Compared to exercise, the effects of exercise combined with cognitive training in people with mild cognitive impairment: a network meta-analysis.

OBJECTIVES: The study aimed to evaluate the relative effectiveness of exercise combined with cognitive training (E&CT) in improving cognitive function compared to exercise alone. METHOD: PubMed, Embase, Cochrane Central Register of Controlled Trials, SPORTDiscus, and OpenGrey were systematically searched. Additional screenings were performed by reviewing citations of relevant articles. Studies were included if they met inclusion criteria. Both pairwise and network meta-analyses were performed using a random effects model in Stata 15.0. RESULTS: Totally, 46 trials from 54 literature (n = 2846) were eligible for inclusion in the meta-analysis. The network meta-analysis indicated that exercise alone was more efficacious than E&CT in improving global cognition and multicomponent exercise exhibited the highest likelihood (SUCRA value= 89.0%) of being the most effective type. Regarding memory function, E&CT presented greater potential than exercise alone, with the interactive modality ranking first (SUCRA value = 88.4%). Multicomponent exercise was identified as the top intervention for enhancing executive function. The overall quality of the included studies was rated as moderate, and the certainty of evidence ranged from low to high. CONCLUSION: Multicomponent exercise emerged as the optimal intervention for improving global cognition and executive function. Nevertheless, for memory function, the interactive modality of E&CT demonstrated the highest probability of being the most effective choice.

Oral frailty: A concept analysis.

AIM: To clarify the concept of oral frailty to provide a clear and standardized conceptual basis for further research in older people. DESIGN: Rodgers and Knafl's evolutionary concept analysis approach. METHODS: The narrative analysis detailedly extracted and synthesized the attributes of oral frailty, as well as its antecedents, consequences and related terms under the guidance of Rodgers' evolutionary method. DATA SOURCES: Multiple databases including Pubmed, CINAHL and Cochrane were searched using selected search terms 'oral frail*', 'oral health' and 'aged' respectively. Articles written between 2013 and 2023 were included, and grey literature was excluded. RESULTS: A total of 32 articles were included for further analysis and synthesis. The attributes of oral frailty were hypofunction, predisposing in nature, non-specific and multidimensional. Antecedents of prefrailty were classified into four categories, namely, sociodemographic characteristics, comorbidity, physical function and psychosocial factors. Consequences of oral frailty include three themes: increased risk of adverse outcomes, poor nutritional status and possibility of social withdrawal. Related terms that had shared attributes with oral frailty were oral health, functional dentition, oral hypofunction and deterioration of oral function. CONCLUSIONS: Oral frailty is an age-related phenomenon reflected in decreased oral function. The findings of this concept analysis are conducive to understanding and clarifying the oral frailty, which can help clinicians or other healthcare providers to consider how to distinguish oral frailty in older adults and further promote the development of this field. IMPACT: Oral frailty is increasingly recognized as an age-related phenomenon reflected in decreased oral function. As it is newly proposed, no consensus has been reached regarding the theoretical and operational concept of it. Through clarifying the concept, this paper will guide future healthcare research on oral frailty regarding the influencing factors, mechanisms and interventions, thus raising the awareness with regard to oral health among older adults. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: In the context of older adults, oral frailty is a concept that requires further research to guide future theoretical development, and the influencing factors, mechanisms and interventions need to be further studied. Raise awareness with regard to oral health among older people and more attention will be paid to the early identification and intervention of oral frailty, so as to further improve the quality of life of older adults.

The application of saccades to assess cognitive impairment among older adults: a systematic review and meta-analysis.

BACKGROUND: Saccade is a novel and feasible method for cognition assessment and has potential to screen older people with cognitive impairment. OBJECTIVES: To systematically summarize the evidence and determine whether different saccade parameters can effectively identify patients with mild cognitive impairment (MCI) and Alzheimer's disease (AD). METHODS: English and Chinese databases were searched until 19 April 2022. Studies analyzing saccade parameters in older adults with normal cognition, MCI, or AD were included. Two researchers independently performed the screening, data extraction, and quality appraisal. Meta-analyses were conducted and standard mean differences and 95% confidence intervals were estimated with a random effects model. RESULTS: Thirty-five studies were included, and 26 studies were pooled for the meta-analysis. The results demonstrated that patients with cognitive impairment exhibited longer latency and lower accuracy rates in the prosaccade and antisaccade tasks, along with lower corrected error rates in the antisaccade tasks. However, the pooled results for antisaccades were more stable, providing the ability to distinguish patients with cognitive impairment among older adults. The results of the subgroup analyses revealed that only the accuracy rates of the antisaccades differed significantly between people with MCI and AD. Regarding the differences between older adults with normal cognition and those with MCI, the effect sizes of latency and the accuracy rates of saccades as well as the corrected error rates of antisaccades were significant. CONCLUSIONS: Saccades, especially antisaccades, are a potential screening and assessment tool for distinguishing older adults with MCI or AD from those with normal cognition.

