Health behavior inventory - short form: a Chinese validation study using classical test theory and item response theory.

BACKGROUND: It is imperative to use a validated tool to measure and understand health behavior as it greatly impacts health status. It has been demonstrated that the Health Behavior Inventory - Short Form (HBI-SF) is valid in several countries. The purpose of this study was to translate the HBI-SF into Chinese and test its psychometric properties. METHODS: This study employed a two-phase methodology. The phase one entailed the cross-cultural adaptation of the HBI-SF, while the subsequent phase evaluated the psychometric properties of the scale. This evaluation encompassed classical test theory (CTT) and item response theory (IRT) tests to assess reliability and validity. It involved 1058 participants, of whom 1036 completed the questionnaire successfully. Out of these, 518 were analyzed for CTT, along with 518 for IRT. RESULTS: The S-CVI was found to be 0.935, while the I-CVI ranged from 0.889 to 1.000. The results of the confirmatory factor analysis suggested the goodness-of-fit indices for the four-factor model was acceptable. Regarding the subscales, the average variance extracted (AVE) and Heterotrait-Monotrait Ratio of Correlations (HTMT) matrix also met the cutoff values (AVE > 0.5 and HTMI < 0.85). Furthermore, the internal consistency and composite reliability indices of all factors were greater than 0.7. Infit and/or outfit values indicated that all items fitted the Rasch model. The Wright map revealed that the average person measures for the participants (mean = - 0.994, SD = 0.430) were comparatively lower than the average item measures (mean = 0.000, SD = 0.257). The person separation reliability values for the four factors ranged from 0.600 to 0.746, indicating an acceptable level of reliability. Two items showed differential item functioning. CONCLUSIONS: The findings derived from both CTT and IRT analyses demonstrate favorable levels of reliability and validity for the Chinese version of the HBI-SF.

[Effect of combined application of organic and chemical fertilizers on yield and quality of Epimedium pubescens].

To investigate the effects of different ratios of organic and chemical fertilizers on the yield and quality of Epimedium pubescens,so as to provide a scientific basis for the fertilization of high-yield and high-quality E. pubescens cultivation. In this experiment,a field plot test was conducted,and CK(without fertilizer) was set as the control group,with five treatment groups with different ratios of organic fertilizers and chemical fertilizers set up,namely OF0(100% chemical fertilizers),OF25(25% organic fertilizers),OF50(50% organic fertilizers),OF75(75% organic fertilizers),and OF100(100% organic fertilizers). The effects of different fertilization patterns on the agronomic traits,yield,effective component content,nutrient accumulation,and soil physicochemical properties of E. pubescens were determined,and the yield and quality of the medicinal herb were comprehensively evaluated by using the CRITIC weights method. It was found that the herb yield of each treatment group was significantly increased compared with the CK group,although the yield of the groups with both organic fertilizer and chemical fertilizer was slightly lower than that of OF0. However,there was no significant difference,which indicated that the organic fertilizer combined with chemical fertilizer could ensure the herb yield. With the increase in organic fertilizer ratios,the medicinal components epimedin A,epimedin B,and epimedin C showed a tendency of first increasing and then decreasing,with the highest content in the OF25,while icariin showed a rising trend,with the best in the OF100. However,overall,the total flavonol glycosides ABCI accumulated the most in the OF25. The results of the CRITIC method showed that the top three fertilization treatments in terms of the comprehensive scores of the medicinal herb were OF25,OF50,and OF75. Organic fertilizer combined with chemical fertilizer is conducive to improving the soil's fertilizer holding and supply capacity,and the soil indexes are optimal in OF100. The soil enzyme activity is the highest in OF75. Meanwhile,organic fertilizer combined with chemical fertilizer can help the plant's uptake and accumulation of nutrients,and OF25 shows the most obvious effect.By comprehensively considering the influence of different ratios of organic and chemical fertilizers on the yield,effective component content,nutrient accumulation,and other indexes of E. pubescens,it is recommended that a 25% ratio(7 500 kg·hm~(-2)) of organic fertilizers and chemical fertilizers should be used in E. pubescens production in the first year,so as to promote the E. pubescens industry to increase yield and improve quality.

Social determinants of health and their relation to suboptimal health status in the context of 3PM: a latent profile analysis.

