The effects of a nurse-led integrative medicine-based structured education program on self-management behaviors among individuals with newly diagnosed type 2 diabetes: a randomized controlled trial.

BACKGROUND: International guidelines advocate providing prompt structured education to individuals with diabetes at diagnosis. However, among the few eligible structured education programs, heterogeneous intervention regimens and inconsistent findings were reported. Eligible programs for Chinese individuals with diabetes are lacking. This study aimed to investigate the effects of a nurse-led integrative medicine-based structured education program on self-management behaviors, glycemic control and self-efficacy among individuals with newly diagnosed type 2 diabetes. METHODS: Employing a randomized controlled trial, 128 individuals with type 2 diabetes diagnosed in the preceding three to nine months were recruited from four university-affiliated tertiary hospitals in Xi'an City, Northwest China, and randomly allocated to the intervention or control groups after baseline assessments. Participants in the intervention group received a 4-week nurse-led integrative medicine-based structured education program, which is theoretically based on the Health Belief Model and Self-Efficacy Theory, in line with updated diabetes management guidelines, and informed by relevant systematic reviews. Participants in the control group received routine care. Self-management behaviors and self-efficacy were measured with the Summary of Diabetes Self-Care Activities and the Diabetes Management Self-Efficacy Scale at baseline, immediate post-intervention and 12 weeks following the intervention while Glycated Hemoglobin A was measured at baseline and the 12th-week follow-up. The intervention effects were estimated using the generalized estimating equation models. RESULTS: Participants in the intervention group exhibited significantly better self-management performance in specific diet regarding intake of fruits and vegetables at both follow-ups (ß = 1.02, p = 0.011 and ß = 0.98, p = 0.016, respectively), specific diet regarding intake of high-fat foods at the immediate post-intervention follow-up (ß = 0.83, p = 0.023), blood glucose monitoring at the 12th-week follow-up (ß = 0.64, p = 0.004), foot care at both follow-ups (ß = 1.80, p <  0.001 and ß = 2.02, p <  0.001, respectively), and medication management at both follow-ups (ß = 0.83, p = 0.005 and ß = 0.95, p = 0.003, respectively). The intervention also introduced significant improvements in Glycated Hemoglobin A (ß = - 0.32%, p <  0.001), and self-efficacy at both follow-ups (ß = 8.73, p <  0.001 and ß = 9.71, p <  0.001, respectively). CONCLUSIONS: The nurse-led integrative medicine-based structured education program could produce beneficial effects on multiple diabetes self-management behaviors, glycemic control and self-efficacy. TRIAL REGISTRATION: This study was retrospectively registered in the ClinicalTrials.gov . on 25/08/2017; registration number: NCT03261895 .

Body image mediates the relationship between post-surgery needs and health-related quality of life among women with breast cancer: a cross-sectional study.

BACKGROUND: Although body image (BI) disturbance is a common problem that often contributes to poor health-related quality of life (HRQoL) among women with breast cancer following surgery, the mediating role of BI (as a self-perceptive factor) in the relationship between needs and HRQoL after controlling for socio-demographic factors remains unclear. The purpose of this study was to identify the mediating role of BI between post-surgery needs and HRQoL after controlling for socio-demographic factors among women with breast cancer. METHODS: In this cross-sectional study, the primary outcome was HRQoL (as measured with the 36-item Short-Form Health Survey version 2 [SF-36v2] and Functional Assessment of Cancer Therapy-Breast version 4.0 [FACT-Bv4.0]). The secondary outcomes included needs (measured in terms of needs importance [NI] and needs satisfaction [NS]) and BI. Structural equation modeling was used to identify the mediating role of BI between needs and HRQoL while considering socio-demographics. RESULTS: The 406 eligible patients reported poor HRQoL, and approximately half reported important unmet needs and poor BI. NI, NS, and socio-demographics had differing direct effects on BI and HRQoL, and contrasting indirect effects on HRQoL via BI. NI, NS, surgery type, presence of chronic disease, and BI explained 4% of the variance in the SF-36v2 physical component summary score; NI, NS, surgery type, residence, and BI explained 20% of the variance in the mental component summary score; and NI, NS, marital status, employment status, radiotherapy, and BI explained 33% of the variance in the FACT-Bv4.0 total score. CONCLUSIONS: After surgery, women with breast cancer have poor HRQoL and BI, and important unmet needs. BI mediates the relationship between needs and HRQoL after controlling for socio-demographics. The present findings provide information for developing comprehensive BI-based needs interventions and preparing targeted health-management programs for patients with breast cancer.

