The training effects of a continuing education program on nurses' knowledge and attitudes to palliative care: a cross sectional study.

BACKGROUND: Most nurses in China have not been trained to take care of end-of-life patients appropriately due to lack of educational resources and insufficient training. A palliative care program was launched by the Jiangsu Nursing Association (JNA training program) and to identify gaps in palliative care training. The main aim of this study was to evaluate the training effects of the JNA training program on nurses' knowledge and attitudes to palliative care. METHODS: A cross-sectional study was conducted with 10 048 registered nurses in all regions of Jiangsu. All participants completed an online questionnaire using the Chinese version of The Palliative Care Quiz for Nursing (PCQN-C) and the Frommelt Attitude Toward Care of the Dying scale (FATCOD-B-C). A propensity score matched analysis was performed between the nurses who had attended the JNA training program and whose who hadn't. RESULTS: The average score of PCQN-C among all nurses was 8.79, while the mean score of the FATCOD-B-C was 103.62. Those participants who attended the JNA training program had significantly better scores than those who did not. Propensity score matching analysis showed that the palliative care training program failed to improve nurses' knowledge in psychosocial and spiritual care or their attitudes towards the necessity of family support although there was positive impact on other aspects of palliative care. CONCLUSIONS: Knowledge of palliative care among Chinese nurses remains low. Training programs may improve general knowledge and attitudes to palliative care. However, important aspects of knowledge such as communication skills, family support, and psychosocial aspects of care, are missing. These gaps should be filled in future palliative care training programs targeting nurses with oriental culture background.

Effects of a home care mobile app on the outcomes of discharged patients with a stoma: A randomised controlled trial.

AIMS AND OBJECTIVES: To explore the effects of a home care mobile app on the outcomes of stoma patients who discharged from hospital. BACKGROUND: Patients with a newly formed stoma experience many difficulties after surgery. Mobile application (app) has the potential to help patients self-manage their diseases and adjust to the changes in their lives and is a convenient way to ensure the continuity of care. However, there is a lack of studies about the effects of a mobile app on the transitional care for improving discharged stoma-related health outcomes. DESIGN: A randomised controlled trial. METHODS: A total of 203 patients with a permanent stoma in tertiary hospitals in China were randomly assigned into two groups. Patients in the control group (n = 103) received routine discharge care. Patients in the intervention group (n = 100) received home care via a mobile app besides routine care. The psychosocial adjustment level, self-efficacy scale and stoma complications incidence were measured in the follow-up period and compared between the two groups. Data were collected at four time points: before intervention (baseline), at 1, 3 and 6 months after discharge. RESULTS: The psychosocial adjustment level and stoma self-efficacy score of the intervention group were significantly higher than those of the control group, respectively, at 1-, 3- and 6-month follow-up (all p < 0.05). The incidence of stoma complications in the intervention group was tending to reduce at 1, 3 and 6 months after discharge. CONCLUSION: The findings indicated that follow-up care at home via a mobile app can effectively improve the psychosocial adjustment level, self-efficacy scale and other related outcomes of stoma patients. RELEVANCE TO CLINICAL PRACTICE: The home care mobile app is an effective intervention to support the psychosocial adjustment and self-efficacy of stoma patients after discharge. It ensures the continuity of care and provides nursing guidance for the patients timely.

Association between ORMDL3 polymorphism and susceptibility to asthma: a meta-analysis.

The aim of this study was to determine whether orosomucoid1- like 3 (ORMDL3) single nucleotide polymorphisms rs7216389, rs11650680, rs12603332 are associated with susceptibility to asthma. We performed a meta-analysis by searching PubMed, EMBASE, Elsevier and Wanfang Databases. Odds ratios (ORs) with 95% confidence intervals (CIs) were used to evaluate the strength of associations. We examined the association between the three SNPs and asthma risk in four genetic models (TT + TC vs. CC, TC vs. CC, TT vs. CC, TT vs. TC + CC). Thirteen published case-control studies involving 6462 cases and 7357 controls were included. Our meta-analysis indicated that rs7216389 was significantly associated with increased asthma risk in overall population. Subgroup analysis by age indicated significant association between the rs7216389 and asthma in children. Moreover, ORMDL3 rs11650680 was significantly associated with decreased asthma risk in dominant model (TT + TC vs. CC), and rs12603332 was significantly associated with decreased asthma risk in 3 models (TT + TC vs. CC, TC vs. CC and TT vs. CC). To Conclude, ORMDL3 rs7216389 polymorphism is associated with susceptibility to asthma. Children with variant T allele (TT or TC) and adults with TT homozygote in rs7216389 are at high risks to suffer from asthma. However, people with T allele in rs11650680 or rs12603332 are protected from asthma.

Epithelial interleukin-25 is a key mediator in Th2-high, corticosteroid-responsive asthma.

