 1.41 to 2.34). Low WLR at birth was associated with decreased risk of overweight at 6–8 years of age (0.52, 0.30 to 0.90).

Conclusions

LGA and high WLR at birth predicted childhood overweight at 3–5 and 6–8 years of age, respectively. Low WLR at birth was associated with decreased risk of childhood overweight at 6–8 years of age.

Analysis of factors associated with needlestick injuries of clinical nurses by applying a human factor analysis and classification system: A nationwide cross‐sectional survey

Abstract

Aims

This study aims to investigate the current situation of needlestick injuries (NSIs) of clinical nurses and identify associated factors by using the theoretical framework of the human factors analysis and classification system (HFACS).

Design

A nationwide cross-sectional survey was conducted.

Methods

Multi-stage sampling was used to investigate 3336 nurses in 14 Chinese hospitals. Descriptive statistics and univariate and multivariate logistic regression were employed to reveal the rate of NSIs and their associated factors.

Results

A total of 970 nurses (29.1%) reported having experienced at least one NSI in the past year. The multivariate logistic regression analysis showed that good hospital safety climate and clinical nurses in intensive care unit (ICU) and emergency department had protective effects against NSIs compared with nurses in internal medicine department. The nurse, senior nurse, and nurse in charge have significantly increased the risk for NSIs compared with the associate chief nurse or above. Patients with poor vision but wearing glasses and poor vision but not wearing glasses were more prone to have NSIs. Working in the operating room compared with internal medicine, average weekly working time of >45 h compared with ≤40 h and poor general health led to increased risk of NSIs.

Conclusion

The rate of NSIs in clinical nurses was high in China. Individual factors including professional title, department, visual acuity and general mental health and organisational factors including weekly working hours and hospital safety atmosphere were significantly correlated with the occurrence of NSIs.

Relevance to Clinical Practice

Nursing managers should focused on physical and psychological conditions of clinical nurses, and organisational support is required to enhance the hospital safety atmosphere.

No Patient or Public Contribution

Contributions from patients or the public are irrelevant because this study aims to explore current situation and factors associated with NSIs in clinical nurses.

Non‐pharmacological interventions on quality of life in stroke survivors: A systematic review and meta‐analysis

Abstract

Background

Non-pharmacological interventions have been used in the rehabilitation of stroke survivors, but their effects on stroke survivors' quality of life (QoL) are unknown.

Aim

This review aimed to summarize the existing evidence regarding non-pharmacological interventions for QoL in stroke survivors and to evaluate the effectiveness of different types of interventions.

Methods

We systematically searched databases including PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Chinese BioMedical Literature Database, China Science and Technology Journal Database, and Wanfang data from the earliest available records to March 2023. Randomized controlled trials which explored the effects of non-pharmacological interventions on QoL in stroke patients were included. The meta-analysis was conducted to evaluate the effectiveness of different interventions on QoL. The Review Manager 5.3 was used to conduct the meta-analysis and the revised Cochrane risk-of-bias tool was used to assess the methodological quality of trials.

Results

A total of 93,245 records were identified, and 34 articles were reviewed and summarized, of which 20 articles were included in the meta-analysis. The summary of the findings of the included studies revealed fitness training, constraint-induced movement therapy (CIMT), physical exercise, music therapy (MT), and art-based interventions may have positive effects on QoL. The fitness training improved total QoL, especially in physical domains including physical functioning (mean difference [MD] = 10.90; 95% CI [7.20, 14.59]), role physical (MD = 10.63; 95% CI [6.71, 14.55]), and global health (MD = 8.76; 95% CI [5.14, 12.38]). The CIMT had a slight effect on general QoL (standardized mean difference [SMD] = 0.48, 95% CI [0.16, 0.80]), whereas significantly improved strength (MD = 8.84; 95% CI [1.31, 16.38]), activities of daily living/instrumental activities of daily living (ADL/IADL; MD = 10.42; 95% CI [2.98, 17.87]), and mobility (MD = 8.02; 95% CI [1.21, 14.83]). MT had a positive effect on the mental health domain (SMD = 0.54; 95% CI [0.14, 0.94]).