Professional support during the postpartum period: primiparous mothers' views on professional services and their expectations, and barriers to utilizing professional help.

BACKGROUND: Primiparous mothers who lack of experience and knowledge of child caring, are usually overwhelmed by multifarious stressors and challenges. Although professional support is needed for primiparas, there is a gap between the necessary high-quality services and the currently provided poor services. This study aimed to explore Chinese primiparous mothers' views on professional services, identify barriers to utilizing professional support, and further understand mothers' expectations of and preferences for the delivery of professional services. METHOD: A descriptive phenomenological study design was utilized in this study, and semi-structured interviews were conducted with 28 primiparous mothers who had given birth in the first year period before the interview and were selected from two community health centres in Xi'an city, Shaanxi Province, Northwest China. Each conversational interview lasted between 20 and 86 min. Colaizzi's seven-step phenomenological approach was used to analyse the data. RESULTS: Three major themes were identified: (a) dissatisfaction with current professional services for postpartum mothers, (b) likelihood of health care professional help-seeking behaviour, (c) highlighting the demands for new health care services. The related seven sub-themes included being disappointed with current hospital services; distrusting services provided by community health centres, private institutes and commercial online platforms; preferring not seeking help from professionals as their first choice; hesitating to express their inner discourse to professionals; following confinement requirement and family burden prevents mothers from seeking professional help; experiencing urgent needs for new baby-care-related services; and determining the importance of mothers' needs. The necessity of professional support in the first month after childbirth was strongly emphasized by the participants. Online professional guidance and support were perceived as the best way to receive services in this study. CONCLUSION: The results of this descriptive phenomenological study suggested that the current maternal and child health care services were insufficient and could not meet primiparous mothers' need. The results also indicated that identifying barriers and providing services focused on mothers' needs may be an effective strategy to enhance primiparous mothers' well-being, and further suggested that feasibility, convenience, and the cultural adaptability of health care services should be considered during the delivery of postpartum interventions.

Development of the body image self-rating questionnaire for breast cancer (BISQ-BC) for Chinese mainland patients.

BACKGROUND: Body image is a complex post-treatment concern among female patients with breast cancer, and various tools have been developed and applied to measure this multifaceted issue. However, these available tools were developed in other countries and only a few have been modified into Chinese versions. Furthermore, body-image evaluation instruments that are specific to Chinese mainland female patients with breast cancer have not been devised yet. Therefore, we developed the Body Image Self-rating Questionnaire for Breast Cancer for Chinese mainland female patients with breast cancer. METHODS: We performed two rounds of the Delphi technique and a cross-sectional pilot survey. Items were selected using a Likert scale (1-5) to determine ratings of importance (i.e., the significance of the item from experts' perspective; coefficients of variation ≤0.25), internal consistency reliability (Cronbach's α ≥ 0.70), convergent validity (hypothesized item-subscale correlations ≥0.40), and discriminant validity (stronger correlations of the item with the hypothesized subscale than for other subscales). All decisions on items were made based on statistical analysis results, experts' recommendations, and in-depth discussion among researchers. RESULTS: Twenty-five eligible experts completed the two Delphi rounds (mean age: 42.20 ± 8.90 years). Over half the experts were professors (56%, n = 14) or worked as clinical staff (68%, n = 17). Twenty (mean age = 49.55 ± 10.01 years) and 50 patients (mean age = 48.44 ± 9.98 years) completed the first- and second-round survey, respectively. Over half the patients had a tertiary education level, were married, and were employed. Regarding the revised questionnaire (comprising 33 items across seven subscales), the expert panelists' ratings of each item met the criteria (Kendall's W = 0.238, p < .001). Five subscales had a Cronbach's α value over 0.60 (range: 0.62-0.69) and two subscales were over 0.80 (range: 0.84-0.88). All items satisfied the criteria for convergent and discriminant validity. CONCLUSIONS: The findings of this study provide evidence of a suitable tool for body image evaluation among Chinese mainland female patients with breast cancer. Studies with larger sample sizes should be conducted to validate this questionnaire in this patient population.

Effectiveness of a multimodal standard nursing program on health-related quality of life in Chinese mainland female patients with breast cancer: protocol for a single-blind cluster randomized controlled trial.

