Cross-cultural adaptation and validation of the medical outcome study social support survey among mothers of children aged 6-23 months in Indonesia.

BACKGROUND: Social support significantly influences a mother's adherence to complementary feeding guidelines, with family support fostering a positive attitude towards this practice. The Medical Outcome Study Social Support Survey (MOS-SSS) is a multidimensional scale designed to evaluate functional aspects of social support, but no instrument has been validated for Indonesia. PURPOSE: The study aims to validate the MOS-SSS instrument for measuring mothers' social support in providing complementary food to infants and young children aged 6-23 months in Indonesia. METHODS: A cross-sectional survey was conducted on 196 mothers with children aged 6-23 months in West Sumatera, Indonesia. The MOS-SSS's internal consistency was assessed using Cronbach alpha, composite reliability, and split-half analysis, while its construct validity was evaluated using convergent and discriminant validity. RESULTS: The Indonesian version of the MOS-SSS among mothers with children aged 6-23 months has been found to be satisfactory in content validity through translation and expert review. The questionnaire exhibits strong convergent and discriminant validity, reliable construct reliability, and internal consistency. CONCLUSIONS AND IMPLICATIONS: The MOS-SSS questionnaire was found to be reliable and valid in measuring the social support mothers perceive in providing complementary feeding to their infants and young children. Future research should explore the psychometric properties of the Indonesian version of the MOS-SSS in various populations, including pregnant women, lactating mothers, and women with special conditions.

Type-wide biochars loaded with Mg/Al layered double hydroxide as adsorbent for phosphate and mixed heavy metal ions in water.

This study discussed the adsorption of mixed heavy metal ions (Cu2+, Co2+, Pb2+) and phosphate ions by ten pristine biochars and those with precipitated Mg/Al layered double hydroxide (LDH). The pristine biochars have adsorption capacities of 6.9-13.4 mg/g for Cu2+, 1.1-9.7 mg/g for Co2+, 7.8-20.7 mg/g for Pb2+, and 0.8-4.9 mg/g for PO43-. The LDH-biochars have markedly increased adsorption capacities of 20.4-25.8 mg/g for Cu2+, 8.6-15.0 mg/g for Co2+, 26.5-40.4 mg/g for Pb2+ with mixed metal ions, and 13.0-21.8 mg/g for PO43-. Part of the Mg ions but Al ions are released from the LDH-biochars during adsorption, counting less than 7.2% of the adsorbed ions. The pristine biochars have specific adsorption sites for Cu2+ and Co2+, separate Pb2+ sites related to ether groups on biochar, and areal-dependent sites for PO43-. There is no universal adsorption mechanism corresponding to mixed metal ion adsorption for individual pristine biochar involving different contributions of C-O-C, C-O-H, and CO groups and graphitic-N, pyrrolic-N, and pyridine-N groups. The LDH complexes with hydroxyl and carbonyl groups of biochar, and the LDH interacts with biochar's ether groups, which contributes to metal adsorption, against the conception that the biochar is merely a carrier of LDH as adsorbents.

Factors associated with appropriate complementary feeding: A scoping review.

PROBLEM: Childhood stunting becomes a vital point of an underlying problem in early life. Appropriate and adequate complementary feeding is necessary for children to prevent malnutrition and introduce healthy eating habits. Knowledge of factors related to complementary feeding practices is needed to design strategies that improve optimal complementary feeding and avoid malnutrition in children. However, factors related to appropriate complementary feeding practices have not been systematically examined; hence, the present study aims to synthesize the available evidence on factors associated with proper complementary feeding practices. METHODS: A scoping review was conducted. Five databases were searched for relevant studies, including Medline, Embase, Cochrane, CINAHL, and Web of Science. The studies selected for review were those published in English from 2009 to 2022 on complementary feeding practices and related factors, measuring at least three complementary feeding indicators, and available in full text. The criteria resulted in 30 eligible articles that were selected, extracted, and then analyzed using descriptive and content analysis. FINDING: Factors associated with complementary feeding practice include maternal factors (knowledge, attitude, self-efficacy, parity, antenatal care visit, place of delivery, and postnatal check-up), socio-environmental factors (age, educational level, income, employment status, residence, household size, mother's ethnicity, and support) and informational factors (exposure to media, source of information and intervention). CONCLUSION AND IMPLICATION: Maternal, socio-environmental, and informational factors are associated with appropriate complementary feeding in infants and young children. Further research is necessary to identify causal relationships between the three groups of factors and complementary feeding practices.

