Determinants of sedentary behavior in community-dwelling older adults with type 2 diabetes based on the behavioral change wheel: a path analysis.

BACKGROUND: Sedentary behavior (SB) is deeply ingrained in the daily lives of community-dwelling older adults with type 2 diabetes mellitus (T2DM). However, the specific underlying mechanisms of the determinants associated with SB remain elusive. We aimed to explore the determinants of SB based on the behavior change wheel framework as well as a literature review. METHODS: This cross-sectional study recruited 489 community-dwelling older adults with T2DM in Jinan City, Shandong Province, China. Convenience sampling was used to select participants from relevant communities. This study used the Measure of Older Adults' Sedentary Time-T2DM, the Abbreviated-Neighborhood Environment Walkability Scale, the Social Support Rating Scale, the Lubben Social Network Scale 6, the Subjective Social Norms Questionnaire for Sedentary Behavior, the Functional Activities Questionnaire, the Numerical Rating Scale, the Short Physical Performance Battery, and the Montreal Cognitive Assessment Text to assess the levels of and the determinants of SB. Descriptive statistical analysis and path analysis were conducted to analyze and interpret the data. RESULTS: Pain, cognitive function, social isolation, and social support had direct and indirect effects on SB in community-dwelling older adults with T2DM (total effects: ß = 0.426, ß = -0.171, ß = -0.209, and ß = -0.128, respectively), and physical function, walking environment, and social function had direct effects on patients' SB (total effects: ß = -0.180, ß = -0.163, and ß = 0.127, respectively). All the above pathways were statistically significant (P < 0.05). The path analysis showed that the model had acceptable fit indices: RMSEA = 0.014, χ 2/df = 1.100, GFI = 0.999, AGFI = 0.980, NFI = 0.997, RFI = 0.954, IFI = 1.000, TLI = 0.996, CFI = 1.000. CONCLUSION: Capability (physical function, pain, and cognitive function), opportunity (social isolation, walking environment, and social support), and motivation (social function) were effective predictors of SB in community-dwelling older adults with T2DM. Deeper knowledge regarding these associations may help healthcare providers design targeted intervention strategies to decrease levels of SB in this specific population.

Digital Behavior Change Interventions to Reduce Sedentary Behavior and Promote Physical Activity in Adults with Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

BACKGROUND: Technological advancements and ease of Internet access have increased the number of digital behavior change interventions (DBCIs). This systematic review and meta-analysis aimed to assess the effectiveness of DBCIs in reducing sedentary behavior (SB) and promoting physical activity (PA) in adults with diabetes. METHODS: A comprehensive search of seven databases-PubMed, Embase, PsycINFO, Cochrane Library, CINAHL, Web of Science, and Sedentary Behavior Research Database-was performed. Two reviewers independently carried out the study selection, data extraction, risk of bias assessment, and quality of evidence evaluation. Meta-analyses were performed where feasible; otherwise, narrative summaries were performed. RESULTS: A total of 13 randomized controlled trials with 980 participants met the inclusion criteria. Overall, DBCIs could significantly increase steps and the number of breaks in sedentary time. The subgroup analyses exhibited significant effects in DBCIs with over 10 behavior change techniques (BCTs) in improving steps, the time spent in light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA). The subgroup analyses showed a significant step increment in DBCIs of moderate and long durations, with over 4 BCT clusters, or in conjunction with a face-to-face component. The subgroup analyses also indicated significant effects in studies with ≥ 2 DBCI components in improving steps, the time spent in LPA and MVPA, and reducing sedentary time. CONCLUSION: There is some evidence that DBCI may increase PA and reduce SB in adults with type 2 diabetes. However, more high-quality studies are required. Future studies are needed to examine the potential of DBCIs in adults with type 1 diabetes.

Evidence-based nursing outputs and hot spot analysis of the last 5 years in mainland China: Results of a bibliometric analysis.

