Co-designing a culturally-sensitive theory-driven advance care planning game with Chinese older adults and healthcare providers.

BACKGROUND: Advance care planning can be challenging because discussing end-of-life care often has negative connotations. Gamification is a novel approach to encourage advance care planning conversations in Western culture. AIM: To co-design a game with multiple stakeholders to promote advance care planning in Chinese communities. DESIGN: A two-phase design guided by the Medical Research Council framework for developing complex interventions was adopted between May 2019 and August 2020. In phase I, a game prototype was developed based on literature review, expert consultation and end-user consultation. In Phase II, the game prototype was tested among end-users and refined according to their feedback and expertise of a multi-disciplinary team through an iterative process. SETTING/PARTICIPANTS: Experts in the field of aged care, palliative care, life education and game development and Chinese community-dwelling adults aged 60 years or older. RESULTS: A board game called 'The Five Tastes Found in a Grocery Store' was developed. The game design was shaped by Bandura's Self-efficacy theory and feedback from experts and end-users. The participants generally found the gaming experience enjoyable and appreciated the opportunity to discuss end-of-life care openly. CONCLUSIONS: This study is the first to develop an evidence-informed, theory-based, culturally sensitive game for promoting advance care planning in the Chinese community using a co-design approach.

Knowledge, perception of HIV symptom severity and cervical cancer screening behaviour among women living with HIV in China.

OBJECTIVE: This study aimed to examine the previous uptake of cervical cancer screening and intention to be screened and its associated factors among women living with HIV in China. METHODS: We conducted a cross-sectional survey of 213 women living with HIV to collect information about cervical cancer screening behaviour, demographics, knowledge about cervical cancer and screening, and perception of HIV symptom severity. RESULTS: Seventy-eight women living with HIV (36.6%) had undergone cervical cancer screening, and 83 (61.5%) of the nonscreened women had the intention to be screened in the future. Using multivariate analysis, women who had more knowledge about cervical cancer screening (OR = 2.373, 95% CI = 1.593-3.534, p = 0.000) and had at least one nongynecological symptom (OR = 0.446, 95% CI = 0.204-0.978, p = 0.044) were more likely to have received screening previously. CONCLUSION: This study emphasised that knowledge, as a salient factor, was crucial to promoting cervical cancer screening behaviour among women living with HIV. Effective measures should be taken to promote the knowledge about cervical cancer prevention. A new healthcare model, including preventive healthcare in addition to HIV/AIDS care, may be needed to address the complex needs of women living with HIV in China.

Effect of a 4-Week Internet-Delivered Mindfulness-Based Cancer Recovery Intervention on the Symptom Burden and Quality of Life of Patients With Breast Cancer: Randomized Controlled Trial.

BACKGROUND: Mindfulness-based interventions (MBIs) can improve the symptoms and psychological well-being of patients with breast cancer. However, standard MBIs are an 8-week program delivered face-to-face, which may be inconvenient for patients with cancer. Many attempts have been made to adapt MBIs to increase their accessibility for patients with cancer while maintaining their therapeutic components and efficacy. OBJECTIVE: This study aimed to investigate the effectiveness of a 4-week internet-delivered mindfulness-based cancer recovery (iMBCR) program in reducing symptom burden and enhancing the health-related quality of life (HRQoL) of patients with breast cancer. METHODS: A total of 103 postoperative patients with breast cancer (stages 0 to IV) were randomly assigned to an iMBCR group (4-week iMBCR; n=51, 49.5%) or a control group (usual care and 4-week program of health education information; n=52, 50.5%). The study outcomes included symptom burden and HRQoL, as measured by the MD Anderson Symptom Inventory and the Functional Assessment of Cancer Therapy-Breast scale. All data were collected at baseline (T0), after the intervention (T1), and at 1-month follow-up (T2). Data analysis followed the intention-to-treat principle. Linear mixed models were used to assess the effects over time of the iMBCR program. RESULTS: Participants in the iMBCR group had significantly larger decreases in symptom burden than those in the control group at T1 (mean difference -11.67, 95% CI -16.99 to -6.36), and the decreases were maintained at T2 (mean difference -11.83, 95% CI -18.19 to -5.46). The HRQoL score in the iMBCR group had significantly larger improvements than that in the control group at T1 and T2 (mean difference 6.66, 95% CI 3.43-9.90 and mean difference 11.94, 95% CI 7.56-16.32, respectively). CONCLUSIONS: Our preliminary findings suggest that the iMBCR program effectively improved the symptom burden and HRQoL of patients with breast cancer, and the participants in the iMBCR group demonstrated good adherence and completion rates. These results indicate that the iMBCR intervention might be a promising way to reduce symptom burden and improve HRQoL of patients with cancer. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2000038980; http://www.chictr.org.cn/showproj.aspx?proj=62659.