BACKGROUND: Breast cancer and its treatment-related adverse effects are harmful to physical, psychological, and social functioning, leading to health-related quality of life (HRQoL) impairment in patients. Many programs have been used with this population for HRQoL improvement; however, few studies have considered the physical, psychological, and social health domains comprehensively, and few have constructed multimodal standard nursing interventions based on specific theories. The purpose of this trial is to examine the effect of a health belief model (HBM)-based multimodal standard nursing program (MSNP) on HRQoL in female patients with breast cancer. METHODS: This is a two-arm single-blind cluster randomized controlled trial (cRCT) in clinical settings. Twelve tertiary hospitals will be randomly selected from the 24 tertiary hospitals in Xi'an, China, and allocated to the intervention arm and control arm using a computer-generated random numbers table. Inpatient female patients with breast cancer from each hospital will receive either MSNP plus routine nursing care immediately after recruitment (intervention arm), or only routine nursing care (control arm). The intervention will be conducted by trained nurses for 12 months. All recruited female patients with breast cancer, participating clinical staff, and trained data collectors from the 12 hospitals will be blind with respect to group allocation. Patients of the control arm will not be offered any information about the MSNP during the study period to prevent bias. The primary outcome is HRQoL measured through the Functional Assessment of Cancer Therapy-Breast version 4.0 at 12 months. Secondary outcomes include pain, fatigue, sleep, breast cancer-related lymphedema, and upper limb function, which are evaluated by a visual analogue scale, the circumference method, and the Constant-Murley Score. DISCUSSION: This trial will provide important evidence on the effectiveness of multimodal nursing interventions delivered by nurses in clinical settings. Study findings will inform strategies for scaling up comprehensive standard intervention programs on health management in the population of female patients with breast cancer. TRIAL REGISTRATION: Chictr.org.cn ChiCTR-IOR-16008253 (April 9, 2016).

Prevalence, emotional and follow-up burden of insulin injection-related needle-stick injuries among clinical nurses in Shaanxi Province, west of China: A cross-sectional study.

AIMS AND OBJECTIVES: The aim of this study was to investigate the prevalence, emotional and follow-up burden of insulin injection-related needle-stick injuries among clinical nurses. BACKGROUND: needle-stick injures introduce statistically significant occupational hazards to healthcare workers. Although the large proportion of the needles injuries attributed to insulin injection, research evidence about the prevalence, emotional and follow-up burden of such injures is lacking. DESIGN: Cross-sectional study. METHODS: 5389 nurses were recruited from 45 hospitals in Shaanxi, China, from November 2018 to July 2019. Participants were administrated with a questionnaire specifically developed for this study. Descriptive statistics were used to present the findings. RESULTS: All 5,389 nurses responded to the survey, of which 396 (7.4%) participants experienced 620 insulin injection-related needle-stick injuries in the past year, representing an annual prevalence of 115.0 per 1000 nurses. The annual prevalence of infection caused by the injuries was 18.7 per 1000 nurses. The injuries occurred most frequently when nurses were recapping the needle (42.4%). In the majority (98.4%) of the injuries, the hurt nurses took proper immediate actions. However, only 30.3% of nurses reported the injuries to the administrative staff, and in 43.2% of the injuries, the nurses refused or discontinued the suggested follow-up. A large proportion (58.6%) of the hurt nurses experienced emotional changes. Multivariate logistic regression showed that department, removing and/or setting back needle caps with bare hands, frequency of insulin pen and syringes are associated with the incidence of insulin injection-related needle-stick injuries. This paper is reported following the STROBE recommendations. CONCLUSIONS: This survey demonstrated a considerably high prevalence of insulin injection-related needle-stick injuries among clinical nurses. Even though the majority of the hurt nurses took proper immediate actions, a large quantity of them failed to report the accidents to the administrative staff and complete the suggested follow-up. Nurses who suffered from insulin injection-related needle-stick injuries were subject to various negative emotional changes. It portends a statistically significant risk to occupational health management for nurses. RELEVANCE TO CLINICAL PRACTICE: Scientific preventive and management strategies are desirable in order to minimize the consequences of insulin injection-related needle-stick injuries.

Perceived needs and health-related quality of life in women with breast cancer undergoing chemotherapy: a cross-sectional study.