Background: Suboptimal health is identified as a reversible phase occurring before chronic diseases manifest, emphasizing the significance of early detection and intervention in predictive, preventive, and personalized medicine (PPPM/3PM). While the biological and genetic factors associated with suboptimal health have received considerable attention, the influence of social determinants of health (SDH) remains relatively understudied. By comprehensively understanding the SDH influencing suboptimal health, healthcare providers can tailor interventions to address individual needs, improving health outcomes and facilitating the transition to optimal well-being. This study aimed to identify distinct profiles within SDH indicators and examine their association with suboptimal health status. Method: This cross-sectional study was conducted from June 16 to September 23, 2023, in five regions of China. Various SDH indicators, such as family health, economic status, eHealth literacy, mental disorder, social support, health behavior, and sleep quality, were examined in this study. Latent profile analysis was employed to identify distinct profiles based on these SDH indicators. Logistic regression analysis by profile was used to investigate the association between these profiles and suboptimal health status. Results: The analysis included 4918 individuals. Latent profile analysis revealed three distinct profiles (prevalence): the Adversely Burdened Vulnerability Group (37.6%), the Adversity-Driven Struggle Group (11.7%), and the Advantaged Resilience Group (50.7%). These profiles exhibited significant differences in suboptimal health status (p < 0.001). The Adversely Burdened Vulnerability Group had the highest risk of suboptimal health, followed by the Adversity-Driven Struggle Group, while the Advantaged Resilience Group had the lowest risk. Conclusions and relevance: Distinct profiles based on SDH indicators are associated with suboptimal health status. Healthcare providers should integrate SDH assessment into routine clinical practice to customize interventions and address specific needs. This study reveals that the group with the highest risk of suboptimal health stands out as the youngest among all the groups, underscoring the critical importance of early intervention and targeted prevention strategies within the framework of 3PM. Tailored interventions for the Adversely Burdened Vulnerability Group should focus on economic opportunities, healthcare access, healthy food options, and social support. Leveraging their higher eHealth literacy and resourcefulness, interventions empower the Adversity-Driven Struggle Group. By addressing healthcare utilization, substance use, and social support, targeted interventions effectively reduce suboptimal health risks and improve well-being in vulnerable populations. Supplementary Information: The online version contains supplementary material available at 10.1007/s13167-024-00365-5.

The effects of simulation-based education on undergraduate nursing students' competences: a multicenter randomized controlled trial.

BACKGROUND: Education in nursing has noticed a positive effect of simulation-based education. There are many studies available on the effects of simulation-based education, but most of those involve a single institution, nonrandomized controlled trials, small sample sizes and subjective evaluations of the effects. The purpose of this multicenter randomized controlled trial was to evaluate the effects of high-fidelity simulation, computer-based simulation, high-fidelity simulation combined with computer-based simulation, and case study on undergraduate nursing students. METHODS: A total of 270 nursing students were recruited from five universities in China. Participants were randomly divided into four groups at each institution: the high-fidelity simulation group, the computer-based simulation group, the high-fidelity simulation combined with computer-based simulation group, and the case study group. Finally, 239 participants completed the intervention and evaluation, with 58, 67, 57, and 57 participants in each group. The data were collected at three stages: before the intervention, immediately after the intervention, and three months after the intervention. RESULTS: The demographic data and baseline evaluation indices did not significantly differ among the four groups. A statistically significant difference was not observed between the four methods for improving knowledge, interprofessional collaboration, critical thinking, caring, or interest in learning. While skill improvement differed significantly among the different groups after the intervention (p = 0.020), after three months, no difference was observed (p = 0.139). The improvement in skill in the computer-based simulation group was significantly lower at the end of the intervention than that in the high-fidelity simulation group (p = 0.048) or the high-fidelity simulation combined with computer-based simulation group (p = 0.020). CONCLUSIONS: Nursing students benefit equally from four methods in cultivating their knowledge, interprofessional collaboration, critical thinking, caring, and interest in learning both immediately and over time. High-fidelity simulation and high-fidelity simulation combined with computer-based simulation improve skill more effectively than computer-based simulation in the short term. Nursing educators can select the most suitable teaching method to achieve the intended learning outcomes depending on the specific circumstances. TRIAL REGISTRATION: This clinical trial was registered at the Chinese Clinical Trial Registry (clinical trial number: ChiCTR2400084880, date of the registration: 27/05/2024).

[Mechanism and application prospects of microbial fertilizers in regulating quality formation of medicinal plants].

