[Occurrence and Risk Assessment of N-nitrosamines and Their Precursors in Qingjiang River Basin].

N-nitrosamines are a type of nitrogen-containing organic pollutant with high carcinogenicity and mutagenicity. In the main drinking water sources of small and medium-sized towns in China, the contamination levels of N-nitrosamines remain unclear. In addition, there is still lack of research on the concentration of N-nitrosamines and their precursors in tributary rivers. In this study, eight N-nitrosamines and their formation potentials （FPs） were investigated in the Qingjiang River, which is a primary tributary of the Yangtze River. The sewage discharge sites were also monitored, and the environmental influencing factors, carcinogenic and ecological risks caused by N-nitrosamines, and their precursors were evaluated. The results showed that six N-nitrosamines were detected in water samples of the Qingjiang River, among which NDMA [（10 ±15） ng·L-1], NDEA [（9.3 ±9.3） ng·L-1], and NDBA [（14 ±7.8） ng·L-1] were the dominant N-nitrosamines, whereas seven N-nitrosamines were detected in chloraminated water samples, among which NDMA-FP [（46 ±21） ng·L-1], NDEA-FP [（26 ±8.3） ng·L-1], and NDBA-FP [（22 ±13） ng·L-1] were the dominant N-nitrosamine FPs. The concentrations of N-nitrosamines in the middle reaches of the Qingjiang River were higher than those in the upper and lower reaches. Furthermore, the concentrations of N-nitrosamines in the sample sites of sewage discharge and tributaries were significantly higher than those in other sampling sites. The monitoring results at the direct sewage discharge points indicated that the main source of N-nitrosamines in river water was the sewage carrying N-nitrosamines and their precursors. In addition, the concentrations of the three dominant N-nitrosamines including NDMA, NDBA, and NDEA were positively correlated with each other, mainly because of their similar sewage sources. The average carcinogenic risk to residents due to N-nitrosamine in drinking water sources was 2.4×10-5, indicating a potential carcinogenic risk. Moreover, due to the high concentrations of N-nitrosamine formation potentials in the Qingjiang River, the carcinogenic risk of drinking water may be even higher. The ecological risk assessment showed that the ecological risk quotient values of N-nitrosamines in the Qingjiang River watershed were lower than 0.002, which was negligible.

Disaster literacy in disaster emergency response: a national qualitative study among nurses.

BACKGROUND: As the largest group of healthcare professionals, nurses play an indispensable and crucial role in disaster response. The enhancement of nurses' disaster literacy is imperative for effective disaster emergency management. However, there is currently a lack of knowledge regarding nurses' disaster literacy. This study represents the first attempt to explore the key components and characteristics of disaster literacy among nurses. METHODS: A qualitative descriptive design was employed, and the reporting followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines (refer to File S1). The purposive sampling method was utilized. Thirty-one rescue nurses from 31 medical institutions across 25 provinces and regions in China were recruited to participate in the study. The respondents were requested to share their experiences and insights regarding disaster rescue operations. Inductive content analysis was employed for data examination. RESULTS: The results indicated that rescue nurses universally recognized that there was a pressing need to enhance the level of disaster literacy among nurses. The disaster literacy of nurses encompasses nine dimensions: physical and mental quality, disaster rescue general knowledge, professional and technical competence, professional ethics, teamwork, emotional ability, information literacy, leadership, and knowledge transformation. CONCLUSIONS: To ensure national sustainability, government departments, healthcare organizations, and hospital administrators can accurately evaluate the disaster literacy of individual clinical nurses, groups, and the workforce as a whole through nine dimensions, which also can provide evidence to support the development of precision strategies to strengthen the disaster literacy of nurses.

Factors associated with urinary retention after vaginal delivery under intraspinal anesthesia: a path analysis model.