Effectiveness of photobiomodulation for people with age-related cognitive impairment: a systematic review and meta-analysis.

The increasing incident of age-related cognitive impairment worldwide and the lack of pharmaceutical treatments emphasizes the value of non-pharmaceutical therapy. Emerging evidence suggested photobiomodulation (PBM) is a popular intervention to brain disorder; however, it remains unclear the efficacy of PBM for patients with age-related cognitive impairment. The purpose of this systematic review is to compare the different parameters used in PBM, analyze the beneficial effects of PBM as a potential therapy for age-related cognitive impairment. Five electronic database, PubMed, Web of Science, Cochrane Library, CINAHL, and PsycINFO, were systematically searched from inception to November 2021. Relevant randomized controlled trials (RCTs) were screened and assessed for risk of bias. Eleven RCTs evaluating PBM interventions were included. The systematic review and meta-analysis has been registered in PROSPERO(CRD42022374562). Results showed that PBM had a significant moderated effect on global cognition function (SMD=0.51, 95% CI [0.162, 0.864], p=0.004). We found that multiple wavelength PBM (SMD=0.648, 95% CI [0.220, 1.075], p=0.003) had significant effects while single wavelength PBM was non-significant (SMD=0.385, 95% CI [-0.168, 0.987], p=0.172). Laser effect (SMD=0.682, 95% CI [0.37, 0,994], p<0.001) was larger than LED effect (SMD=0.582, 95% CI [0.269, 0.895], p<0.001). PBM in clinical setting (SMD=0.468, 95% CI [0.050, 0.887], p=0.028) had significant effect, but there was no significant effect of home-used PBM (SMD=0.616, 95% CI [-0.121, 1.354], p=0.101). The pool effect of multi-modality PBM (SMD=0.720, 95% CI [0.027, 1.414], p=0.040) was significantly higher in the studies of transcranial irradiation (SMD=0.616, 95% CI [-0.121, 1.354], p=0.010). Cumulative irradiation time was a moderator between the PBM and cognitive function improvement. Photobiomodulation have the potential to improve cognitive function in aging adults. Cumulative irradiation duration, light source, device type, penetration modality, and intervention site can affect the effectiveness of PBM intervention.

Nurses' work engagement: The influences of ambidextrous leadership, clinical nurse leadership and workload.

AIM: To test the relationships among staff nurses' work engagement, nurse managers' ambidextrous leadership and staff nurses' clinical leadership and workload. DESIGN: A multicentre cross-sectional survey design was used. METHODS: The study was conducted in eight medical centres from six representative provinces of China in October 2019. The participants completed electronic questionnaires that measured ambidextrous leadership, clinical nurse leadership, workload and work engagement. We used structural equation modelling to test a hypothetical model. RESULTS: The hypothetical model had a good fit to the actual data. Ambidextrous leadership was positively associated with clinical nurse leadership and work engagement, and clinical nurse leadership had a significant positive relationship with work engagement, which partially mediated the path from ambidextrous leadership to work engagement. In addition, workload moderated the relationship between ambidextrous leadership and clinical nurse leadership. CONCLUSION: This study makes a timely contribution to the nursing literature by demonstrating that nurse managers' ambidextrous leadership and clinical nurse leadership are important determinants of work engagement. Improving the level of ambidextrous leadership and clinical nurse leadership helps to enhance work engagement. IMPACT: This study provides a new strategy to increase nurses' work engagement from a new perspective of nursing leadership. Enhancing nurse managers' ambidextrous leadership and clinical nurse leadership can increase work engagement. Nurse managers should value the role of ambidextrous leadership and clinical nurse leadership in promoting work engagement, especially when nurses perceive they have a low workload.