OBJECTIVES: Women with breast cancer have different needs that are various in perceived importance and satisfaction. This study aimed to examine the relationship among perceived needs satisfaction, perceived needs importance with health-related quality of life (HRQoL) in women with breast cancer and determine the intermediary role of perceived needs importance in the relationship between perceived needs satisfaction and HRQoL. DESIGN: Cross-sectional design. SETTING: Two tertiary level hospitals in Shaanxi Province, China. PARTICIPANTS: Women newly diagnosed with breast cancer were recruited. OUTCOME MEASURES: The Needs Self-Rating Questionnaire for Breast Cancer and the Medical Outcomes Study 36-item Short-Form Health Survey V. 2.0 were used for data collection regarding perceived needs satisfaction, perceived needs importance and HRQoL. RESULTS: A total of 359 valid questionnaires were collected. The perceived needs importance was negatively associated with physical component summary (PCS) (b=-0.067, p=0.024) and mental component summary (MCS) (b=-0.185, p<0.001). On the contrary, perceived needs satisfaction was positively associated with PCS (c'=0.005, p=0.843), although not statistically significant. Perceived needs satisfaction was positively associated with MCS (c'=0.194, p<0.001) and perceived needs importance (a=0.458, p<0.001). Furthermore, the perceived needs importance suppressed the relationship between perceived needs satisfaction and PCS (a*b=-0.031; 95% CI -0.058 to -0.004) and the relationship between perceived needs satisfaction and MCS (a*b=-0.085; 95% CI -0.138 to -0.043). CONCLUSION: For women with breast cancer, higher perceived needs satisfaction is associated with higher HRQoL. However, higher perceived needs importance would be conversely associated with lower HRQoL by suppressing the positive association of perceived needs satisfaction with HRQoL. Healthcare providers should pay more attention to those who have high perceived needs importance but low perceived needs satisfaction and fulfil the important needs.

The Needs Self-Rating Questionnaire for Breast Cancer (NSQ-BC): Development of a tool for the needs assessment of women with breast cancer in mainland China.

RATIONALE, AIMS, AND OBJECTIVES: A needs assessment tool considering the cultural background of mainland China has not been reported. This study developed a Needs Self-rating Questionnaire for Breast Cancer (NSQ-BC) based on Maslow's hierarchy of needs for mainland Chinese patients. METHODS: The Delphi technique and pilot cross-sectional surveys (two rounds) were performed for item selection. In the Delphi technique, items were selected according to the experts' perspective on the item's significance (ie, 1-5 Likert-scale ratings of importance; mean > 4.0 and coefficients of variation <0.25). In the pilot cross-sectional surveys, items were selected according to internal consistency reliability (Cronbach's α ≥ 0.70), discriminant validity (stronger correlations of the item with the hypothesized subscale than for other subscales), and convergent validity (hypothesized item-subscale correlations ≥0.40). All decisions were made based on the results of statistical analyses, recommendations of the experts, and in-depth discussion among research team members. RESULTS: Following the two evaluation rounds, the revised NSQ-BC comprised 26 items across five subscales of needs: physical, psychological, respect/self-esteem, information, and rehabilitation. Item ratings from the expert panellists met the aforementioned criteria (ie, Kendall's W = 0.329, P < 0.001). Except for the "respect/self-esteem needs" subscale, Cronbach's α for all subscales exceeded 0.70. All items had acceptable discriminant and convergent validity. Additionally, two new items-good environment/facilities and economic support-were added to the NSQ-BC, as recommended by the experts. CONCLUSIONS: The NSQ-BC was developed fully via the comprehensive use of Delphi technique and pilot cross-sectional surveys. It provides evidence of a proper instrument for needs assessment and evaluation among women with breast cancer in mainland China.

Reliability, validity, and sensitivity of the Chinese Short-Form 36 Health Survey version 2 (SF-36v2) in women with breast cancer.