Nurse researchers' perspectives on research ethics in China.

BACKGROUND: In China, research ethics is a subject of increasingly formal regulation. However, little is known about how nursing researchers understand the concept of research ethics and the ways in which they can maintain ethical standards in their work. AIM: The aim of this study is to examine nursing researchers' perspectives on research ethics in China. RESEARCH DESIGN: We conducted a descriptive qualitative study. Qualitative research methods enabled us to gain an in-depth understanding of nursing researchers' views on research ethics. PARTICIPANTS AND RESEARCH CONTEXT: We carefully selected and extensively interviewed 28 nursing researchers, nursing faculty, and clinical nurses who had been involved in research or who may undertake research in the future. We collected data between October 2014 and March 2015. ETHICAL CONSIDERATIONS: This study was approved by the institutional review boards of Yale University and Central South University. FINDINGS: We grouped the data into five categories based on the interviewees' responses: (1) perceptions of ethics, bioethics, and research ethics; (2) perception of the ethics review process; (3) perception of the function of institutional review boards; (4) the need for comprehensive ethical guidelines for future studies; and (5) ethical challenges faced by the interviewees. DISCUSSION AND CONCLUSION: This study contributes new insights into nursing researchers' views on research ethics in China and finds considerable shortcomings in researchers' understanding and implementation of ethical principles. Intensive educational efforts are needed to provide nursing researchers, institutional review board members, and even study subjects with accurate and up-to-date information and guidance on research ethics. In addition, while Western research ethics theoretically have guided Chinese clinical research for several years, the ways in which nursing researchers have implemented these ethical standards highlight the differences between the Eastern and Western ethical paradigms. This finding suggests the need for ethical standards that are more tailored to the Chinese context.

Understanding the cervical screening behaviour of Chinese women: The role of health care system and health professions.

BACKGROUND: In China, cervical cancer cases are increasing, making an impact on the worldwide burden of cervical cancer. Despite the initiatives undertaken by the Chinese government, the current coverage of cervical screening in China remains suboptimal. There is an urgent need to identify the facilitators and barriers associated with the uptake of cervical cancer screening among the Chinese population. PURPOSE: The study aimed to explore the experiences and perceptions of cervical cancer screening of mainland Chinese women in relation to their screening behaviour, particularly in the aspects of health care system and health profession roles. METHODS: A qualitative research was conducted using semi-structured interviews. A total of 27 Chinese women aged 25 to 50 (both screened and non-screened women) completed the interviews. The analysis of the interview data was undertaken inductively using latent content analysis. DISCUSSION AND CONCLUSION: Results showed that organised health examination programmes provide a good basis for integrating cervical screening into broader checks on the health of women, and utilising different networks of social support facilitate the utilisation of the screening service. However, education on cervical cancer and screening must be made more generally available. More importantly, there is a need for a more participatory and empowering exchange in the encounter between health professions and these women. Appropriate training program is strongly recommended for health professions about communicate skills with patients. Future work should focus on identifying strategies to overcome the barriers to cervical screening related to health care system and medical professions among this population.

Human papillomavirus vaccine acceptability among female undergraduate students in China: the role of knowledge and psychosocial factors.