INTRODUCTION AND HYPOTHESIS: Women who have intraspinal anesthesia for delivery are more likely to experience postpartum urinary retention (PUR), which, if not recognized and treated promptly, can result in long-term urinary dysfunction. Many factors influencing PUR have been proposed, but no study has been conducted to investigate the relationship between them. This study is aimed at determining the influencing factors of PUR and to explore the relationship between them. METHODS: A prospective, cross-sectional survey using self-made questionnaires was conducted among 372 puerperae in a Grade A hospital in Guangzhou, China, from April to September 2022. SPSS25.0 and AMOS24.0 were used for data analysis, and a path analysis model was established to determine the relationship between the influencing factors. RESULTS: The incidence of PUR was 49.85%. Residence, the level of postpartum pain, and the change of postnatal urination position had a direct effect on PUR. Episiotomy and analgesic duration have both direct and indirect effects on PUR. Forceps delivery, perineal edema and oxytocin had an indirect effect on PUR. Variables could influence the occurrence of PUR by mediating the analgesic duration, episiotomy, postpartum pain level, and postnatal urination position changes. CONCLUSIONS: This study provides an empirical model to illustrate the relationship between PUR and related factors in women who delivered under intraspinal anesthesia. In future management, more attention should be paid to women who live in cities, have higher levels of postpartum pain, longer analgesic duration, higher grade of perineal edema, and received episiotomy, forceps delivery, and oxytocin during labor.

Exploration of Inflammatory Biomarkers and Psychological Cardiovascular Disease Risk Factors Among Community Dwelling Adults: A Gender Comparison Study.

Patients with rheumatic disease (RD) are at high risk for cardiovascular disease (CVD), which is the leading non-communicable chronic disease cause of death worldwide. Inflammatory biomarkers and psychological health status are reliable predictors of CVD in patients with RD. The primary aim of this study was to compare the inflammatory biomarkers and psychological CVD risk factors (CRFs) between a group of community-dwelling adults with RD and CRFs and a group of their peers with CRFs only. The secondary aim of this study was to analyze and compare the collected data by gender in the RD group. Data were collected and analyzed from 355 participants, with the 135 participants with physician-diagnosed RD assigned to the RD group and the remainder (n = 220) assigned to the comparison group. The measures used included a demographic datasheet, medical information, serum homocysteine (Hcy) levels, high sensitive C-reactive protein (hs-CRP) levels, and depression and global sleep-quality scale scores. The RD group had higher ratios of hypertension and depression diagnoses than the comparison group. The gender analysis of the RD group found significantly more-severe sleep disturbances in women than men and a significantly higher mean value of Hcy in men than women. The women in the RD group were significantly older, less educated, and less employed than their male counterparts and thus may be presumed to at higher risk of health illiteracy. Gender-tailored interventions to modify the risk factors of CVD identified in this study for patients with RD are recommended.

Construction of a clinical prediction model for the impact of acupuncture on pregnancy outcomes in poor ovarian response (POR) patients based on a patient registry research platform. / åŸºäºŽç— ä¾‹æ³¨å†Œç™»è®°ç ”ç©¶å¹³å°æž„å»ºé’ˆç¸å¯¹åµå·¢ä½Žååº”æ‚£è€ å¦Šå¨ ç»“å±€çš„ä¸´åºŠé¢„æµ‹æ¨¡åž‹.

