The experiences of nursing students participating in a student death doula service-learning program in palliative care settings: A qualitative study.

Nursing students desire more training and experience in palliative care due to a need for more skills and knowledge. This descriptive qualitative study explored nursing students' experiences in participating in a student death doula service-learning program in palliative care settings. Fourteen final-year undergraduate nursing students participated in semi-structured focus group discussions via Zoom. Four focus group discussions were conducted. Six themes with 19 subthemes were developed: (1) initial feelings of fear and uncertainty, (2) death doula training and orientation, (3) palliative wards being a happier place than expected, (4) experience of watching their patients deteriorate over time, (5) benefits of participating in service-learning in palliative care settings, and (6) improving the service-learning experience. The program was well received by the nursing students, who recommended incorporating it into the nursing curriculum to enhance palliative nursing education. Additional refinements were proposed to better support nursing students during service-learning.

Dance Exergames for Older Adults: A Systematic Review and Meta-Analysis With Narrative Synthesis.

BACKGROUND: A systematic review and meta-analysis with narrative synthesis was conducted to evaluate the impact of dance exergaming on older adults' health-related outcomes and its feasibility, usability, and safety. METHODS: PubMed, Scopus, CINAHL, Web of Science, The Cochrane Library, ProQuest Dissertations and Theses Global, and Google Scholar were searched from inception to December 7, 2023. Interventional studies using immersive or nonimmersive virtual reality platforms conducted on older adults ≥60 years old were eligible. Meta-analysis was conducted using the random effects model by pooling mean differences (MD) or standardized mean differences. Outcomes were narratively synthesized when meta-analysis was not possible. RESULTS: Forty-three articles from 37 studies were included (n = 1 139 participants at baseline). Postintervention, dynamic balance measured using Berg Balance Scale (pooled MD = 2.65, 95% CI: 1.73-3.57, p < .0001), Timed-Up-and-Go times (pooled MD = -1.04, 95% CI: -2.06 to -0.03, p = .04), choice stepping reaction time (pooled MD = -92.48, 95% CI: -167.30 to -17.67, p = .02), and movement time (pooled MD = -50.33, 95% CI: -83.34 to -17.33, p = .003) were significantly better in the experimental group compared to the control group. Adherence ranged from 76.5% to 100%, whereas attrition ranged from 9.1% to 31.9%. Most participants completed the intervention with no or minimal adverse effects. CONCLUSIONS: Dance exergames are effective, feasible, usable, and safe for older adults. Further research is needed as the findings were limited by small sample sizes. Many studies could not be included in the meta-analysis as outcomes were too varied.

Experiences of older adults participating in dance exergames: A systematic review and meta-synthesis.

BACKGROUND: Interventions to encourage adequate physical activity amongst older adults have had limited long-term success. Dancing and exergames, two beneficial and enjoyable physical activities for older adults, may make regular exercise more interesting and effective. Dance exergames are physical exercises that integrate sensory, cognitive, psychological, and physical functions by requiring users to interact with game scenarios through deliberate body motions and receive real-time feedback. They provide an inherently enjoyable gaming and workout experience, which may boost exercise adherence. However, little is known about older adults' experiences with dance exergames. OBJECTIVE: To synthesise the qualitative experiences of older adults participating in dance exergames. DESIGN: Systematic review and meta-synthesis. METHODS: Dance exergame studies (peer-reviewed and grey literature) involving older adults in any setting published in English from inception to 17 August 2023 were included. Qualitative or mixed-method studies must use immersive or non-immersive virtual-reality platforms. PubMed, Scopus, CINAHL, The Cochrane Library, ProQuest Dissertations & Theses Global, Google Scholar, and reference lists of relevant studies and reviews were searched for eligible studies. The search strategy for Scopus was: (TITLE-ABS-KEY (danc*) AND TITLE-ABS-KEY (exergames OR exergame OR video AND games OR virtual AND reality) AND TITLE-ABS-KEY (older AND adults OR elderly OR seniors OR geriatrics)). Thematic synthesis by Thomas and Harden was used for meta-synthesis. RESULTS: Eleven studies (n = 200 older adults) were included. Three themes and 14 subthemes were synthesised: 1) Dance exergames as dual-task training for physical, cognitive, and psychological well-being, 2) Concerns on usability issues, and 3) Possible enhancements of dance exergames. Older adults recognised that dance exergames could improve their physical, cognitive, and psychological well-being. Existing dance exergame systems had several usability issues. For example, some older adults were unfamiliar with using new technology and had trouble in navigating the game systems. The older adults also provided various suggestions for adaptation to their age group, such as ensuring a variety of dances, difficulty levels suited for older adults' cultural backgrounds, and physical and cognitive capabilities. CONCLUSIONS: Dance exergames may be an attractive way to encourage older adults to exercise, but appropriate modifications are needed. When designing/selecting dance exergames for older persons, researchers, healthcare professionals, and senior care centres should consider using exergames that have simple designs, varied dances that are locally adapted, and appeal to a large proportion of older adults. REGISTRATION: PROSPERO CRD42023395709.

