Nursing students' experiences of digital learning in Chinese higher education institutions: A descriptive qualitative study.

BACKGROUND: As digital learning is rapidly developing and being applied to almost all subjects in higher education nursing. Although digital learning has been shown to have a wide range of benefits, little is known about research into Chinese students' perceptions of digital learning, and there is a need to explore students' digital learning experiences. AIM: This study aimed to explore the digital learning experiences of undergraduate nursing students in Chinese higher education institutions, with the aim of informing future improvements in digital teaching and learning. DESIGN: A descriptive qualitative study. SETTINGS: This study was conducted at six universities in three cities in China. PARTICIPANTS: Twenty-six nursing students with at least one year's experience of digital learning. METHOD: Semi-structured online interviews were used to collect the data, and conventional content analysis was used to analyze the data. FINDINGS: Nursing students' digital learning experiences were categorized into three themes: positive digital learning experience, negative digital learning experience, and barriers to digital learning perception of students. CONCLUSIONS: With the help of advanced digital technology, students can access rich and diversified learning resources anytime and anywhere according to their personal learning pace and interests, which greatly enhances their autonomy and interest in learning. Open online courses have effectively compensated for regional differences in teachers' qualifications, enabling students in remote areas to enjoy high-quality teaching from top educational institutions and giving a solid impetus for improving nursing education in China. However, with the popularity of digital teaching, its design and innovation shortcomings have gradually emerged: students feel lonely and alienated when learning online, and long for more of the interaction and care found in traditional teaching. At the same time, the lack of regulation and assessment standards has created inequities in learning and affected student motivation.

Effects of modified oropharyngeal exercises on individuals with simple snoring: An online randomized controlled trial.

BACKGROUND: Individuals who suffer from simple snoring rarely go to a doctor due to a lack of medical knowledge, but simple snoring can reduce the individual's quality of life and may cause social problems to the bed partner/family members. OBJECTIVES: The aims of the present study are to explore the effects of online modified oropharyngeal exercises on the individuals with simple snoring and to provide a rehabilitation method for individuals with simple snoring. METHODS: This study is a double-blinded, two-arm, randomized controlled trial. Participants were enrolled and randomly assigned to the intervention group (n = 33) or the control group (n = 33). The participants in the control group received health education on snoring, while the participants in the intervention group received the modified oropharyngeal exercise besides health education on snoring. The intervention duration was 4 weeks. The primary outcomes included snoring index, snoring loudness, and snoring quantity. The secondary outcomes included self-reported snoring, sleep quality, daytime sleepiness, anxiety symptoms, depression symptoms, and quality of life. All outcomes were measured at baseline, 4 weeks, and 8 weeks. RESULTS: Generalized estimating equations (GEE) analyses showed significant differences between the intervention group and the control group on snoring index, loudness, and quantity (p < .001). Moreover, modified oropharyngeal exercise had effects on sleep quality, daytime sleepiness, anxiety symptoms, depression symptoms, and quality of life in individuals with simple snoring (p < .001). Self-reported snoring also improved at 8 weeks. CONCLUSION: The modified oropharyngeal exercises were effective in improving simple snoring. It could also improve sleep quality, daytime sleepiness, anxiety symptoms, depression symptoms, and quality of life.

Traditional Chinese Exercises for Cardiovascular Diseases: A Bibliometric Analysis.

Traditional Chinese exercises (TCEs) have great value in the prevention and effective treatment of cardiovascular diseases (CVD). Our purpose in this study was to summarize present research trends and future directions regarding the link between TCEs and CVD by bibliometrics analysis. We searched the Web of Science Core Collection (WoSCC) for all original articles and reviews on TCEs for CVD published in English before August 7, 2022 using CiteSpace 5.8.R3 and Microsoft Excel 2019 software, and we displayed the results in the form of network maps, line graphs, and tables. We initially obtained 725 articles. Our results showed that the United States was the most influential country in this line of research, with Harvard University the most prolific institution in the field, and, Evidence-Based Complementary and Alternative Medicine was the most productive journal for these articles. The highest-frequency keywords in this research area were Tai Chi, exercise, blood pressure, quality of life, and older adult. Additionally, important research topics included heart rate variability, quality of life, meta-analysis, Baduanjin exercise, and breathing exercise. In addition, our results revealed that among all the TCEs, Tai Chi, Baduanjin, and Qigong emerged as the most extensively studied. However, it's important to note our exclusive focus on literature published in English may have led to our missing important results. Future investigators should broaden their search to include other databases and languages to present a still more comprehensive overview of this field.

