Perspectives and experiences of community-dwelling older adults who experience falling: A qualitative meta-synthesis.

Objectives: This study aimed to systematically review and synthesize the perspectives and experiences of community-dwelling older adults who experience falling, to inform the subsequent development of fall prevention and management interventions, and to provide recommendations for healthcare policy and practice. Methods: The review was a qualitative meta-aggregation study following the JBI qualitative systematic review methodology. Databases searched included Medline (through PubMed), CINAHL, PsycINFO, Embase, and the Web of Science. Peer-reviewed articles published in the English language from January 2010 to May 2023 were retrieved. The JBI Qualitative Assessment and Review Instrument (JBI-QARI) was used to assess the quality of the methodology. The ConQual ranking system was used to establish confidence in the synthesized findings. The protocol was registered with PROSPERO (CRD 42023421789). Results: This review included ten qualitative studies with an overall quality score of 60%-90%. Data extracted from eligible studies resulted in 59 findings, which were then aggregated into seven categories based on the similarity in meaning. Three synthesized findings were generated and rated as moderate for synthesized finding 2 and low for synthesized finding 1 and 3 on the ConQual score. Synthesized finding 1: Older adults experience physical injuries and pain, restricted daily activities, and limitations in social activities, reduction or loss of in independence, and have feelings of fear and helplessness. Synthesized finding 2: After experiencing a fall, older adults reflect on the cause of the fall and recognize and interpret the risk factors. Synthesized finding 3: Older adults' reflections on the causes and impact of falls reveal both positive and negative reactions. They perceive a number of strategies for coping with falls and their consequences, such as using assistive devices, correcting risk factors, seeking medical help, and receiving ongoing physical and psychological attention. Conclusions: Healthcare providers should pay attention to the feelings and experiences of older adults after falling, as well as their reflection on the causes and impacts of falling, and develop tailored plans for intervention. There is also a need for longitudinal studies to examine the longer-term impact of falls on older adults to provide insights into the stability and changes in their reflections, perceptions, attitudes, and preventive behaviors over time.

Nursing undergraduates' experiences of a simulation-centred educational program in hospice care in Macao: A qualitative research.

Objectives: The study aimed to explore the experiences of nursing undergraduates participating in a simulation-centred educational program in hospice care in Macao, China. Methods: This descriptive qualitative study was based on the data collected through semi-structured individual interviews. Seventeen nursing undergraduates in Macao, China who attended the simulation-centred program in hospice care participated in this qualitative from November to December 2020. This program included three parts: introduction to hospice care (2 h), management of terminal symptoms (10 h), and hospice situation simulations (6 h). The interview data were analyzed using qualitative content analysis. Results: This study revealed two themes and six sub-themes. Theme 1 was developing competencies in caring for dying patients and their families, which included four subcategories of sensitivity to patients' needs, knowledge of hospice care, skills of symptom control and comfort supply, and communication skills. Theme 2 was improving the ability to self-care and support colleagues, which included two subcategories of reflection on life and death and sharing and supporting among colleagues. Conclusion: This program improved the competency of nursing undergraduates in hospice care and participants' learning experience was good.

Defining subpopulations of differential drug response to reveal novel target populations.

Personalised medicine has predominantly focused on genetically altered cancer genes that stratify drug responses, but there is a need to objectively evaluate differential pharmacology patterns at a subpopulation level. Here, we introduce an approach based on unsupervised machine learning to compare the pharmacological response relationships between 327 pairs of cancer therapies. This approach integrated multiple measures of response to identify subpopulations that react differently to inhibitors of the same or different targets to understand mechanisms of resistance and pathway cross-talk. MEK, BRAF, and PI3K inhibitors were shown to be effective as combination therapies for particular BRAF mutant subpopulations. A systematic analysis of preclinical data for a failed phase III trial of selumetinib combined with docetaxel in lung cancer suggests potential indications in pancreatic and colorectal cancers with KRAS mutation. This data-informed study exemplifies a method for stratified medicine to identify novel cancer subpopulations, their genetic biomarkers, and effective drug combinations.

[Posterolateral minimal incision, poking reduction, and simple internal fixation in treatment of collapsed fractures of posterolateral tibial plateau].