Palliative prognostic scores for survival prediction of cancer patients: a systematic review and meta-analysis.

BACKGROUND: The Palliative Prognostic Score (PaP) is the most widely validated prognostic tool for cancer survival prediction, with modified versions available. A systematic evaluation of PaP tools is lacking. This systematic review and meta-analysis aimed to evaluate the performance and prognostic utility of PaP, Delirium-PaP (D-PaP), and PaP without clinician prediction in predicting 30-day survival of cancer patients and compare their performance. METHODS: Six databases were searched for peer-reviewed studies and grey literature published from inception till 2/6/2023. English studies must assess PaP, D-PaP, or PaP without clinician predicted survival for 30-day survival in adults ≥18 years old with any stage or type of cancer. Outcomes were pooled using the random effects model or summarised narratively when meta-analysis was not possible. RESULTS: Thirty-nine studies (n = 10,617 patients) were included. PaP is an accurate prognostic tool (pooled AUC = 0.82, 95% CI 0.79-0.84) and outperforms PaP without clinician predicted survival (pooled AUC = 0.74, 95% CI 0.71-0.78), suggesting that the original PaP should be preferred. The meta-analysis found PaP and D-PaP performance to be comparable. Most studies reported survival probabilities corresponding to the PaP risk groups, and higher risk groups were significantly associated with shorter survival. CONCLUSIONS: PaP is a validated prognostic tool for cancer patients that can enhance clinicians' confidence and accuracy in predicting survival. Future studies should investigate if accuracy differs depending on clinician characteristics. Reporting of validation studies must be improved, as most studies were at high risk of bias, primarily because calibration was not assessed.

Nursing students' perspectives and learning experiences of participating in a palliative and end-of-life care simulation programme: A qualitative study.

BACKGROUND: Simulation-based learning has become an integral part of the nursing curriculum, allowing students to acquire clinical knowledge and relevant skills and apply them to real-life clinical encounters. However, little is known about the best practices in palliative and end-of-life care simulations. OBJECTIVE: To explore the perspectives and learning experiences of undergraduate nursing students participating in a newly developed advanced practice nurse-led palliative and end-of-life care simulation program. DESIGN: A descriptive qualitative study based on focus group discussions. SETTINGS: A healthcare simulation centre at a university in Singapore. PARTICIPANTS: A purposive sample of 75 third-year undergraduate nursing students who had attended a palliative and end-of-life care simulation program. METHODS: Eight face-to-face focus group discussions were conducted and audio recorded. Data were analysed using inductive thematic analysis. RESULTS: Four themes encompassing 12 subthemes were derived: (1) Patient, family and caregiver needs during palliative and end-of-life care, (2) Nursing competencies in palliative and end-of-life care, (3) Experience of palliative and end-of-life care simulations and (4) Suggestions for future palliative and end-of-life simulations. The students expressed their support for including advanced practice nurses as facilitators and suggested the use of other simulation modalities such as virtual simulations to enable the participation of all students and provide a wider range of simulated scenarios. CONCLUSIONS: Simulation-based learning plays a crucial role in the palliative care curriculum. Clinical experts should be involved as facilitators to provide essential insights. It is also vital to consider students' prior experiences with death and dying, which may positively or negatively influence their palliative and end-of-life care competencies. RECOMMENDATIONS: Nursing schools should utilise clinical experts and other simulation modalities to improve students' learning experiences, provide more simulation experiences and overcome resource constraints such as limited curriculum time.