With the promotion of chemical fertilizer and pesticide reduction and green production of traditional Chinese medicines, microbial fertilizers have become a hot way to achieve the zero-growth of chemical fertilizers and pesticides, improve the yield and qua-lity of medicinal plants, maintain soil health, and promote the sustainable development of the planting industry of Chinese herbal medicines. Soil conditions and microenvironments are crucial to the growth, development, and quality formation of medicinal plants. Microbial fertilizers, as environmentally friendly fertilizers acting on the soil, can improve soil quality by replenishing organic matter and promoting the metabolism of beneficial microorganisms to improve the yield and quality of medicinal plants. In this regard, understanding the mechanism of microbial fertilizer in regulating the quality formation of medicinal plants is crucial for the development of herbal eco-agriculture. This study introduces the processes of microbial fertilizers in improving soil properties, participating in soil nutrient cycling, enhancing the resistance of medicinal plants, and promoting the accumulation of medicinal components to summarize the mechanisms and roles of bacterial fertilizers in regulating the quality formation of medicinal plants. Furthermore, this paper introduces the application of bacterial fertilizers in medicinal plants and makes an outlook on their development, with a view to providing a scientific basis for using microbial fertilizers to improve the quality of Chinese herbal medicines, improve the soil environment, promote the sustainable development of eco-agriculture of traditional Chinese medicine, and popularize the application of microbial fertilizers.

A Systematic Review and Meta-Analysis of Efficacy and Safety of Cilostazol Prescription in Patients With Femoropopliteal Peripheral Artery Disease After Endovascular Therapy.

PURPOSE: The purpose of this study is to assess the efficacy and safety of cilostazol prescription in patients with femoropopliteal peripheral artery disease (PAD) after endovascular therapy (EVT). MATERIALS AND METHODS: We conducted a systematic review and meta-analysis of all studies reporting the outcomes of cilostazol after femoropopliteal EVT of PAD up to September 2022. Clinical outcomes of interest included primary patency, in-stent restenosis (ISR), vessel re-occlusion, freedom from target lesion revascularization (TLR), repeat revascularization, all-cause mortality, amputation, major adverse cardiovascular events (MACEs) and major adverse limb events (MALEs), and bleeding complication. RESULTS: A total of 4 randomized controlled trials (RCTs) and 8 observational studies containing a total of 4898 patients met the inclusion criteria and were included in this systematic review and meta-analysis. We found that the use of cilostazol was associated with higher primary patency after femoropopliteal artery EVT (odds ratio [OR]=1.67, 95% confidence interval [CI]=1.50-1.87, p<0.001, I2=33.2%), a lower risk of ISR (OR=0.43, 95% CI=0.29-0.63, p<0.001, I2=37.6%), repeat revascularization (OR=0.43, 95% CI=0.24-0.76, p<0.005, I2=27.4%), and vessel re-occlusion (OR=0.59, 95% CI=0.38-0.93, p<0.05, I2=0%). There was an increase in freedom from TLR rate (OR=2.19, 95% CI=1.58-3.05, p<0.001, I2=0%), as well as a reduction in the occurrence of MALEs (OR=0.50, 95% CI=0.29-0.85, p<0.05, I2=0%). However, there was no significant difference in amputation, MACEs, all-cause mortality, and major bleeding complications. Subgroup analysis showed that cilostazol treatment in patients with femoropopliteal drug-eluting stents (DES) implantation remained associated with higher primary patency and a lower risk of ISR. CONCLUSIONS: After EVT of femoropopliteal artery lesions, additional oral cilostazol enhances primary patency, reduces the occurrences of ISR and vessel re-occlusion, diminishes the risks associated with MALEs, lowers the need for repeat revascularization, and increases freedom from TLR rates. However, it does not impact amputation, MACEs, all-cause mortality, or major bleeding complications. These findings suggest cilostazol as a potentially safe and effective adjunct therapy in patients with femoropopliteal PAD after EVT. CLINICAL IMPACT: After undergoing endovascular therapy (EVT) for femoropopliteal artery lesions, the addition of cilostazol to antiplatelet therapy can significantly improve primary patency, reducing the incidence of in-stent restenosis, repeat revascularization, vessel re-occlusion, and major adverse limb events while increasing freedom from target lesion revascularization rate. The simultaneous use of drug-eluting stents in the femoropopliteal artery lesions, combined with cilostazol, potentially results in a synergistic anti-stenotic effect. This therapeutic approach does not appear to be associated with an increased risk of major bleeding events or all-cause mortality. These findings provide additional evidence supporting the treatment of anti-stenosis in patients with femoropopliteal artery lesions after EVT.