RATIONALE, AIMS, AND OBJECTIVES: The psychometrics of the Short-Form 36 Health Survey version 2 (SF-36v2) in female breast cancer patients remains unknown. This study aimed to test the reliability, validity, and sensitivity of the Chinese SF-36v2 in women with breast cancer. METHODS: The sample included 326 eligible participants. The reliability and the item convergent and discriminant validity were estimated using Cronbach α (≥0.70) and the multi-trait multi-item matrix analysis, respectively. The structural validity was tested using confirmatory factor analysis. Sensitivity was determined via an analysis of variance and the relative efficiency for initially diagnosed cases (yes vs no) as well as the time since diagnosis (years) before and after stratifying by initially diagnosed cases. RESULTS: The overall Cronbach α was 0.91 (eight scales range: 0.72-0.92). All hypothesized item-scale correlations were greater than the alternatives (r ≥ 0.40). With acceptable model fit indices, the physical functioning, role-physical, bodily pain, and general health subscales had stronger contributions to the physical component summary (goodness-of-fit index [GFI]: 0.92, parsimony goodness-of-fit index [PGFI]: 0.60, comparative fit index [CFI]: 0.91, Tucker-Lewis index [TLI]: 0.93, adjusted goodness-of-fit index [AGFI]: 0.91, root mean square error of approximation [RMSEA]: 0.06, normed chi-squared [NC]: 2.65), while the vitality, social functioning, role-emotional, and mental health subscales contributed more to the mental component summary (GFI: 0.91, PGFI: 0.62, CFI: 0.91, TLI: 0.92, AGFI: 0.91, RMSEA: 0.07, NC: 2.76). The relative efficiencies with significant F-statistics were found for mental health (relative efficiency: 34.28; initially diagnosed cases), physical functioning (12.88; time since diagnosis), and physical functioning (5.80), role-physical (5.15), bodily pain (7.70), social functioning (4.62), role-emotional (4.72), mental health (4.75), and physical component summary (6.96; initially diagnosed cases with time since diagnosis; P < 0.05 for all variables). CONCLUSIONS: Chinese SF-36v2 has acceptable psychometric properties and is suitable for women with breast cancer.

The effectiveness of traditional Chinese medicine-based lifestyle interventions on biomedical, psychosocial, and behavioral outcomes in individuals with type 2 diabetes: A systematic review with meta-analysis.

BACKGROUND: Integrative diabetes care, which combines conventional diabetes therapy with traditional Chinese medicine (TCM)-based interventions, has gained popularity worldwide. Numerous TCM-based lifestyle modification approaches have been proposed for individuals with type 2 diabetes (T2DM). OBJECTIVES: To synthesize and present the best available evidence on the effectiveness of TCM-based lifestyle interventions in individuals with T2DM. DESIGN: We undertook a systematic review of randomized controlled trials or controlled clinical trials. DATA SOURCES: Six English and four Chinese electronic databases were searched from their inceptions to December 2016. REVIEW METHODS: Trials investigating the effectiveness of various TCM-based lifestyle interventions among adults with T2DM were reviewed. Studies were excluded if TCM-based lifestyle interventions were only part of the intervention regimen. Two reviewers independently selected studies according to pre-specified inclusion and exclusion criteria and appraised the risk of bias of the included studies. One reviewer extracted details of the included studies and the second reviewer checked the extracted data critically. When feasible, data were statistically pooled for meta-analysis. Otherwise, narrative summaries were used. RESULTS: Twenty-four studies were included. The pooled analysis of the eight studies on tai chi showed tai chi practice for at least 150 min per week was beneficial in lowering glycosylated hemoglobin (mean difference, -1.48%; 95%CI, -2.58% to -0.39%; p < 0.001). Tai chi was effective in reducing fasting blood glucose (mean difference, -1.14 mmol/L; 95%CI, -1.78 to -0.50 mmol/L; p < 0.001) and body mass index (mean difference, -0.62; 95%CI, -1.14 to -0.11; p = 0.02), and improving quality of life. The effects of tai chi on blood pressure and waist circumference were inconclusive due to the limited number of studies. The meta-analysis of the 12 studies on ba duan jin demonstrated beneficial effects on glycosylated hemoglobin (mean difference, -0.77%; 95%CI, -0.97% to -0.56%; p < 0.001), fasting blood glucose (mean difference, -0.82 mmol/L; 95%CI, -1.05 to -0.59 mmol/L; p < 0.001), body mass index (mean difference, -2.77; 95%CI, -4.11 to -1.43; p < 0.001), and depression (mean difference, -4.53; 95%CI, -7.12 to -1.94; p < 0.001). Conclusions on the effects of ba duan jin on quality of life cannot be drawn because only two studies measured the outcome. Evidence regarding the effectiveness of other TCM-based lifestyle interventions is limited. CONCLUSIONS: Tai chi and ba duan jin are potentially effective options for individuals with T2DM to improve biomedical and psychosocial well-being. Further well-designed studies are needed to explore the optimal intervention dose and to investigate the effectiveness of other TCM-based lifestyle interventions.