Identification of biomarkers for the early detection of non-small cell lung cancer: a systematic review and meta-analysis.

Lung cancer (LC) causes few symptoms in the earliest stages, leading to one of the highest mortality rates among cancers. Low-dose computerised tomography (LDCT) is used to screen high-risk individuals, reducing the mortality rate by 20%. However, LDCT results in a high number of false positives and is associated with unnecessary follow-up and cost. Biomarkers with high sensitivities and specificities could assist in the early detection of LC, especially in patients with high-risk features. Carcinoembryonic antigen (CEA), cytokeratin 19 fragments and cancer antigen 125 have been found to be highly expressed during the later stages of LC but have low sensitivity in the earliest stages. We determined the best biomarkers for the early diagnosis of LC, using a systematic review of eight databases. We identified 98 articles that focussed on the identification and assessment of diagnostic biomarkers and achieved a pooled area under curve of 0.85 (95% CI 0.82-0.088), indicating that the diagnostic performance of these biomarkers when combined was excellent. Of the studies, 30 focussed on single/antigen panels, 22 on autoantibodies, 31 on miRNA and RNA panels, and 15 suggested the use of circulating DNA combined with CEA or neuron-specific enolase (NSE) for early LC detection. Verification of blood biomarkers with high sensitivities (Ciz1, exoGCC2, ITGA2B), high specificities (CYFR21-1, antiHE4, OPNV) or both (HSP90α, CEA) along with miR-15b and miR-27b/miR-21 from sputum may improve early LC detection. Further assessment is needed using appropriate sample sizes, control groups that include patients with non-malignant conditions, and standardised cut-off levels for each biomarker.

The quality of verbal feedback given by nursing near-peer tutors: A qualitative study.

BACKGROUND: Students' acceptance of peer feedback (PF) in health professions education has been mixed because of doubts about its quality and accuracy. Providing peer tutor (PT) training in giving effective feedback may increase the quality of PF. OBJECTIVES: To analyse the (1) quality and (2) accuracy of near-PF provided to first-year nursing students after simulated practice and (3) evaluate the discrepancies between what faculty, PTs and clinical staff teach about certain nursing skills by analysing PT-student feedback discussions. DESIGN: Qualitative study using content analysis. SETTINGS: This study was conducted in a simulation centre in a Singapore university during first-year undergraduate nursing students' laboratory lessons. PARTICIPANTS: Near-PT (second- to fourth-year undergraduate nursing students). METHODS: Near-PTs received virtual training on providing structured feedback. They provided in-person PF to first-year nursing students after simulated practice of a technical nursing skill. PF was audio recorded. Quality was determined by PTs' adherence to the proposed PF structure and the Debriefing Assessment for Simulation in Healthcare-Rater Version Short Form (DASH-RV-Short) scores. Directed content analyses were also conducted to qualitatively evaluate PF quality based on DASH-RV-Short, PF accuracy and discrepancies in content taught for each nursing skill. RESULTS: Most PTs evaluated the skill chronologically or focused on the mistakes made instead of following the PF structure. DASH-RV-Short scores were 'good' for most elements because PTs gave specific suggestions and justified them, ensured students' psychological safety, and used effective verbal communication. PF was mostly accurate, but expectations relating to each nursing skill differed among the PTs, faculty and clinical staff. CONCLUSIONS: With training, senior nursing students can provide specific and detailed feedback to their juniors, which may fill the gap for timely and specific feedback in health professions education. Future PT training programmes should clarify common variations and mistakes in skills performance to ensure PTs and faculty tutors agree on what students should learn.

Using palliative and end-of-life simulation to enhance pre-licensure nursing students' emotional intelligence, palliative care knowledge and reflective abilities: A single group, pretest-posttest study.