Caregivers' experiences of having a child with cerebral palsy. A meta-synthesis.

AIM: To synthesize qualitative research findings of caregiver experiences and challenges in caring for and raising a child with cerebral palsy. DESIGN: A systematic review and meta-synthesis. METHODS: Four electronic databases: CINAHL, Embase, OVID Medline, and Cochrane, were systematically searched for qualitative research papers published before December 2022. Two independent reviewers assessed eligibility and further appraised the quality of methodology using the Critical Appraisal Skills Program (CASP) tool for qualitative research. A content thematic analysis approach was used to synthesize the qualitative research findings, construct core subthemes, and synthesize themes. RESULTS: Sixty-seven findings were extracted from the 12 included studies. The findings were grouped into eleven sub-themes and then into five synthesized themes. The synthesized themes are 1. Need for convenient healthcare facilities, therapeutic services, and accessible public places, 2. Need for healthcare information and financial aid, 3. Psychological, and physical constraints, 4. Societal rejection and stigma, and 5. Overwhelming caring burden. CONCLUSION: Caregivers face many challenges in adjusting their lifestyles to meet the needs of the child with cerebral palsy. Some adjustments reported included giving up full-time jobs and businesses to be full-time caregivers, giving up leisure activities, and confinement to one place.

[Establishment of Administrative Core Competencies and Evaluation Indicators for Head Nurses].

BACKGROUND: The increasing complexity of the healthcare environment in recent years highlights the importance of cultivating in head nurses the leadership and management competencies necessary to effectively handle complicated administrative tasks and lead nurses in facing various challenges. Identifying the core administrative management competencies required of head nurses and evaluating competency level using behavioral indicators are fundamental to evaluating related training outcomes. PURPOSE: This study was designed to identify the core administrative management competencies required of head nurses as well as the associated job responsibilities, tasks, behavioral evaluation indicators, work outputs, and requisite knowledge and skills. METHODS: This study was conducted in two phases using a qualitative method. The first phase identified the core administrative management competencies and their behavioral definitions. The second phase established competency-related job responsibilities, tasks, behavioral evaluation indicators, work outputs, and requisite knowledge and skills. Each phase consisted of (1) a qualitative interview (first stage) or focus group discussion (second stage) to establish the prototype content; (2) a head nurse workshop to obtain multiple perspectives to modify the prototype content; and (3) a focus group discussion to achieve consensus regarding the content. RESULTS: Nine core competencies related to head nurse administration were identified, including: strategic planning, care supervision, quality improvement, communication, crisis management, responsible leadership, evidence-based practice, digital technology application, and presentation persuasion. Corresponding to these competencies, four responsibilities and associated work tasks were identified. Finally, the related behavioral evaluation indicators, work outputs, and requisite knowledge and skills were confirmed. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The results of this study may be used as the basis for head nurse administrative management training programs, while the identified behavioral evaluation indicators may be used to evaluate head nurse work performance and training outcomes. We recommend other institutions apply the results of this study and develop their own administrative core competencies and evaluation indicators for head nurses.

Exploring dementia care competence of nurses working in acute care settings.

AIMS AND OBJECTIVES: To examine the current status of dementia care competence of nurses working in acute care settings as well as the relationship between competence and demographic attributes. BACKGROUND: Most people with dementia are older individuals when they are admitted to unfamiliar acute care settings for treatment, and they are prone to displaying BPSD. If nurses working in acute care settings are not sufficiently competent in dementia care, providing proper patient care is difficult. DESIGN: The study used a one-sample descriptive-correlation design. METHODS: This study enrolled nurses at two medical centres in southern Taiwan as the research participants and performed a stratified random sampling according to the units where they served. The Dementia Care Competence Scale was used for data collection. An independent samples t test, ANOVA and Pearson's product-moment correlation were performed for data analysis (See STROBE). RESULTS: A total of 308 valid questionnaires were collected. The results showed that dementia care competence of nurses working in acute care settings was moderate. In particular, they had insufficient knowledge of the special needs related to dementia and lacked the skills and patience necessary for identifying, preventing and managing BPSD. Additionally, although the nurses tended to have a positive attitude, they seldom communicated with people with dementia. This study also found that dementia care competence was better in nurses who were older, who had more seniority, who had taken care of people with dementia for a longer period of time and who had received training in dementia care. CONCLUSIONS: Dementia care training topics for nurses working in acute care settings should include palliative care for dementia, skills for managing behavioural and psychological symptoms of dementia and communication techniques for improving person-centred care. Nurses should also be encouraged to maintain a warm, friendly attitude when providing patient care. RELEVANCE TO CLINICAL PRACTICE: Continuing education in managing behavioural and psychological symptoms of dementia is necessary for currently practicing acute care nursing staff and should be developed according to the staff's educational background and needs.