Risk factors and prevalence of cognitive impairment in maintenance haemodialysis patients: A systematic review and meta-analysis of observational studies.

AIMS: To systematically identify the risk factors for cognitive impairment in maintenance haemodialysis patients and to assess its prevalence in included studies. DESIGN: Systematic review and meta-analysis about observational studies. DATA SOURCES: Systematic search of seven databases, including PubMed, Web of Science, Scope, Wanfang Database, China National Knowledge Infrastructure, Chinese Biomedical Literature Database and Weipu Chinese Science and Technology Journal Database, from inception until October 2021. REVIEW METHODS: Observational studies reporting the risk factors for cognitive impairment in maintenance haemodialysis patients in English and Chinese language were included. Meta-analysis was performed to identify risk factors and prevalence of cognitive impairment in maintenance haemodialysis patients with STATA 15.0 software. RESULTS: Overall, 37 eligible studies encompassing 129,849 cases were included. The risk factors with statistical significance after meta-analysis were older age, female sex, fewer years of education, hypertension, diabetes, cerebrovascular accident, multiple comorbid conditions, systolic blood pressure variability, arterial stiffness and low haemoglobin and albumin level. The overall prevalence of cognitive impairment in maintenance haemodialysis patients was 49.1%. CONCLUSION: The current analysis indicated a high prevalence of cognitive impairment in maintenance haemodialysis patients. Eleven risk factors for cognitive impairment in maintenance haemodialysis patients were identified, among which more attention should be paid to modifiable factors such as cardiovascular disease risk factors and specific kidney and dialysis-related factors. IMPACT: This paper provides an updated estimate of the pooled prevalence of cognitive impairment in maintenance haemodialysis patients. Identification of risk factors associated with cognitive impairment may assist in developing targeted prevention strategies for maintenance haemodialysis patients at high risk. NO PATIENT OR PUBLIC CONTRIBUTION: This study was a systematic review completed by the authors in accordance with relevant guidelines and processes and did not include the participation of patients, service users, caregivers or the general public.

Physical activity trajectories and their determinants in patients with chronic obstructive pulmonary disease: A cohort study.

AIMS AND OBJECTIVES: The aim was to identify latent trajectories in physical activity (PA) and their determinants in adults with chronic obstructive pulmonary disease (COPD) based on the socio-ecological model. BACKGROUND: PA has been linked to poor long-term outcomes in patients with COPD. However, few studies have explored their PA trajectories and their predictors. DESIGN: Cohort study. METHODS: We used data from a national cohort and included 215 participants. PA was quantified using a short PA questionnaire, and group-based trajectory modelling was used to explore the PA trajectories. Multinomial logistic regression was conducted to identify the predictors of PA trajectories. Generalised linear mixed models were used to elucidate the associations between predictors and PA during follow-up. A STROBE checklist was used to guide the reporting of this study. RESULTS: Three PA trajectory patterns were identified among 215 COPD participants with an average age of 60.51 ± 8.87: stable inactive group (66.7%), sharp decline group (25.7%) and stable active group (7.5%). The logistic regression showed that age, sex, income, peak expiratory flow, upper limb capacity, depressive symptoms, the frequency of contact with children were PA predictors. Upper limb capacity weakness and depressive symptoms were found to be associated with a sharp decline in PA during follow-up. CONCLUSIONS: This study revealed three PA trajectories among patients with COPD. In addition to strengthening the physical functions and mental health of patients, support from the family, community and society also play a crucial role in promoting PA of patients with COPD. RELEVANCE TO CLINICAL PRACTICE: It is essential to identify distinct PA trajectories in patients with COPD to develop future interventions that promote PA. NO PATIENT OR PUBLIC CONTRIBUTION: A national cohort study was used and no patients or the public were involved in the design and implementation of this study.

[A Health Education Program for Home Emergency Management of Acute Complications of Diabetes in the Elderly].

Objective To establish a health education program for home emergency management of acute complications of diabetes in the elderly.Methods The program was drafted by literature review and panel discussion.The final draft was formed after two rounds of correspondence from 13 experts.Results The recovery rate of the two rounds of expert correspondence was 100%,and the expert authority coefficient was 0.98.The Kendall's harmony coefficients of the two rounds of correspondence were 0.263 and 0.212 respectively(both P<0.001).The established health education program included indicators of three categories:early stage of acute complications of diabetes at home(understanding the inducing factors),emergency warning(quick and early identification in case of emergency),and emergency treatment at home.Conclusion The contents of the health education program are systematic and reliable and meet the needs of health education for home emergency management of the elderly with diabetes.