Effects of blended learning on undergraduate nursing students' knowledge, skills, critical thinking ability and mental health: A systematic review and meta-analysis.

AIM: This study aimed to evaluate the effects of blended learning on nursing students. The primary outcomes include knowledge and skills, and the secondary outcomes include critical thinking ability, mental health, blended learning design, and nursing students' attitudes toward blended learning. BACKGROUND: Blended learning combines the advantages of online learning and traditional face-to-face learning, and makes up for the disadvantages of simple online learning or traditional learning. The effects of blended learning on the knowledge, skills, critical thinking ability, and mental health of nursing students were unknown. DESIGN: Systematic review and meta-analysis. METHODS: The present systematic review and meta-analysis was applied according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. Publications were searched in PubMed, Web of Science, EMBASE, ERIC, CINAHL and the Cochrane's Library before February 2023. Two researchers independently retrieved articles and evaluated quality. The meta-analysis was performed using Stata 12.0 software according to PRISMA guidelines. The risk of bias in the selected studies was evaluated using the Revised Cochrane risk-of-bias tool for randomized trials. Heterogeneity was assessed by I2 and P statistics. Standardized mean difference (SMD) and 95% confidence intervals (CIs) were used as effective indicators. RESULTS: A total of 26 studies involving 2823 nursing students were included in the present study. The results showed that blended learning courses were designed based on learning theory. Blended learning was more effective on the knowledge (SMD = 0.73, 95%CI [0.37, 1.09]) and skills (SMD = 0.86, 95% CI [0.35, 1.37]) compared with non-blended learning for nursing students. Critical thinking ability improved significantly through BL (SMD = 2.23, 95% CI [0.85, 3.61]). In addition, blended learning had a positive impact on nursing students' mental health. Nursing students were very satisfied with blended learning. CONCLUSIONS: The results of this study indicated that blended learning had a positive impact on nursing students. In the future, the optimal ratio of online to offline learning in blended learning should also be explored.

Effects of virtual reality on the treatment of amblyopia in children: A systematic review and meta-analysis.

PROBLEM: Virtual reality technology has been used to treat amblyopia in children. However, it is unclear how virtual reality technology differs from conventional patching therapy in terms of effectiveness. ELIGIBILITY CRITERIA: Eligible randomized controlled studies were retrieved from PubMed, Embase, Scopus, the Cochrane Library, and Web of Science through February 2023. SAMPLE: Eight studies included 10 trials with 459 participants were included in the current meta-analysis. Two studies (Herbison et al., 2016; Huang et al., 2022) included two trials each. Thus, a total of ten trials were included in the current meta-analysis. RESULTS: Overall, virtual reality technology treatment significantly improved visual acuity by 0.07 log MAR (95% confidence interval [CI], -0.11 to -0.02; P < 0.001; I2 = 94.4%) compared with traditional patching therapy. In addition, subgroup analyses also revealed that treatment with virtual reality technology was more effective when the child was younger than seven years old, or when the duration of the intervention was no more than twenty hours. CONCLUSIONS: Virtual reality technology treatment showed significant effects in improving visual acuity in children who were seven years of age or younger with amblyopia. IMPLICATIONS: Virtual reality technology treatment is effective in treating amblyopia in children. Virtual reality therapy is also entertaining and popular among children and can be applied to the treatment of amblyopia in children in the future.

Effects of telemedicine-based follow-up management on adults with obstructive sleep apnea: A systematic review and meta-analysis.