BACKGROUND: Evidence-based nursing has been highlighted and highly developed in recent decades in mainland China. Nevertheless, little is known about its overall development. AIMS: To gain insights on the overall development of evidence-based nursing in the most recent 5 years and to inform future evidence-based nursing research in mainland China. METHOD: Four Chinese and four English databases were searched with the search terms "evidence-based practice," "nurse or nursing," and "China or Chinese" from 2012 to 2016. Bibliometric and co-word cluster analysis were conducted with the final included publications. RESULTS: A total of 9036 papers published by 13 808 authors in 606 journals were included. Publication numbers were increasing. None of the top ten journals publishing evidence-based nursing papers were core nursing journals. The research hot spots on evidence-based nursing in the recent five years were cardiovascular disease, mental health, and complication prevention. However, little attention has been paid to education for evidence-based nursing. CONCLUSION: Evidence-based nursing has penetrated into various nursing branches in mainland China and become a well-recognized and relatively mature research domain. More importance should be attached to the study design, methodological, and reporting quality of evidence-based nursing projects.

Scientific Collaboration in Chinese Nursing Research: A Social Network Analysis Study.

Collaboration has become very important in research and in technological progress. Coauthorship networks in different fields have been intensively studied as an important type of collaboration in recent years. Yet there are few published reports about collaboration in the field of nursing. This article aimed to reveal the status and identify the key features of collaboration in the field of nursing in China. Using data from the top 10 nursing journals in China from 2003 to 2013, we constructed a nursing scientific coauthorship network using social network analysis. We found that coauthorship was a common phenomenon in the Chinese nursing field. A coauthorship network with 228 subnetworks formed by 1428 nodes was constructed. The network was relatively loose, and most subnetworks were of small scales. Scholars from Shanghai and from military medical system were at the center of the Chinese nursing scientific coauthorship network. We identified the authors' positions and influences according to the research output and centralities of each author. We also analyzed the microstructure and the evolution over time of the maximum subnetwork.

Ozone response to precursors changes in the Chengdu-Chongqing economic circle, China, from satellite and ground-based observations.

Ozone (O3) pollution has become a noticeable problem in the Chengdu-Chongqing Economic Circle in China. The April-September MDA8 O3 level increases significantly by 2.26 µg m-3 year-1 from 2015 to 2023, with meteorological factors occupying merely 18 % in line with multivariate linear regression. To reveal the impact of anthropogenic emissions on O3 increase, O3 production sensitivity is accurately diagnosed by deriving localized thresholds for satellite formaldehyde (HCHO) to NO2 ratio and validated by in-situ measurements and observation-based model. Tracking volatile organic compounds (VOCs) and NOx through satellite HCHO and NO2, the O3 responses to precursor changes are assessed for long-term and special cases, and appropriate precursor reduction ratios are inferred. The results present that the transition range of satellite HCHO/NO2 from VOC-limited to NOx-limited in the region ranges from 2.7 to 4.3. The VOC-limited regime is concentrated in the urban areas of Chongqing and Chengdu as well as the central of the neighboring cities such as Deyang, Mianyang, and Meishan. The relative incremental reactivity from in-situ observations and box model at three sites in August 2019 demonstrates that O3 is most sensitive to anthropogenic VOC at urban and suburban sites, consistent with satellite results. Satellite and surface NO2 decrease at an annual rate of -2.1 % and - 2.9 % between 2015 and 2023, with larger decreases in Chengdu and Chongqing. In contrast, the trend of satellite HCHO is insignificant, indicating effective reduction in NOx but no significant reduction in VOC. This inappropriate reduction results in an increase in urban O3. The three short-term cases further validate the need for synergistic NOx and VOC reductions. Based on the relationship between O3 and satellite NO2 and HCHO, the minimum and optimal reduction ratios of VOC to NOx are 0.4:1 and 2.4:1 for the entire region, with higher ratios in Chengdu and Chongqing.

"All about the value?" Decisional needs of breast reconstruction for breast cancer patients in the Chinese context: A mixed-methods study.