[Establishment of Role and Core Competencies of Geriatric Case Managers in Taiwan].

BACKGROUND: Older adults have unique and complex care needs that are multifaceted, continuous, and integrated and that span prevention and treatment to long-term rehabilitation. Case managers are able to integrate healthcare and social resources to help older adults and their caregivers manage the needs of daily life. Therefore, identifying the role and core competencies of geriatric case managers in Taiwan is crucial. PURPOSE: To develop the role and core competencies of geriatric case managers in Taiwan. METHODS: Based on a review of the literature, a two-round modified Delphi technique was used to evaluate the framework of the geriatric case manager role and core competencies. Experts were invited to join a panel to review and rank the importance of each role and competency within the context of the Delphi technique. RESULTS: Four roles and 36 core competencies of geriatric case managers were identified, and 94.4% consensus was reached in round two. The roles and core competencies included care expert (18 competencies), coordinator (6 competencies), consultant (6 competencies), and evidence-based practitioner (6 competencies). CONCLUSIONS / IMPLICATIONS FOR PRACTICE: Training programs may be developed for geriatric case managers based on the results of this study to further promote the quality of provided geriatric care.

Is nurse-led case management effective in improving treatment outcomes for cancer patients? A systematic review and meta-analysis.

AIMS: To identify and synthesize the outcomes of nurse-led case management interventions for improving cancer treatment. DESIGN: Systematic review with meta-analysis. DATA SOURCES: PubMed, MEDLINE, CINAHL, EMBASE, Cochrane Library and CEPS were searched for articles published from inception till June 2019, and search was finalized in January 2020. REVIEW METHODS: The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines. The quality of evidence was assessed using Joanna Briggs Institute Critical Appraisal Tools. Outcomes were analysed by using a pool of data of 95% confidence intervals (CIs), p value and fitting model based on heterogeneity of test results. RESULTS: Eleven articles were included in the meta-analysis. When compared with the regular care group, the nurse-led case management group had: 1) shorter time from diagnosis to treatment by 9.07 days, 2) an improved treatment completion rates (OR = 2.45) and 3) more number of patients received hormone therapy. CONCLUSION: The synthesized results presented that nurse-led case management is more effective than regular care in improving treatment timeliness, treatment completion rates and hormone therapy rates.

Development and validation of the prenatal activity restriction stress questionnaire: a Rasch rating scale analysis.

BACKGROUND: Antepartum activity restriction (AAR) is a common recommendation given to women at risk for preterm delivery. However, such treatment has been shown to cause heavy emotional burdens on the women receiving it since it requires them to face many challenges derived from the intervention. Nevertheless, current existing scales lack effective items that can reflect the distress of these women. The aim of this study was to develop a reliable instrument to assess the distress of women experiencing AAR. METHOD: The Prenatal Activity Restriction Stress Questionnaire (PARSQ) was developed according to comprehensive literature review, women's interviews, and existing pregnancy-special stress scales from August 2016 to July 2017 in southern Taiwan. Six experts evaluated its content validity; the Rasch rating scale model (RSM) was used to examine its item-fit, dimensionality, and reliability with 200 women with AAR experience. Furthermore, the concurrent validity was assessed through computing the correlation of AAR women's scores on the PARSQ and Perceived Stress Scale (PSS), and discriminant validity of the PARSQ was assessed to compare the scores' differences between the AAR women and the healthy pregnant women. RESULTS: The PARSQ was constructed with 23 items in the 4-dimensional scale: Role function changes (8 items), Fetal safety and health (5 items), Physical and psychological care issues (5 items), and Socioeconomic and medical issues (5 items). It was confirmed to have satisfactory content vitality (CVI = 0.78 to 1.0), reasonable item-fit (0.77 to 1.51), and good reliability in RSM model, as well as adequate concurrent validity (p = 0.005) and discriminant validity (p < 0.001). CONCLUSIONS: Understanding the distress of women undergoing AAR is necessary for developing appropriate prenatal care to assist women in coping with their situation to alleviate their emotional burdens. The developed PARSQ with satisfied psychometric properties can be an informative instrument for clinicians/researchers to assess the specific stress of pregnant women with AAR.

