Multicentre Randomized Controlled Trial of a Nurse-Led Sexual Rehabilitation Intervention to Rebuild Sexuality and Intimacy After Treatment for Gynecological Cancer.

OBJECTIVE: To evaluate the effectiveness of a sexual rehabilitation program, SEXHAB, in improving sexual functioning, reducing sexual distress, and enhancing marital satisfaction for women after gynecological cancer treatment. METHODS: This is a randomized controlled trial that included 150 women newly diagnosed with gynecological cancer from three public hospitals in Hong Kong. Participants were randomly assigned to the intervention group (n = 78) to receive the SEXHAB or to an attention control group (n = 72) to receive attention. The SEXHAB comprises four individual- or couple-based sessions with three major components: information provision, cognitive-behavioral therapy and counseling using motivational interviewing skills. The outcomes were measured at baseline (T0), upon completion of the program (T1) and 12-month post-treatment (T2). Semi-structured interviews were also conducted with the SEXHAB group participants to explore their experiences with and opinions toward the program. RESULTS: At both follow-ups, there were no statistically significant differences between groups in improving sexual functioning, sexual distress and marital satisfaction. Nevertheless, participants in the SEXHAB group reported their partners having significantly greater sexual interest at T1 (76% vs. 52%, rate ratio: 1.46, 95% CI: 1.07 to 1.99, p = 0.024) and T2 (74% vs. 48%, rate ratio: 1.55, 95% CI: 1.11 to 2.10, p = 0.014). From the qualitative interviews, the interviewees who resumed sexual activity reported positive experiences in rebuilding sexuality and intimacy. CONCLUSIONS: Despite the quantitative results are negative, the qualitative findings suggest potential benefits of the SEXHAB for women resuming sexual activities after treatment for gynecological cancer. Further studies with longer intervention period and follow-ups are needed to confirm the intervention effects.

Predictors of surgery choices in women with early-stage breast cancer in China: a retrospective study.

BACKGROUND: The breast-conserving surgery and reconstruction rate in China is relatively low when compared with those in Western countries. Moreover, predictors of surgical choices for women with breast cancer in China have not yet been explored. This study aims to explore differences in the surgical choices of women with different demographic and clinical characteristics and the predictors that influence surgical choices of women with early-stage breast cancer. METHODS: This retrospective study included women with early-stage (0-II) breast cancer who underwent surgeries at one of two Xiamen University-affiliated hospitals between 2009 and 2017. Using medical records, eleven variables were collected: the woman's age, year of diagnosis, hospital, marital status, payment method, cancer stage, presence of positive axillary lymph node, histology, neoadjuvant chemotherapy, radiotherapy, and the type(s) of surgery they chose. Binary logistic regression was used to analyse predictors of surgical choice. RESULTS: A total of 1,787 cases were included in this study. Of the total number of women with breast cancer, 61.3% underwent mastectomy without breast reconstruction, 26.4% underwent mastectomy with breast reconstruction, and the remaining 12.2% chose breast-conserving surgery. Women with different demographic and clinical characteristics underwent different types of surgery. Cancer stage, neoadjuvant chemotherapy, radiotherapy, and the choice of hospital were found to be predictors of breast-conserving surgery. Meanwhile, age, year of diagnosis, payment method, neoadjuvant chemotherapy, and the choice of hospital were found to be predictors of reconstruction after mastectomy in women with early-stage breast cancer. CONCLUSIONS: In China, surgical choices for women with breast cancer have diversified. Healthcare workers should understand the surgical preferences of women of different ages. For early detection of breast cancer, knowledge of breast self-examination and breast cancer screening should be provided. Adequate information about the safety of reconstruction and advocacy for medical insurance coverage of reconstruction should be offer. Breast surgeons need specialised training and standardising protocols towards different types of breast surgery. These actions will help women make better, well-informed decisions about their breast surgeries.

Effects of breastfeeding training programmes for midwives on breastfeeding outcomes: a systematic review and meta-analysis.