OBJECTIVE: To explore breast cancer (BC) patients' participation in breast reconstruction (BR) decision-making and specific decisional needs, especially the manifestations and causes of decisional conflicts, in China. METHODS: A mixed-methods study was conducted using triangulation of data from interviews and a questionnaire survey with health care professionals (HCPs) and BC patients with BR decision-making experience at 5 Beijing centers. The Ottawa Decision Support Framework guided (ODSF) the qualitative and quantitative data analyses. RESULTS: A total of 82.53% of Chinese BC patients would consider BR. Seven themes captured patients' BR decisional needs per the ODSF: inadequate support/resources (100%, 58.82%) and knowledge (75%, 52.94%) were most frequently cited. Health beliefs (unclear values) reflected Chinese characteristics. Patients had inadequate knowledge (M=19.99/50, SD=8.67) but positive BR attitudes (M=59.48/95, SD=10.45). CONCLUSIONS: BR decisions for Chinese BC patients are complex and often accompanied by decisional conflicts. Inadequate knowledge and inadequate support and resources contribute to these conflicts, emphasizing the need for culturally tailored information and support to promote SDM. PRACTICE IMPLICATIONS: HCPs need specialized training in SDM to guide patients in decision-making. It is essential to provide relevant resources and support that are culturally and clinically appropriate for Chinese patients.

Composition and Sources of Organic Aerosol in Two Megacities in Western China Using Complementary Mass Spectrometric and Statistical Techniques.

Over 300 daily PM2.5 filter samples were collected in two western Chinese megacities, Xi'an and Chongqing, from October 2019 to May 2020. Their aqueous extracts were nebulized simultaneously to an aerosol mass spectrometer (AMS) and a recently developed extractive electrospray ionization (EESI) mass spectrometer, for bulk and near-molecular organic aerosol (OA) composition, respectively. Carbonate was quantified using EESI and a total organic carbon analyzer to separate inorganic carbon from dust. Via isotopically-labelled internal standards and positive matrix factorization, seven water-soluble sources were quantified separately using the AMS- and EESI-based analyses, with consistent types, concentrations, and correlations. These include dust, solid fuel combustion (SFC)-related, nitrogen- (and sulfur-) containing, summer/winter oxygenated OAs, and a cigarette-related OA only in EESI. When accounting for water-solubility, SFC-related OAs were the largest (53%) sources in Chongqing, while dust (consisting of 77% OA and 23% carbonates) was the largest (30%) source in Xi'an. Overall, this study presents one of the first times that complementary mass spectrometric techniques independently resolved consistent OA sources-with added chemical information-over multiple seasons and locations of complex pollution. The methods and quantified sources are essential for subsequent chemical, modelling, and health studies, and policy making for air pollution mitigation.

Substantial contribution of transported emissions to organic aerosol in Beijing.

Haze in Beijing is linked to atmospherically formed secondary organic aerosol, which has been shown to be particularly harmful to human health. However, the sources and formation pathways of these secondary aerosols remain largely unknown, hindering effective pollution mitigation. Here we have quantified the sources of organic aerosol via direct near-molecular observations in central Beijing. In winter, organic aerosol pollution arises mainly from fresh solid-fuel emissions and secondary organic aerosols originating from both solid-fuel combustion and aqueous processes, probably involving multiphase chemistry with aromatic compounds. The most severe haze is linked to secondary organic aerosols originating from solid-fuel combustion, transported from the Beijing-Tianjing-Hebei Plain and rural mountainous areas west of Beijing. In summer, the increased fraction of secondary organic aerosol is dominated by aromatic emissions from the Xi'an-Shanghai-Beijing region, while the contribution of biogenic emissions remains relatively small. Overall, we identify the main sources of secondary organic aerosol affecting Beijing, which clearly extend beyond the local emissions in Beijing. Our results suggest that targeting key organic precursor emission sectors regionally may be needed to effectively mitigate organic aerosol pollution.

Local incomplete combustion emissions define the PM2.5 oxidative potential in Northern India.

The oxidative potential (OP) of particulate matter (PM) is a major driver of PM-associated health effects. In India, the emission sources defining PM-OP, and their local/regional nature, are yet to be established. Here, to address this gap we determine the geographical origin, sources of PM, and its OP at five Indo-Gangetic Plain sites inside and outside Delhi. Our findings reveal that although uniformly high PM concentrations are recorded across the entire region, local emission sources and formation processes dominate PM pollution. Specifically, ammonium chloride, and organic aerosols (OA) from traffic exhaust, residential heating, and oxidation of unsaturated vapors from fossil fuels are the dominant PM sources inside Delhi. Ammonium sulfate and nitrate, and secondary OA from biomass burning vapors, are produced outside Delhi. Nevertheless, PM-OP is overwhelmingly driven by OA from incomplete combustion of biomass and fossil fuels, including traffic. These findings suggest that addressing local inefficient combustion processes can effectively mitigate PM health exposure in northern India.