OBJECTIVES: To construct a clinical prediction model for the impact of acupuncture on pregnancy outcomes in poor ovarian response (POR) patients, providing insights and methods for predicting pregnancy outcomes in POR patients undergoing acupuncture treatment. METHODS: Clinical data of 268 POR patients (2 cases were eliminated) primarily treated with "thirteen needle acupuncture for Tiaojing Cuyun (regulating menstruation and promoting pregnancy)" was collected from the international patient registry platform of acupuncture moxibustion (IPRPAM) from September 19, 2017 to April 30, 2023, involving 24 clinical centers including Acupuncture-Moxibustion Hospital of China Academy of Chinese Medical Sciences. LASSO and univariate Cox regression were used to screen factors influencing pregnancy outcomes, and a multivariate Cox regression model was established based on the screening results. The best model was selected using the Akaike information criterion (AIC), and a nomogram for clinical pregnancy prediction was constructed. The prediction model was evaluated using receiver operating characteristic (ROC) curves and calibration curves, and internal validation was performed using the Bootstrap method. RESULTS: (1) Age, level of anti-Müllerian hormone (AMH), and total treatment numbers of acupuncture were independent predictors of pregnancy outcomes in POR patients receiving acupuncture (P<0.05). (2) The AIC value of the best subset-Cox multivariate model (560.6) was the smallest, indicating it as the optimal model. (3) The areas under curve (AUCs) of the clinical prediction model after 6, 12, 24, and 36 months treatment were 0.627, 0.719, 0.770, and 0.766, respectively, and in the validation group, they were 0.620, 0.704, 0.759, and 0.765, indicating good discrimination and repeatability of the prediction model. (4) The calibration curve showed that the prediction curve of the clinical prediction model was close to the ideal model's prediction curve, indicating good calibration of the prediction model. CONCLUSIONS: The clinical prediction model for the impact of acupuncture on pregnancy outcomes in POR patients based on the IPRPAM platform has good clinical application value and provides insights into predicting pregnancy outcomes in POR patients undergoing acupuncture treatment.

The mediation of health-promoting lifestyle on self-perceived health status and quality of life among nurses: a cross-sectional study.

BACKGROUND: Nurses with busy workloads lack the time to maintain health, leading to a decline in physical and mental health and quality of life. It is widely accepted that self-perception of health triggers health-promoting behaviors and impacts the quality of life; however, the relationship between these factors among nurses is unclear. The purpose of this study was to investigate the ability of a health-promoting lifestyle to mediate the relationship between self-perceived health and quality of life among nurses. METHODS: A cross-sectional survey was conducted in four regional Taiwanese teaching hospitals with over 500 beds. The survey used stratified random sampling of 600 nurses who had worked for more than six months. The Self-Perceived Health Questionnaire, the Health-Promoting Lifestyle Profile, and the World Health Organization Quality of Life Scale were used to measure nurses' self-perceived health (SPH), health-promoting lifestyle (HPL), and quality of life (QoL). A Hayes PROCESS analysis and bootstrapping method were used for the mediation analysis. RESULTS: A total of 518 nurses' data was included in the analysis. Nurses perceived their health status as less favorable than their colleagues, but frequently adopted health promotion behaviors. Nurses reported a moderate QoL. QoL and SPH were correlated (r = .33) and a high correlation between QoL and HPL (r = .64) was found. SPH and HPL both affect QoL (B = 0.077 and 0.070). SPH and HPL explained 42.6% of the variation in QoL. HPL played a partial mediation role. CONCLUSIONS: The study confirmed that HPL has an important role in mediating nurses' SPH and QoL. Nurse administrators are advised to encourage nurses to monitor their health status and provide health promotion mechanisms to improve their quality of life.

Burnout, resilience, and empowerment among COVID-19 survivor nurses in Indonesia.

The primary frontline healthcare providers who have frequent contact with COVID-19 patients are nurses. Many nurses have been infected with COVID-19 and have experienced severe emotional exhaustion and burnout. It is essential to assess nurses' psychological health during the COVID-19 pandemic. This study aimed to analyze the factors associated with burnout, resilience, and empowerment among Indonesian COVID-19 nurse survivors. In this cross-sectional study, 182 COVID-19 survivor nurses participated from September to November 2022 with convenience sampling. An online survey using the Copenhagen Burnout Inventory (CBI), the Connor-Davidson Resilience Scale (CD-RISC), and the Psychological Empowerment Scale (PES) were used to collect data. The data were analyzed using descriptive and binary logistic regression analyses. The majority of the nurses were aged between 30-45 years (61.6%), and females (67.4%) experienced burnout. Higher resilience was found among nurses contracting COVID-19 (83.1%). In the multivariate logistic regression analysis, the absence of psychological impact (OR = 0.44, 95% CI = 0.21-0.93) is significantly related to higher burnout experience. In addition, workplace, especially in hospital (OR = 4.32, 95% CI = 1.09-17.09) was associated with resilience, and a gap time after receiving negative COVID-19 result (OR = 3.90, 95% CI = 1.27-12.03) was correlated with psychological empowerment, in our results 4-6 month after had a negative result was at higher risk. To maintain a positive psychological aspect for COVID-19 nurse survivors, it needs to implement psychological support in the workplace and ensure an appropriate workload of nurse professionals.