The effect of family health on suboptimal health status: The parallel mediation role of sleep quality and health behaviour.

Background: The prevalence of suboptimal health status has been increasing worldwide, posing a significant challenge to public health. Meanwhile, family health has been recognised as an important factor influencing individual health outcomes. However, the mechanisms through which family health affects suboptimal health status remain unclear. We aimed to investigate the parallel mediation role of sleep quality and health behaviour in the relationship between family health and suboptimal health status. Methods: We conducted a cross-sectional online survey with a sample of adults >18 years old from four provinces in China. The survey questionnaires queried their demographic characteristics, family health, suboptimal health status, sleep quality, and health behaviour. We assessed family health by the Family Health Scale-Short Form and suboptimal health status using the Suboptimal Health Status Questionnaire. We employed structural equation modelling to analyse the data and test the proposed mediation model. Results: we collected 4918 valid questionnaires. The mean age of the participants was 30.1 years (standard deviation = 12.5). The correlation analysis demonstrated a significant negative association between family health and suboptimal health status (r = -0.44; P < 0.001). The results of the parallel mediation analysis showed that family health had a significant indirect effect on suboptimal health status through both sleep quality (ß = -0.350; P < 0.001) and health behaviour (ß = -0.137; P < 0.001). The total indirect effect of family health on suboptimal health status through both sleep quality and health behaviour was also significant (ß = -0.569, P < 0.001). Conclusions: This study highlights the significance of family health as a predictor of suboptimal health status and suggests that sleep quality and health behaviour are parallel mediators in this relationship. By understanding the role of family health, sleep quality, and health behaviour, interventions can be targeted to improve overall health outcomes.

Chinese version of Yoon Critical Thinking Disposition Instrument: validation using classical test theory and Rasch analysis.

BACKGROUND: Despite the availability of a wide range of critical thinking instruments, there was no original design for nurses that has been translated into Chinese. However, only instruments designed specifically for the nursing discipline would be reliable. This study aimed to translate, culturally adapt, and validate the Yoon Critical Thinking Disposition Instrument in the Chinese context. METHODS: A four-step translation process was implemented according to Word Health Organization guidelines, which included forward translation, expert panel review, backward translation, and pre-testing. Experts and nursing students participated in testing the validity and reliability of the Chinese version. RESULTS: The translation of the instrument went smoothly. According to a confirmatory factor analysis, there was an acceptable fit for the seven-factor model. Content validity indices ranged from 0.6 to 1 at item level, and 0.94 at scale level. In addition, there was extremely high internal consistency and test-retest reliability in the translated instrument. There was a good fit for the items with both person and item reliabilities greater than 0.6 and a separation index of 2.19, respectively. The item location was identified from the wright map as not covering person ability, but the scale did not have a gender-related differential item functioning. CONCLUSIONS: In this study, a critical thinking disposition instrument for nursing students was translated into Chinese for the first time. This translated instrument is a reliable tool with satisfactory validity and reliability. It could provide opportunities for building a cross-cultural understanding of critical thinking disposition.

Gender similarities and differences in the perception of caring among nurses during the COVID-19 pandemic: a mixed-methods study.

BACKGROUND: Caring is the essence and core of nursing. Current studies on the effect of gender on nurses' perception of caring have been inconsistent. Most of these studies were quantitative and conducted before the COVID-19 pandemic. The study aimed to explore the gender similarities and differences in nurses' perception of caring during the COVID-19 pandemic. METHODS: In 2020, a cross-sectional mixed-method study was conducted in 11 cities in China using structured online questionnaire (n = 8030) and face-to-face individual interview (n = 42). Data collection tools included the Caring Dimensions Inventory and semi-structured interview. RESULTS: In stepwise multivariable linear regression analysis, female nurses scored 1.93 points higher on caring than male nurses, after completely controlling for the other factors. The interview results showed that both male and female nurses agreed that caring was to deal with three kinds of relationships, namely nurses and people, nurses and themselves, nurses and society. There were gender differences in the connotation of caring between nurses and themselves, but not in the connotations of caring between other relationships. The ranking of the importance of caring connotations among these relationships showed no gender difference except between nurses and themselves. CONCLUSION: The quantitative findings suggest that gender influences nurses' perception of caring. The qualitative findings demonstrate that nurses regard themselves as both recipients and implementers of caring. The qualitative results indicate nurses of different genders have similarities and differences in their perception of caring, and the biggest difference lies in the relationship between nurses and themselves.