OBJECTIVES: This meta-analysis aimed to investigate the effects of telemedicine-based follow-up management on adults with obstructive sleep apnea. METHODS: Publications were searched in the Cochrane Library, PubMed, Scopus, Web of Science and Embase. Studies were selected according to the predefined screening criteria, and their qualities were assessed by the Revised Cochrane risk-of-bias tool for randomized trials. The statistical analyses were performed using Stata12.0 software. It was registered in PROSPERO with the number: CRD42021276414. RESULTS: A total of 33 articles with 8,689 participants were included. Telemedicine-based follow-up management improved average daily continuous positive airway pressure usage by 36 min (weighted mean difference:0.61;95% confidence interval: 0.39 to 0.83), and the percentage of days with continuous positive airway pressure usage more than four hours by 10.67% in obstructive sleep apnea patients. The meta-analysis of good continuous positive airway pressure compliance showed telemedicine-based follow-up management did not lead to good continuous positive airway pressure compliance (odds ratio: 1.13;95% confidence interval: 0.72 to 1.76). The pooled mean difference of sleep quality was 0.15 (standardized mean difference:0.15; 95% confidence interval: -0.03 to 0.32), and daytime sleepiness was -0.26 (weighted mean difference: -0.26;95% confidence interval: -0.79 to 0.28). The pooled mean difference of apnea hypopnea index was -0.53 (95% confidence interval: -3.58 to 2.51). As for the overall quality of life, the pooled mean difference was -0.25 (standardized mean difference: -0.25;95% confidence interval: -0.25 to 0.76). CONCLUSION: Telemedicine-based follow-up management was beneficial for continuous positive airway pressure compliance of obstructive sleep apnea patients within six months. However, it could not improve sleep quality, daytime sleepiness, the severity of obstructive sleep apnea, and quality of life in obstructive sleep apnea patients compared with traditional follow-up. Moreover, it was more cost-effective, but there was no consensus on whether it would increase the workload of medical staff.

Effect of nanoparticles on gouty arthritis: a systematic review and meta-analysis.

OBJECTIVE: The purpose of this study was to explore the effects of nanoparticles on gouty arthritis, and to provide evidence for the preclinical application of nanoparticles in gouty arthritis and ideas for nanomedicine improvement for nanoparticle researchers. METHODS: Five databases including the Cochrane Library, PubMed, Scopus, Web of Science, and Embase were searched for eligible studies until April 2022. The quality of the selected studies was assessed by SYRCLE's risk of bias (RoB) tool, and the random-effects model was used to calculate the overall effect sizes of weighted mean differences (WMD). RESULTS: Ten studies met the inclusion criteria. Results showed that nanoparticles were effective in reducing uric acid levels (WMD: -4.91; 95% confidence interval (CI): - 5.41 to - 4.41; p < 0.001), but were not better than allopurinol (WMD: -0.20; 95% CI: - 0.42 to 0.02; p = 0.099). It was worth noting that the nanoparticles were safer than allopurinol. Subgroup analyses indicated that nanoparticle encapsulated substance, animal species, nanoparticle dosage, animal quantity, and animal gender were all sources of heterogeneity. CONCLUSION: The nanoparticles are safe medications for gouty arthritis which can effectively reduce uric acid levels in rodents. Although the results are still uncertain, it is expected to have certain clinical application value. The nanoparticles may be the preclinical medications for gouty arthritis in the future.

Flaxseed supplementation significantly reduces hemoglobin A1c in patients with type 2 diabetes mellitus: A systematic review and meta-analysis.

Flaxseed is a functional food because of its high content of alpha-linolenic acid, lignans, and dietary fiber. We hypothesized that flaxseed supplementation would improve cardiometabolic parameters in patients with type 2 diabetes mellitus (T2DM); however, clinical trials have shown conflicting results. Therefore, this systematic review and meta-analysis was conducted to determine the impact of flaxseed supplementation in patients with T2DM. Randomized controlled trials were systematically searched in PubMed, Web of Science, Scopus, Cochrane Library, and Embase until 25 March 2022. A total of 13 studies were included, and the results showed that flaxseed supplementation significantly reduced hemoglobin A1c (HbA1c) in participants with T2DM compared with the control group. In contrast, it had no effects on body weight, body mass index, blood pressure, fasting blood glucose (FBG), homeostatic model assessment for insulin resistance, quantitative insulin sensitivity check index, and lipid parameters. In the subgroup analyses, FBG was significantly reduced with supplementation of flaxseed in participants with baseline FBG ≥8.0 mmol/L or baseline HbA1c ≥7.0%. And a significant decrease in HbA1c in participants with baseline HbA1c ≥7.0% after flaxseed supplementation. In addition, subgroup analyses indicated that whole flaxseed supplementation significantly increased high-density lipoprotein cholesterol and reduced total cholesterol or low-density lipoprotein cholesterol in participants with T2DM. In conclusion, flaxseed supplementation significantly reduced HbA1c in participants with T2DM, especially those with poorly controlled blood sugar levels. However, larger scale studies with better designs are needed to confirm insignificant and/or ambiguous findings.