Relationship between physical activity and perceptions of ageing from the perspective of healthy ageing among older people with frailty with chronic disease: a cross-sectional study.

BACKGROUND: In Taiwan, the 2019 Elderly Frailty Assessment found that 11.2% of older people have frailty problems. Some researchers have found that older persons' negative perspectives on ageing aggravate the progression of frailty, thereby increasing their risk of disability. This study aimed to investigate associations of physical activity and perceptions of ageing on perspectives of healthy ageing in older people with frailty and chronic diseases and to compare the differences in their frailty status. METHODS: This study used a descriptive cross-sectional design. Participants were recruited from community long-term care stations. The inclusion criteria were (1) no severe cognitive impairment and ability to communicate in Mandarin and Taiwanese; (2) over 65 years old; (3) at least one chronic disease; and (4) at least one debilitating item in the Study of Osteoporotic Fracture index. A total of 312 participants were recruited. The Brief Ageing Perceptions Questionnaire Chinese version, Healthy Ageing Perspectives Questionnaire, and Physical Activity Scale for the Elderly Chinese Version were used for measurement. RESULTS: The study results found that demographic variables, perceptions of ageing, and physical activity were significantly correlated with perspectives on healthy ageing, including age, Activities of Daily Living, education, all domains of perceptions of ageing, and household- and work-related physical activity. With regard to the frailty status level, prefrailty was better than frailty from the perspective of healthy ageing in older people with chronic disease (t = 5.35, p < 0.05). Hierarchical regression analysis was used to predict the healthy ageing perspectives of older persons with chronic disease involving a chronic time-line, positive control, health-related changes, and work-related activities. Those domains could predict 21% of the variance in healthy ageing perspectives. CONCLUSION: It is suggested that in community long-term care stations, health care providers can arrange activities to improve the perception of ageing that are acceptable for older people with frailty and chronic diseases and encourage older people to participate in service activities to achieve a sense of social participation.

Decreasing the incidence of central line-associated bloodstream infection in a medical intensive care unit: a best practice implementation project.

INTRODUCTION AND OBJECTIVES: Bloodstream infections are common in critically ill patients using central venous access devices (CVAD) in intensive care units (ICU). This project aimed to decrease the incidence of central line-associated bloodstream infections (CLABSI) by using evidence-based strategies. METHODS: The project applied the JBI audit and feedback methods. Thirty-two nurses and five resident physicians from the medical ICU of a medical center participated in the project. Preintervention compliance was measured for the 11 key evidence-based criteria (six audit criteria of central venous catheter insertion and five audit criteria of dressing and catheter securement). Strategies were implemented to overcome the barriers identified in the baseline assessment. Impact evaluation and sustainability were conducted to change the CLABSI rate and the competence of healthcare professionals in providing CVAD care. The JBI Practical Application of Clinical Evidence System and Getting Research into Practice audit tools were used for the data collection, analysis, and implementation planning. RESULTS: Barriers included insufficient knowledge among nurses and physicians, poor compliance with the standard CVAD insertion procedure by physicians, inadequate cooperation among the CVAD care team members, and lack of CVAD-related equipment. The strategies included education and training in CVAD care, the establishment of a team resource management program, and the provision of appropriate equipment. Following project implementation, the CLABSI rate decreased from 8.38 to 3.9 BSIs/1000 CVAD-days. CONCLUSIONS: The project successfully decreased the CLABSI rate and increased the competence of healthcare professionals. Implementation of best practices in clinical care should focus on leadership, team resource management, education, monitoring, and innovation.