[Social Impacts of International Nursing Education].

The objective of international nursing education in Taiwan is to prepare nursing elites to improve the quality of global healthcare. Nurses are on the frontlines in terms of helping the public through increasingly frequent climate-change disasters, helping care for the rising populations of older adults and patients with chronic diseases, and dealing with the emergence of new infectious diseases. Advancing the knowledge and capabilities of global nursing elites is imperative. The main purpose of nursing education is to educate future nursing leaders. This paper describes the internationalization of nursing education in the Department of Nursing at National Cheng Kung University as well as the process of establishing the Asia-Pacific Nursing Education Alliance to highlight the international characteristics of nursing education, the related global social influence, and the pursuit of sustainable development goals.

[Evidence-Based Clinical Practice Guidelines: Delirium Management in Hospitalized Older Patients].

BACKGROUND: The health problems of hospitalized older patients are complicated, with delirium a common neurocognitive disorder in this population. Delirium has been correlated with the longer periods of hospitalization, higher mortality, and higher rates of institutionalization. However, clinical practice guidelines for delirium management in hospitalized older patients are lacking. PURPOSE: The purpose of this study was to develop evidence-based practice guidelines for delirium management in hospitalized older patients. METHODS: A multidisciplinary task group at a medical center in southern Taiwan was established. Team members reviewed current delirium practice guidelines. A revised set of practice guidelines was developed by constructing foreground questions on key issues and by systematically searching, appraising, and synthesizing the relevant evidence. After a new draft of the guidelines was established, the Delphi method was used to reach a consensus among experts. Finally, the developed guideline document was applied in a geriatric ward of a medical center in order to evaluate applicability. RESULTS: The developed delirium guidelines address 3 issues with 35 recommendations. The panel of clinical and methodological experts recommended that these delirium guidelines be applied in practice. Most nurses in the targeted geriatric ward indicated that the guidelines were feasible and easy to implement. However, several of the procedures were identified as difficult to implement, including "provide a therapeutic environment", "promote good sleep patterns and sleep hygiene", and "consider psychotropic medication as a last resort for agitation". CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The evidence-based delirium management guidelines for hospitalized older patients that were developed in this study integrates the recommendations from the best available evidence and earned a high consensus among clinical experts. Thus, these guidelines are recommended for clinical application.

Variations in the rancid-flavor compounds of human breastmilk under general frozen-storage conditions.

BACKGROUND: Human breastmilk provides the best nutrition for infants. When women or infants have difficulties in breastfeeding directly, breastmilk is usually pumped and frozen for later use. However, while frozen, breastmilk may develop a rancid flavor, which induces infant feeding stress and raises the mothers' concerns about the quality of frozen breastmilk. Nevertheless, few studies have investigated the variations in the compounds that cause the rancid flavor of breastmilk during frozen storage. METHODS: A repeated-measures design was adopted to quantify the variations in rancid-flavor compounds, namely acid value (AV), total free fatty acids (FFAs), and short-and intermediate-chain FFAs of breastmilk during frozen storage. Breastmilk was obtained from ten healthy mothers of full-term infants and each milk sample was divided into three aliquots: fresh, 7-day frozen and 30-day frozen samples. The fresh samples were immediately analyzed, while the others were frozen in a domestic fridge within a temperature range of -15 to -18 °C and analyzed 7 and 30 days later. RESULTS: The rancid-flavor compounds of the breastmilk, namely AV, total FFAs and intermediate-chain FFAs, significantly increased with storage time, all of which reached the sensory threshold for detecting the rancid flavor of milk. In addition, the FFAs of the breastmilk samples frozen for 7 days far exceeded the detection threshold for unpleased rancid flavor, while the 30-day samples were higher than the intolerable level for most people. CONCLUSIONS: This study revealed that the human breastmilk develops a rancid flavor during frozen storage. Therefore, we recommend that when infants refuse thawed milk, mothers can try to provide freshly expressed milk whenever possible or provide breastmilk frozen for less than 7 days. Future studies could explore the methods for slowing breastmilk lipolysis to maintain its fresh flavor.