Factors related to quality of life for patients with type 2 diabetes with or without depressive symptoms - results from a community-based study in China.

AIMS AND OBJECTIVES: To explore the factors related to quality of life for patients with type 2 diabetes with or without depressive symptoms in China. BACKGROUND: In patients with type 2 diabetes with or without depressive symptoms, different factors such as gender, social context or regional setting may affect their quality of life. DESIGN: This was a cross-sectional study. METHODS: Of 791 registered patients with type 2 diabetes from four communities in Beijing, cluster sampling was used to recruit patients for participation. Self-rating depression scale was used to screen for depressive symptoms; demographic and clinical data were collected, and quality of life and social support were assessed using appropriate tools. The factors associated with quality of life were tested using multivariate linear regression. RESULTS: The prevalence of depressive symptoms in 667 patients with diabetes was 44·2%. Quality of life of patients with depressive symptoms was worse than that of patients without depressive symptoms, and this was associated negatively with history of diabetic complications, usage of hypoglycaemic agents or insulin and self-rating depression scale scores and positively with salary and subjective social support. CONCLUSIONS: The factors related to quality of life for patients with or without depressive symptoms are different. For patients with depressive symptoms, better salary and subjective social support are associated positively with their quality of life, while the presence of diabetic complications, a higher score for depressive symptoms and need for hypoglycaemic agents or insulin are negatively associated with quality of life. RELEVANCE TO CLINICAL PRACTICE: It is suggested that the nurse should screen depression for patients with diabetes, especially for those with diabetic complications or low social support. This should be done in the community regularly in order to find diabetic patients with depression in time. In addition, the results can provide a reference to clinical nursing care for patients with diabetes in hospitals.

Chinese herbal medicine in treatment of polyhydramnios:a meta-analysis and systematic review.

OBJECTIVE: To compare the efficacy of Chinese herbal medicine (therapy A) or Chinese herbal medicine plus indomethacin (therapy B) with that of indomethacin alone (therapy C) in treating polyhydramnios. METHODS: Literatures published up to April 2012 were retrieved from PubMed, Embase and Cochrane library, Chinese National Knowledge Infrastructure (CNKI), Chinese Scientific and Technological Periodical Database (VIP), Wangfang, and Traditional Chinese Medicine online. Two researchers collected data independently. The assessment of methodological quality was based on Cochrane handbook and the materials were analyzed with software RevMan 5.1.2. The outcome measure index was relative risk or difference of mean value (95% confidence interval). The following outcomes were evaluated (1) general clinical improvement rate; (2) maximum vertical pocket depth; (3) amniotic fluid index (AFI) value; (4) rate of fetal ductus arteriosus constriction; (5) incidence of adverse events. RESULTS: Based on the search strategy, 5 trails involving 1017 patients were finally included. Compared with therapy C, therapy A decreased the rate of fetal ductus arteriosus constriction (P<0.01). Therapy B was more effective than therapy C in general clinical improvement and decrease of AFI for polyhydramnios (P<0.01). No serious adverse events were reported in therapy A and therapy B. CONCLUSIONS: Compared with therapy C, therapy A and therapy B may appear to be more effective for polyhydramnios. However, the exact effect needs to be confirmed with well-designed large-scale clinical trials.

A descriptive and comparative study from China on patients with type-2 diabetes with and without depressive symptoms.

The aim of this study was to assess the prevalence of depressive symptoms for patients with type-2 diabetes at the population level in China and explore differences in demographic, socioeconomic, and disease-specific parameters between diabetic patients with and without depression. Self-rating depression scale was used to screen for depressive symptoms in 667 patients with type-2 diabetes from 4 communities in Beijing; their quality of life and social support was assessed using appropriate and validated tools. The results indicate that 44.23% of diabetic patients report depressive symptoms; patients with depressive symptoms had a significantly higher rate of diabetic complications, a lower quality of life and less social support than patients without depressive symptoms.