BACKGROUND: Appropriate breastfeeding training for midwives is necessary to enhance their knowledge, attitude, and practice (KAP). However, evidence surrounding the effects of midwife breastfeeding training programmes is insufficient to draw a conclusion of its effectiveness on breastfeeding initiation, duration, and rates. OBJECTIVE: The aim of this systematic review was to identify, summarise, and critically analyse the available literature to evaluate the effects of midwife breastfeeding training programmes on the midwives' KAP towards breastfeeding and breastfeeding initiation, duration and rates among postnatal mothers. METHODS: Nine English and six Chinese databases were searched with relevant key words. The methodological quality of the included studies were assessed by two reviewers independently using the Joanna Briggs Institute critical appraisal checklists. RESULTS: Nine English and one Chinese articles were included in this review. Five articles investigating midwives' KAP towards breastfeeding reported positive results (p < 0.05). The meta-analysis revealed that breastfeeding training programmes significantly improved midwives' breastfeeding-related knowledge and skills (standardised mean difference = 1.33; 95% confidence interval, 0.98 to 1.68; p < 0.01; I2 = 36%), as well as their attitude towards breastfeeding (p < 0.05). An additional five articles measured the effects of breastfeeding training programmes on the initiation, duration, and rates of breastfeeding among postnatal mothers. Following the implementation of a breastfeeding training programme for midwives, mothers had significantly longer durations of exclusive breastfeeding (p < 0.05), fewer breastfeeding challenges (p < 0.05) (e.g. breast milk insufficiency), and higher satisfaction with breastfeeding counselling (p < 0.01), and fewer infants received breast milk substitutes in their first week of life without medical reasons (p < 0.05) in the intervention group compared with the control group. However, no significant effects were seen on the initiation and rates of breastfeeding after implementation of the programmes. CONCLUSIONS: This systematic review has demonstrated that midwife breastfeeding training programmes could improve midwives' KAP towards breastfeeding. However, the breastfeeding training programmes had limited effects on breastfeeding initiation and rates. We suggest that future breastfeeding training programme should incorporate counselling skills alongside breastfeeding knowledge and skills training. REVIEW REGISTRATION: This systematic review has been registered in the International prospective register of systematic reviews (PROSPERO) (ID: CRD42022260216).

Breastfeeding challenges and opportunities during COVID-19 in Hong Kong.

Barriers to sustain breastfeeding could be time and place specific. Here, we summarise new and old challenges to breastfeeding during COVID-19 pandemic in Hong Kong, some of which were obtained from qualitative in-depth interviews with health-care professionals. We document how unnecessary massive mother-baby separations in hospitals and doubts in COVID-19 vaccine safety seriously harm breastfeeding. We also discuss how the trends and increase in acceptance of receiving post-natal care from family doctors, online-antenatal class, work-from-home policy and telemedicine implicate new strategies to protect, promote and support breastfeeding during and after the pandemic. The challenges from the COVID-19 pandemic on breastfeeding have revealed new opportunities to support breastfeeding in Hong Kong and similar settings where exclusive breastfeeding for 6 months is still not the norm.

Effect of mHealth interventions on psychological issues experienced by women undergoing chemotherapy for breast cancer: A systematic review and meta-analysis.

BACKGROUND: A range of psychological issues often accompany breast cancer chemotherapy. Due to their ubiquity, mobile phones have been used to deliver supportive interventions addressing these issues. However, we currently lack sufficient evidence to guide the design of such interventions. AIM: To analyse and synthesise available evidence on the effectiveness of mobile-phone-based (mHealth) interventions in alleviating the psychological issues experienced by women receiving chemotherapy for breast cancer. METHODS: A systematic literature search was conducted from 14 relevant databases. Revman 5.4 was used to pool the quantitative results from comparable studies for statistical meta-analysis. For clinically heterogeneous studies where statistical pooling of results was not possible, a narrative summary was used to present the findings. RESULTS: The review included nine RCTs which covered 1457 patients. The meta-analysis results indicated a significant improvement in the quality of life (standardised mean difference [SMD] = 0.32, 95% confidence interval [CI] [0.07, 0.58], p = .01, I2  = 17%). No significant effects were found for anxiety (SMD = -0.01, 95% CI [-0.26, 0.25], p = .96, I2  = 53%) and depression (SMD = 0.02, 95% CI [-0.17, 0.20], p = .87, I2  = 0%). Individual studies suggest reduced symptom prevalence (p = .033, d = 0.27), symptom distress (p = .004, d = 0.34), symptom interference (p = .02, d = 0.51), supportive care needs (p < .05, d = 2.43); improved self-efficacy (p = .03, d = 0.53), self-esteem (p < .001, d = 0.87) and emotional functioning (p = .008, d = 0.30). The methodological quality ranged from low to moderate. CONCLUSION: mHealth interventions might help address certain psychological issues experienced by this population, although the evidence is still being gathered and not yet conclusive. More rigorous trials are warranted to confirm the suitable duration while addressing the methodological flaws found in previous studies. PROSPERO REGISTRATION NUMBER: CRD42021224307.