Power and sample size calculation for paired recurrent events data based on robust nonparametric tests.

The purpose of this paper is to develop a formula for calculating the required sample size for paired recurrent events data. The developed formula is based on robust non-parametric tests for comparing the marginal mean function of events between paired samples. This calculation can accommodate the associations among a sequence of paired recurrent event times with a specification of correlated gamma frailty variables for a proportional intensity model. We evaluate the performance of the proposed method with comprehensive simulations including the impacts of paired correlations, homogeneous or nonhomogeneous processes, marginal hazard rates, censoring rate, accrual and follow-up times, as well as the sensitivity analysis for the assumption of the frailty distribution. The use of the formula is also demonstrated using a premature infant study from the neonatal intensive care unit of a tertiary center in southern Taiwan. Copyright © 2017 John Wiley & Sons, Ltd.

[Theoretical Development and Research Trends in Developmental Care].

The Newborn Individualized Developmental Care and Assessment Program (NIDCAP), based on the Synactive Theory, is applied to improve brain development in premature and illness infants within a supportive environment. The NIDCAP has been used widely in the clinical setting. The aim of this article was to systematically review research published between 2000 and 2013 that relates to the evidence and application of developmental care. Most studies support the effectiveness of developmental care in terms of facilitating the healthy growth of premature infants, reducing oxygen dependence, reducing hospitalization times, and improving neurodevelopmental outcomes at two years of age. However, research results related to the effects of developmental care on neurodevelopmental outcomes from 2 years old to school age are not consistent. The heterogeneity of interventions, outcome indicators, and measurements in studies may contribute to these mixed results. In addition, as developmental care has been applied for many years, the contamination of participants in the supportive environment should be considered. Based on current evidence, neonatal healthcare professionals must recognize the core value of developmental care in dealing with premature infants and their families. In order to provide effective interventions for infants, further research is needed to assess the comparative effects of the single intervention and the holistic approach in developmental care.

Predictors of Health Status in Mothers of Premature Infants with Implications for Clinical Practice and Future Research.

BACKGROUND: Postpartum health research has focused primarily on full-term mothers. AIMS: To explore postpartum stress, depression, social support, health status, and predictors of health status in mothers of premature infants. METHODS: This study employed a cross-sectional design. With convenience sampling, a total of 203 mothers of premature infants were recruited from two medical centers and four community teaching hospitals in southern Taiwan. The Hung Postpartum Stress Scale, Social Support Scale, Beck Depression Inventory, and Chinese Health Questionnaire were used to assess the mothers' psychosocial features during the first 6 weeks postpartum. RESULTS: Mothers' health status differed significantly according to levels of postpartum stress and depression. The important health status predictors were age, education, postpartum stress, and depression level. DISCUSSION: The concerns and needs of mothers of premature infants differed from those of full-term mothers during the first 6 weeks postpartum; premature infants' health status was found to be a major perceived stressor for their mothers. LINKING EVIDENCE TO ACTION: In the process of caring for premature infants' mothers, healthcare providers should provide individualized care to meet their needs, thus facilitating the reduction of postpartum stress and depression levels. During premature infants' hospitalizations, healthcare providers should hold regular faculty meetings to provide postpartum women with relevant information about their infants' health and how to best care for them. Future studies should explore postpartum stress, social support, depression, and health status each postpartum week, which could serve as a guide for nursing interventions.

[Development of evidence-based clinical practice guidelines for endotracheal suction in premature infants].