The mediating effect of critical thinking between interest in learning and caring among nursing students: a cross-sectional study.

BACKGROUND: Previous studies have explored the influence of interest in learning on caring and critical thinking, as well as the relationship between caring and critical thinking. However, the mediating effect of critical thinking in interest learning and caring among nursing students has not been clarified. METHODS: Nursing students who enrolled for the 2021/2022 academic year in diploma, undergraduate, or graduate programs in five provinces of China (Guangdong, Sichuan, Jiangsu, Hunan and Macao). An online survey with a convenience sampling method was employed to collect data. The questionnaires were administered to 692 participants between January 20 and 26, 2022. Amos 26.0 was employed to establish the structural equation modelling and analyze the mediating effect of critical thinking on interest in learning and caring. RESULTS: The first regression equation showed that interest in learning significantly influenced caring (ß = 0.339, p <  0.001). The third regression equation showed that critical thinking significantly influenced caring (ß = 0.494, p <  0.001). The effect of interest in learning on caring was less in the third equation than in the first equation (ß = 0.154 vs ß = 0.339), which indicates partial mediation. Furthermore, interest in learning had an indirect positive effect (ß = 0.186, p <  0.001) on caring mediated by critical thinking, with 95% confidence interval of 0.142 to 0.233. CONCLUSIONS: Critical thinking was a significant mediator of the relationship between interest in learning and caring. It is suggested that nursing colleges and instructors should take into account students' interest in learning and critical thinking as potential intervention elements to enhance caring.

Impact of scenario validity and group size on learning outcomes in high-fidelity simulation: A systematics review and meta-analysis.

OBJECTIVES: To determine the effects related to scenario validity and group size in high-fidelity simulation among undergraduate nursing students. DESIGN: A systematic review and meta-analysis of randomized controlled trials and quasi-experiment. DATA SOURCES: Embase, PubMed, Web of Science, Wangfang database, and Cochrane Library, China National Knowledge Infrastructure were searched from the start of each database to February 22, 2022. The references and citations lists were manually screened to find additional references. REVIEW METHODS: Screening and quality assessment of the retrieved studies were conducted independently by two authors. Discussions with a third author sorted out any discrepancies between the two authors. Using meta-analysis procedures based on a random-effect model, outcome data were synthesized and standard mean difference was computed with a 95 % confidence interval. RESULTS: Thirty-three studies were included. A total 4077 undergraduate nursing students were recruited, of which 2068 participated in experimental groups. High-fidelity simulation with scenario validity was better than high-fidelity simulation without scenario validity in cultivating undergraduate nursing students' knowledge (p = 0.03), and they were equivalent in improving students' skills (p = 0.75). Groups of six or fewer students in each high-fidelity simulation tend to be more effective at promoting knowledge (standard mean difference = 0.98) and skill (standard mean difference = 1.00), but the differences were not statistically significant. CONCLUSIONS: High-fidelity simulation with scenario validity and with less than six students in each group can be more effective in cultivating knowledge and skills among undergraduate nursing students. For high-fidelity simulation to be as effective as possible, nursing instructors should ensure scenario validity and limit the number of students in each group to under six.

Master mitotic kinases regulate viral genome delivery during papillomavirus cell entry.

Mitosis induces cellular rearrangements like spindle formation, Golgi fragmentation, and nuclear envelope breakdown. Similar to certain retroviruses, nuclear delivery during entry of human papillomavirus (HPV) genomes is facilitated by mitosis, during which minor capsid protein L2 tethers viral DNA to mitotic chromosomes. However, the mechanism of viral genome delivery and tethering to condensed chromosomes is barely understood. It is unclear, which cellular proteins facilitate this process or how this process is regulated. This work identifies crucial phosphorylations on HPV minor capsid protein L2 occurring at mitosis onset. L2's chromosome binding region (CBR) is sequentially phosphorylated by the master mitotic kinases CDK1 and PLK1. L2 phosphorylation, thus, regulates timely delivery of HPV vDNA to mitotic chromatin during mitosis. In summary, our work demonstrates a crucial role of mitotic kinases for nuclear delivery of viral DNA and provides important insights into the molecular mechanism of pathogen import into the nucleus during mitosis.