The effects of decision aids for genetic counselling among people considering genetic testing: A systematic review.

AIM: To assess the effectiveness of decision aids for genetic counsellees to improve their conflicts in decision-making and psychological well-being when considering genetic tests for inherited genetic diseases, and their knowledge about these tests and their genetic risks. DESIGN: Systematic review. DATA SOURCES: Six electronic databases (PubMed, MEDLINE, OVID Nursing, APA PsycINFO, EMBASE and CINAHL) were searched from inception to May 2022. REVIEW METHODS: Only randomised controlled trials that examined the effect of decision aids for information provision centring genetic testing on outcomes including decisional conflicts, informed choice making, knowledge on genetic risks or genetic tests, and psychological outcomes among participants who had undergone genetic counselling were included. Their risk of bias was assessed using the Version 2 of the Cochrane risk of bias tool for randomised trials. Results were presented narratively. The review was conducted according to the PRISMA checklist. RESULTS: Eight included studies examined the effect of booklet-based, computer-based, film-based or web-based decision aids on individuals considering genetic testing for their increased cancer risks. Despite contrasting findings across studies, they showed that decision aids enable genetic counsellees to feel more informed in decision-making on genetic tests, although most showed no effect on decisional conflict. Knowledge of genetic counsellees on genetic risks and genetic tests were increased after the use of decision aids. Most studies showed no significant effect on any psychological outcomes assessed. CONCLUSIONS: Review findings corroborate the use of decision aids to enhance the effective delivery of genetic counselling, enabling genetic counsellees to gain more knowledge of genetic tests and feel more informed in making decisions to have these tests. RELEVANCE TO CLINICAL PRACTICE: Decision aids can be used to support nurse-led genetic counselling for better knowledge acquisition and decision-making among counsellees. NO PATIENT OR PUBLIC CONTRIBUTION: Patient or public contribution is not applicable as this is a systematic review.

Perceived feasibility and usefulness of mHealth interventions for psychoeducational support among Nigerian women receiving chemotherapy for breast cancer: a focus group study.

BACKGROUND: Women diagnosed with breast cancer (BC) receiving chemotherapy have reported various side effects, which adversely affect their psychological state. Evidence suggests that psychoeducational interventions (PEIs) delivered through mobile phones might effectively provide psychoeducational support for this population. However, there is a lack of evidence on Nigerian women's perception of mobile health (mHealth) PEI, which prompted this study. METHOD: A qualitative study was conducted among women with BC who had completed chemotherapy at two tertiary hospitals in Nigeria. Face-to-face focus group discussions were conducted at the oncology clinics. Data were collected using focus groups until data saturation was reached. Data were analyzed using thematic analysis. RESULTS: In total, 32 women were recruited, with seven focus group discussions conducted. The participants were between 22 and 75 years old and mostly diagnosed with Stage III BC. Four main themes emerged from the data analysis, including experiences of BC diagnosis and treatment phase, patients' needs during chemotherapy, coping with chemotherapy, and perception of mHealth intervention for psychoeducational support. BC diagnosis was devastating, and psychological disturbances were experienced while receiving chemotherapy, but the participants indicated that mHealth intervention was acceptable as it could provide psychological and informational support. The suggested contents include information on chemotherapy, how to deal with the fear of chemotherapy, nutritious diet locally available, and information on exercise. CONCLUSION: This study has shown that the participants perceived a mHealth PEI is feasible and acceptable in providing psychoeducational support for Nigerian women diagnosed with BC receiving chemotherapy. It is hoped that the unmet needs of this population will be addressed while receiving chemotherapy.