A Qualitative Exploration of Older Patients' Experiences With Frailty and Related Management Strategies.

BACKGROUND: Frailty is highly prevalent in hospitalized older patients and may increase the risk of adverse health outcomes. Understanding the experiences of older patients and the management strategies they use to recover from frailty is crucial to developing appropriate interventions. PURPOSE: This study was designed to explore the frailty experiences of older adults and the management strategies they use to recover from frailty. METHODS: Using purposive sampling, semistructured, face-to-face interviews were conducted with 16 older patients with frailty. Data were analyzed using content analysis. RESULTS: The experiences of participants were classified into three phases, including the (a) individual sensing phase, (b) daily-living-threatening phase, and (c) acclimatization and acceptance phase. When experiencing frailty, the participants developed management strategies to facilitate recovery, which manifested in three phases: (a) making flexible adjustments to the daily routine, (b) using adequate support systems, and (c) adopting positive thinking. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The results indicate that familial support and positive thinking are important management strategies for successful recovery in frail individuals. Older patients require adequate support systems. Positive thinking was also found to be an effective management strategy for recovery. Healthcare professionals should not only focus on providing supportive resources but also provide support to older patients to facilitate their adoption of positive thinking to face life changes brought on by frailty.

A biocompatible double-crosslinked gelatin/ sodium alginate/dopamine/quaterniazed chitosan hydrogel for wound dressings based on 3D bioprinting technology.

438Severe skin injuries can cause serious problems, which could affect the patient's normal life, if not dealt properly in a timely and effective manner. It is an urgent requirement to develop personalized wound dressings with excellent antibacterial activity and biocompatibility to match the shape of the wound to facilitate clinical application. In this study, a bioink (GAQ) based on gelatin (Gel)/sodium alginate (SA)/ quaternized chitosan (QCS) was prepared, and GAQ hydrogel dressing grafting with dopamine (GADQ) was fabricated by an extrusion three-dimensional (3D) printing technology. QCS was synthesized by modifying quaternary ammonium group on chitosan, and its structure was successfully characterized by nuclear magnetic resonance (1H NMR) and Fourier-transform infrared spectroscopy (FT-IR). Our results showed that the GADQ hydrogel dressing that was double-crosslinked by EDC/ NHS and Ca2+ had good tensile strength, considerable swelling ratio, and effective antioxidation properties. It also showed that GADQ1.5% had 93.17% and 91.06% antibacterial activity against Staphylococcus aureus and Escherichia coli, respectively. Furthermore, the relative survival ratios of fibroblast cells seeded on these hydrogels exceeded 350% after cultured for 7 days, which proved the biocompatibility of these hydrogels. Overall, this advanced 3D-printed GADQ1.5% hydrogels with effective antioxidation, excellent antibacterial activity and good biocompatibility had a considerable application potential for wound healing.

Classification and citation analysis of the 100 top-cited articles on nurse resilience using chord diagrams: A bibliometric analysis.