Self-reported practices, competence and difficulties towards palliative care among nurses: A cross-sectional study.

OBJECTIVE: Nurses' palliative care practice ability is the key to evaluating the quality of palliative care. This study aimed to identify the current situation of palliative care practices, competence and difficulties among nurses and determine whether difficulties play a mediating role between practices and competence. METHODS: A cross-sectional study was conducted. The online survey comprised demographics, the Palliative Care Self-Reported Practices Scale, the Palliative Care Nursing Self-competence Scale and the Palliative Care Difficulties Scale. Data were analysed by using descriptive statistics, univariate analysis, linear regression and mediation analysis. RESULTS: A total of 284 questionnaires were included for statistical analysis. The mean scores for practices, competence and difficulties were 67.81 (SD = 13.60), 124.28 (41.21) and 44.32 (12.68), respectively. There was a correlation between practices, competence and difficulties (p < 0.01). Competence and difficulties were independent predictors of practices (R2 adj  = 0.384, p < 0.001). Furthermore, difficulties mediated the relationship between practices and competence (b = 0.052, 95% confidence interval: 0.008-0.155). CONCLUSIONS: Continuous efforts should be made to enhance nurses' practices, competence and problem-solving abilities in palliative care. This study suggested further targeted education programmes, especially in special symptom management, interagency and multidisciplinary communication.

The relative effectiveness of different combination modes for exercise and cognitive training on cognitive function in people with mild cognitive impairment or Alzheimer's disease: a network meta-analysis.

OBJECTIVES: To compare and rank the relative effectiveness of different modes for exercise combined cognitive training (ECT) in people with Alzheimer's disease (AD) or Mild Cognitive Impairment (MCI). METHODS: We searched PubMed, Web of Science, Embase, Cochrane Central Register of Controlled Trials, SPORTDiscus, PsycInfo, and OpenGrey systematically from inception to May 2020. Studies were included that met the inclusion criteria: randomized controlled trials, involving people with MCI or dementia, performing ECT without other interventions, and assessing global cognitive function, memory function, and executive function. Pairwise and network meta-analyses were performed using a random effects model. RESULTS: We included 20 articles from 16 studies with 1180 participants. For global cognition, separate modality had the highest probability of being the optimal approach (the surface under the cumulative ranking curve (SUCRA) value = 77.5%). For memory function, the interactive mode had the greatest probability of being the best choice (SUCRA = 84.7%). Concerning executive function, the dual-task modality and separate modality had similar SUCRA values. Subgroup analysis revealed no differences for the relative effectiveness of ECT among people with MCI or among all participants. CONCLUSIONS: Separate and interactive combination modality had the highest probability of being the most effective mode for overall cognition and memory performance. However, the evidence is insufficient to reveal the best combination mode for executive function.Supplemental data for this article is available online at https://doi.org/10.1080/13607863.2022.2026879 .

Effect of exercise on bone mineral density among patients with osteoporosis and osteopenia: A systematic review and network meta-analysis.

AIMS AND OBJECTIVES: To systematically review and compare the efficacy of different exercise interventions on bone mineral density (BMD, g/cm2 ) in patients with osteoporosis and osteopenia. BACKGROUND: It is vitally important to prevent and treat bone loss in patients with osteoporosis and osteopenia. Exercise can effectively increase bone density and slow down bone loss in middle-aged and older people. However, it is still unclear which type of exercise intervention is the most effective on bone mineral density. DESIGN: Systematic review and network meta-analysis (NMA) according to PRISMA. METHODS: Randomised controlled trials of different exercise treatments for osteopenia and primary osteoporosis were included. A Frequentist network meta-analysis was conducted to appraise the efficacy of different types of exercise. The outcome was bone mineral density of different parts of the body. RESULTS: Ninety-seven studies were included. The network meta-analysis showed that combined exercise, resistance exercise, aerobic exercise and mind-body exercise had a significant effect in improving the bone density of lumbar spine. The surface under the cumulative ranking area (SUCRA) values for mind-body exercise was 0.99 and ranked first. For BMD of the femoral neck, all kinds of exercise interventions increased the bone density significantly compared with no exercise and the optimal type was mind-body exercise (SUCRA = 0.99). In terms of the total hip bone mineral density, aerobic exercise and resistance exercise could improve hip bone density, with the resistance exercise (SUCRA = 0.95) ranking as first. CONCLUSIONS: This NMA demonstrated the mind-body exercise might be the optimal exercise type to increase the BMD of the lumbar spine and femoral neck and resistance exercise is the most promising type for total hip BMD.