Development of an evidence­based, theory­driven, and culturally appropriate character strengths-based intervention for breast cancer patients, following the Medical Research Council Framework.

PURPOSE: To design and develop a complex, evidence­based, theory­driven, and culturally appropriate character strengths-based intervention (CSI) for breast cancer patients, following the Medical Research Council (MRC) framework. METHODS: From 2018 September to 2020 November, a complex intervention perspective was adopted. The rationale, methods, and processes employed in carrying out the study were reported. The acceptability and feasibility of intervention program were evaluated as a part of subsequent pilot study. Based on piloting, a refined and optimized definitive intervention was obtained. The development of the intervention is an iterative process involving input from three key stakeholders: experts, medical staff, and patient representatives. RESULTS: The systematic review revealed CSIs were effective and the selected theory served as a guide and indicated theory-inspired modifications. A representative team of breast cancer patients and oncology nurses collaboratively developed and tailored the intervention content and format with attention to the acceptability and feasibility. Five main strategies, including peripheral, evidential, linguistic, constituent-involving, and sociocultural strategies, were used to achieve and strengthen the cultural appropriateness. After the pilot phase, several refinements were made on the CSI program, such as editorial changes in the booklet or alternative suggestions for difficult strengths-based activities (e.g., outdoor activities). All participants not only expressed satisfaction with the program in process evaluation, but also reported perceived benefits such as enjoyable and sociable experience, better well-being, and increased confidence. CONCLUSION: Consideration of the MRC framework, theory guidance, and suggestions from stakeholders during intervention development can optimize uptake and sustainability in the clinical setting. It is recommended that randomized controlled trial be used in future studies to assess the intervention, the process and the mechanisms of the intervention. Our approach may offer implications for the design and implementation of similar initiatives to support cancer patients. TRIAL REGISTRATION: ClinicalTrials.gov Register Identifier: NCT04219267, 07/01/2020, retrospectively registered.

Perception of music and its cultural elements on acute post-mastectomy pain management among Nigerian women: an exploratory qualitative study.

PURPOSE: This study aimed to explore the cultural elements of music in relation to pain management among women who have undergone mastectomy. METHOD: An exploratory qualitative study with in-depth interviews. Using the purposive sampling technique, 20 participants were recruited for the study. The interviews were conducted face to face at the surgical out-patient clinic and female surgical ward. Data collection continued until data saturation was reached. The inductive approach was used to analyse the data, and the concepts were organised into themes. The consolidated criteria for reporting qualitative research guidelines (COREQ) were used to report this study. RESULTS: The participants were between 28 and 83 years old and mostly diagnosed with stage III breast cancer. Three main themes emerged from the data analysis, including pain experienced after mastectomy, culture and music, and the perception of music for postoperative pain management after mastectomy. CONCLUSION: In this study, the knowledge of participants and the utilisation of music for pain management remains inadequate, but the participants perceived that music could be useful for pain control after mastectomy when the language and religion of the patient and the meaningfulness of the music were considered when introducing and selecting the music. This study will help open and extend the conversation about the utilisation and cultural elements of music that can be used clinically for pain management after mastectomy.

A nurse-led sexual rehabilitation programme for rebuilding sexuality and intimacy after treatment for gynaecological cancer: Study protocol for a randomized controlled trial.