BACKGROUND: Studies of most-cited articles have been frequently conducted on various topics and in various medical fields. To date, no study has examined the characteristics of articles associated with theme classifications and research achievements of article entities related to nursing resilience. This study aims to graphically depict the characteristics of the 100 top-cited articles addressing nurse resilience (T100NurseR), diagram the relationship between articles and author collaborations according to themes extracted from article keywords, and examine whether article keywords are correlated with article citations. METHODS: T100NurseR publications were retrieved from the Web of Science (WoS) core collection on October 13, 2022. Themes associated with articles were explored using coword analysis in WoS keywords plus. The document category, journal ranking based on impact factor, authorship, and L-index and Y-index were used to analyze the dominant entities. To report the themes of T100NurseR and their research achievements in comparison to article entities and verify the hypothesis that keyword mean citation can be used to predict article citations, 5 visualizations were applied, including network diagrams, chord diagrams, dot plots, Kano diagrams, and radar plots. RESULTS: Citations per article averaged 61.96 (range, 25-514). There were 5 themes identified in T100NurseR, including Parses theory, nurse resilience, conflict management, nursing identity, and emotional intelligence. For countries, institutes, departments, and authors in comparison of category, journal impact factor, authorship, and L-index scores, Australia (129.80), the University of Western Sydney (23.12), Nursing (87.17), and Kim Foster (23.76) are the dominant entities. The weighted number of citations according to Keywords Plus in WoS is significantly correlated with article citations (Pearson R = 0.94; P = .001). CONCLUSION: We present diagrams to guide evidence-based clinical decision-making in nurse resilience based on the characteristics of the T100NurseR articles. Article citations can be predicted using weighted keywords. Future bibliographical studies may apply the 5 visualizations to relevant studies, not being solely restricted to T100NurseR.

Effectiveness of Positioning in Unconscious Adults During Nasogastric Intubation on Correct Placement and Intubation Time: A Systematic Review and Meta-analysis.

Nasogastric intubation is a common procedure in hospitals that causes adverse outcomes if performed incorrectly. There is currently insufficient guidance for patient positioning, which increases the success of nasogastric intubation at the bedside. Therefore, a systematic review with a meta-analysis was performed to determine the effectiveness of changing an unconscious adults' positions compared with the supine position to improve the correct placement of a nasogastric tube, intubation time, and complications. The Cochrane Library, MEDLINE, Embase, PubMed, and CINAHL databases were searched from inception to April 2019 for randomized controlled trials. The Cochrane Collaboration Risk of Bias tool was used to assess the quality of eligible studies. Cochrane Review Manager 5.3 software was used to analyze the data. A total of 288 articles were obtained in the literature search, 10 of which were included in the analysis. Most of the included trials were at low risk of bias. All postures were significantly effective, though neck flexion had the highest success rate (odds ratio = 4.87, 95% confidence interval [2.48, 9.57], Z = 4.6, p < .00001, I2 = 0%) for nasogastric intubation. In terms of the time required for the procedure, compared with the usual posture, although the total effects were significant ( MD =-10.33, 95% confidence interval [-15.38, -5.29], Z = 4.02, p < .00001, I2 = 98%), only neck flexion and lifting of the larynx reduced the time. The meta-analysis suggests that patient positioning improves the success rate of nasogastric intubation and increases safety. Finally, the authors developed a procedural instruction sheet to aid practitioners with nasogastric intubation.

The Effects of Work Satisfaction and Work Flexibility on Burnout in Nurses.

BACKGROUND: The World Health Organization has encouraged improving working conditions for nurses to decrease turnover and increase nurse staffing and nursing capacity. The International Council of Nurses has pointed out that a positive work environment can improve satisfaction and decrease burnout in nurses. However, the effects of working conditions and work satisfaction on burnout in nurses remain unclear. PURPOSE: The purpose of this study was to explore the effects of working-condition-related flexibility and work satisfaction on burnout in nurses. METHODS: A cross-sectional design was employed, and 450 nurses from a single medical center participated in this study. In addition to demographic information, three survey instruments, including the Taiwanese Hospital Nurses' Job Satisfaction Scale, the Working Conditions and Flexible System Scale, and the Maslach Burnout Inventory-Chinese Version, were used to measure working condition flexibility, work satisfaction, and burnout. Descriptive statistics, the Pearson correlation coefficient, and hierarchical linear regression were used to analyze the data. RESULTS: Four hundred thirty-five nurses were enrolled as participants. Most were female, with a mean age of 29 years. Over four fifths (83.1%) were unmarried, and 65.5% had at least 2 years of prior experience working at other hospitals. Although the participants reported experiencing burnout several times per month, they reported feeling satisfied with their work. They noted flexibility related to working conditions, especially task-related flexibility, as important. Four variables (satisfaction/professional autonomy, interpersonal interaction, workload, and working condition flexibility/task flexibility) were found to be significant predictors of emotional exhaustion (adjusted R2 = 0.212). However, only professional autonomy was found to significantly predict a sense of low personal accomplishment (adjusted R2 = .077), whereas nursing competence significantly predicted depersonalization (adjusted R2 = .086). CONCLUSIONS: Work satisfaction and flexibility related to working conditions were shown to relate negatively to burnout. Nursing managers should improve the level of satisfaction related to professional autonomy, interpersonal interaction, and workload as well as task flexibility for nurses.