Spatial and species-specific responses of biogenic volatile organic compound (BVOC) emissions to elevated ozone from 2014-2020 in China.

China suffered from serious and elevated ozone (O3) pollution during 2014-2020. O3 exposure increased with W126, a biologically based cumulative exposure index, at a rate of 1.738 ppm-hr yr-1. MEGAN3.1 was applied to estimate biogenic volatile organic compound (BVOC) emissions and their response to O3 pollution in China by quantifying species responses to O3 stress. In 2020, China's BVOC emissions were 23.26 Tg when considering the effects of O3 pollution, which was 1.7 % higher than that without O3 stress. Isoprene, monoterpenes, sesquiterpenes, and other VOC emissions changed by -1.0 %, 1.4 %, 15.5 %, and 2.7 %, respectively. The stimulated BVOC emissions were mainly focused on the North China Plain (NCP) and a partial area of the Tibetan Plateau, which increased by >45 %. Changes in monthly emissions differed, with the greatest increase, 181 tons (3.25 %), in August. The seasonal patterns for the impacts of O3 pollution were also distinguished spatially. The elevated O3 exposure caused BVOC emission increases of 104.7 Gg yr-1 during 2014-2020, with isoprene, monoterpenes, sesquiterpenes, and other VOCs contributing -18.6 %, 27.5 %, 40.4 %, and 50.8 %, respectively. The greatest increase in emissions appeared on the NCP and eastern and central China, with annual increases of >100 tons per grid (36 km × 36 km). The interannual variations in BVOC emissions also displayed different seasonal patterns.

Cultural adaptation of the Pan-Canadian Oncology Symptom triage and remote support practice guide for cancer-related fatigue in China: Integration of traditional Chinese medicine nursing evidence.

Objective: This study aimed at culturally adapting pan-Canadian Oncology Symptom Triage and Remote Support (COSTaRS) Cancer-related fatigue (CRF) Practice Guide to enable its use in China. This article focuses on presenting the key cultural adaptation step: supplementing traditional Chinese medicine (TCM) nursing recommendations for CRF symptom management according to evidence. Methods: Guided by A Guideline Adaptation and Implementation Planning Resource (CAN-IMPLEMENT), the process for cultural adaptation of the CRF guide in the COSTaRS project included translation, expert committee review, acceptability and feasibility assessment, and targeted adaptation to include TCM nursing techniques for CRF management via the Delphi method. Results: First, an expert committee of nurses, nurse leaders, and researchers was established. The practice guide was translated and verified by the members of the expert committee. Nurses then rated the practice guide for acceptability and feasibility. Concurrently, 83 stakeholders (nurses and patients) identified five relevant TCM nursing techniques: acupuncture, moxibustion, acupressure therapy, Taijiquan, and auricular acupoint embedding. A systematic review of literature identified three clinical practice guidelines and four systematic reviews. Through two rounds of Delphi expert consultation, five TCM care strategies were added into the culturally adapted COSTaRS practice guide. Conclusions: Cultural adaptation of the Canadian CRF practice guide involved not only language translation but also the addition of relevant TCM evidence. Combining TCM evidence and the Delphi method was a novel aspect of the cultural adaptation process. Further research is needed to investigate the implementation of the guide in appropriate settings in China.

Shared decision-making in healthcare in mainland China: a scoping review.