AIM: To implement a nurse-led sexual rehabilitation programme for gynaecological cancer (GC) survivors and to evaluate its effects on their sexual functioning, sexual distress and marital satisfaction. DESIGN: An assessor-blinded, randomized controlled trial. METHODS: The development of the nurse-led sexual rehabilitation intervention was guided by the concept of sexual health, as stated in the Neotheoretical Framework of Sexuality; the explicit permission giving, limited information, specific suggestions and intensive therapy model; and evidence-based nursing interventions for sexuality. Four intervention sessions will be delivered along the treatment trajectory. Women newly diagnosed (within 3 months) with GC will be recruited from the gynaecological units of three hospitals in Hong Kong. The participants (N = 172) will be randomly assigned to the intervention group to receive the nurse-led sexual rehabilitation programme, or to an attention control group to receive attention on four occasions during the same period when the intervention group receives the intervention. Sexual functioning, sexual distress and marital quality will be measured at baseline, 1 month after the completion of cancer treatment, after completion of the sexual rehabilitation programme and 12 months after cancer treatment. Semi-structured interviews will be conducted with the participants in the intervention group to explore their experiences with and feelings towards the programme. The study was funded in March 2019 and ethics approval was obtained in January 2019. DISCUSSION: Positive outcomes of the nurse-led sexual rehabilitation programme will contribute to scientific and practical knowledge about nursing interventions to help GC survivors and their partners to resume a satisfying intimate relationship and adapt to changes in sexuality after treatment. IMPACT: This study will contribute to the evidence for and advance research on the effectiveness of nurse-led sexuality rehabilitation interventions to support women and their partners to rebuild sexuality and intimacy after treatment for GC.

Chinese adolescents' sexual and reproductive health education: A quasi-experimental study.

OBJECTIVE: This study investigated the effectiveness of an interactive sexual and reproductive health education program in aspects of knowledge, attitudes, and self-efficacy among adolescents. DESIGN: Quasi-experimental study underpinned by social cognitive theory. SAMPLE: A stratified cluster sample of 469 students from the two-branch middle school in a city in eastern China who were assigned to the experimental (n = 233) and control (n = 236) groups. MEASUREMENTS: Students' sexual knowledge, attitudes, and refusal self-efficacy were assessed before (T0), immediately after (T1), and 1 month after the intervention (T2), respectively. INTERVENTION: Students in the experimental group received two 40-min sessions of the educational program while the control group received the usual mode of sexual and reproductive health education. RESULTS: Compared with the control group, students in the experimental group acquired more sexual knowledge (p < .01), and developed more positive sexual attitudes (p < .05) and stronger sexual self-efficacy (p < .05) across the study period. CONCLUSIONS: The proposed sexual and reproductive health education program incorporating various interactive activities was effective and could be used for school-based implementation led by nurses and other health care workers.

Association of early-life gut microbiome and lifestyle factors in the development of eczema in Hong Kong infants.

Childhood eczema is common but its prevalence is variable in different regions of the world. In this study, we explore the associations of various risk factors such as the microbiome, environment, lifestyle, diet and maternal stress with the development of eczema among infants in Hong Kong. Upon enrolment in the study, the infants' parents provided demographic data by self-reporting. At enrolment and 1 year after birth, the infants' allergic conditions, lifestyles and dietary factors and the degree of maternal stress were assessed using various questionnaires. The infants' gut microbiomes were analysed by 16S RNA sequencing, and the longitudinal changes in various bacterial strains were compared between control and eczema-affected groups. Multivariate analyses (after adjustment for other significant factors) revealed that the changes in the abundance of Hungatella hathewayi in the gut were significantly associated with the development of eczema (p = 0.005). In conclusion, the increased abundance of Hungatella hathewayi was associated with an increased risk of developing eczema by 1 year of age. This study thus explored the potential risk factors for the development of eczema in Hong Kong infants, and sheds light on the possible association between early-life gut microbiome and other environmental factors.

Association of single nucleotide polymorphisms of cytochrome P450 enzymes with experience of vasomotor, vaginal and musculoskeletal symptoms among breast cancer patients: a systematic review.