Linking Evidence to Action

Our findings suggest that fitness training and CIMT have a significant effect on improving physical QoL, while MT has a positive effect on improving psychological QoL. Future studies may use comprehensive and multicomponent interventions to simultaneously improve the patients' physical, psychological, and social QoL.

Nursing management of cognitive dysfunction in adults with brain injury: Summary of best evidence‐practiced strategies

Abstract

Objective

To summarize the best evidence-based strategies for the management of cognitive dysfunction in patients with brain injury and to provide a reference for clinical nursing practice.

Design

Review.

Methods

The review was presented using PRISMA guidelines. A systematic search of evidence on the management of cognitive dysfunction in patients with brain injury was conducted in computerized decision systems, guideline websites, professional association websites and comprehensive databases from the date of creation to 21 June 2023. The types of evidence included were clinical decision making, guidelines, evidence summaries, best practices, recommended practices, expert consensus, systematic reviews and meta-analyses. Two researchers trained in evidence-based methodological systems independently evaluated the quality of the literature and extracted, integrated and graded the evidence for inclusion.

Results

A total of 20 articles were selected, including nine guidelines, three expert consensus articles, one clinical practice article and seven systematic reviews, and the overall quality of the literature was high. Thirty pieces of evidence were summarized in seven areas: assessment, multidisciplinary team, rehabilitation program, cognitive intervention, exercise intervention, music intervention and medication management.

Conclusions

This study summarizes the latest evidence on the management of cognitive dysfunction in the care of adults with brain injury and provides a reference for clinical nursing practice. The best evidence should be selected for localized and individualized application in clinical work, and the best evidence should be continuously updated to standardize nursing practice.

Implications for the profession and/or patient care

Patients with cognitive impairment after brain injury often suffer from memory loss, attention deficit and disorientation and are unable to have a normal life and experience much enjoyment, which seriously affects their physical and mental health and creates a great burden of care for their families and society. Best evidence-based strategies for the nursing management of cognitive impairment in brain injury are essential for standardizing clinical nursing practice and providing timely, professional, systematic and comprehensive nursing interventions for patients.

Reporting method

This review is reported following the PRISMA 2020 statement guidelines, as applicable, to enhance transparency in reporting the evidence synthesis.

Trial and protocol registration

This study has been registered with the Fudan University Centre for Evidence-based Nursing, a JBI Centre of Excellence under registration number ES20232566, http://ebn.nursing.fudan.edu.cn/myRegisterList.

Patient or public contribution

No patient or public contribution.

Extensive analysis of risk factors associated with surgical site infections post‐cardiothoracic open surgery

Abstract

Surgical site infections (SSIs) post-cardiothoracic surgery represent a significant challenge in patient care. Understanding the risk factors contributing to SSIs is essential for improving surgical outcomes and patient safety. A comprehensive retrospective analysis was conducted at our institution from January 2021 to December 2022. This study included 30 patients with SSIs and 60 without, following cardiothoracic open surgery. Data were collected on various variables, including hypertension, anaemia, operation time, hospital stay, alcohol consumption, smoking habits, Body Mass Index, age, and drainage tube placement. Univariate and multivariate logistic regression analyses were employed using SPSS software to identify significant predictors of SSIs. Univariate analysis indicated a strong correlation between SSIs and factors like smoking, diabetes mellitus, drainage tube placement, anaemia, and significant intraoperative blood loss (≥800 mL). These factors were statistically significant with p-values < 0.05. Multivariate logistic regression further confirmed the impact of these factors, with high odds ratios indicating a substantial increase in SSI risk associated with these conditions. This study highlights intraoperative blood loss, anaemia, drainage tube placement, smoking, and diabetes mellitus as key risk factors for SSIs post-cardiothoracic surgery. Recognising and addressing these factors through targeted preventive measures is crucial in clinical practice to reduce the incidence of SSIs and improve postoperative care in cardiothoracic surgery.