BACKGROUND: Nursing students have reported that they lack skills and knowledge in palliative and end-of-life care, and as a result, they faced numerous challenges caring for patients and families receiving palliative and end-of-life care during clinical attachments. OBJECTIVES: To develop a palliative and end-of-life care simulation program and evaluate its effects on nursing students' emotional intelligence, palliative care knowledge and reflective abilities. DESIGN: A single group, pretest-posttest quasi-experimental study. SETTINGS: A simulation center in a Singapore university. PARTICIPANTS: A convenience sample of 135 third-year undergraduate nursing students. METHODS: Students attended a two-day simulation program consisting of four scenarios in total. Outcomes were measured before and after the study. Palliative care knowledge was measured using the Palliative Care Knowledge Test, emotional intelligence using the Trait Meta-Mood Scale-24, and reflective abilities using the Groningen Reflective Ability Scale. Outcome and demographic data were analyzed using descriptive and inferential statistics. RESULTS: Total Palliative Care Knowledge Test scores (p = 0.003) and total Trait Meta-Mood Scale-24 scores (p < 0.001) improved significantly, but there was no significant change in Groningen Reflective Ability Scale scores (p = 0.650). Demographic characteristics did not significantly influence most outcome variables. Students' highest education level and experience with caring for a person receiving palliative or end-of-life care significantly affected the posttest scores of the Palliative Care Knowledge Test. Students with prior experience in caring for a person receiving palliative or end-of-life care scored significantly better in the Palliative Care Knowledge Test post-simulation compared to those who did not (p = 0.011). CONCLUSIONS: The palliative and end-of-life simulation program significantly improved nursing students' emotional intelligence and palliative care knowledge. Further research is needed on developing a reliable tool to measure nursing students' palliative care knowledge. Future simulations should include structured and deliberate reflection features aside from debriefings to enhance reflective abilities, which is an important nursing competency. More research is needed on the effect of palliative and end-of-life care simulations on emotional intelligence and reflective abilities, and the influence of demographic variables on nursing students' outcomes.

Performance of the Palliative Prognostic Index for cancer patients: A systematic review and meta-analysis.

BACKGROUND: Clinician predicted survival for cancer patients is often inaccurate, and prognostic tools may be helpful, such as the Palliative Prognostic Index (PPI). The PPI development study reported that when PPI score is greater than 6, it predicted survival of less than 3 weeks with a sensitivity of 83% and specificity of 85%. When PPI score is greater than 4, it predicts survival of less than 6 weeks with a sensitivity of 79% and specificity of 77%. However, subsequent PPI validation studies have evaluated various thresholds and survival durations, and it is unclear which is most appropriate for use in clinical practice. With the development of numerous prognostic tools, it is also unclear which is most accurate and feasible for use in multiple care settings. AIM: We evaluated PPI model performance in predicting survival of adult cancer patients based on different thresholds and survival durations and compared it to other prognostic tools. DESIGN: This systematic review and meta-analysis was registered in PROSPERO (CRD42022302679). We calculated the pooled sensitivity and specificity of each threshold using bivariate random-effects meta-analysis and pooled diagnostic odds ratio of each survival duration using hierarchical summary receiver operating characteristic model. Meta-regression and subgroup analysis were used to compare PPI performance with clinician predicted survival and other prognostic tools. Findings which could not be included in meta-analyses were summarised narratively. DATA SOURCES: PubMed, ScienceDirect, Web of Science, CINAHL, ProQuest and Google Scholar were searched for articles published from inception till 7 January 2022. Both retrospective and prospective observational studies evaluating PPI performance in predicting survival of adult cancer patients in any setting were included. The Prediction Model Risk of Bias Assessment Tool was used for quality appraisal. RESULTS: Thirty-nine studies evaluating PPI performance in predicting survival of adult cancer patients were included (n = 19,714 patients). Across meta-analyses of 12 PPI score thresholds and survival durations, we found that PPI was most accurate for predicting survival of <3 weeks and <6 weeks. Survival prediction of <3 weeks was most accurate when PPI score>6 (pooled sensitivity = 0.68, 95% CI 0.60-0.75, specificity = 0.80, 95% CI 0.75-0.85). Survival prediction of <6 weeks was most accurate when PPI score>4 (pooled sensitivity = 0.72, 95% CI 0.65-0.78, specificity = 0.74, 95% CI 0.66-0.80). Comparative meta-analyses found that PPI performed similarly to Delirium-Palliative Prognostic Score and Palliative Prognostic Score in predicting <3-week survival, but less accurately in <30-day survival prediction. However, Delirium-Palliative Prognostic Score and Palliative Prognostic Score only provide <30-day survival probabilities, and it is uncertain how this would be helpful for patients and clinicians. PPI also performed similarly to clinician predicted survival in predicting <30-day survival. However, these findings should be interpreted with caution as limited studies were available for comparative meta-analyses. Risk of bias was high for all studies, mainly due to poor reporting of statistical analyses. while there were low applicability concerns for most (38/39) studies. CONCLUSIONS: PPI score>6 should be used for <3-week survival prediction, and PPI score>4 for <6-week survival. PPI is easily scored and does not require invasive tests, and thus would be easily implemented in multiple care settings. Given the acceptable accuracy of PPI in predicting <3- and <6-week survival and its objective nature, it could be used to cross-check clinician predicted survival especially when clinicians have doubts about their own judgement, or when clinician estimates seem to be less reliable. Future studies should adhere to the reporting guidelines and provide comprehensive analyses of PPI model performance.