BACKGROUND: Adjuvant endocrine therapies are known to induce undesirable adverse effects such as vasomotor, vaginal and musculoskeletal symptoms among breast cancer patients. Drugs used in these therapies are often metabolised by cytochrome P450 (CYP) enzymes, in which their metabolising activities can be modified by single nucleotide polymorphisms (SNP) in CYP genes and CYP genotypes. This review aims to explore whether SNPs or genotypes of CYP are associated with the occurrence, frequency and severity of vasomotor, vaginal and musculoskeletal symptoms in breast cancer patients on adjuvant endocrine therapies. METHODS: A literature review was conducted using five electronic databases, resulting in the inclusion of 14 eligible studies, and their findings were presented narratively. Selected items from the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist were used for critical appraisal of the reporting quality of the included studies. RESULTS: Most of the included studies showed that SNPs or genotypes of CYP that modify its metabolising activity have no effect on the occurrence, frequency or severity of vasomotor symptoms, including hot flashes. One study showed no correlation of these genetic variations in CYP with musculoskeletal symptoms, and no data were available on the association between such genetic variations and vaginal symptoms. CONCLUSIONS: Overall, genetic variations in CYP have no effect on the experience of hot flashes among breast cancer patients. We recommend exploration of the link between the active metabolites of chemotherapeutic drugs and the molecules shown to affect the occurrence or severity of hot flashes, and the establishment of the relationship between such genetic variations and patients' experience of musculoskeletal and vaginal symptoms. Subgroup analyses based on patients' duration of adjuvant endocrine therapies in such studies are recommended.

How patients with cancer experience dignity: An integrative review.

BACKGROUND: A diagnosis of cancer and its treatments can be associated with a prominent issue of loss of dignity or an undermined sense of dignity for patients. Research is increasingly being conducted into how patients with cancer experience dignity, with the aim to build clinical foundations for care that preserves patients' sense of dignity. AIM: This review summarises and synthesises the available empirical literature on the experience of dignity in patients with cancer regarding both the perception of dignity and associated factors. METHOD: An integrative review method was used. A literature search was conducted in 11 databases using the search terms 'dignity' OR 'existential' OR 'existentialism' combined with 'cancer'. The Mixed Methods Appraisal Tool (version 2011) was adopted to appraise the methodological quality of the included studies. RESULTS: Nine qualitative studies and 13 quantitative studies met the selection criteria and were included in the review. The ways that patients with cancer perceived dignity include autonomy/control, respect, self-worth, family connectedness, acceptance, hope/future and God/religious. Factors associated with dignity include demographics, physical and psychosocial distress, experiences of suffering and coping strategies. CONCLUSION: Dignity-conserving care should respect patients' human autonomy to strengthen their sense of self-worth, acceptance, hope, reinforce family connectedness, and foster coping strategies to control the physical, psychosocial factors and experience of sufferings that threaten their sense of dignity.

A practice model of sexuality nursing care: a concept mapping approach.

PURPOSE: The aim of this study is to develop a practice model to enhance the provision of sexuality nursing care for patients with gynaecological cancers. METHODS: A concept mapping approach with three phases was adopted, with phase I involving individual interviews, phase II producing a concept map, and phase III evaluating the applicability of the concept map to clinical practice. A sample of 80 participants, consisting of patients with gynaecological cancers, their spouses/partners, and registered nurses and physicians, was recruited from the gynaecological oncology unit of two acute hospitals in Hong Kong. The participants were involved in all three phases. RESULT: In phase I, 50 statements were generated from the interviews. In phase II, we applied statistical techniques to produce a concept map illustrating the relationships and clustering between the statements. The map depicted seven clusters of statements in descending level of importance: discussion about sexual impact of treatment, organisational support, information-giving, attitude towards sexuality care, personnel involved in sexuality care delivery, timing of sexuality care delivery, and mode of sexuality care delivery. Finally, in phase III, the concept map was used to inform the development of a practice model which is adapted from the extended PLISSIT model. The feedback from participants supported the acceptability and appropriateness of the newly developed practice model to guide the delivery of sexuality care in the local clinical context. CONCLUSION: The newly developed practice model could serve as a reference point for other countries with Chinese populations in matters concerning sexuality care.

The effectiveness of self-management programmes for people with type 2 diabetes receiving insulin injection: A systematic review and meta-analysis.