Impact of stapler versus manual closure techniques on pharyngocutaneous fistula development post‐total laryngectomy: A systematic review and meta‐analysis

Abstract

Pharyngocutaneous fistula (PCF) is a major complication after total laryngectomy, with significant morbidity and mortality. Whether mechanical stapler closure of the pharynx reduces fistula rates compared to hand-sewn techniques remains unclear. We conducted an updated systematic review and meta-analysis to clarify this question. Five databases were systematically searched from inception through November 2023 for studies comparing stapler versus suture closure for fistula outcomes after laryngectomy. Odds ratios (OR) were pooled using random-effects models and fixed-effects models. Subgroup and sensitivity analyses were performed. Risk of bias was appraised using NHLBI tools. Nine studies with 803 patients were included. Mechanical closure significantly reduced fistula incidence versus suture closure (OR = 0.57, 95% CI 0.34–0.95, p = 0.03). Subgroup analysis found that stapling's protective effect varied by patient age, country/region, linear stapler size and female percentage. Stapling reduced fistula odds by 80% in the Turkey subgroup (OR = 0.20, 95% CI 0.09–0.50) but showed no benefit in other regions. Patients <60 years showed an 84% fistula reduction with stapling (OR = 0.17, 95% CI 0.06–0.45), whereas older subgroups did not. Linear stapler size of 60 mm significantly reduced fistula occurrence while 75 mm did not. There was no evidence that low female percentage mitigated stapling benefits. Mechanical stapler closure after total laryngectomy meaningfully reduces the likelihood of postoperative PCF formation compared to hand-sewn closure, especially for patients younger than 60 years old. The absolute risk reduction supports its utility to prevent this complication.

The impact of glucocorticoids therapy on cutaneous wounds in Kawasaki disease: A meta‐analysis of randomized controlled trials

Abstract

Kawasaki disease (KD) is one of the most challenging diseases that is defined as an acute vasculitis that affects the coronary arteries primarily in children. It causes complications if left untreated at early stages, ultimately leading to death. Corticosteroids have been recognized to treat and cause great impact on the patients with KD. Glucocorticoid is one of the main corticosteroids that are being used to treat KD and cutaneous wounds. However, ineffectiveness of a few glucocorticoids can limit the efficacy of this treatment. This study particularly aimed to elucidate the impact of glucocorticoids on cutaneous wounds in KD. To perform the meta-analysis, a comprehensive literature survey was conducted to unveil the studies and research conducted on Kawasaki patients that revealed different glucocorticoids in the form of specific interventions influencing KD. The literature was searched using numerous keywords, screened and data was extracted to perform the meta-analysis and then it was conducted using the metabin function of R package meta. A total of 2000 patients from both intervention and control groups were employed to carry out the meta-analysis to analyse and evaluate the impact of glucocorticoids on curing KD and cutaneous wounds in patients. The results disclosed that glucocorticoids along with other steroids, mainly IVIG (intravenous immunoglobulin), was an effective intervention to patients suffering from Kawasaki. The results depicted significant outcomes with the values (risk ratio [RR]: 1.08, 95% confidence interval [CI]: 0.58–2.00, p < 0.01) and enlightened the fact that adopting different glucocorticoids may significantly improve the efficacy of skin lesions along with KD. Hence, interventions of glucocorticoids must be utilized in the clinical practice to reduce the incidence of skin wounds and adverse effects caused due to KD.

Construction of an instrument to enable the assessment of the risk of falls in older outpatients: A quantitative methodological study

Abstract

Objectives

To develop an instrument to facilitate the risk assessment of falls in older outpatients.

Design

A quantitative methodological study using the cross-sectional data.