Effect of Oat Consumption on Blood Pressure: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

BACKGROUND: Current clinical trials have had controversial results regarding the effects of oat consumption on blood pressure (BP) in adults. OBJECTIVE: The meta-analysis was conducted to systematically evaluate the effects of oat consumption on BP in adults. METHODS: Electronic databases including PubMed, Web of Science, Scopus, Cochrane Library, and Embase were searched until December 13, 2021 for eligible randomized controlled trials (RCTs). RCTs published in English and that explored the effects of oat consumption on BP in adults under matched total energy intake were included. Meta-analysis using a random-effects model was performed. The pooled effect size was expressed as mean difference and 95% CI. I2 statistics were used to quantify heterogeneity. The risk of bias was assessed using the Cochrane Risk-of-Bias Tool, version 2. RESULTS: Twenty-one RCTs involving 1,569 participants were included. The pooled results indicated that consuming oats reduced systolic blood pressure (SBP) significantly (mean difference = -2.82 mm Hg; 95% CI -4.72 to -0.93 mm Hg; P = .004). Subgroup analyses indicated that oat consumption reduced SBP significantly in hypertensive participants, or when compared with control group participants who consumed refined grains. No significant reduction in diastolic blood pressure (DBP) was observed after oat consumption (mean difference = -1.16 mm Hg; 95% CI -2.37 to 0.04 mm Hg; P = .060). However, the sensitivity analysis of DBP, removal of individual studies, or "leave one out meta-analysis," showed a significant reduction in DBP, suggesting that the pooled result in the main analysis was not robust. Subgroup analyses showed that oat consumption did significantly reduce DBP in participants with baseline BP in the prehypertensive range. Both SBP and DBP were significantly reduced when the dosage of oat consumption was ≥5 g/day ß-glucan, or the oat consumption duration was ≥8 weeks. CONCLUSIONS: Oat consumption is effective in reducing SBP levels, particularly in individuals whose baseline BP is in the hypertensive range or when compared with control group participants consuming refined grains at matched total energy intake.

Research trends in hypertension associated with obstructive sleep apnea: a bibliometric analysis.

OBJECTIVES: The purpose of this study was to systematically analyze the studies of hypertension associated with obstructive sleep apnea to assess the current status and hot spots in this field. METHODS: We searched the Web of Science Core Collection for publications related to hypertension associated with obstructive sleep apnea published before July 3, 2021. Bibliometric analyses and science mappings were carried out using the CiteSpace 5.8.R1 and Microsoft Office Excel 2019. CiteSpace 5.8.R1 was used to visualize the distribution of research fields, analyze co-occurring keywords and burst terms to detect trends and frontiers, and identify leading collaborations among countries, authors, and institutions. Microsoft Office Excel 2019 was used to make bar graphs, histograms and line graphs. RESULTS: According to the search strategy, a total of 7263 published articles and reviews were retrieved. The research on hypertension associated with obstructive sleep apnea has been developing quickly at present. Sleep and Breathing was the most productive journal. The USA was a major producing country and Harvard Medical School was the most productive institution in this field. In the field of hypertension associated with obstructive sleep apnea, the main research hotspots were continuous positive airway pressure, cardiovascular disease, and obesity. CONCLUSIONS: The present study provides a new perspective for the study of hypertension associated with obstructive sleep apnea and valuable information for researchers to find potential partners and cooperative institutions, hot issues and research frontiers.

Association between self-reported snoring and hypertension: a systematic review and meta-analysis.

OBJECTIVES: The purpose of this study is to summarize the evidence for the association between snoring and hypertension and the effect of snoring on hypertension in men and/or women. METHODS: We searched the articles in the Cochrane Library, PubMed, Scopus, Web of Science and Embase published up to 12 November 2020 to evaluate the association between snoring and hypertension. Studies were selected according to the predefined screening criteria and their qualities were assessed by Newcastle-Ottawa Quality Evaluation Scale. The odds ratio and 95% confidence interval were used as effective indicators. It was registered in PROSPERO with the number: CRD42021224912. RESULTS: According to the inclusion/exclusion criteria, 11 studies including eight prospective cohort studies and three cross-sectional studies were included. The results showed that compared with non-snoring participants, snoring significantly increased the risk of hypertension in both men and women [odds ratio (OR) = 1.32, 95% confidence interval (CI), 1.23-1.42; men: odds ratio (OR) = 1.32; 95% confidence interval (CI), 1.18-1.49; women: odds ratio (OR) = 1.26; 95% confidence interval (CI), 1.14-1.40]. Besides, the risk of hypertension was significantly increased when the snoring frequency was ≥4 nights/week [frequency≥4 nights/week: odds ratio (OR) = 1.42; 95% confidence interval (CI), 1.21-1.66; 4 nights/week >frequency>0: odds ratio (OR) = 1.23; 95% confidence interval (CI),1.13-1.34]. CONCLUSIONS: Snoring is considered as an independent predictor of hypertension in both men and women, which may play a role in the prevention and control of hypertension. People who snore frequently should pay close attention to their blood pressure levels to prevent hypertension.