[Application of Tiaojing Cuyun acupuncture in treatment of diseases with ovarian function decline].

Taking regulating the thoroughfare vessel and the conception vessel, tonifying liver and kidney, calming mind as the treatment principle, Tiaojing Cuyun acupuncture (acupuncture for regulating menstruation and promoting pregnancy) is commonly used in clinical treatment of diseases with ovarian function decline, and recommends full cycle acupuncture treatment. Clinical research shows that Tiaojing Cuyun acupuncture can improve menstruation and ovulation, increase the reserve function and response of ovary as well as endometrial receptivity, so as to improve the pregnancy outcome. It can also improve the related symptoms caused by negative emotions and low estrogen, and comprehensively enhance the health related quality of life in patients. The mechanism of Tiaojing Cuyun acupuncture mainly involves 2 aspects, i.e. overall regulation on hypothalamus-pituitary-ovary (HPO) axis and the local regulation on FSH/cAMP signal transduction in ovarian granulosa cells.

Effect of Vitamin B2 supplementation on migraine prophylaxis: a systematic review and meta-analysis.

OBJECTIVE: Migraine is a common disease worldwide and migraine prevention is primarily currently based on pharmaceuticals. The mechanism of Vitamin B2 may positively contribute to migraine. This systematic review and meta-analysis aimed to evaluate the impact of Vitamin B2 supplementation on the days, duration, frequency, and pain score of the migraine attack. METHODS: : The PRISMA guideline was used for the studying process. Five electronic databases, PubMed, Embase, Cochrane, CINAHL, and CEPS were searched from 1990 to March 2019. The search terms were Vitamin B2, migraine, and prophylactic. A meta-analysis was performed using Comprehensive Meta-Analysis (CMA) version. RESULTS: : Nine articles were included in systemic review and finally meta-analysis. Eight randomized controlled trials and one controlled clinical trial with 673 subjects were analyzed using meta-analysis. Vitamin B2 supplementation significantly decreased migraine days (p = .005, I2 = 89%), duration (p = .003, I2 = 0), frequency (p = .001, I2 = 65%), and pain score (p = .015, I2 = 84%). CONCLUSIONS: A pooled analysis of available randomized controlled clinical trials demonstrated that Vitamin B2 400 mg/day for three months supplementation had significant effect on days, duration, frequency, and pain score of migraine attacks.

Acupuncture Combined with Three-Step Analgesic Drug Therapy for Treatment of Cancer Pain: A Systematic Review and Meta-Analysis of Randomised Clinical Trials.