Methods

This study enrolled 1988 older participants who underwent comprehensive geriatric assessment (CGA) in an outpatient clinic from May 2020 to November 2022. The history of any falls (≥1 falls in a year) and recurrent falls (≥2 falls in a year) were investigated. Potential risk factors of falls were selected by stepwise logistic regression, and a screening tool was constructed based on nomogram. The tool performance was compared with two reference tools (Fried Frailty Phenotype; CGA with 10 items, CGA-10) by using receiver operating curves, sensitivity (Sen), specificity (Spe), and area under the curve (AUC).

Results

Age, unintentional weight loss, depression measured by the Patient Health Questionnaire-2, muscle strength measured by the five times sit-to-stand test, and stand balance measured by semi- and full-tandem standing were the most important risk factors for falls. A fall risk screening tool was constructed with the six measurements (FRST-6). FRST-6 showed the best AUC (Sen, Spe) of 0.75 (Sen = 0.72, Spe = 0.69) for recurrent falls and 0.65 (Sen = 0.74, Spe = 0.48) for any falls. FRST-6 was comparable to CGA-10 and outperformed FFP in performance.

Conclusions

Age, depression, weight loss, gait, and balance were important risk factors of falls. The FRST-6 tool based on these factors showed acceptable performance in risk stratification.

Impact

Performing a multifactorial assessment in primary care clinics is urgent for falls prevention. The FRST-6 provides a simple and practical way for falls risk screening. With this tool, healthcare professionals can efficiently identify patients at risk of falling and make appropriate recommendations in resource-limited settings.

Patient or Public Contribution

No patient or public contribution was received, due to our study design.

Role of hydrocolloid dressing in preventing face pressure ulcers from non‐invasive ventilation and facilitating postoperative wound healing in maxillofacial surgery: A meta‐analysis

Abstract

Facial pressure ulcers from non-invasive ventilation (NIV) and challenges in wound healing post-maxillofacial surgery are significant concerns in clinical care. This meta-analysis aimed to evaluate the effectiveness of hydrocolloid dressings in these contexts. From a pool of 1135 articles, 8 studies met the inclusion criteria. Hydrocolloid dressings demonstrated a significant reduction in facial pressure ulcers for NIV patients, with lower REEDA scores 1-week postapplication (standardized mean difference [SMD] = −16.7, 95% confidence interval [CI]: −24.26 to −9.15, p < 0.01). In maxillofacial surgery, patients treated with hydrocolloid dressings exhibited improved wound healing and reduced scar formation, evidenced by lower Manchester Scar Scale scores 3 months post-surgery (SMD = −15.46, 95% CI: −20.28 to −10.64, p < 0.01). These findings suggest that hydrocolloid dressings are effective in both preventing NIV-related facial pressure ulcers and enhancing wound healing in maxillofacial surgery.

Association of nurse managers' paternalistic leadership and nurses' perceived workplace bullying: The mediating effect of organizational climate

Abstract

Aims

To explore the association between nurse managers' paternalistic leadership and nurses' perceived workplace bullying (WPB), as well as to examine the mediating role of organizational climate in this association.

Background

There is a lack of empirical evidence regarding the relationship between nurse managers' paternalistic leadership, organizational climate and nurses' perceived WPB. Clarifying this relationship is crucial to understand how paternalistic leadership influences WPB and for nursing managers to seek organizational-level solutions to prevent it.

Methods

A cross-sectional survey was performed from 4 January to 10 February 2022, in six tertiary hospitals in mainland China. Demographic information, Paternalistic Leadership Scale, Organizational Climate Scale and Negative Acts Questionnaire-Revised were used in the survey. Descriptive statistics, Spearman correlation analyses and a structural equation model were used for data analysis.

Results

A total of 5093 valid questionnaires were collected. Moral leadership and authoritarian leadership have both direct and indirect effects on WPB through the mediating effect of organizational climate. The former is negatively related to WPB and the latter is positively related to WPB. Benevolent leadership was only negatively associated with WPB via the mediating effect of organizational climate.