RATIONALE: Activation of type 2 cytokine pathways plays a central role in a large subset of subjects with asthma. Th2-high and Th2-low asthma have distinct clinical, pathologic, and molecular phenotypes and respond differently to therapy. The factors that initiate type 2 responses in some subjects with asthma are unknown. OBJECTIVES: To determine whether expression of epithelial cytokines IL-25, IL-33, and thymic stromal lymphopoietin are associated with type 2 responses and predict response to inhaled corticosteroid (ICS) in asthma. METHODS: We analyzed pulmonary function tests, blood, and bronchoscopic biopsies from 21 healthy control subjects and 43 subjects with asthma. Subjects with asthma underwent an 8-week treatment with inhaled budesonide. MEASUREMENTS AND MAIN RESULTS: Epithelial expression of IL-25, but not IL-33 or thymic stromal lymphopoietin, was increased in a subset of subjects with asthma. The IL-25-high subset had greater airway hyperresponsiveness, more airway and blood eosinophils, higher serum IgE, more subepithelial thickening, and higher expression of Th2 signature genes. ICS improved FEV1 and hyperresponsiveness in the IL-25-high but not the IL-25-low subset. Plasma IL-25 levels correlated with epithelial IL-25 expression, airway eosinophilia, and beneficial responses to ICS treatment. CONCLUSIONS: IL-25 measurements identify two subsets of subjects with distinct asthma phenotypes and different responses to ICS. Because IL-25 has a major role in triggering type 2 responses, bronchial epithelial IL-25 expression is likely a key determinant of type 2 response activation in asthma. Plasma IL-25 level reflects airway IL-25/type 2 response activation and may be useful for predicting responses to asthma therapy.

A meta-analysis of P2X7 gene-762T/C polymorphism and pulmonary tuberculosis susceptibility.

AIM: We performed a comprehensive meta-analysis to determine the association between P2X7 -762T/C polymorphism and pulmonary tuberculosis susceptibility. METHODOLOGY: Based on comprehensive searches of the PubMed, SCI, Elsevier, China National Knowledge Infrastructure (CNKI) and Wanfang Database, we identified eligible studies about the association between P2X7 -762T/C polymorphism and pulmonary tuberculosis risk. Pooled odds ratio (ORs) and 95% confidence intervals (95%CIs) were calculated in random-effects model. RESULTS: A total of 2207 tuberculosis cases and 2220 controls in 8 case-control studies were included in this meta-analysis. Allele model (C vs. T: p = 0.15; OR = 0.83, 95% CI = 0.65-1.07), homozygous model (CC vs. TT: p = 0.23; OR = 0.73, 95% CI = 0.44 to 1.22), and heterozygous model (CT vs. TT: p = 0.57; OR = 0.92, 95% CI = 0.68 to 1.24) did not show increased risk of developing pulmonary tuberculosis. Similarly, dominant model (CC+CT vs. TT: p = 0.32; OR = 0.84, 95% CI = 0.59 to 1.19) and recessive model (CC vs. CT+TT: p = 0.08; OR = 0.77, 95% CI = 0.57 to 1.04) failed to show increased risk of developing pulmonary tuberculosis. Subgroup analysis by ethnicity did not detect any significant association between P2X7-762T/C polymorphism and pulmonary tuberculosis susceptibility. CONCLUSIONS: P2X7 -762T/C gene polymorphism is not associated with pulmonary tuberculosis susceptibility.

The value of early diagnostic screens for the diagnosis of influenza A, B and Mycoplasma pneumoniae infections.

BACKGROUND: Rapid diagnosis of influenza virus and Mycoplasma pneumoniae infections is of importance for therapeutic intervention. It was the aim of the study to evaluate screening tests for influenza A (Flu A), B (Flu B), and Mycoplasma pneumoniae (M. pneumoniae) infections in young patients admitted to the hospital. METHODS: 522 children and juvenile patients were admitted to the hospital because of symptoms suspecting Flu A, B or M. pneumoniae infections. Gold Immunochromatography Assays were used to screen for Flu A and Flu B and rapid identification culturing with subsequent polymerase chain reaction (PCR) was carried out at admission for identification of M. pneumoniae infections. Diagnoses were based upon seroconversion during the clinical course. RESULTS: In the current study, 26% of 522 patients were shown to be infected with Flu A and 77% had positive screens using the Gold Immunochromatography Assays. 19% of 522 patients were infected with Flu B as diagnosed by seroconversion and 89% were detected by the screen. The rapid identification culture showed that 169 of 522 patients were M. pneumoniae positive. The positive samples based on rapid identification showed negative and poor concordance with PCR tests. The consistency test between the two screening methods mentioned above showed higher kappa value in the children group than infant group. CONCLUSIONS: The results are in agreement with literature and indicate that in juvenile patients and children the screening efficiency was limited. PCR assays may be applied prior to evaluation of antibody titres in the case of M. pneumoniae infections confirming previous results. The pronounced effect of age on the outcome has to be taken into account for evaluation of the screening methods.