Using peer feedback to enhance nursing students' reflective abilities, clinical competencies, and sense of empowerment: A mixed-methods study.

AIM: To assess the use of a framework to provide structured peer feedback and compare the effects of peer video feedback, peer verbal feedback versus faculty feedback on nursing students and peer tutors' learning outcomes and experiences BACKGROUND: Peer feedback has been utilized widely in health professions education to fill the gap for timely feedback, but some students were concerned with its quality, leading to perceptions that peer feedback may not be useful. DESIGN: Sequential explanatory mixed-methods study METHODS: The study took place from January to February 2022. In phase 1, a quasi-experimental pretest-posttest design was used. First-year nursing students (n = 164) were allocated to peer video feedback, peer verbal feedback or faculty feedback arms. Senior nursing students (n = 69) were recruited to be peer tutors or the control group. The Groningen Reflective Ability Scale was used by first-year students to assess their reflective abilities, while the Simulation-based Assessment Tool was used by peer or faculty tutors to evaluate nursing students' clinical competence of a nursing skill during the simulation. The Debriefing Assessment for Simulation in Healthcare-Student Version was used by students to assess their peer/faculty tutors' feedback quality. Senior students' empowerment levels were measured using the Qualities of an Empowered Nurse scale. In phase 2, six semi-structured focus group discussions with peer tutors (n = 29) were conducted and thematically analyzed. RESULTS: Peer video feedback and peer verbal feedback significantly improved students' reflective abilities but not in the faculty feedback arm. Students' clinical competence in a technical nursing skill significantly improved in all three arms. Improvements were significantly larger in those receiving peer video feedback and peer verbal feedback than faculty feedback, with no significant differences between peer video feedback and peer verbal feedback. Debriefing Assessment for Simulation in Healthcare-Student Version scores were not significantly different among the 3 arms. Empowerment levels of peer tutors significantly improved after providing peer feedback but not those in the control group. Seven themes were generated from the focus group discussions. CONCLUSIONS: Although peer video feedback and peer verbal feedback were similarly effective in improving clinical competencies, peer video feedback was more time-consuming and stressful to students. The use of structured peer feedback improved peer tutors' feedback practices and were comparable to quality of faculty feedback. It also significantly increased their sense of empowerment. Peer feedback was widely supported by peer tutors who agreed that it should supplement faculty teaching.

Nursing students' experiences with patient death and palliative and end-of-life care: A systematic review and meta-synthesis.