Background: Shared decision-making (SDM) facilitates the participation of healthcare professionals and patients in treatment decisions. We conducted a scoping review to assess SDM's current status in mainland China, referencing the Ottawa Decision Support Framework (ODSF). Methods: Our review encompassed extensive searches across six English and four Chinese databases, and various gray literature until April 30, 2021. Results were synthesized using thematic analysis. Results: Out of the 60 included studies, we identified three key themes based on the ODSF framework: decisional needs, decision support, and decisional outcomes. However, there appears to be a lack of comprehensive understanding of concepts related to decisional needs in China. Only a few studies have delved into feasibility, preference, choice, and outcome factors in the SDM process. Another challenge emerges from an absence of uniform standards for developing patient decision aids (PDAs). Furthermore, regarding health outcome indicators, their predominant focus remains on physiological needs. Conclusion: SDM is in its infancy in mainland China. It is important to explore the concept and expression of decisional needs in the context of Chinese culture. Subsequent studies should focus on constructing a scientifically rigorous and systematic approach for the development of PDAs, and considering the adaptation of SDM steps to the clinical context in China during SDM implementation. Concurrently, The focus on health outcomes in Chinese SDM studies, driven by the unique healthcare resource landscape, underscores the necessity of prioritizing basic needs within limited resources. Systematic review registration: https://inplasy.com/?s=202130021.

VOC species controlling O3 formation in ambient air and their sources in Kaifeng, China.

The concentration of ozone has been in a rising crescendo in the last decade while the fine particles (PM2.5) is gradually decreasing but still at a high level in central China. Volatile organic compounds (VOCs) are the vital precursors of ozone and PM2.5. A total of 101 VOC species were measured in four seasons at five sites from 2019 to 2021 in Kaifeng. VOC sources and geographic origin of sources were identified by the positive matrix factorization (PMF) model and the hybrid single-particle Lagrangian integrated trajectory transport model. The source-specific OH loss rates (LOH) and ozone formation potential (OFP) were calculated to estimate the effects of each VOC source. The average mixing ratios of total VOCs (TVOC) were 43.15 parts per billion (ppb), of which the alkanes, alkenes, aromatics, halocarbons, and oxygenated VOCs respectively accounted for 49%, 12%, 11%, 14%, and 14%. Although the mixing ratios of alkenes were comparatively low, they played a dominant role in the LOH and OFP, especially ethene (0.55 s-1, 7%; 27.11 µg/m3, 10%) and 1,3-butadiene (0.74 s-1, 10%; 12.52 µg/m3, 5%). The vehicle-related source which emitted considerable alkenes ranked as the foremost contributing factor (21%). Biomass burning was probably influenced by other cities in the western and southern Henan and other provinces, Shandong and Hebei.

Characterizing the sources of ambient PM10 organic aerosol in urban and rural Catalonia, Spain.

Organic aerosols (OA) have recently been shown to be the dominant contributor to the oxidative potential of airborne particulate matter in northeastern Spain. We collected PM10 filter samples every fourth day from January 2017 to March 2018 at two sampling stations located in Barcelona city and Montseny Natural Park, representing urban and rural areas, respectively. The chemical composition of PM10 was analyzed offline using a broad set of analytical instruments, including high-resolution time-of-flight mass spectrometry (HR-ToF-AMS), a total organic carbon analyzer (TCA), inductively coupled plasma atomic emission spectrometry (ICP-AES), inductively coupled plasma mass spectrometry (ICP-MS), ion chromatography (IC), and thermal-optical carbon analyzer. Source apportionment analysis of the water-soluble organic content of the samples measured via HR-ToF-AMS revealed two primary and two secondary sources of OA, which included biomass-burning OA (BBOA), sulfur-containing OA (SCOA), as well as summer- and winter­oxygenated OA (SOOA and WOOA). The presence of hydrocarbon-like water-insoluble OA was also identified based on concentration trends in black carbon and nitrogen oxides. The results from the source apportionment analysis of the inorganic composition were correlated with different OA factors to assess potential source contributors. Barcelona showed significantly higher average water-soluble OA concentrations (5.63 ± 0.56 µg m-3) than Montseny (3.27 ± 0.37 µg m-3) over the sampling period. WOOA accounted for nearly 27 % of the averaged OA in Barcelona compared to only 7 % in Montseny. In contrast, SOOA had a greater contribution to OA in Montseny (47 %) than in Barcelona (24 %). SCOA and BBOA were responsible for 15-28 % of the OA at both sites. There were also seasonal variations in the relative contributions of different OA sources. Our overall results showed that local anthropogenic sources were primarily responsible for up to 70 % of ambient soluble OA in Barcelona, and regulating local-scale emissions could significantly improve air quality in urban Spain.

[Qualitative research of the elderly real experience of long-term adherence to Tai Chi exercise].