Conclusion

The three components of paternalistic leadership have different effects on WPB through the mediating effect of organizational climate. Nurse managers are recommended to strengthen moral leadership, balance benevolent leadership, reduce authoritarian leadership and strive to create a positive organizational climate in their efforts to mitigate WPB among nurses.

Impact

This study enhanced our comprehension of the relationship between different leadership styles and WPB. Greater emphasis should be placed on moral leadership in the promotion of nursing managers and nursing leadership training programs. Additionally, nursing managers should focus on establishing a positive organizational climate that helps to reduce WPB.

Patient or Public Contribution

No patient or public contribution. This study did not involve patients, service users, caregivers or members of the public.

Attrition from longitudinal ageing studies and performance across domains of cognitive functioning: an individual participant data meta-analysis

Por: Hernandez · R. · Jin · H. · Lee · P.-J. · Schneider · S. · Junghaenel · D. U. · Stone · A. A. · Meijer · E. · Gao · H. · Maupin · D. · Zelinski · E. M.
Objectives

This paper examined the magnitude of differences in performance across domains of cognitive functioning between participants who attrited from studies and those who did not, using data from longitudinal ageing studies where multiple cognitive tests were administered.

Design

Individual participant data meta-analysis.

Participants

Data are from 10 epidemiological longitudinal studies on ageing (total n=209 518) from several Western countries (UK, USA, Mexico, etc). Each study had multiple waves of data (range of 2–17 waves), with multiple cognitive tests administered at each wave (range of 4–17 tests). Only waves with cognitive tests and information on participant dropout at the immediate next wave for adults aged 50 years or older were used in the meta-analysis.

Measures

For each pair of consecutive study waves, we compared the difference in cognitive scores (Cohen’s d) between participants who dropped out at the next study wave and those who remained. Note that our operationalisation of dropout was inclusive of all causes (eg, mortality). The proportion of participant dropout at each wave was also computed.

Results

The average proportion of dropouts between consecutive study waves was 0.26 (0.18 to 0.34). People who attrited were found to have significantly lower levels of cognitive functioning in all domains (at the wave 2–3 years before attrition) compared with those who did not attrit, with small-to-medium effect sizes (overall d=0.37 (0.30 to 0.43)).

Conclusions

Older adults who attrited from longitudinal ageing studies had lower cognitive functioning (assessed at the timepoint before attrition) across all domains as compared with individuals who remained. Cognitive functioning differences may contribute to selection bias in longitudinal ageing studies, impeding accurate conclusions in developmental research. In addition, examining the functional capabilities of attriters may be valuable for determining whether attriters experience functional limitations requiring healthcare attention.

Family resilience, patient‐reported symptoms in young stroke dyads: The effect of caregiver readiness and social support

Abstract

Aims and Objectives

To investigate empirically the direct effect and potential mechanism of family resilience on patient-reported outcomes among young stroke dyads in China.

Background

Young patients with stroke have been becoming an important public health issue. According to relevant theories and previous studies, we found that family resilience might play an important role in patient's symptoms. However, it is less clear about the specific relationship and potential mechanisms of these two variables.

Design

We used a prospective cross-sectional design.

Methods

A multi-item questionnaire was used to assess the constructs of interest. Researchers progressively constructed and validated conditional process models. The PROCESS macro was used to verify the research hypotheses.

Results

A total of 560 questionnaires were collected in this study. We found that family resilience of stroke patients and their spouses had a direct effect on the physical, psychological and social aspects of patient-reported symptoms. We further revealed that caregiver preparedness partially mediated the relationship between family resilience and patient's symptoms in stroke patient-spouse dyads, while perceived social support moderated the relationship between caregiver preparedness and patient's symptoms. Finally, we observed that the impact of caregiver readiness and social support on patients' symptoms predominantly manifested in physical and physiological outcomes.

Conclusions

Our research provides evidence about the positive impact of family resilience on patient-reported symptoms in young stroke dyads. Meanwhile, it further revealed how caregiver preparedness and perceived social support may play out in the relationship.