AIM: To synthesise the experiences of nursing students encountering patient death and caring for patients under palliative care or at end-of-life and their families in clinical settings BACKGROUND: Nurses are pivotal in caring for dying patients and families. It has been reported that nursing students feel unprepared in caring for dying patients and handling patient death. Understanding their experiences would better inform how palliative care education can be improved and how students can be better supported in clinical settings. DESIGN: A qualitative systematic review and meta-synthesis METHODS: PubMed, Embase, CINAHL, PsycINFO, ProQuest and Google Scholar were searched for peer-reviewed articles and theses/dissertations published between 1 January 2012-25 Feb 2023. Qualitative studies of any design reporting nursing students' experiences of patient death, caring for patients under palliative care, at end-of-life, or with time-limiting diseases in clinical settings in English were included. Study quality was evaluated using the Critical Appraisal Skills Programme tool. Data were synthesised using Sandelowski and Barroso's 2-step framework through a meta-summary using thematic analysis, which were then integrated into meta-syntheses using an event timeline. RESULTS: The review included 71 studies from 26 countries (n = 1586 nursing students). The meta-summary contained 8 themes and 23 subthemes: (1) Communication experience with patients and families, (2) Satisfaction with care provided to patients and families, (3) Impact of the COVID-19 pandemic on death and dying, (4) Perceptions of death and dying, (5) Impact of death, (6) Nursing education on palliative end-of-life care, (7) Support systems and coping methods, (8) Learning outcomes. The meta-synthesis depicted nursing students' experiences before, during and after encountering dying patients, families and patient death. Suggestions for nursing faculty and clinical staff on how they could equip students with necessary skills and knowledge and support them in clinical settings were also provided. CONCLUSIONS: While caring for dying patients and families was beneficial to nursing students' learning and professional development, they encountered many challenges. Governments, clinical and academic nursing leaders must prioritise the integration of palliative care content into the curricula across nursing schools in face of increasing palliative and end-of-life care needs in patients. Nursing schools should ensure that students are adequately prepared by designing culturally and socioeconomically relevant curricula, integrating theoretical and experiential learning and offering students a thorough understanding of palliative and end-of-life care. Clinical staff and nursing instructors should support students emotionally and guide them in patient care.

Using a 3-Phase Peer Feedback to Enhance Nursing Students' Reflective Abilities, Clinical Competencies, Feedback Practices, and Sense of Empowerment.

BACKGROUND: Peer feedback (PF) has attracted much attention in health profession education with growing evidence on its benefits. However, it lacks a proper framework to guide its operation, which raises concerns about its quality in nursing education. PURPOSE: To compare the effects of a 3-phase PF versus faculty feedback (FF) on students' reflective abilities and clinical competencies after simulated practice, and its impacts on peer tutors' feedback practices and empowerment level. METHODS: This study used a 3-arm pretest-posttest quasi-experimental methodology. RESULTS: Peer verbal feedback significantly increased students' reflective abilities and clinical competencies, while peer video feedback significantly increased clinical competencies. However, FF outcomes did not reach significance. Peer tutors' empowerment level did not significantly improve, but feedback practices were perceived as comparable with FF. CONCLUSIONS: Peer feedback can potentially improve students' reflective abilities and clinical competencies. Proper feedback training with a structured framework will likely enhance peer tutors' feedback practices.

Effectiveness of peer teaching in health professions education: A systematic review and meta-analysis.

BACKGROUND: The reform in health professions education requires the focus to shift from fact memorization to exploring, analyzing, assimilating, and synthesizing information to promote active and collaborative learning. Peer teaching is one of the educational strategies. AIMS: This review aimed to explore and synthesize quantitative evidence to determine the overall effect of peer teaching in enhancing students' theoretical knowledge and practical skills (e.g., procedural skills and resuscitation) in health professions education. METHODS: PubMed, ScienceDirect, CINAHL, ERIC, ProQuest, reference lists of relevant studies, and reviews were searched till November 2021. Results were pooled using random-effects meta-analysis or narrative synthesis. RESULTS: A total of 44 RCTs were included. This review showed a significant effect of peer teaching on procedural skills improvement and a comparable effect on theoretical knowledge and resuscitation skills acquisition compared to the conventional teaching method. Near-peer teaching seemed to be the most effective method for skill improvement. Subgroup analysis showed no significant differences between peer teaching and conventional teaching groups (e.g., expert/faculty teaching, self-study or lectures). CONCLUSIONS: Peer teaching seems to be a promising teaching and learning strategy in health professions education, positively affecting theoretical knowledge and procedural skills. Future research should explore the effect of peer teaching in developing countries to provide a comprehensive picture of peer teaching.