BACKGROUND: People with type 2 diabetes (T2D) receiving insulin injection are reported to encounter challenges to achieve optimal glycaemic control. The evidence on effectiveness of self-management programmes for T2D people receiving insulin injection is far from conclusive. AIM: To examine the effectiveness of self-management programmes for people with T2D receiving insulin injection. METHODS: Twelve databases were searched from dates of inception to June 2021. All randomised controlled trials (RCTs) and controlled clinical trials examining the effectiveness of self-management programmes were included. The methodological quality was appraised using the Joanna Briggs Institute critical appraisal tools by two independent researchers. Data were summarised narratively or pooled statistically where appropriate. RESULTS: Nine RCTs involving 2613 participants were included. At post-intervention, meta-analysis results showed that self-management programmes significantly improved glycated haemoglobin A1c (HbA1c) (mean difference [MD]: -0.21, 95% confidence interval [CI] -0.29 to -0.12, P < .001), self-management behaviours (standardised MD [SMD]: 0.23, 95% CI: 0.12 to 0.33, P < .001) and self-efficacy (SMD: 0.20, 95% CI: 0.09 to 0.31, P = .0002). Only one intensive lifestyle intervention reported significant improvements in body weight and waist circumference. Three RCTs demonstrated significant improvements in body mass index compared with the control group. Only one study demonstrated significant improvements in total cholesterol and triglycerides in favour of the intervention group. At six months post-intervention, pooled results of two studies revealed decreased diabetes-related distress (MD: -2.98, 95% CI: -5.15 to -0.82, P = .007). No significant changes in blood pressure, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, depression and anxiety were found. CONCLUSIONS: Self-management programmes have the potential to improve glycaemic control, weight management, blood lipids, self-management behaviours, self-efficacy and diabetes-related distress of people with T2D receiving insulin injection. More rigorous experimental trials are warranted to examine the effectiveness of self-management programme and its maintenance.

Effects of non-pharmacological interventions on preoperative anxiety and postoperative pain in patients undergoing breast cancer surgery: A systematic review.

BACKGROUND: Poorly managed preoperative anxiety and pain were reported to slow the postoperative recovery of breast cancer patients. Thus, proactive management using non-pharmacological interventions becomes essential for decreasing opioid or anxiolytics consumption, anxiety level, pain intensity, postoperative complications and improving patients' haemodynamics and satisfaction with care. PURPOSE: To identify, analyse and synthesise the effects of non-pharmacological interventions on preoperative anxiety and acute postoperative pain in women undergoing breast cancer surgery. METHOD: For this systematic review, 12 databases including Ovid Nursing, PsycInfo, British Nursing Index, CINAHL, Cochrane Library were searched to identify relevant studies. A total of 6,012 articles were identified from the search, six RCTs and one quasi-experimental study that met the inclusion criteria were included after eligibility screening. Narrative synthesis was used to analyse data extracted from the included articles. The review adhered to the PRISMA guideline. RESULTS: Twelve outcomes were measured in the included studies, including preoperative anxiety, and acute postoperative pain. Music, massage, aromatherapy and acupuncture were the interventions delivered. Music had a small-to-large effect size and aromatherapy had a small effect size on reducing preoperative anxiety. Also, music had a large effect size whilst acupuncture had a medium effect size on minimising postoperative pain in women undergoing breast cancer surgery. CONCLUSION: Music, aromatherapy and acupuncture appeared to be effective for reducing preoperative anxiety and postoperative pain in women undergoing breast cancer surgery. However, the small number of studies available for each intervention prevents conclusive statements about which the most effective method. IMPLICATION FOR CLINICAL PRACTICE: A nursing care pathway that standardises the use of non-pharmacological interventions for the management of both preoperative anxiety and postoperative pain in breast cancer surgery patients should be developed.

Enhancing generic capabilities and metacognitive awareness of first-year nursing students using active learning strategy.