OBJECTIVE: To explore the experience of the process of Tai Chi exercise. METHODS: The study was conducted in a local park in Beijing of China where varying numbers of community members gathered to practice Tai Chi every day. Volunteers meeting the inclusion and exclusion criteria were recruited after signed an informed consent form. In-depth interview and the participatory observation were used to know of the real feeling of practicing Tai Chi. The qualitative data obtained from the interviews were analyzed by using Colaizzi seven-step method to find the subjects. RESULTS: Six volunteers having a long-time Tai Chi exercise were recruited in this qualitative study, and their real experience was summarized in the physiological level, psychological level, social level and cultural level. In the physiological level, Tai Chi improves the health and exercise of Tai Chi assists the elderly to develop good living habits. In the psychological level, Tai Chi practice guides the person to inner peace, relieves tension, improves depressive mood state, and makes the elderly regain self worth. In the social level Tai Chi is a good form of community practice. In the cultural level, Tai Chi roots in yin and yang culture and integrates internal and external exercises. CONCLUSION: Tai Chi is good for body and mind health and the community of practice is very important for practitioners. Tai Chi gains popularity for its benefits to health and psychological adjustments, and its cultural connotation.

Implementation strategies to improve evidence-based practice for post-stroke dysphagia identification and management: A before-and-after study.

Objectives: Even though guidelines are available to guide dysphagia identification and management practice, there is still a gap between evidence and practice, which requires improvement. The purpose of this study was to determine the effect of using tailored, multifaceted strategies to improve evidence-based post-stroke dysphagia identification and management practice in a community hospital. Methods: Guided by the Knowledge to Action framework, the tailored, multifaceted strategies were developed and implemented for 5 months in a community hospital using a before-and-after study design. These strategies consisted of training intervention, policy intervention, and audit and feedback intervention. Nurses' level of knowledge and adherence, were collected in March 2019 and again in January 2020. Patients' quality of life and satisfaction were evaluated during the pre-intervention period (between February 2019 and April 2019) and the post-intervention period (between November 2019 and January 2020). Results: A total of 55 patients with post-stroke dysphagia (28 in the pre-intervention period and 27 in the post-intervention period) and 17 registered nurses were recruited. Following implementation, there were statistically significant improvements in patients' outcomes (quality of life and satisfaction) and nurses' outcomes (level of knowledge and adherence). Conclusions: This study assists in closing the research-practice gap by using tailored, multifaceted strategies to increase the use of evidence-based nursing care for dysphagia identification and management practices.

Unfolding and characterizing the barriers and facilitators of scaling-up evidence-based interventions from the stakeholders' perspective: a concept mapping approach.

INTRODUCTION AND AIMS: Much attention has been paid to scaling-up evidence-based interventions (EBIs) in previous implementation science studies. However, there is limited research on how stakeholders perceive factors of the scaling-up of EBIs. This study aimed to identify the barriers and facilitators of scaling-up the nurse-led evidence-based practice of post-stroke dysphagia identification and management (EBP-PSDIM) from the stakeholders' perspective, and to assess their importance and feasibility. METHODS: This study was conducted using concept mapping. Through purposive sampling, 18 stakeholders were recruited for brainstorming in which they responded to the focus prompt. Here, statements regarding perceived barriers and facilitators to EBI scaling-up were elicited and then sorted by similarity before being rated based on the importance and feasibility. Cluster analysis, multidimensional scaling, and descriptive statistics were utilized to analyze the data. RESULTS: Ultimately, 61 statements perceived to influence the scaling-up were grouped into four primary clusters, that is, community-related factors, resource team-related factors, evidence-based practice program-related factors, and scaling-up strategy-related factors. The 'perceived needs of the community' was rated as the most important and feasible factor to address, whereas 'costs/resource mobilization' was rated as the least important and feasible one. CONCLUSION: From the stakeholders' perspective, factors involved in the EBP-PSDIM program scaling-up were initially validated as being multidimensional and conceptually distinct;The importance and feasibility ratings of the barriers and facilitators could be used to help decision-makers to prioritize the most appropriate factors to be considered when developing implementation strategies.