Global nursing research activity from 2009 to 2020: A bibliometric analysis.

AIM: Bibliometric analysis of the nursing literature can provide insights into the current state and dynamics of the nursing profession. This study aimed to assess global nursing-related research activity from 2009 to 2020. METHOD: The corpus of nursing papers was harvested from the Web of Science Core Collection database. The bibliometric indicators and VOSviewer mapping of the retrieved papers were presented. RESULTS: The search found 109,782 papers, and 39.0% of papers reported funded studies. Publication numbers were increasing. The USA was the most prolific country in literature production and international collaboration in nursing studies. International cooperation in nursing research was dominated by developed regions. Among the 20 most cited articles, 75% were published in first quartile journals, and review papers received a higher number of citations than original research articles. Author keyword analysis identified 'quality of life', 'mental health', 'nursing students' education' and 'adolescent' as common nursing focus topics. CONCLUSIONS: The publication trend of nursing papers was positive. However, several problems were associated with nursing research activity, including low research funding, regionally centred research activity and inactivity of developing regions in terms of international collaborations, which need to be addressed by policy makers, nursing managers and scholars.

The feasibility and efficacy of the home-based exercise programs in patients with cognitive impairment: A pilot study.

OBJECTIVE: To examine the feasibility and efficacy of home-based aerobic and resistance exercise interventions for geriatric individuals with cognitive impairment. METHODS: Fourteen participants with cognitive impairment were allocated to either the aerobic group (n = 8) or the resistance group (n = 6), after which they implemented a two-month home-based training program. Feasibility and efficacy outcomes were evaluated. A semi-structured interview was performed after the intervention. RESULTS: All fourteen participants completed the two-month training program. The adherence rate was 0.94 for the aerobic group and 0.96 for the resistance group. No adverse events occurred. The results revealed a trend of group×time interaction effect on delayed recall. Significant group×time interaction effects were revealed on simple physical performance and body composition. Semi-structured interviews identified four motivators for participating in this program, four facilitators for and three barriers to keeping exercising, and some perceived benefits. CONCLUSION: Home-based aerobic and resistance exercise programs are feasible for geriatric individuals with cognitive impairment. The efficacy needs to be further examined.

Effects of self-rated workload and nurse staffing on work engagement among nurses: A cross-sectional survey.

AIM: To analyse net effects of self-rated workload and nurse staffing (nurse-to-patient ratio and staff skill mix) on work engagement among clinical nurses. BACKGROUND: Improving nurses' engagement is necessary to enhance patient outcomes, so factors that influence engagement should be explored. METHODS: A cross-sectional study was conducted in 1,428 registered nurses from 145 units of 11 hospitals. A hierarchical linear model was used to analyse the data. RESULTS: Self-rated workload had a negative effect on engagement (ß = -0.353, p < .001, effect size (f2 ) = 14.20%), while only one index of skill mix (percentage of nurses with ≤ 5 work years) had a significant effect on engagement, which was positive (ß = 0.258, p < .05, f2  = 8.50%). These two variables explained 22.7% of the variance of engagement at the unit level (R2 between  = 22.7%, p < .05). No significant effect of staffing on self-rated workload was found. CONCLUSIONS: Self-rated workload had more effect on engagement than did staffing, and factors that influence self-rated workload need to be explored. IMPLICATIONS FOR NURSING MANAGEMENT: Balancing the mix of experience levels in nursing teams may improve work engagement. Managers should pay attention to multiple strategies to motivate nurses to engage in work in clinical practice.

The relative effectiveness of different types of exercise for people with Mild Cognitive Impairment or dementia: Systematic review protocol.