AIMS AND OBJECTIVES: To examine young women's perceptions and acceptability of human papillomavirus vaccination and factors influencing acceptability in mainland China. BACKGROUND: In the light of current concepts, human papillomavirus vaccines serve as new paradigms in cervical cancer prevention programme for young women. However, knowledge and acceptability of human papillomavirus vaccination and factors influencing acceptability among young Chinese women are not known. DESIGN: We implemented a cross-sectional descriptive study in the Hunan province of China. METHODS: One hundred and seventeen female undergraduate students completed confidential surveys in 2012. The questionnaire included five parts: background information, awareness and knowledge of human papillomavirus vaccine and cervical cancer, attitudes towards the vaccine and intentions to be vaccinated, psychosocial burden of human papillomavirus infection, and human papillomavirus-related sexual stigma. RESULTS: Only 44% of the participants were willing to be vaccinated in the future. Young women demonstrated low awareness and knowledge about human papillomavirus vaccine and cervical cancer. Their intention to receive future vaccination was associated with the high levels of knowledge about risk factors for cervical cancer and perceptions that infected women are responsible for their own infection of human papillomavirus. CONCLUSION: The results of this study suggest low awareness and knowledge among young Chinese women about the preventive nature and value of human papillomavirus vaccination. Social and cultural factors including moral obligation and STD-related stigma may influence young women's intention to future vaccination. RELEVANCE TO CLINICAL PRACTICE: Educational interventions are necessary to promote public awareness and deliver information about human papillomavirus vaccination and cervical cancer prevention. Results of this study can help health care practitioners develop appropriate programmes for the promotion of human papillomavirus vaccination among this population.

Effect of group counseling on depression, compliance and blood sugar level in diabetic patients.

OBJECTIVE: To establish an interference mode of group counseling for diabetic patients with depression and to evaluate the effectiveness of this mode on depression, treatment compliance and blood sugar level in the patients.
 METHODS: One hundred diabetic patients with depression were randomly divided into a counseling group and a control group (n=50 per group). Self-Rating Depression Scale (SDS) was applied to all the patients. The interference mode of group counseling was established through literature review, expert consultation or interview. The counseling group received counseling for 8 times within 2 months.
 RESULTS: There was a significant difference in the SDS scores at 0, 3, 6 or 12 months after the intervention between the 2 groups (P<0.001). For the counseling group, there was a significant difference in the SDS scores between pre-intervention and 3, 6 or 12 months after intervention (P<0.001). However, there was no significant difference in the SDS scores between any two time points after the intervention (P>0.05). There was a significant difference in the compliance between any two time points after the intervention (P<0.05). Fasting blood glucose (FBG), 2 h postprandial blood glucose (2hPG) or glycosylated hemoglobin (HbA1c) was significantly different at any two time points after the intervention (P<0.05).
 CONCLUSION: Group counseling can improve depression, compliance and blood sugar control in the diabetic patients.

Features of Studies on Transition Interventions for Childhood Cancer Survivors: A Scoping Review.

PURPOSE: in this scoping review, previously reported data were described and synthesized to document transition interventions in CCSs, and the features of intervention components of the current transition studies for CCSs were summarized. METHODS: A literature search was conducted in PubMed, Web of Science, EMBASE, PsycINFO, CINAHL, Ovid, and the Cochrane Library following the PRISMA-ScR statement. All original studies (n = 9) investigating transition interventions in CCSs were included. RESULTS: The current studies identified essential elements for transition programs, such as delivering knowledge, developing skills for coordination of care, and addressing psychosocial needs. However, the current transition interventions were generally in their infancy, and major deficits were found, including poorly reported intervention components and procedures, a limited number of relevant validated outcomes, and a failure to incorporate conceptual frameworks and international consensus statements. CONCLUSIONS: This scoping review mapped current evidence of transition interventions for CCSs and highlighted the paucity of data in this area. More high-quality and well-reported randomized controlled trials are needed for the enrichment and standardization of future transition interventions.

Patient delay and related influencing factors in Chinese women under 35 years diagnosed with cervical cancer: A cross-sectional study.