Practice Implications

Our research introduces a novel perspective and pathway to enhance short-term recovery outcomes for patients. It also furnishes clinicians and nurses with evidence to guide the implementation of interventions aimed at improving patient health outcomes and facilitating smoother transitions from the hospital to home.

Impact

What problem did the study address?

Families play a crucial role in a patient's recovery process from illness, with family resilience serving as an important force for families to overcome adversity. However, the impact on patient symptoms and the underlying mechanisms of this relationship are uncertain. Empirical research is required to validate these aspects.

What were the main findings?

Family resilience has a positive impact on the physical, psychological and social aspects of patient-reported symptoms in young stroke dyads. Both the actor effect and partner effect are supported. The impact of caregiver readiness and social support on patient-reported symptoms is primarily observed in physical and physiological outcomes.

Where and on whom will the research have an impact?

This study offers a novel approach to enhance the short-term recovery of stroke patients. The researchers believe that the findings of this study will play an even more significant role during patients' transition from the hospital to home.

Reporting Method

This study followed the STROBE statement of cross-sectional studies.

Patient or Public Contribution

The study was conducted by patients, their spouses, healthcare professionals and the research team.

Effectiveness of musculoskeletal manipulations in patients with neck pain: a protocol for a systematic review and network meta-analysis

Por: Gong · Z. · Gao · Y. · Liu · W. · Liu · X. · Chen · Q. · Zhang · S. · Liu · L. · Li · J. · Li · W.
Introduction

Neck pain is a common problem that severely affects physical and mental health. While musculoskeletal manipulations are recommended as the first-line treatment for adults with neck pain, the comparative effectiveness of different musculoskeletal manipulations remains unclear. This systematic review and network meta-analysis of randomised controlled trials (RCTs) will compare the effectiveness of different types of musculoskeletal manipulations, with the overarching aim of guiding clinical practice.

Methods and analysis

Two independent reviewers will search four English electronic databases (Web of Science, Cochrane Library, EMBASE, PubMed) and three Chinese electronic databases (China National Knowledge Infrastructure, China Science and Technology Journal Database, Wanfang) for relevant RCTs published from 1 January 2013 to 30 April 2023. The Clinical Trials Registry (ClinicalTrials.gov) will be searched for completed but unpublished RCTs. English and Chinese will be used to search English databases and Chinese databases, respectively. RCTs of musculoskeletal manipulations for adults (aged ≥18 years) with neck pain will be considered eligible for inclusion. A pairwise meta-analysis and network meta-analysis will be performed, and pooled risk ratios, standardised mean differences and 95% CIs will be determined.

Ethics and dissemination

Ethics approval is not required as this study is a literature review. The results of this review will be published in peer-reviewed journals or disseminated at conferences.

PROSPERO registration number

CRD42023420775.

Which aspects of patient experience are the 'moment of truth in the healthcare context: a multicentre cross-sectional study in China

Por: Chen · X. · Yuan · J. · Zhao · W. · Qin · W. · Gao · J. · Zhang · Y.
Objective

This study aimed to examine the differential magnitude of associations between specific dimensions of patient experience and overall patient satisfaction.

Design

A descriptive, cross-sectional design was used to collect patient experience and overall satisfaction data.

Setting

Participants were recruited at one tertiary general hospital, one tertiary specialised hospital, and one secondary hospital in Shanghai, China. These three institutes represent the main kinds of hospitals in the Chinese healthcare system.

Participants

1532 inpatients were recruited, and 1469 were included. The inclusion criteria were as follows: (1) having received inpatient service for at least 2 days; (2) able to understand the questions in the questionnaires; and (3) aged>18 years old. Patients who had impaired cognitive function and completed the questionnaires with missing information were excluded.

Primary and secondary outcome measure

Patient experience was measured using the Inpatient Experience with Nursing Care Scale, which is widely used in the China. The overall patient satisfaction was measured with 10-point response option.

