Effects of the online and offline hybrid continuous group care on maternal and infant health: a randomized controlled trial.

BACKGROUND: The group care is a well-established maternal care model that has been widely used in many developed countries, but in China, it is confined to prenatal care services. In addition, affected by traditional birth culture, Chinese women tend to focus more on their fetuses and newborns but lack attention to their own intrapartum and postpartum care. The aim of this study was to construct and implement a prenatal, intrapartum, and the postpartum continuous group care model that combines online and offline service in Hainan Province, China, and to evaluate the effect on maternal women and newborns. METHODS: This study was a randomized controlled trial involving 144 pregnant women in a first-class tertiary general hospital in Hainan Province, China. Women were divided into an intervention group and a control group using the random number table, with 72 women in each group. The control group received routine maternal care services, and the intervention group received the continuous group care based on the routine maternal care services. Count data such as rate of cesarean section and incidence rate of fetal macrosomia were analyzed with the chi-square test or Fisher's exact test, and the General Self-efficacy Scale scores were analyzed by repeated measures ANOVA. P < 0.05 was considered statistically significant, with two-sided probability values. RESULTS: Compared with the control group, the rate of excessive prenatal weight gain, cesarean section, and 42-day postpartum depression were significantly lower in the intervention group (P < 0.05), and higher General Self-efficacy Scale scores (in the expectant period and 42 days postpartum) and exclusive breastfeeding rate (42 days postpartum) (P < 0.05). The incidence of fetal macrosomia was significantly lower in the intervention group (P < 0.05). But there was no significant difference in birth weight, preterm birth, the incidence of low-birth-weight infants and 1-min Apgar score (P > 0.05). CONCLUSION: The continuous group care with online and offline service can effectively control the gestational weight gain, reduce the rate of cesarean section, macrosomia, and postpartum depression. It can improve the self-efficacy of women and the rate of exclusive breastfeeding effectively. TRIAL REGISTRATION: Chinese Clinical Trial Regestry (ChiCTR2200065765, 04/11/2022, Retrospectively registered).

The application of a continuous partnership-based birth plan in China: A randomized controlled trial.

BACKGROUND: The cesarean section rate is as high as 36.7% in China, much higher than the average cesarean section rate of 27% in Asia. With the implementation of the two-children and three-children policy, the primipara with cesarean will also face the choice of repeated or even multiple cesareans, which will increase the risk of maternal perinatal mortality and serious fetal pulmonary morbidity. To reduce the cesarean section rate, a series of midwifery service measures such as the birth plan have been taken in China and it has played a certain role in improving the birth outcome and maternal birth experience. However, the areas carrying out birth plan are often economically developed with advanced medical conditions. the application effect of birth plan in economically underdeveloped areas with limited medical conditions in China is unknown. OBJECTIVE: To evaluate the effects of a continuous partnership-based birth plan on local women's birth outcomes and experience in Haikou which is an economically underdeveloped city in China. DESIGN: A randomized controlled trial study design was used. PARTICIPANTS: 90 primiparous women who received pregnancy service from the obstetrics clinic of one of tertiary hospitals in Haikou city, Hainan Province between July 2020 and December 2020 and planned to give birth in this hospital were recruited. METHODS: After eligibility was determined, consents obtained and baseline surveys completed, 90 participants were randomly allocated to study groups with concealed opaque envelopes by a blinded research assistant and each group were 45 participants. Participants in control group received routine obstetric health service and nursing care, while participants in the experimental group received the continuous partnership service of midwives on the basis of routine care. At the same time, the birth plan was formulated and implemented, and the relevant indicators were recorded and analyzed during and after birth, including cesarean section rate, non-medical indication cesarean section rate, oxytocin use rate, perineal lateral resection rate and anxiety degree. RESULTS: The cesarean rate in the experiment and control groups were 20.45% and 57.14%, of which the non-medical indication cesarean rate in the experiment and control groups were 22.22% and 50.00%, respectively, whereby the difference of cesarean rate and nonmedically indicated cesarean section rate between the groups was statistically significant (χ2 = 12.231, p < 0.001;χ2 = 9.101, p = 0.003). Besides, the differences in anxiety degree, neonatal NICU transfer rate and satisfaction of birth between the two groups were statistically significant (p < 0.05). While there was no significant difference in oxytocin use rate, perineal lateral resection rate, neonatal 1-min and 5-min Alzheimer's score between the two groups (P > 0.05). CONCLUSION: The birth plan based on continuous partnership can reduce medical intervention, improve birth outcomes, reduce anxiety and optimize maternal birth experience of women, which is worthy of promotion in economically underdeveloped areas of China.