Objective: Patient delay was defined as an interval between the discovery of the initial symptoms and diagnosis, which was longer than 90 days. This study aimed to determine the patient delay rate and related factors in women with cervical cancer in Hunan province, South-Central China. Methods: A cross-sectional study was conducted among 140 women with cervical cancer aged <35 years from October, 2019 to March, 2021. Assumptions in Andersen Behavioral Model of Health Services Utilization were used to measure the factors influencing patient delay. Logistic regression models were used to identify factors associated with patient delay. A P-value of <5% was considered significant. Results: A total of 57 (40.71%) young women with cervical cancer had patient delay, with an average delay time of 178.70 (307.90) days. Predisposing factors, such as religion, unemployment, health beliefs related to cancer screening, and a history of cervical cancer screening within 2 years or more (P â€‹< â€‹0.05), were associated with patient delay. Enabling factors, such as distance to the nearest medical facility and type of the nearest medical facility, were associated with a reduced likelihood of patient delay. With the need-for-care factor, young women who experienced vaginal pain after or during intercourse had a higher risk (adjusted odds ratio, 33.48; 95% confidence interval, 3.22-348.68, P â€‹= â€‹0.003) of patient delay. Conclusions: These findings reinforce the need for programs to enhance knowledge and awareness about cervical cancer screening and the importance of early diagnosis in women to help eliminate cervical cancer in China by 2050.

A serious game for engaging older adults in end-of-life care discussion: A mixed method study.

OBJECTIVE: To examine the acceptability of a board game newly developed through a co-design process for promoting end-of-life care discussion among Chinese older adults. METHODS: A multi-centre mixed method study, including a one group pre-test post-test study and focus group interviews, was conducted. Thirty older adults participated in a one-hour game session in a small group format. Acceptability was assessed by attrition rate and satisfaction with the game. Participants' experiences with the game were explored qualitatively. Within-subject changes in self-efficacy and readiness for advance care planning (ACP) behaviours were also examined. RESULTS: The players generally had positive experiences with the game, giving a low attrition rate. A significantly higher level of self-efficacy in sharing end-of-life care preferences with surrogates was reported after the game session (p = 0.008). There was a slight increase in the proportion of players indicated that they would complete ACP behaviours in the coming months immediately after the intervention. CONCLUSION: A serious game is acceptable by Chinese older adults to raise discussions regarding end-of-life matters. PRACTICE IMPLICATIONS: A game can be an ice-breaking tool to increase self-efficacy towards communicating end-of-life care preferences with surrogates, but follow-up support is needed to facilitate the uptake of ACP behaviours.

The influence of knowledge and perception of the risk of cervical cancer on screening behavior in mainland Chinese women.

BACKGROUND: Theories of health behavior and empirical research highlight the risk perception as a significant factor for people adopting cancer screening. However, screening uptakes and risk perception of cervical cancer in mainland Chinese women remains unknown. OBJECTIVE: This paper adopted the protection motivation theory (PMT) to examine Chinese women's knowledge and perceptions of cervical cancer risk and factors influencing utilization of cervical screening. METHODS: A self-administered questionnaire was completed by 167 participants in mainland China (79 nonscreened and 88 screened women) in 2007 which consisted of four sections: background information, women's attendance pattern for cervical screening, perceptions related to body health and knowledge about cervical cancer and screening, and PMT measures. RESULTS: All women considered themselves at low risk of cervical cancer. No significant association was observed between previous screening uptake and PMT variables. Using multivariate analysis, having children, a perception that visiting doctors regularly is important to health, average and high levels of knowledge about cervical screening were significantly associated with having been received screening. CONCLUSION: Chinese women demonstrated an unrealistic optimism about their personal risk of cervical cancer. The findings do not support an association between risk perception and screening uptake. In spite of this, current findings revealed some possible factors influencing women's screening behavior. This study highlights the significance of knowledge and culturally-relevant health behavior and beliefs about cervical screening for Chinese women in determining whether or not they receive screening. The promotion of cervical cancer prevention and early detection should be integrated into public education about women's health.