Results

The LASSO (least absolute shrinkage and selection operator) regression results showed that as the penalty factor () = 0.0162, age, marriage status, financial status, length of hospital stay and numbers of previous of hospitalisation and six dimensions of nursing care remained in the model. As increases to 0.1862, only four patient experience variables, potentially the most influential on patient satisfaction, remained in the model. Patient experience with emotional support was the most significant dimension explaining patient satisfaction (β=0.1564), the second most significant dimension was admission and discharge management (β=0.1562), and the third was monitoring and coping with the progress of diseases (β=0.0613).

Conclusion

Patient experience with emotional support, admission and discharge management, monitoring and coping with the progress of diseases, and information and education are the most significant dimensions explaining patient satisfaction.

Interventions to address parenting stress among caregivers of children with chronic diseases: An umbrella review

Abstract

Background

Caregivers of children with chronic diseases suffer from great parenting pressure, which directly affects the treatment and rehabilitation of children, reduces the quality of life of caregivers and damages family functioning. Existing reviews have not systematically summarized and evaluated interventions for parenting stress in caregivers of children with chronic diseases.

Data Sources

Embase, PubMed, Web of Science, OVID, CNKI, CBM, Wan Fang and Cochrane Library were searched for eligible reviews in November 2021 and October 2022.

Methods

Two reviewers independently screened titles and abstracts, reviewed full texts of articles for eligibility, and appraised the quality of reviews using JBI. The quality of the evidence was assessed using GRADE. Findings are reported in accordance with PRISMA checklist. Narrative summaries grouped findings by intervention types.

Results

Out of 2632 records, we included 21 systematic reviews for a synthesis. Interventions for parenting stress in children with chronic diseases were divided into seven categories. Cognitive behavioural interventions, psychosocial interventions, child behavioural and/or developmental parent interventions and synthesized interventions have shown high-level evidence in reducing parenting stress for caregivers of children with chronic diseases. Furthermore, outcome measures and intervention protocols were highly heterogeneous across interventions.

Conclusions

This umbrella review suggest that reducing the parenting stress of caregivers of children with chronic diseases can directly target caregivers' parenting stress through cognitive behavioural interventions/psychosocial interventions and/or provide guidance to parents on the behavioural and developmental problems of children with chronic diseases. A more standardized approach to outcome measures is essential to assess efficacy and compare interventions across studies.

Relevance to Clinical Practice

The findings provide information and evidence for reducing parenting stress among caregivers of children with chronic diseases to guide the development of comprehensive intervention strategies.

Patient or Public Contribution

Patient or public contribution does not apply to this study.

Intolerance of uncertainty and mental health in China “Post-pandemic” age: The mediating role of difficulties in emotion regulation

Por: Zi-Hao Gao · Jun Li

by Zi-Hao Gao, Jun Li

The Chinese government adjusted its national epidemic prevention and control policy in December 2022 after the worldwide declaration of COVID-19 as a common influenza. After the policy adjustment, there has been widespread infection in China, which has brought a lot of uncertainty to the lives and studies of Chinese university students. This study focused on the impact of the intolerance of uncertainty for COVID-19 (IUC) on the emotional and mental health of college students in China “Post-pandemic” age. This study examined the mediating role of difficulties in emotion regulation (DER) between IUC and mental health (MH). 1,281 university students in China were surveyed using the intolerance of uncertainty for COVID-19 scale, the difficulties in emotion regulation scale and the mental health scale. A structural equation model was used to test the hypothesis model, and it was shown that IUC had a significant negative effect on the MH of college students and a significant positive effect on the DER. DER had a significant negative effect on the MH, and DER had a complete mediation effect between IUC and MH. The findings of this study enrich our understanding of the influencing factors of mental health of university students under the background of post-epidemic in China, and provide practical reference for universities on how to prevent mental health problems under the current uncertain environment in China.
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