Silencing METTL3 Stabilizes Atherosclerotic Plaques by Regulating the Phenotypic Transformation of Vascular Smooth Muscle Cells via the miR-375-3p/PDK1 Axis.

PURPOSE: Atherosclerosis (AS) is a primary cause of cardiovascular diseases. This study investigated the mechanism of methyltransferase-like 3 (METTL3) in AS plaques via modulating the phenotypic transformation of vascular smooth muscle cells (VSMCs). METHODS: AS mouse models and MOVAS cell models were established through high-fat diet and the treatment of ox-LDL, respectively. METTL3 expression in AS models was detected via RT-qPCR and Western blot. The AS plaques, lipid deposition, and collagen fibers were examined via histological staining. The levels of Ly-6c, α-SMA, and OPN were examined via Western blot. The blood lipid indexes in mouse aortic tissues were determined using kits. The proliferation and migration of MOVAS cells were detected via CCK-8 and Transwell assays. The m6A modification level of mRNA was quantified. The binding relationship between pri-miR-375 and DGCR8, and the enrichment of m6A on pri-miR-375 were detected via RIP. The binding relationship between miR-375-3p and 3-phosphoinositide-dependent protein kinase-1 (PDK1) was verified via dual-luciferase assay. Joint experiments were designed to investigate the role of miR-375-3P/PDK1 in the phenotypic transformation of VSMCs. RESULTS: METTL3 was highly expressed in AS. Silencing METTL3 alleviated AS progression and stabilized AS plaques in mice, and limited the phenotypic transformation of VSMCs induced by ox-LDL. Silencing METTL3 inhibited m6A level and decreased the binding of DGCR8 to pri-miR-375 and further limited miR-375-3p expression. miR-375-3p targeted PDK1 transcription. miR-375-3p upregulation or PDK1 downregulation facilitated the phenotypic transformation of VSMCs. CONCLUSION: METTL3-mediated m6A modification promoted VSMC phenotype transformation and made AS plaques more vulnerable via the miR-375-3p/PDK1 axis.

The impact of caring for COVID-19 patients on nurse professional identity: A cross-sectional study using propensity score analysis.

Objective: To examine the impact of caring for COVID-19 patients on the professional identity of nurses. Methods: An online survey was conducted between 19 May and 7 August 2020 in 11 Chinese cities, including Dongguan, Foshan, Guangzhou, Hong Kong, Huizhou, Jiangmen, Macao, Shenzhen, Zhaoqing, Zhongshan, and Zhuhai. Propensity score matching was used to adjust for confounding variables between nurses with and without experience caring for COVID-19 patients. To analyze the impact of caring for COVID-19 patients on nurses' professional identity, a nominal logistic regression model was used rather than an ordinal regression model because the parallel regression assumption was violated. Results: After propensity score matching, the final sample contained 1,268 participants, including 634 nurses who cared for COVID-19 patients. During the COVID-19 outbreak, 88.6% of nurses had high levels of professional identity. Nurses who cared for COVID-19 patients had the lowest percentage of high score level on the professional identity subscale for "sense of organizational influence," as did nurses who did not care for COVID-19 patients. The findings indicated that nurses who cared for COVID-19 patients were 17.95 times more likely to have a high professional identity than a low professional identity (95% CI 2.38-135.39, p = 0.005), after completely controlling for the other factors. There were significant differences between nurses who cared for COVID-19 patients and those who did not in scores on the subscales of professional identity, except for the subscales "sense of self-decision-making" (χ2 = 4.85, p = 0.089) and "sense of organizational influence" (χ2 = 4.71, p = 0.095). Conclusion: Nurses' professional identity is positively impacted by their experience caring for COVID-19 patients. Caring for COVID-19 patients should be highlighted as an opportunity to enhance nurses' professional identity. To further enhance the professional identity of nurses, we call for visible nursing leadership during the COVID-19 pandemic and improve their working environment.

Factors influencing caring behaviour among registered nurses during the COVID-19 pandemic in China: A qualitative study using the COM-B framework.