Effects of Drawing Therapy on Pediatric Oncology Patients: A Systematic Review.

BACKGROUND: A small but significant number of children and adolescents with cancer experience severe physical and psychological distress. Previous studies have shown that drawing therapy positively affects relieving psychological problems. However, the effect of drawing therapy on pediatric oncology patients has not been established by systematic review. OBJECTIVE: The aim of this study was to determine the effect of drawing therapy on the pediatric oncology population. METHODS: PubMed, EMBASE, MEDLINE, Cochrane, PsycINFO, CINAHL, and Chinese databases including CNKI, Wanfang, VIP, and CBM were searched. Studies published in the English and Chinese languages up to December 2019 were screened, and randomized controlled trials and nonrandomized experimental studies of drawing therapy interventions for pediatric oncology patients were reviewed. Screening was undertaken independently by 2 reviewers. The review protocol was registered with PROSPERO (registration number: CRD42020178365). RESULTS: Eight studies were included. Three studies were randomized controlled trials, and 5 studies were nonrandomized experimental studies. Seven studies showed that drawing therapy had positive effects on reducing depression and anxiety and improving quality of life. However, 1 study showed a contradictory result, that is, participants had an increased anxiety level after intervention. CONCLUSIONS: Drawing therapy is effective in improving negative emotions, relieving somatic symptoms, and increasing social communication for pediatric oncology patients. IMPLICATIONS FOR PRACTICE: Drawing therapy may be considered an adjuvant psychological intervention strategy for pediatric oncology patients. Meanwhile, more rigorous studies are needed to address the deficiencies of small number size and methodological weakness.

Effect of a telehealth-based exercise intervention on the physical activity of patients with breast cancer: A systematic review and meta-analysis.

Telehealth-based exercise intervention as a non-pharmacological intervention has gradually emerged in breast cancer (BC), which shows feasibility and high levels of patient satisfaction. This systematic review aims to identify the effect of telehealth-based exercise interventions on the physical activity (PA) of patients with BC. We searched CENTRAL, CINAHL, PsycINFO, EMBASE, PubMed, Web of Science, ClinicalTrials.gov, CNKI, Wanfang, VIP, and SinoMed. Study selection and quality appraisal were performed independently by two reviewers. The review protocol was registered in PROSPERO (CRD42022326484). Nine studies, which included 1127 patients with BC, were identified. Compared with usual care, the telehealth-based exercise intervention had a significantly positive effect on PA (Standardized mean difference (SMD) = 0.26, 95% confidence interval (CI) 0.09 to 0.43, P = 0.003), aerobic capacity (SMD = 0.20, 95% CI 0.03 to 0.38, P = 0.02), upper body function (Mean difference (MD) = -4.56, 95% CI -7.66 to -1.47, P = 0.004), upper muscle strength (SMD = 0.26, 95% CI 0.09 to 0.42, P = 0.002), lower muscle strength (SMD = -0.95, 95% CI -1.27 to -0.62, P < 0.00001), abdominal muscle strength (MD = 23.85, 95% CI 13.84 to 33.86, P < 0.000,01), fatigue (SMD = 0.56, 95% CI 0.13 to 1.00, P = 0.01), and quality of life (SMD = 0.26, 95% CI 0.04 to 0.49, P = 0.02). Conversely, anthropometric and body composition and pain did not differ significantly between the two groups. Telehealth-based exercise intervention improved PA, physical performance, fatigue, and quality of life of patients with BC compared with routine care, which should be promoted clinically as a comprehensive treatment for BC.

Efficacy of a smartphone-based care support programme in improving post-traumatic stress in families with childhood cancer: protocol of a randomised controlled trial.