AIMS: To investigate which type of exercise is the most effective for people with mild cognitive impairment (MCI) or dementia. BACKGROUND: Exercise is recommended as a promising intervention for people with cognitive impairment. However, which type of exercise is the most beneficial for people with MCI or dementia seems still unclear. The objective of this article is to assess the relative effectiveness of different types of exercise on cognitive function in people with MCI or dementia using network meta-analysis. DESIGN: Systematic review, meta-analysis, and network meta-analysis. METHODS: We will systematically search electronic databases including PubMed, Cochrane Central Register of Controlled Trials, EMBASE, Web of Science, SPORTDiscus, and PsycINFO. To avoid missing the eligible literature, we will examine the reference lists of systematic reviews publication since 2017. WHO International Clinical Trials Registry Platform and ClinicalTrials.gov will also be retrieved to identify eligible trials. Two independent researchers will identify the eligible trials according to selection criteria and extract data. The risk of bias for included studies will be assessed by two pairs of reviewers based on the modified Cochrane Risk of Bias Tool. Discrepancies or disagreement will be discussed and resolved. Data will be analysed using pairwise meta-analysis and network meta-analysis. DISCUSSION: This study will compare the relative effectiveness of different types of exercise and identify which type of exercise is the most effective for people with MCI or dementia. IMPACT: The results of this review will provide evidence on which domains of cognitive function are more responsive to what type of exercise. It will also help guide nursing clinical practice to optimize exercise therapy in people with MCI or dementia. PROSPERO registration number: CRD42020160620.

Path analysis from physical activity to quality of life among dementia patients: A dual-path mediating model.

AIMS: To clarify the specific impact paths among physical activity, activity of daily living, depression and quality of life among dementia patients. DESIGN: A descriptive, cross-sectional design. METHODS: Dementia patients and their caregivers from five tertiary general hospitals and one dementia patients' club were recruited. A total of 216 valid questionnaires were collected from November 2018 - March 2019. Path analysis was performed by Mplus 7.0 to test the casual relationship among physical activity, activity of daily living, depression and quality of life. RESULTS: Most patients with dementia presented a low level of physical activity and suffered from impaired quality of life. The modified model presented a good model fit and revealed that physical activity had indirect positive effects on quality of life mediated by activity of daily living and depression. CONCLUSION: The results showed that physical activity was a promising non-pharmacological method to improve the performance of activity of daily living and reduce depressive symptoms and then enhance the quality of life among dementia patients. IMPACT: The findings were beneficial to elevate the awareness of physical activity among patients and professionals. This study was helpful to understand how physical activity exerted effects on life quality of dementia patients. This study provided a new perspective for researchers to elucidate the causal relationship of variables among dementia patients.

Benefits of a transtheoretical model-based program on exercise adherence in older adults with knee osteoarthritis: A cluster randomized controlled trial.

AIMS: Benefits of a transtheoretical model-based exercise program on exercise adherence (primary outcome) and secondary outcomes (self-efficacy, decisional balance, knee osteoarthritis symptoms, and physical function) were assessed among older adults with knee osteoarthritis. DESIGN: A two-arm, superiority, assessor-blinded, cluster randomized trial with randomization at the community level. METHODS: Participants were recruited from 14 communities in Beijing between April - October 2018 (N = 189). The intervention was a 24-week transtheoretical model-based exercise program and the control group underwent a non-theory-based exercise program. Exercise adherence was collected every 4 weeks and secondary outcomes were measured at baseline, 12 weeks, and 24 weeks. An independent t test and repeated-measures ANOVA were the main statistical tests. RESULTS: Most participants were women (92.5%), married (81.4%), with high-school education (36.0%), with both knees affected (50.3%), and did not make use of a walker (93.8%). There were no significant differences between groups in any of the outcome measures at baseline. Repeated-measures ANOVA indicated that there was a significant difference in the trend of adherence scores between the two groups from 0-24 weeks. The independent t test showed that scores in the intervention group were significantly better than in the control group at 16, 20, and 24 weeks. Improvements in the intervention group were also significantly greater in all secondary outcomes than in the control group. CONCLUSION: A theory-based exercise program could improve exercise adherence, self-efficacy, decisional balance, knee osteoarthritis symptoms, and physical functioning in older adults with knee osteoarthritis. TRIAL REGISTRATION: Chinese Clinical Trials Registry number ChiCTR1800015458. Registered 31 March 2018. IMPACT: The 24-week theory-based exercise program could improve exercise adherence, self-efficacy, decisional balance, symptoms of knee osteoarthritis, and physical functioning in older adults with knee osteoarthritis. The theory-based exercise program could help older adults with knee osteoarthritis to improve their symptoms and knee function.