OBJECTIVE: The purpose of this study was to systematically evaluate the efficacy and safety of acupuncture combined with the WHO three-step analgesic drug ladder for cancer pain. METHODS: The Cochrane Library, PubMed, and CNKI Database of Systematic Reviews were searched. Using the Cochrane Register for Randomized Controlled Trials, the quality of the included literature was evaluated, and the meta-analysis was carried out with RevMan 5.3 software. RESULTS: Compared with three-step analgesia alone, acupuncture combined with three-step analgesia for cancer pain increased pain relief response rates (RR = 1.12, 95% CI: 1.08∼1.17, P < 0.00001), reduced NRS score (SMD = -1.10, 95% CI: -1.86∼-0.35, P=0.004), reduced the rate of side effects (RR = 0.45, 95% CI: 0.38∼0.53, P < 0.00001), including nausea (P < 0.00001), vomiting (P=0.008), constipation (P < 0.00001), and dizziness (P=0.010), reduced the burst pain rate (SMD = -1.38; 95% CI: -2.44∼-0.32, P=0.01), shortened analgesia effect onset time (P=0.004), and extended the duration of response (P < 0.0001). CONCLUSION: For the treatment of cancer pain, acupuncture combined with three-step analgesic drugs is better than using only three-step analgesic drugs.

Exploration of Geriatric Care Competencies in Registered Nurses in Hospitals.

BACKGROUND: Older adults occupy one third of acute care hospital beds, and the regular duties of many nurses include caring for older patients. A working knowledge of geriatric care competencies is necessary for nurses to provide high-quality care to older patients and their families. It is unclear how nurses who work in acute care hospitals self-evaluate their geriatric care competencies and how these self-evaluated abilities differ from the objective abilities of these nurses. PURPOSES: This study was designed to explore the geriatric care competencies of nurses in hospitals and to identify the factors associated with these competencies. METHODS: This was a cross-sectional study. Nurses who were employed and directly caring for patients aged 65 years and older in any of the adult wards of a medical center located in southern Taiwan were recruited as participants. A structured questionnaire was developed based on a review of the relevant literature and validated using expert consensus. This questionnaire included a demographic datasheet, knowledge of geriatric care scale, attitude of geriatric care scale, self-evaluation of geriatric care competency, and geriatric care competency test. Descriptive and inferential statistics were used to analyze the geriatric care competencies of the participants and related factors. RESULTS: One hundred seventy nurses were enrolled as participants. The average self-evaluation score for geriatric care competency was 67.74 (SD = 0.84). However, the average percentage of correct answers given on the geriatric care competency test was much lower (17.6%). The self-evaluation score was found to be significantly associated with job satisfaction and having received continuing education in geriatric care. In addition, age was shown to significantly affect the percentage of correct answers given on the geriatric care competency test. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: A significant gap was found between the self-perceived and actual competencies of nurses in terms of providing geriatric care. Appropriate policies are necessary to improve the geriatric care competencies of nurses working in hospitals and to oversee the implementation of effective educational methods in Taiwan.

Validating a brief aging perception questionnaire (B-APQ) for older persons with chronic disease in Taiwan.

OBJECTIVES: The purpose of this study was to validate the Chinese version of the Brief Aging Perception Questionnaire (B-APQ) for older persons with chronic disease living in Taiwan. METHODS: This study recruited older patients with chronic diseases from outpatient departments of a medical center in southern Taiwan. Five steps were used to develop the Chinese version of the B-APQ, including assessment of item quality, testing of the original model by confirmatory factor analysis (CFA), establishing the new model by exploratory factor analysis (EFA) and CFA, testing the correlation between the new model and criterion instrument, and evaluating the reliability. RESULTS: A total of 415 participants completed the survey. The structure of the original version was not suitable for the Taiwanese elderly. We developed a Chinese version of the B-APQ from outpatient dimensions and one additional item that accounted for cultural differences (for a total of 18 items). The indicators of construct validity were Chi-square (387.79), GFI (0.91), AGFI (0.88), RMSEA (0.07), and SRMR (0.054). For the convergent validity, the correlation coefficient was -0.07-0.39 for the Physical Activity Scale and -0.07-0.71 for the scale of the World Health Organization Quality of Life. The Cronbach's alpha was 0.86-0.91. CONCLUSIONS: The Chinese version of the B-APQ has good validity and reliability and is suitable for the measurement of the aging perceptions of older persons with chronic diseases in Taiwan.