INTRODUCTION: Diagnosis and treatment represent distressing experiences for the families of children with cancer. Psychosocial challenges are faced by these families in China because of limited health services and resources for psychosocial oncology care. Effective interventions tailored to the knowledge level and cultural values of this population are needed. The goal of this study is to evaluate a smartphone-based care support (SBCS) programme for the families of children with cancer in China. METHODS AND ANALYSIS: A parallel randomised controlled trial will be conducted to examine the efficacy of an evidence-based and culturally tailored SBCS programme for the families of children with cancer in China. A total of 180 families will be recruited. The intervention will consist of an introduction session and four main sessions and will be conducted sequentially on a single weekend day. Participating families will be included in the intervention group. The post-traumatic stress and quality of life of families will be evaluated at baseline, during the intervention, immediately after the intervention, and 2 and 6 months after the intervention. ETHICS AND DISSEMINATION: Ethical approval for this protocol has been obtained from the Nursing and Behavioural Medicine Research Ethics Review Committee, Xiangya School of Nursing, Central South University (Protocol #: E2020125). The findings of the trial will be disseminated through conference presentations and publications in peer-reviewed journals. TRIAL REGISTRATION NUMBER: ChiCTR2000040510.

PPARγ mediates the anti-pulmonary fibrosis effect of icaritin.

BACKGROUND: Pulmonary fibrosis is a fatal lung disease with limited treatment options. Icaritin is the active ingredient derived from the traditional Chinese medical plant Epimedium and possesses many biomedical activities. This study aimed to investigate the effects and molecular mechanisms of icaritin on bleomycin-induced pulmonary fibrosis in mice. METHODS: To assess its preventative effects, bleomycin treated mice received 0, 0.04, 0.2, and 1 mg/kg of icaritin from day 1 onwards. To assess its therapeutic effects, bleomycin treated mice received 0 and 1 mg/kg of icaritin from day 15 onwards. Mice were sacrificed on day 21 and lung tissues were collected, stained with HE, Masson and immunohistochemistry. Q-PCR was used to measure Collagen I and Collagen III expression, western blotting was used to quantify α-SMA, Collagen I expression. Hydroxyproline content was measured using a biochemical method. NIH3T3 and HLF-1 cells were treated with TGF-ß1with or without icaritin, and α-SMA, Collagen I were tested. PPARγ antagonist GW9662 and PPARγ-targeted siRNA were used to investigate the mechanism of icaritin in inhibiting myofibroblast differentiation. RESULTS: Both preventative and therapeutic administration of icaritin improved the histopathological changes, decreased Collagen and α-SMA, lowered hydroxyproline content in bleomycin-treated lung tissues. Icaritin decreased α-SMA and Collagen I expression in TGF-ß1-stimulated NIH3T3 and HLF-1 cells. However, its effect in reducing α-SMA and Collagen I expression was suppressed when expression or activity of PPARγ was inhibited. CONCLUSIONS: Icaritin has therapeutic potential against pulmonary fibrosis via the inhibition of myofibroblast differentiation, which may be mediated by PPARγ.

Dynamic characteristics of high-speed gasoline engine turbocharger based on thermo-elasto-hydrodynamic lubrication bearing model and flexible multibody dynamics method.

A flexible multibody dynamic calculation model based on thermo-elasto-hydrodynamic lubrication bearing model was established. This numerical simulation method provided a more realistic turbocharger calculation model and a more reliable theoretical support for studying the dynamic vibration characteristics of the floating ring bearing turbocharger system. In order to fully consider the dynamic characteristics of each component, the behavior of the floating ring bearing was described by generalized incompressible Reynolds equation in thermo-elasto-hydrodynamic lubrication model. The flexible body substructure models were established by the modal synthesis method. Based on this model, the direct mathematical model of the relationship between the eccentricity of the rotor and the oil film clearance on the turbocharger's surface vibration was established. The influence of eccentricity and oil film thickness on the surface vibration of the turbocharger body was calculated by transient dynamics method. The results showed that the eccentricity of the rotor and the vibration of turbocharger housing were monotonic functions, but the interaction between the whirl of internal and external oil films made the mechanism of the influence of the oil film thickness on the turbocharger body's vibration complicated. The research provided a new idea for the structural vibration and synchronous noise control of the supercharger.