Observation of the Effect of Focused Psychological Intervention Combined with Standardized Pain Nursing on Postoperative Pain Levels and Depression and Anxiety in Patients with Intestinal Obstruction.

Objective: The purpose of this study was to investigate the effect of targeted psychological intervention combined with standardized pain care on postoperative pain, depression, and anxiety in patients with intestinal obstruction. Methods: 84 patients with intestinal obstruction hospitalized at our hospital from October 2019 to February 2021 were randomly divided into study and control groups. The patients in the control group were treated with routine nursing, and the patients in the study group were treated with focused psychological intervention combined with standardized pain nursing. The pain degree (VAS), depression and anxiety (SDS, SAS) score, sleep quality (PSQI) score, and nursing satisfaction of the two groups before and after intervention were calculated. Results: Before intervention, no significant differences in VAS score between the study and control groups were observed. The VAS score of 6 h, 12 h, 24 h, and 48 h dry prognosis in the study group was lower than that in the control group. There was no significant difference in the scores of SDS and SAS between two groups. After intervention, the scores of SDS and SAS in the study group were lower than those in the control group. After intervention, the scores of daytime dysfunction, hypnotic drugs, sleep disorders, sleep efficiency, sleep time, and sleep quality in the study group were significantly lower than those in the control group. The scores of nursing state, nursing technique, nurse-patient communication, and inspection observation in the study group were higher than those in the control. Conclusion: The intervention of focused psychological intervention combined with standardized pain nursing on patients with intestinal obstruction can effectively relieve their negative emotion and reduce the degree of postoperative pain. In addition, it can improve patients' sleep quality and enhance patients' satisfaction with all kinds of nursing work.

The use of Kumpfer's resilience framework in understanding the breastfeeding experience of employed mothers after returning to work: a qualitative study in China.

BACKGROUND: The increasing numbers of women in the workforce is an inevitable trend in China. More and more employed women stop breastfeeding because of working stressors. Many mothers, however, overcome the challenges and insist on breastfeeding after returning to work. Their individual experience of breastfeeding may provide a new insight to promote and support breastfeeding on employed mothers. This study sought to understand mothers' experience with insisting on breastfeeding after returning to work based on Kumpfer's Resilience Framework in Chinese context. METHODS: This qualitative study was designed with semi-structured interviews. Purposive sampling and snowball sampling were employed to recruit 13 full-time working mothers with a stable job in the public sector who continued to breastfeed for 1 month or longer after returning to work in Haikou, Hainan Province, China. Interviews were conducted from January to March 2020 to capture participants' experiences of breastfeed after returning to work. Grounded theory and Kumpfer's Resilience Framework were used to analyze data via a systematic and iterative process. RESULTS: Employed mothers built resilience while continuing to breastfeed after returning to work. The core concept was "dynamic interaction". Other categories were the background and explanation of this phenomenon. For working mothers who continued to breastfeed, resilience involved "dynamic interaction", which started from "experiencing stressors" and "obtaining support", two environmental factors interacted with the individual to "build resilience qualities", which interact with environment led to "behavioral resilience". And then the ongoing dynamic interaction between behavioral resilience and environment ultimately led to three different "weaning processes", including natural weaning, active weaning, and forced weaning. CONCLUSIONS: This study identified the framework of resilience in mothers who were in the adversity of breastfeeding after returning to work based on Kumpfer's Resilience Framework. It provided a new insight into the resilience of employed mothers around the world to continue breastfeeding and showed the different culture of breastfeeding on employed mothers.

Application effects of targeted nursing model in patients undergoing thyroid surgery and its influence on patients' negative emotions.

OBJECTIVE: To explore the effectiveness of a targeted nursing model for patients undergoing thyroid surgery, and to analyse the influence of intervention on the negative emotions of patients. METHODS: Eighty patients who received thyroid surgery in our hospital were enrolled and divided into a study group (n=40, given targeted nursing) and a control group (n=40, given routine surgical nursing) according to the difference of intervention measures. The postoperative bed-leaving time, hospitalization time, medical expenses, drainage tube indwelling time and incidence of postoperative adverse reactions were compared between the two groups. The degree of pain, anxiety and depression was compared between the two groups at 1 d, 3 d, 5 d, and 7 d after surgery. The scales of voice handicap index (VHI-10) and standard swallowing assessment (SSA) were used to evaluate voice quality and swallowing function in the two groups. RESULTS: The postoperative bed-leaving time, hospitalization time, medical expenses, drainage tube indwelling time and incidence of postoperative adverse reactions of patients in the study group were lower than those in the control group (P<0.05). The scores of visual analogue scale (VAS), self-rating anxiety scale (SAS) and self-rating depression scale (SDS) in the study group at 3 d, 5 d and 7 d after surgery were lower than those in the control group (P<0.05). The scores of VHI-10 and SSA in the study group were lower than those in the control group at 7 d and 30 d after surgery (P<0.05). CONCLUSION: Targeted nursing for patients undergoing thyroid surgery can help accelerate the improvement of postoperative clinical symptoms, relieve the unhealthy emotions and pain of patients, and help improve their voice quality and swallowing function, which also has a positive effect on reducing postoperative complications. Therefore, it is worthy of clinical popularization and application.