Educational effects of community service-learning involving older adults in nursing education: An integrative review.

BACKGROUND: Community service-learning is a structured experiential learning approach in which students engage in service activities in response to identified community need(s). Service-learning programmes are developed to promote understanding of societal issues and facilitates critical learning for the learners, with emphasis on learning through reflection. OBJECTIVES: To synthesize findings from published and grey literature related to the educational effects of community service-learning involving older adults in nursing education and evaluate the quality of existing service-learning programmes. DESIGN: Integrative review following Whittemore and Knafl's framework to analyse and synthesize a broader range of evidence. DATA SOURCES: Six databases (PubMed, ScienceDirect, CINAHL, PsycINFO, ERIC and ProQuest) were systematically searched from inception until 30 July 2021. Reference lists of relevant studies and reviews were also assessed for eligible studies. We also searched for grey literature and dissertations in ProQuest and Google Scholar. REVIEW METHODS: The 5-step method was used: problem identification, literature search, data evaluation, analysis, and presentation. Included studies were appraised using the Mixed Methods Appraisal Tool checklist. Service-learning programmes were evaluated using the Service-Learning Quality Assessment Tool. RESULTS: A total of 21 studies were included. Educational benefits of service-learning in the three domains of learning (cognitive, affective and psychomotor) were identified. Nine service-learning programmes achieved adequate quality and implementation of service-learning principles, while 12 exhibited emergent quality and implementation. CONCLUSIONS: Service-learning provides various benefits in nursing education. Existing empirical studies do not always follow established service-learning principles, and the quality of evidence is considered low. Future studies should use more rigorous methodologies and improve the reporting of research.

Death doulas as supportive companions in end-of-life care: A scoping review.

BACKGROUND: Death doulas have gained greater attention recently by offering psychosocial, spiritual and other non-clinical support for patients with time-limiting diseases, including their families, with the potential to complement existing end-of-life care services. However, their roles, scope of practice and care impact remain poorly understood. AIM: To describe existing knowledge on death doulas regarding their roles, care impact, training and regulation. DESIGN: This scoping review utilised Levac et al.'s framework and textual narrative synthesis to summarise the findings. DATA SOURCES: PubMed, Scopus, CINAHL, PsycINFO, ProQuest, Google Scholar were searched for relevant articles from inception to 20 May 2021. Empirical studies, narrative reports, unpublished theses and studies in English were included. RESULTS: Thirteen articles were included. Death doulas take on diverse roles in end-of-life care. Their roles include providing psychosocial, spiritual, practical support, companionship and resource navigation. The positive impacts of engaging a death doula include continuous presence, holistic service and flexible payment regime. The negative aspects include role inconsistencies and confusion among healthcare professionals and the public. CONCLUSIONS: Death doulas can augment existing end-of-life care services by providing holistic and personalised care services at home or hospital settings. Their roles are still evolving and remain mostly unregulated, with little evidence about their impact. There is a need for more rigorous studies to explore healthcare professionals' views about this role and examine the clinical outcomes among dying persons and their families.

Effect of Aerobic and Resistant Exercise Intervention on Inflammaging of Type 2 Diabetes Mellitus in Middle-Aged and Older Adults: A Systematic Review and Meta-Analysis.