AIM: The aim of this work is to explore the influencing factors of nurses' caring behaviour during the COVID-19 pandemic based on the Capability, Opportunity, Motivation as determinants of Behaviour (COM-B) theoretical framework. BACKGROUND: Nurse caring behaviour is vital to reduce and speed up the healing process of COVID-19 patients. It is important to understand the factors that influence caring behaviour among nurses during the COVID-19 pandemic. Research suggests that when it comes to understanding behaviour, using a theoretical framework is likely to be most effective, and the COM-B framework is a recommended approach. METHODS: Semistructured interviews with 42 nurses working in 11 Chinese cities were conducted, and their verbatim statements were transcribed and analysed using thematic analysis. The results were mapped to COM-B framework. RESULTS: Ten key themes emerged: Capability (professional knowledge and skills, emotional intelligence, cross-cultural care competence); opportunity (resources, organizational culture, social culture); motivation (past experience, character, role, beliefs). CONCLUSIONS: Ten factors were found to influence nurses' caring behaviour. This study added two new influencing factors, social culture and past experiences, that further contributed to the understanding of nurses' care behaviours. IMPLICATIONS FOR NURSING MANAGEMENT: Nurses' caring behaviour is influenced not only by themselves but also by institutions and society, so interventions aiming to improve their caring behaviour should consider these elements. The negative impact of the pandemic on capability factors that influence nurses' caring behaviour should be counteracted as soon as possible.

Prebriefing for high-fidelity simulation in nursing education: A meta-analysis.

BACKGROUND: Briefing, scenario development, and debriefing of high-fidelity simulation (HFS) have been widely discussed in the past, but less attention is given to prebriefing, and its role in learning outcomes. The prebriefing engages students and equips them with the knowledge and skills they need for a successful simulation. OBJECTIVES: To identify the effectiveness of prebriefing of HFS in Bachelor of Science in Nursing (BSN) students. DESIGN: A meta-analysis of randomized controlled trials and quasi-experiment. DATA SOURCES: The Web of Science, PubMed, Embase, Cochrane Library, WANFANG, and CNKI were for randomized controlled and quasi-experimental studies published in English or Chinese up to June 26, 2022. REVIEW METHODS: Two authors independently screened the literature, extracted data and evaluated the quality of the included studies. The standardized mean difference with a 95 % confidence interval was used to facilitate direct comparisons between studies. All statistical tests were conducted with Review Manager 5.4 software. RESULTS: This meta-analysis included 17 randomized controlled studies and 25 quasi-experimental studies involving 4926 BSN students. No significant differences in knowledge (p = 0.58), skill (p = 0.67), satisfaction (p = 0.84), critical thinking (p = 0.56), caring (p = 0.11), learning interest (p = 0.85), and self-confidence (p = 0.21) between HFS with and without prebriefing were found in subgroup analyses. HFS with prebriefing generated larger effect for collaboration (0.82 vs 0.27, p = 0.004). CONCLUSION: HFS with prebriefing facilitates collaboration of BSN students more effectively, and it has an equivalent effect to HFS without prebriefing on fostering BSN students' knowledge, skills, critical thinking, caring, learning interest, and self-confidence.

The rare complication caused by thrombus shedding during arteriovenous fistula thrombolysis: a case report.

BACKGROUND: Arteriovenous fistula is the lifeline of maintenance for patients requiring hemodialysis, with thrombosis being a common complication of this procedure. Traditionally, thrombi have been removed via thrombectomy. In recent years, it has been reported that newly occurring thrombi can be treated by urokinase thrombolysis. However, the thrombus shedding in the process should be valued, which may cause the distal limb ischemia syndrome. The complication of thrombolysis is rare but serious. Patients will experience pain and numbness, and possibly even extremity necrosis may occur without diagnosed or treated timely. There are not any reports about the occurrence or treatment of distal limb ischemia syndrome caused by thrombus shedding during thrombolysis. CASE DESCRIPTION: Considering the thrombosis volume and texture of this case, we attempted to use urokinase thrombolysis to resolve the thrombus in fistula. During thrombolysis, thrombus shedding occurred in the distal limb. The patient's fingers of the limbs on the side of the internal fistula were pale, numb, and painful in the case. Fortunately, we solved the problem ultimately by continuously pumping urokinase. The heparin, urokinase, infusion pumps, ultrasound, and infrared therapy devices were obtained from the Affiliated Hospital of Chuanbei Medical College. Their usage and dosage are described in the relevant literature and China's 2020 blood purification standard operating procedures. CONCLUSIONS: In the process of thrombolysis of arteriovenous fistula, attention should be paid to thrombus shedding. Distal limb ischemia syndrome is a rare but serious complication of thrombus shedding. Continued pumping of urokinase may be effective for this complication.