BACKGROUND: Developing students' generic capabilities is a major goal of university education as it can help to equip students with life-long learning skills and promote holistic personal development. However, traditional didactic teaching has not been very successful in achieving this aim. Kember and Leung's Teaching and Learning Model suggests an interactive learning environment has a strong impact on developing students' generic capabilities. Metacognitive awareness is also known to be related to generic capability development. This study aimed to assess changes on the development of generic capabilities and metacognitive awareness after the introduction of active learning strategy among nursing students. METHODS: This study adopted a quasi-experimental single group, matched pre- and posttest design. It was conducted in a school of nursing at a university in Hong Kong. Active learning approaches included the flipped classroom (an emphasis on pre-reading) and enhanced lectures (the breaking down of a long lecture into several mini-lectures and supplemented by interactive learning activities) were introduced in a foundational nursing course. The Capabilities Subscale of the Student Engagement Questionnaire and the Metacognitive Awareness Inventory were administered to two hundred students at the start (T0) and at the end of the course (T1). A paired t-test was performed to examine the changes in general capabilities and metacognitive awareness between T0 and T1. RESULTS: A total of 139 paired pre- and post-study responses (69.5 %) were received. Significant improvements were observed in the critical thinking (p < 0.001), creative thinking (p = 0.03), problem-solving (p < 0.001) and communication skills (p = 0.04) with the implementation of active learning. Significant changes were also observed in knowledge of cognition (p < 0.001) and regulation of cognition (p < 0.001) in the metacognitive awareness scales. CONCLUSIONS: Active learning is a novel and effective teaching approach that can be applied in the nursing education field. It has great potential to enhance students' development of generic capabilities and metacognitive awareness.

A theory-driven psycho-educational intervention programme for gynaecological cancer patients during treatment trajectory: A randomised controlled trial.

OBJECTIVE: This study aims to evaluate the effects of a theory-driven psycho-educational intervention programme on uncertainty in illness, anxiety, and sexual functioning in a cohort of Chinese patients with gynaecological cancer. METHODS: Women with newly diagnosed gynaecological cancer (n = 202) received either a four-session, 12-week-long, culturally appropriate psycho-educational intervention programme (n = 102) or attention from intervener (n = 100) in a two-group randomised controlled trial. Patient-reported measures included Chinese version of Mishel's Uncertainty in Illness Scale (C-MUIS), Hospital Anxiety and Depression Scale (HADS)-Anxiety subscale, and Sexual Function-Vaginal Changes Questionnaire (SVQ). Data regarding uncertainty in illness and anxiety were collected at baseline and postintervention, while data on sexual functioning were collected postintervention. RESULTS: Patients receiving psycho-educational intervention reported significantly greater reductions in ambiguity, inconsistency, and overall uncertainty in illness, as measured by C-MUIS (P < .01). They were also more likely to be sexually active (P = .037), report their partners having greater sexual interest (P = .008), and perceive a significantly greater level of intimacy (P = .001) in the SVQ. CONCLUSIONS: Given the growing population of gynaecological cancer survivors and the universal side effects of the disease and its related treatments, the established design and content of the psycho-educational intervention programme should be incorporated into routine clinical practice.

Qualitative study on perceived dignity of cancer patients undergoing chemotherapy in China.

PURPOSE: Safeguarding the perceived dignity of cancer patients has been recently attracting attention, but its development is constrained by the ambiguous construct of dignity. This study aims to describe the perceived dignity of cancer patients undergoing chemotherapy on the basis of the dignity model and to provide insights into the promotion of dignity-conserving care in China. METHODS: A qualitative descriptive design was conducted with face-to-face, semi-structured, and individual interviews. Consecutive sampling of cancer patients undergoing chemotherapy in a public hospital was conducted. Semi-structured interviews were performed by a registered nurse with experience in palliative care research. Data were analysed using the framework method with inductive and deductive approaches. RESULTS: Twenty patients aged 28-70 years old completed the interviews. Perceived dignity themes were classified into three categories, namely illness-related concerns, dignity-conserving repertoire, and social dignity inventory. In comparison with the dignity model, social dignity inventory had two added themes: communication openness and financial burden. These themes affect the perceived dignity of Chinese patients. CONCLUSIONS: The perceived dignity of patients can be affected by various issues, including illness, personal attitudes and practices and social environments. Culture and economics considerably affect the construct of dignity among the Chinese population. Family-oriented approaches are recommended to create an environment where patients feel valued, respected and supported. This method will help cancer patients adapt to the changes brought on by their illness and maintain dignity.