The effect of online training-based continuous nursing care for rectal cancer-patients undergoing permanent colostomy.

OBJECTIVE: The study explored and analyzed the effects of online training based continuous nursing care on the health-related life quality and self-care ability of rectal cancer patients undergoing permanent colostomy. METHODS: A total of 119 patients who were hospitalized and underwent permanent colostomy due to rectal cancer from January 2018 to December 2019 were collected as research subjects and were divided into the control group (n=57) and the observation group (n=62) based on their admission time. The control group received routine nursing, while the observation group was treated with online training based continuous nursing care in addition to routine nursing. Both groups' self-efficacy, self-care ability, quality of life, psychological status and complications within 6 months after discharge were compared. RESULTS: Both groups had increased scores in self-efficacy, and their dimensional scores and total scores of self-care ability after intervention were higher compared with pre-intervention (P<0.05), and the indexes of the observation group after intervention were significantly higher than that of the control group (P<0.05). The two groups had remarkably increased SF-36 scores of each dimension after intervention compared with pre-intervention (P<0.05), and the observation group had apparently higher SF-36 scores than the control group after intervention (P<0.05). The two groups had increased SAS and SDS grades in post-intervention compared with pre-intervention (P<0.05), and the observation group had notably higher SAS and SDS scores than the control group (P<0.05). The complication rate within 6 months after discharge in the observation group was obviously lower than which in the control group (P<0.05). CONCLUSION: An online training based continuous caring model can effectively improve the self-care ability and self-efficacy of rectal cancer patients with permanent enterostomy, thus promoting better life quality and psychological states, and effectively reducing the incidence of complications after discharge.

The effects of mindfulness-based stress reduction therapy combined with intensive education on the effectiveness of the care and the awareness rate in patients with arthritis and diabetes.

OBJECTIVE: To explore the effect of mindfulness-based stress reduction (MBSR) therapy combined with intensive education on the effectiveness of the care and the awareness rate in patients with diabetes and arthritis. METHODS: A total of 94 patients with diabetes and arthritis admitted to our hospital were recruited as the study cohort and randomly divided into two groups, with 47 patients in each group. Both groups underwent routine nursing interventions. The control group underwent an eight-week-long intensive education program, while the observation group was additionally cared for with MBSR for 8 weeks. The two groups were assessed using the Symptom Checklist 90 (SCL-90), the Hamilton Anxiety Scale (HAMA-14), the Hamilton Depression Scale (HAMD-17), the Simple Coping Style Questionnaire (SCSQ), the diabetes specificity quality of life scale (DSQL), and their cortisol levels and awareness/satisfaction rates. RESULTS: The SCL-90 scores were lower in both groups after 8 weeks of nursing (P < 0.05), and the scores in the observation group were lower than the scores in the control group (P < 0.05). The observation group exhibited lower HAMA-14, HAMD-17, and negative coping scores (P < 0.05) and higher positive coping scores than the control group (P < 0.05). The DSQL scores and the cortisol levels in the observation group at 2, 4, 6, and 8 weeks after the nursing were lower than they were in the control group (P < 0.05). The satisfaction rate with the nursing methods, the nursing effectiveness, and the awareness rate with regard to regular review, knowledge of pathogenesis, and clinical manifestations in the observation group were higher than they were in the control group (P < 0.05). CONCLUSION: MBSR therapy combined with intensive education can improve patients' symptoms, reduce their anxiety/depression, improve their coping levels, quality of life, and cortisol levels as well as their satisfaction/awareness rates in diabetic patients with arthritis.

The effect of evidence-based nursing program of progressive functional exercise of affected limbs on patients with breast cancer-related lymphoedema.