Use of Contact Immunotherapy in the Treatment of Skin Diseases Other than Alopecia Areata.

For decades, contact immunotherapy with dinitrochlorobenzene, diphencyprone, and squaric acid dibutylester has played an important role in both clinical practice and scientific research. It is listed as the first-line treatment for extensive alopecia areata and was more recently approved for melanoma treatment as an orphan drug in the USA. Moreover, owing to the relative low cost and safety, topical immunotherapy has also been used in many infectious, neoplastic, and inflammatory dermatological diseases. It is especially valuable in vulnerable groups, for cosmetic/pain sensitive areas, or for multiple lesions. In this review, we summarize the current evidence supporting the use of contact immunotherapy for treatment of skin diseases, from articles collected from PubMed database. Owing to space limitation and already numerous studies focusing on alopecia areata, we include only skin diseases other than alopecia areata. In addition to diseases that have been reported to be treated by contact immunotherapy, the hypothesized mechanism, prognosis prediction, efficacy, and safety of these topical agents are discussed.

Outcomes of Patients With Metastatic Differentiated Thyroid Cancer After Excellent Response to Treatment.

Background: To evaluate the outcomes in differentiated thyroid cancer (DTC) patients who achieved excellent response to initial treatment and developed distant metastasis during follow-up. Methods: Thyroid cancer patients registered in Chang Gung Memorial Hospital thyroid cancer database between January 1979 and December 2019 were assessed. Results: Among 1053 DTC patients with excellent response to initial therapy, 14 (1.3%) patients developed metastatic disease during follow-up, including 6 males and 8 females with median age of 50.2 years [interquartile range (IQR), 39.9-53.7]. Nine (64.3%) patients had papillary cancer, four (28.6%) had follicular cancer, and one (7.1%) had Hürthle cell cancer. Most patients (92.9%) had stage I disease at diagnosis. The sites of metastasis were lung (71.4%), bone (7.1%), mediastinum (7.1%) and multiple sites (14.3%). With a median follow-up of 18.3 years (IQR, 14.8-23.8), 2 patients had disease-specific mortality. The 5- and 10-year disease-specific survival after the diagnosis of distant metastasis was 92% and 74%, respectively. Multiple sites of metastasis was associated with increased risk of mortality (P = 0.022). Conclusions: A small proportion of DTC patients with an excellence response to initial therapy developed distant metastasis during follow-up. Multiple organ distant metastases conferred a worse disease-specific survival.

High-fidelity simulation duration and learning outcomes among undergraduate nursing students: A systematic review and meta-analysis.

OBJECTIVES: To explore the effects of different lengths of the three key steps (prebriefing, simulation, and debriefing) of high-fidelity simulation (HFS) on the knowledge and skills of undergraduate nursing students. DESIGN: A systematic review and meta-analysis. DATA SOURCES: A systematic search was conducted for Chinese and English publications from the Web of Science, PubMed, Embase, Cochrane, and two Chinese databases (Wanfang and CNKI) up to November 24, 2021. REVIEW METHODS: Two independent raters screened the retrieved studies and extracted data based on a coding protocol from the studies that met the inclusion criteria. Data were synthesized using meta-analytic procedures based on a random-effect model and computing effect sizes by standard mean differences (SMD) with a 95% confidence interval (CI). RESULTS: Forty-four studies were included, and 23 studies were analyzed. High-fidelity simulation (HFS) with debriefing of 10 min or less (SMD = 1.18), simulation of 15-20 min (SMD = 1.43), and debriefing of 11-30 min (SMD = 1.19) showed larger effect sizes for knowledge, while HFS with debriefing of >10 min (SMD = 0.91), simulation of 15 min or less (SMD = 0.89), and over 30 min of debriefing cultivation (SMD = 0.84) showed larger effect sizes for skill. CONCLUSIONS: During the prebriefing, simulation, and debriefing, shorter sessions are more effective for improving knowledge in BSN students, whereas longer sessions are most effective for improving skills in BSN students. Nurse educators can schedule HFS to meet the expectations of learning outcomes based on the actual situation.