BACKGROUND: Endotracheal suctioning (ETS) for mechanically ventilated premature infants is a routine practice in neonatal intensive care. However, ETS is associated with hypoxemia and bradycardia, which may cause brain damage and negatively affect neurodevelopmental outcomes. PURPOSE: This study develops a set of evidence-based clinical-practice ETS guidelines for premature infants. METHODS: A multidisciplinary task group at a medical center in southern Taiwan was established. Team members analyzed current ETS practice guidelines, constructed foreground questions, reviewed each question systemically, drafted a new set of guidelines, established expert consensus, disseminated the developed guidelines within a hospital setting, and evaluated their efficacy in practice. RESULTS: The developed ETS guidelines address 13 issues with 39 recommendations. The Delphi method found that 75% of experts agreed with all of the recommendations. Issues addressed in the ETS included pre-assessment, frequency of suctioning, pre-oxygenation, suction-tube selection, infection control, suction pressure and depth decision making, humidity with normal saline, suction duration and number, containment and comforting, assessment during and after suctioning, recovery time, and documentation. The panel of clinical and methodological experts recommended that ETS be used in practice and nurses in the neonatal intensive care unit evaluated the ETS as applicable and accessible. The cardiorespiratory responses to ETS of 5 premature infants were within normal ranges without episodes of hypoxemia (oxygen saturation < 85%) or bradycardia (heart rate < 100 beat/min). CONCLUSIONS: This set of evidence-based ETS guidelines for premature infants integrated recommendations from the best available literature and obtained a high consensus among clinical experts. Thus, these guidelines are recommended for clinical application.

Implementation of shared decision-making about rooming-in: A before and after an audit of breastfeeding in Taiwan.

BACKGROUND: The 24-h rooming-in policy is crucial to the Baby-Friendly Hospital Initiative (BFHI) for promoting breastfeeding. However, this policy may restrict maternal autonomy. In 2018, to integrate women's preferences into care decisions, Taiwan's Baby-Friendly certification included prenatal shared decision-making (SDM) for rooming-in. Prior to 2018, maternal knowledge, considerations, and intentions regarding rooming-in and the impact of prenatal SDM were unknown. METHODS: A retrospective electronic medical record cohort study was conducted in southern Taiwan. Data on healthy postpartum women eligible for rooming-in and breastfeeding for the years 2017 and 2019, reflecting the periods before and after prenatal SDM was introduced, were gathered. Maternal and newborn characteristics, maternal knowledge, considerations, and prenatal intentions for postpartum rooming-in and breastfeeding during hospitalization were collected. Additionally, data on actual postpartum rooming-in practices during hospitalization and exclusive breastfeeding (EBF) practices from birth to hospital discharge, to 1 month, and to 2 months postpartum were collected. Descriptive and non-parametric statistics were applied to analyze the data. RESULTS: A total of 621 women in 2017 and 311 women in 2019 were included. After prenatal SDM was introduced, the rooming-in rate during hospitalization fell from 42.2% in 2017 to 25.6% in 2019 (p < 0.001), and the EBF rate declined from 45.9% to 35.7% (p = 0.01). Additionally, the 1-month postpartum EBF rate decreased from 46.4% in 2017 (n = 571) to 44.3% in 2019 (n = 264), and the 2-month postpartum EBF rate dropped from 45.5% in 2017 (n = 591) to 40.2% (n = 308). According to the 2019 Patient Decision Aids responses (n = 236), women demonstrated limited understanding of rooming-in, with only 40.7% expressing an intention toward 24-h rooming-in. Women of older maternal age (p < 0.001), with a graduate degree (p = 0.02), full-time employment (p = 0.04), and concerns about rest disruption (p < 0.001), were more likely to prefer non-24-h rooming-in. CONCLUSIONS: Initiatives must promote prenatal SDM to enable healthcare providers to address misconceptions and tailor education, thereby increasing women's intention toward 24-h rooming-in and EBF. Future research should explore women's experiences and unmet needs at BFHI facilities to inform the construction of a baby- and mother-friendly environment.

The effect of breast reconstruction surgery on body image among women after mastectomy: a meta-analysis.

The purpose of this study was to analyze the available evidence concerning the effects of breast reconstruction (BR) on body image of women with breast cancer. BR is a potential intervention to improve the body image of women with breast cancer. Conflicting research findings about the effects of breast reconstructive surgery on body image compared to breast conservative surgery (BCS) or mastectomy exist. A meta-analysis of studies found in MEDLINE, CINAHL, PsychINFO, PubMed as well as PQDT (dissertation and theses), and other unpublished literature resources from 1970 to 2010 were searched. Comparable studies that examined the difference of body image between breast cancer women receiving mastectomy plus BR and those with BCS were included. A clear definition about the domains of body image including body stigma, body concern, and transparency were identified. Mean effect sizes were calculated. Twelve studies were included in the meta-analysis. Women with BR and BCS were no different on the body concern domain of body image. However, women with BR had a significantly worse score on body stigma domain of body image than women receiving BCS. Women with BR had a better body image score than women with mastectomy. Women who are satisfied with their body shape may still perceive deficiencies because of the stigma of mastectomy and affect on body image. Consistent application of valid and reliable measures of body image specific to breast cancer women is needed.