OBJECTIVE: This study explored and analyzed the effect of evidence-based nursing program of progressive exercise on patients with breast cancer-related lymphoedema. METHODS: 78 breast cancer patients who underwent breast cancer surgery in our hospital from January to December 2018 were chosen as the control group, and 83 patients enrolled from January to December 2019 with the same condition were selected as the observation group. The control group was given routine nursing measures after surgery, while the observation group was given the evidence-based nursing (EBN) program of progressive functional exercise on affected limbs after breast cancer surgery. The postoperative lymphedema, function recovery of upper limb, score of quality life and the satisfaction of patients to nursing were compared between the two groups. RESULTS: The degree of lymphedema in the observation group was significantly lower than that in the control group 4 weeks after surgery (P<0.05). The limb lifting function, abduction function and rotatory function of the observation group were significantly superior to those of the control group (P<0.05). The scores of physiological status, emotional status, functional status and additional concerns in the observation group were significantly higher than those in the control group 4 weeks after operation (25.46±3.97 vs. 16.95±4.17; 24.74±3.11 vs. 17.42±2.86; 25.48±1.69 vs. 25.48±1.69; 24.51±4.12 vs. 18.32±2.56) (P<0.05). There was no significant difference in social/family status scores between the two groups (P>0.05). Additionally, the satisfaction of patients in the observation group to nursing care was also significantly higher than that in control group (P<0.05). CONCLUSION: The evidence-based nursing program of progressive exercise can effectively reduce the lymphedema of patients after breast cancer surgery, improve their postoperative upper limbs function, and effectively promote the quality of life and nursing satisfaction, which is worthy of clinical promotion.

In Situ Detection of Plasma Exosomal MicroRNA-1246 for Breast Cancer Diagnostics by a Au Nanoflare Probe.

Breast cancer is the second cause of cancer mortality in women globally. Early detection, treatment, and metastasis monitoring are of great importance to favorable prognosis. Although conventional diagnostic methods, such as breast X-ray mammography and image positioning biopsy, are accurate, they could cause radioactive or invasive damage to patients. Liquid biopsy as a noninvasive method is convenient for repeated sampling in clinical cancer prognostic, metastatic evaluation, and relapse monitoring. MicroRNAs encased in exosomes circulating in biofluids are promising candidate cancer biomarkers because of their cancer-specific expression profiles. Here, we report an in situ detection of microRNA-1246 (miR-1246) in human plasma exosomes as breast cancer biomarker by a nucleic acid functionalized Au nanoflare probe. Needing neither time-consuming and costly isolation of exosomes from the plasma sample nor transfection means, the Au nanoflare probe can directly enter the plasma exosomes to generate fluorescent signal quantitatively by specifically targeting miR-1246. Only 40 µL of plasma is needed to incubate 4 h with the probe, giving signal sensitive enough to distinguish samples of breast cancer to normal control. Using plasma miR-1246 level detected by our assay as a marker, we differentiated 46 breast cancer patients from 28 healthy controls with 100% sensitivity and 92.9% specificity at the best cutoff. This simple, accurate, sensitive, and cost-effective liquid biopsy by the Au nanoflare probe is potent to be developed as a noninvasive breast cancer diagnostic assay for clinical adaption.

Parental support for sexual and reproductive health information and services for unmarried youth in Chengdu, China.

The objective of the study was to explore parental perspectives and attitudes towards the provision of sexual and reproductive health (SRH) information and services to unmarried youth in Chengdu, China. A representative sample of parents was drawn using multi-stage stratified cluster sampling technique, and information was collected using a structured questionnaire. The eligible respondents were parents (both fathers and mothers) who had at least one unmarried adolescent and/or youth aged 15 to 24 years old. A total of 2,871 fathers and mothers were interviewed. Parents' SRH-related knowledge was poor and dissonant attitudes of tolerance and ambivalence towards provision of SRH information and services to unmarried youth were found. About 80% of parents accepted and understood unmarried youth seeking SRH counseling service, but the percentages of such positive attitude was much lower for premarital contraceptive use. Over half of the parents were supportive of providing SRH education and information to unmarried youth; whereas on the provision of contraceptive services to sexually active unmarried youth, 27% were negative, 25% accepted, 36% indicated an understanding, and the rest 12% had no opinion. Parents' SRH-related knowledge and attitudes were associated with parental social-demographic characteristics. Findings from this study suggest that parent-oriented programs are needed to apprise them of the existing SRH conditions of the unmarried youth in China, to allay fears and misconceptions of parents, and to enhance family-based sex education in terms of increasing parents' SRH knowledge and their capacity and skills of providing such information to unmarried youth.