Effects of organisational justice, work engagement and nurses' perception of care quality on turnover intention among newly licensed registered nurses: A structural equation modelling approach.

AIMS AND OBJECTIVES: To investigate turnover intention among newly licensed registered nurses and to clarify the impact pathways of organisational justice, work engagement and nurses' perception of care quality on turnover intention. BACKGROUND: Nurse shortage is an ongoing and urgent issue worldwide, in which nurse turnover could exacerbate the situation. Newly licensed registered nurses will become the main nursing workforce in the future; however, previous studies have not revealed the specific reasons underlying their turnover intentions. DESIGN: A descriptive cross-sectional design. METHODS: A total of 569 newly licensed registered nurses undertaking direct care were recruited from thirteen hospitals from October to November 2018 across Beijing, China. Based on the job demands-resources model, we advanced a hypothetical model, linking the paths between organisational justice, work engagement, nurses' perception of care quality and turnover intention. Structural equation modelling was used to examine the hypothetical model. The study adhered to the STROBE statement for observational studies. RESULTS: In total, 22.3% of newly licensed registered nurses had a high turnover intention. The final model had an acceptable fit and could explain 58% of the variance in turnover intention. The organisational justice was directly related to high work engagement, great nurses' perception of care quality and low turnover intention. Additionally, organisational justice also had indirect effects on great nurses' perception of care quality and low turnover intention, which were partially mediated by work engagement. However, the effect of nurses' perception of care quality on turnover intention was not significant. CONCLUSION: The improvement of organisational justice could enhance work engagement, and nurses' perception of care quality, and reduce turnover intention, which is crucial to improving care quality and addressing the shortage of nurses. RELEVANCE TO CLINICAL PRACTICE: This study provides evidence for policymakers and hospital administrators to take targeted measures to enhance work engagement, foster high-quality care and create better defences against losing nurses.

Cross-Cultural Adaptation and Psychometric Evaluation of the Community Healthy Activities Model Program for Seniors Physical Activity Questionnaire in Chinese Older Adults.

The study's aims were to translate the Community Healthy Activities Model Program for Seniors (CHAMPS) questionnaire to Chinese and examine its psychometric properties. Adapting it for use in China involved forward translation, synthesis, back translation, expert review, and pretesting. A convenience sample of 201 Chinese older adults completed the Chinese version (CHAMPS-C) to evaluate its construct validity index and associations with physiological, psychosocial, and energy expenditure measures. The construct validity index of the CHAMPS-C was 0.95, and it had fair to moderate associations with physiological and psychosocial measures, other scales of physical activity, and accelerometer measurements. Our structured, stepwise process of cross-cultural adaptation produced a scale (i.e., CHAMPS-C), with items equivalent in meaning to the English version, for use with Chinese older adults. The findings of this study indicate that the CHAMPS-C has acceptable reliability and validity to assess the physical activity of older Chinese adults.

The effect of nurse staffing on patient-safety outcomes: A cross-sectional survey.

AIM: To analyse the effect of nurse staffing (number of nurses and staff structure) on patient-safety outcomes in hospitals in China. BACKGROUND: The number of nurses has been shown to have a significant effect on patient-safety outcomes, but the structure of the nursing staff has received little attention. METHODS: A cross-sectional survey was conducted in 211 units of 13 hospitals. Data on four patient-safety outcomes and numerical and structural indices of nurse staffing were collected from seven types of hospital units. RESULTS: Nurse staffing had inconsistent effects on units' rates of fall and hospital-acquired pressure ulcers. The nurse-to-patient ratio and rate of nurses with work experience ≤5 years predicted fall rates, and rate of hospital-acquired pressure ulcers was positively correlated to the level of nurse staffing (low nurse-to-patient ratio and high bed-to-nurse number). CONCLUSIONS: The number and structure of nurses are both important to patient safety, and the rate of nurses with work experience ≤5 years might be a protective factor against adverse events. IMPLICATIONS FOR NURSING MANAGEMENT: Patient outcomes correlated with the number and structure of the nursing staff. Methods to balance the structure of nursing staff might be a topic worthy of examination in future studies.