Effect of combined aerobic and resistance exercise on blood pressure in postmenopausal women: A systematic review and meta-analysis of randomized controlled trials.

OBJECTIVE: The purpose of this study is to evaluate the effects of combined aerobic and resistance exercise on blood pressure (BP) in postmenopausal women. The results of this study will provide an effective means for postmenopausal women to control BP and reduce the morbidity and mortality of cardiovascular disease (CVD). METHODS: Eligible studies were searched in five electronic databases until November 2020, and 11 randomized controlled trials that met the inclusion criteria were included in this systematic review and meta-analysis. The random-effects model was used to calculate overall effect sizes of weighted mean differences (WMD) and 95% confidence interval (CI). This study was registered in PROSPERO with the registration number: CRD42021225546. RESULTS: Compared with the control group, the aerobic combined resistance exercise significantly decreased the systolic blood pressure (SBP) and diastolic blood pressure (DBP) by 0.81 mmHg (95% CI, -1.34 to -0.28) and 0.62 mmHg (95% CI, -1.11 to -0.14), respectively. The results of the meta-analysis also indicated that a significant reduction in brachial-to-ankle pulse wave velocity (baPWV) of - 1.18 m/s (95% CI, -1.81 to -0.56) and heart rate (HR) of -0.22 beats/min (95% CI: -0.42 to -0.02) after combined aerobic and resistance exercise intervention. Subgroup analysis showed that postmenopausal women ≥60 years of age who were overweight or had a normal baseline BP were more sensitive to the combined aerobic and resistance exercise. When combined aerobic and resistance exercise frequency < 3 times/week, weekly exercise time ≥ 150 min, or the duration of exercise lasted for 12 weeks, the SBP and DBP of postmenopausal women could be reduced more effectively. CONCLUSIONS: The present study indicates that combined aerobic and resistance exercise can significantly reduce BP in postmenopausal women. Accordingly, combined aerobic and resistance exercise may be an effective way to prevent and manage hypertension in postmenopausal women.

Effect of inorganic nitrate supplementation on blood pressure in older adults: A systematic review and meta-analysis.

BACKGROUND: Previous clinical studies have shown controversial results regarding the effect of inorganic nitrate supplementation on blood pressure (BP) in older individuals. We performed this systematic review and meta-analysis to assess the effect of inorganic nitrate on BP in older adults. METHODS: Eligible studies were searched in Cochrane Library, PubMed, Scopus, Web of Science, and Embase. Randomized controlled trials which evaluated the effect of inorganic nitrate consumption on BP in older adults were recruited. The random-effect model was used to calculate the pooled effect sizes. RESULTS: 22 studies were included in this meta-analysis. Overall, inorganic nitrate consumption significantly reduced systolic blood pressure (SBP) by -3.90 mmHg (95% confidence interval: -5.23 to -2.57; P < 0.001) and diastolic blood pressure (DBP) by -2.62 mmHg (95% confidence interval: -3.86 to -1.37; P < 0.005) comparing with the control group. Subgroup analysis showed that the BP was significantly reduced when participants' age≥65, BMI>30, or baseline BP in prehypertension stage. And both SBP and DBP decreased significantly after acute nitrate supplementation of a single dose (<1 day) or more than 1-week. However, participants with hypertension at baseline were not associated with significant changes in both SBP and DBP. Subgroup analysis of measurement methods showed that only the resting BP group showed a significant reduction in SBP and DBP, compared with the 24-h ambulatory BP monitoring (ABPM) group and daily home BP measurement group. CONCLUSION: These results demonstrate that consuming inorganic nitrate can significantly reduce SBP and DBP in older adults, especially in whose age ≥ 65, BMI＞30, or baseline BP in prehypertension stage.