Objective: To explore the effectiveness of limited incision, poking reduction, and simple internal fixation in the treatment of collapsed fractures of the posterolateral tibial plateau. Methods: Between October 2010 and January 2016, 16 patients with collapsed fractures of the posterolateral tibial plateau underwent posterolateral incision, poking reduction, and simple internal fixation. There were 10 males and 6 females with the age of 22-63 years (mean, 43.5 years). The injury was caused by falling in 5 cases, traffic accident in 7 cases, and falling from height in 4 cases. All cases had closed fractures. The left knee was involved in 9 cases and the right knee in 7 cases. The injury-to-admission time was 2 hours to 3 days (mean, 10 hours). X-ray films showed that the articular surface collapsing was more than 2 mm. According to Schatzker criteria, 6 cases were rated as type II and 10 cases as type III. Twelve cases had fracture of fibular head. The incision length, operation time, intraoperative blood loss, and incision healing were recorded; fracture healing was observed, and tibial plateau angle and posterior slope angle were measured on X-ray films; loss of articular surface reduction was observed by CT scan; and American Hospital for Special Surgery (HSS) score was used to evaluate the knee joint function. Results: The incision length was 7-10 cm (mean, 8.6 cm); operation time was 35-55 minutes (mean, 46 minutes); intraoperative blood loss was 10-35 mL (mean, 28 mL). Primary healing of incision was obtained. Skin pain occurred in 1 case at 2 months because Kirschner wire retracted. Fifteen cases were followed up 8-21 months (mean, 13.5 months). The fracture healing time was from 3 to 6 months (mean, 4.8 months). There was no significant difference in tibial plateau angle and posterior slope angle between at immediate after operation and at last follow-up ( t=-1.500, P=0.156; t=-1.781, P=0.097). The anatomic reduction rate of articular surface was 93.8% (15/16) at immediate after operation. At last follow-up, the recollapse height of articular surface was 0.1-1.2 mm (mean, 0.36 mm). According to the HSS score system, the results were excellent in 12 cases, good in 2 cases, and fair in 1 case, and the excellent and good rate was 93.3%. Conclusion: The limited incision by posterolateral approach, poking reduction, and simple internal fixation have the advantages of small injury, full exposure, and easy operation in the treatment of simple posterolateral tibial plateau fractures; bone graft support and simple internal fixation can prevent recollapse of the articular surface and achieve satisfactory knee function.

Knowledge of urinary incontinence among Chinese community nurses and community-dwelling older people.

The purpose of this study was to describe knowledge of urinary incontinence among community nurses and community-dwelling older people in China. The descriptive study was undertaken in 2007 using a cross-sectional research design. A random sampling method was used to recruit 100 Chinese older people and 100 Chinese nurses in JinShan and NanHui communities, Shanghai, China. All participants completed all items of a demographic survey and the Urinary Incontinence Knowledge Scale (UIKS). Based on the literature, the UIKS was developed in 2007. The value of content validity index tested by five experts was 0.75. Measures of internal consistency (Kuder-Richardson formula 20) were 0.72 for the community nurses and 0.69 for the older people. The UIKS consisted of 30 items with dichotomous choices (Correct = 1; False or Do not know = 0). The mean UIKS score of the nurses (mean 20.7, SD 3.5) was significantly higher than that of the older people (mean 13.4, SD 4.0) with a 95% confidence interval for difference in means 6.3-8.4 (t = 13.84; df = 198; P < 0.001). Although community nurses had moderate knowledge of the impact of incontinence, they still lacked knowledge of risk factors, symptoms, prevention, treatment, and management. Older people had poor knowledge about risk factors, symptoms, impact, prevention, treatment and management of urinary incontinence. Because of their knowledge deficits, community nurses and older people viewed urinary incontinence as a normal part of the ageing process. The findings suggested that both nurses and older people in the community had educational needs related to the incontinence. Further studies to develop specific educational programmes concerning urinary incontinence are suggested. Ways to enhance support and acceptable forms of specific content knowledge, process measures and regulatory enforcement require additional exploration.

Improvement of nursing students' critical thinking skills through problem-based learning in the People's Republic of China: a quasi-experimental study.

A quasi-experimental, two-group pretest-post-test design was conducted to examine the effect of problem-based learning on the critical thinking skills of 46 Year 2 undergraduate nursing students in the People's Republic of China. The California Critical Thinking Skills Test Form A, Chinese-Taiwanese version was used as both a pretest and as a post-test for a semester-long nursing course. There was no significant difference in critical thinking skills at pretest, whereas, significant differences in critical thinking skills existed between the problem-based learning and lecture groups at post-test. The problem-based learning students had a significantly greater improvement on the overall California Critical Thinking Skills Test, analysis, and induction subscale scores compared with the lecture students. Problem-based learning fostered nursing students' critical thinking skills.

A systematic review of selected evidence on developing nursing students' critical thinking through problem-based learning.

Rapidly changing developments and expanding roles in healthcare environment requires professional nurses to develop critical thinking. Nursing education strives to facilitate students' critical thinking through the appropriate instructional approaches. Problem-based learning (PBL) is a student-centered approach to learning which enables the students to work cooperatively in small groups for seeking solutions to situations/problems. The systematic review was conducted to provide the available evidence on developing nursing students' critical thinking through PBL. The computerized searches from 1990-2006 in CINAHL, Proquest, Cochrane library, Pubmed etc were performed. All studies which addressed the differences in critical thinking among nursing students in PBL were considered. Two independent reviewers assessed the eligibility of each study, its level of evidence and the methodological quality. As a result, only ten studies were retrieved, they were: one RCT with a Jadad quality score of 3, one nonrandomized control study, two quasi-experimental studies with non-controlled pretest-posttest design, and six descriptive studies. The available evidence in this review did not provide supportive evidence on developing nursing students' critical thinking through PBL. Clearly, there is a need for additional research with larger sample size and high quality to clarify the effects of PBL on critical thinking development within nursing educational context.