Systematic review of effectiveness of situated e-learning on medical and nursing education.

OBJECTIVES: Because of the complexity of clinical situations, traditional didactic education is limited in providing opportunity for student-patient interaction. Situated e-learning can enhance learners' knowledge and associated abilities through a variety of activities. Healthcare providers who interact with virtual patients in designed situations may avoid unnecessary risks and encounters with real patients. However, the effectiveness of situated e-learning is inconsistent. The purpose of this study is to determine the effectiveness of situated e-learning in prelicensure and postlicensure medical and nursing education. METHODS: Literature databases of PubMed, Medline, CINAHL, ERIC, and Cochrane Library were searched. The study eligibility criteria included articles published in English, which examined the effectiveness of situated e-learning on the outcomes of knowledge and performance for clinicians or students in medicine and nursing. Effect sizes were calculated with 95% confidence intervals. RESULTS: Fourteen articles were included for meta-analysis. Situated e-learning could effectively enhance learners' knowledge and performance when the control group received no training. Compared to traditional learning, the effectiveness of situated e-learning on performance diminished but still remained significant whereas the effect become insignificant on knowledge. The subgroup analyses indicate the situated e-learning program significantly improved students' clinical performance but not for clinicians. CONCLUSIONS: Situated e-learning is an effective method to improve novice learners' performance. The effect of situated e-learning on the improvement of cognitive ability is limited when compared to traditional learning. Situated e-learning is a useful adjunct to traditional learning for medical and nursing students.

Effects of the experience of breastfeeding-friendly practices and breastfeeding intention and self-efficacy on breastfeeding behavior: a cohort study in Taiwan.

BACKGROUND: Approximately 80% of births in Taiwan occurred in Baby-Friendly accredited facilities, although the trend of exclusively breastfeeding infants until 6 months of age has stagnated in the last ten years. To guide breastfeeding promotion interventions during postnatal stays and encourage mothers to continue breastfeeding for the first 6 months, factors associated with breastfeeding behaviors to 6 months post-delivery must be investigated. This study explored the relationships among breastfeeding intention, experience of breastfeeding-friendly practices, breastfeeding self-efficacy, and breastfeeding behavior at four and 6 months after childbirth. METHODS: In this longitudinal cohort study, women who gave birth to healthy newborns at two Baby-Friendly hospitals in Taiwan and who had initiated breastfeeding were recruited two to 4 days after giving birth. Data were collected three to 5 days after childbirth during hospitalization and at one, two, four, and 6 months after childbirth using a self-developed questionnaire to measure breastfeeding intention and the experience of breastfeeding-friendly practices, and the traditional Chinese version of the Breastfeeding Self-Efficacy Scale-Short Form to measure self-efficacy. RESULTS: A total of 155 women completed the questionnaires five times within 6 months. The determinants of exclusive breastfeeding at 4 months and any breastfeeding at 6 months were the intention to breastfeed for over 6 months; a higher score for the experience of breastfeeding-friendly practices; and a higher level of breastfeeding self-efficacy during that period. The experience of breastfeeding-friendly practices during hospitalization did not predict breastfeeding behavior at 4 and 6 months. Intending to breastfeed for less than 4 months and lower breastfeeding self-efficacy during the hospital stay were both associated with shorter breastfeeding durations of less than 6 months after childbirth. CONCLUSIONS: Longer intended duration of breastfeeding, sustaining breastfeeding-friendly practices after discharge, and maintenance of a higher level of breastfeeding self-efficacy were the determinants of breastfeeding at 4 and 6 months. Healthcare professionals in Taiwan must support breastfeeding-friendly practices and consider interactive interventions to promote continued breastfeeding at different stages during the first 6 months after childbirth on the basis of the mother's breastfeeding plan and breastfeeding self-efficacy during their postnatal hospitalization.