The Effects of a Modified Mindfulness-Based Stress Reduction Program for Nurses: A Randomized Controlled Trial.

The purpose of the study was to evaluate the effects of a modified mindfulness-based stress reduction (MBSR) program on the levels of stress, affect, and resilience among nurses in general hospitals in mainland China. In addition, the study attempted to determine the impact of the program on job satisfaction. A total of 110 nurses were randomly assigned to the intervention versus control groups. The intervention group participated in a modified 8-week MBSR program. All participants were evaluated with questionnaires at baseline, immediately after the intervention, and 3 months later. The intervention group showed decreases in stress and negative affect and increases in positive affect and resilience after the intervention. No improvement in job satisfaction was observed, but the trends of the data were in the hypothesized direction that job satisfaction would improve. The modified MBSR program is an effective approach for nurses to decrease stress and negative affect and improve positive affect and resilience. In addition, the program has the potential to improve job satisfaction.

Self-care confidence mediates the relationship between type D personality and self-care adherence in chinese heart failure patients.

BACKGROUND: Existing theory and evidence suggest that self-care confidence may mediate the relationship between Type D personality and self-care adherence. OBJECTIVES: To assess the mediating role of self-care confidence between Type D personality and self-care adherence in Chinese HF patients. METHODS: This is a secondary analysis of a cross-sectional study. Self-care confidence and self-care adherence (maintenance) were measured by the subscales of the Self-Care of Heart Failure Index (v6). The Type D Scale-14 was administered to assess negative affect (NA), social inhibition (SI), and Type D personality. Mediation analysis based on Baron and Kenny was performed. RESULTS: A total of 127 HF patients were included. Self-care confidence partially mediated the relationship between Type D personality and self-care adherence but completely mediated the relationship between NA/SI and self-care adherence. CONCLUSIONS: Clinicians may effectively improve self-care adherence by enhancing self-care confidence in HF patients with Type D personality.

Effect of tiaozhi yanggan decoction in treating patients with non-alcoholic fatty liver.

OBJECTIVE: To observe the clinical efficacy and safety of Tiaozhi Yanggan Decoction (TZYGD) in treating non-alcoholic fatty liver. METHODS: One hundred and thirty-eight patients were enrolled and randomized into two groups according to the random number table in a ratio of 3:1, with 8 cases eventually dropping out. The symptoms, signs, liver function markers, blood lipids, iconographic indices and clinical comprehensive efficacy after a 12-week treatment course were assessed in 101 patients treated with TZYGD in the treated group and 29 patients treated with Thiola in the control group. RESULTS: The total effective rate in the treated group and the control group was 81.19% and 68.97%, respectively, showing a significant difference between the two groups with the former being significantly higher than the latter (P<0.05). Moreover, the improvements in the symptoms, signs, liver function, blood lipids and iconographic indices in the treated group were favorable with no serious adverse reactions. CONCLUSION: TZYGD is effective and highly safe in treating non-alcoholic fatty liver.

The challenges that head nurses confront on financial management today: A qualitative study.

AIM: To explore challenges that Chinese head nurses confront on financial management from the perspective of different levels of nursing and non-nursing managers and to provide contemporary nurse managers with suitable supports. METHODS: Eighteen nursing leaders in different levels were divided into two groups: Junior Leadership Group (head nurses) and Senior Leadership Group (nurse coordinator, nurse executive, and vice-president of the hospital). All the subjects were invited to participate in a semi-structured interview. The interviews were audio-taped and transcribed, and data were analyzed using a comparative content approach. RESULTS: The four following challenges that head nurses confront on financial management practice were identified from the research findings: 1) lack of intrinsic motivation; 2) insufficient training and education on financial management and nursing economics; 3) desires for cross-uniting communication and cooperation; 4) insufficient reference managerial tool. CONCLUSIONS: The confusion confronted by head nurses in Changsha include three aspects: managerial roles, managerial training, and managerial tools. Cooperative management model, evidence-based management training, and data-driven tools will contribute to improving the financial management capacity of nurse managers.