OBJECTIVES: To examine the effect of aerobic and resistant exercise intervention on inflammaging in middle-aged and older adults with type 2 diabetes mellitus (T2DM) using inflammatory cytokines, such as interleukin (IL)-1 ß, IL-6, tumor necrosis factor-α (TNF-α), and C-reactive protein (CRP) as biomarkers. DESIGN: Systematic review and meta-analysis. SETTING AND PARTICIPANTS: Middle-aged and older adults with T2DM in the community. METHODS: Articles were searched from 8 electronic databases. Randomized control trials (RCTs) published in English, from inception to October 31, 2021, were included in this review. Two authors conducted data extraction and quality appraisal independently following guidelines in the Cochrane Handbook for Systematic Reviews of Interventions. Meta-analysis was conducted using Review Manager. Heterogeneity was investigated using subgroup and sensitivity analysis. RESULTS: This review included 14 RCTs. The meta-analysis showed significant improvement in IL-6 [Z = 3.05; 95% confidence interval (CI): -3.60 to -0.79; P = .002], CRP (Z = 2.44; 95% CI: -0.55 to -0.06; P = .01) and TNF-α levels (Z = 2.96; 95% CI: -2.21 to -0.45; P = .003) post-exercise programs. Subgroup analysis revealed that combined aerobic and resistance exercises and long-term exercises have more significant improvement to the outcomes than usual care. Based on the Grades of Recommendation, Assessment, Development and Evaluation system, considerable risk of bias and low level of certainty were revealed in all biomarker outcomes. CONCLUSIONS AND IMPLICATIONS: Exercise intervention is effective in improving inflammatory, metabolic, and lipid markers in middle-aged and older adults with T2DM. By modifying the levels of these markers with exercise, inflammation and insulin resistance can be improved. Long-term, combined aerobic and resistance exercise interventions have more significant effect on biomarkers. The small sample size of this meta-analysis limited the generalizability of the results. Future studies can consider adopting a more optimized exercise regimen to achieve effective T2DM management in middle-aged and older adults. Similar studies should expand to other populations and larger sample sizes to explore replicability of these effects.

Effectiveness and quality of peer video feedback in health professions education: A systematic review.

OBJECTIVES: This review aimed to evaluate the effectiveness of peer video feedback (PVF) on healthcare students' reactions and learning outcomes against other feedback methods (e.g., expert- or self-video feedback). It also synthesized the characteristics of PVF within health professions education to identify its effective elements. DATA SOURCES: Seven databases were systematically searched to identify relevant studies, including CENTRAL, CINAHL, ERIC, Embase, PubMed, PsycINFO, and Scopus. REVIEW METHODS: This review was conducted based on the PRISMA Statement Guidelines. Reviewers independently extracted data from the included articles and assessed the risk of bias and quality of the studies. The effectiveness of PVF on students' reactions, learning, and quality of peer feedback was summarized. RESULTS: A total of 22 articles were included. Results showed PVF was a helpful learning tool, and students were satisfied with its overall learning experience. PVF demonstrated its positive effect on skill-based learning. The top concern was its quality (accuracy and content), ascribing to peers' limited knowledge, expertise, or feedback experience. CONCLUSIONS: This review affirmed the potential effect of PVF on skill-based learning but revealed students' ambivalent feelings towards its quality. Six effective elements were proposed for its best practice. Future studies are needed to investigate further these proposed elements and how they mediate the educational effects of PVF.

The prognostic utility of CSF neurogranin in predicting future cognitive decline in the Alzheimer's disease continuum: A systematic review and meta-analysis with narrative synthesis.

Core cerebrospinal fluid (CSF) biomarkers (Aß42, T-tau, P-tau) were included as supporting diagnostic criteria for Alzheimer's Disease (AD), but they lack the power to predict AD progression. On the other hand, a new biomarker CSF Neurogranin (Ng) has been shown to predict cognitive decline. This systematic review aims to synthesise the prognostic utility of CSF Ng in predicting cognitive decline in the AD continuum. Seven databases were searched systematically from inception to 30 September 2020. Participants were 55 years or older, who had baseline and at least one follow-up cognitive assessments. Risk of bias was assessed using the Quality in Prognosis Studies tool. Meta-analysis was conducted by pooling standardised beta coefficients and adjusted hazard ratios. Thirteen studies were included and high-quality evidence suggests that CSF Ng predicts Mini-Mental State Examination (MMSE) decline in Aß+ mild cognitive impairment (MCI). Moderate quality evidence showed that CSF Ng could predict the decline of memory and executive function in MCI. Narrative synthesis found that CSF Ng/Aß42 was also likely to predict cognitive decline. More studies are required to validate the use of CSF Ng as an AD prognostic marker and its application in future development of drug treatment and diagnosis.