Development and acceptability of a gestational diabetes mellitus prevention system (Better pregnancy) based on a user-centered approach: A clinical feasibility study.

Background: Gestational diabetes mellitus (GDM) can increase the risk of adverse outcomes for both mothers and infants. Preventive interventions can effectively assist pregnant women suffering from GDM. At present, pregnant women are unaware of the importance of preventing GDM, and they possess a low level of self-management ability. Recently, mHealth technology has been used worldwide. Therefore, developing a mobile health app for GDM prevention could potentially help pregnant women reduce the risk of GDM. Objective: To design and develop a mobile application, evaluate its acceptance, and understand the users'using experience and suggestions, thus providing a valid tool to assist pregnant women at risk of GDM in enhancing their self-management ability and preventing GDM. Methods: An evidence-based GDM prevent app (Better pregnancy) was developed using user-centered design methods, following the health belief model, and incorporating GDM risk prediction. A convenient sampling method was employed from June to August 2022 to select 102 pregnant women at risk of GDM for the pilot study. After a week, the app's acceptability was evaluated using an application acceptance questionnaire, and we updated the app based on the feedback from the women. We used SPSS 26.0 for data analysis. Results: The application offers various functionalities, including GDM risk prediction, health management plan, behavior management, health information, personalized guidance and consultation, peer support, family support, and other functions. In total, 102 pregnant women consented to participate in the study, achieving a retention rate of 98%; however, 2% (n = 2) withdrew. The Better pregnancy app's average acceptability score is 4.07 out of 5. Additionally, participants offered several suggestions aimed at enhancing the application. Conclusions: The Better pregnancy app developed in this study can serve as an auxiliary management tool for the prevention of GDM, providing a foundation for subsequent randomized controlled trials.

Risk prediction models for postpartum glucose intolerance in women with a history of gestational diabetes mellitus: a scoping review.

Objective: The objective of this scoping review was to investigate the effectiveness and limitations of risk prediction models for postpartum glucose intolerance in women with gestational diabetes mellitus (GDM). The aim was to provide valuable insights for healthcare professionals in the development of robust risk prediction models. Methods: A comprehensive literature search was conducted across multiple databases, including PubMed, EBSCO, Web of Science Core Collection, Ovid Full-Text Medical Journal Database, ProQuest, Elsevier ClinicalKey, China National Knowledge Infrastructure, China Biology Medicine, and WanFang Database, spanning from January 1990 to July 2023. To assess the quality of the included models, the Predictive Model Risk of Bias Assessment Tool (PROBAST) was employed. Results: Fourteen relevant studies were identified and included in the final review, all focusing on model development. The discrimination ability of the included models ranged from 0.725 to 0.940, indicating satisfactory prediction accuracy. However, a notable limitation was that nine of these models (64.3%) did not provide clear guidelines on the selection of potential predictors. Furthermore, only six models (42.86%) underwent internal validation, with none undergoing external validation. A high risk of bias was observed across the included models. Logistic regression, Cox regression, and machine learning were the primary methods employed in the construction of these models. Conclusion: The risk prediction models included in this review demonstrated favorable prediction accuracy. However, due to variations in construction methodologies, direct comparison of their performance is challenging. These models exhibited certain shortcomings, such as inadequate handling of missing data and a lack of internal and external validation, resulting in a high risk of bias. Therefore, it is recommended that these models be updated and externally validated. The development of prospective, multi-center studies is encouraged to construct predictive models with low risk of bias and high clinical applicability, ultimately guiding evidence-based clinical practice. Supplementary Information: The online version contains supplementary material available at 10.1007/s40200-023-01330-1.

Perceptions and needs for a community nursing virtual simulation system for Chinese nursing students during the COVID-19 pandemic: A qualitative study.

Background: Virtual simulation systems are being increasingly used in the field of nursing education. However, these systems are mostly designed based on the perspective of developers, and the needs of the end users are often neglected. The purpose of this study was to explore the perceptions and needs of Chinese undergraduate nursing students for the development of a community nursing virtual simulation system. Methods: This was a descriptive qualitative study enrolling 12 undergraduate nursing students at a University in China. Data were collected through semi-structured interviews. The content analysis method was used for data analysis. Result: Three themes and 15 sub-themes were extracted from this study: (1) Positive perceptions regarding virtual systems: a) Provides space for trials and errors, b) Not limited by time and space, c) Provides auxiliary tools; (2) Design and use requirements: a) Performance needs, b) Contents design needs, c) Appearance design needs, d) Support Needs; (3) Competency enhancement needs: a) Community nursing practice ability, b) Critical thinking ability, c) Independent thinking ability, d) Ability to deal with emergencies, e)Teamwork skills, f) Self-efficacy, g) Resilience, h)Interpersonal communication skills. Conclusion: Designers and engineers should consider students' needs, aim to improve students' abilities, improve the diversity, the scientific and rigor of content, and enhance user immersion and interest. The system should be programmed to provide real-time feedback, timely technical and professional support, in order to optimize use experience of nursing students.

Facilitators and barriers of initiation and maintenance of physical activity among people with coronary heart disease: a qualitative study.

PURPOSE: We aimed to describe the facilitators and barriers of physical activity for patients with coronary heart disease. METHODS: A qualitative descriptive study using semi-structured interviews was conducted with 15 participants with coronary heart disease. The interview guide was developed based on a multi-theory model. Interviews were audio-recorded, transcribed verbatim, and analyzed using a thematic analysis. RESULTS: Two main themes were identified: facilitators of initiation and maintenance of physical activity (behavioral motivation, perceived benefits, behavioral confidence, supportive physical environment, positive emotional experience, self-regulation, supportive social environment, illness perception, and excellent self-control), barriers of initiation and maintenance of physical activity (perceived barriers, restricted physical environment, psychological distress, insufficient social support, and poor self-control). CONCLUSIONS: This study presents an in-depth theory-based exploration of facilitators and barriers to initiating and maintaining physical activity among people with coronary heart disease. Relevant factors should be taken into account to increase their effectiveness when designing the target interventions to encourage a physically active lifestyle in this population.

Before commencing cardiac rehabilitation, it is imperative to assess patients with coronary heart disease (CHD) to ascertain whether they have limited activity capacity, psychological distress, insufficient social support, and poor self-control.A customized cardiac rehabilitation plan should be meticulously devised for each patient with CHD.For patients in the early stage of initiating physical activity (PA), rehabilitation professionals should assist them in recognizing the severity of their condition and the advantages of engaging in PA.Rehabilitation professionals should also promote active utilization of social networks, stimulate CHD patients' motivation, and enhance their behavioral confidence.When guiding patients during the maintenance stage of PA, it is essential to regularly evaluate their psychological well-being, assist them in self-regulation based on their physical condition, and foster the development of self-control.Rehabilitation professionals should consistently provide social support to reinforce the patients' motivation to maintain their PA behavior.

Risk factors associated with early postpartum glucose intolerance in women with a history of gestational diabetes mellitus: a systematic review and meta-analysis.

PURPOSE: This meta-analysis was aimed at exploring the incidence and risk factors of glucose intolerance in women with gestational diabetes mellitus (GDM) at 6-12 weeks postpartum to inform the development of preventive strategies. METHOD: We searched Pubmed, Embase, Web of Science, the Cochrane Library, Ovid, China Knowledge Resource Integrated Database (CNKI), Wanfang Database and China Biology Medicine Database for entries between January 1990 and September 2022. The search terms included gestational diabetes mellitus, postpartum, glucose intolerance and type 2 diabetes. The meta-analysis was conducted using Stata 14.0. RESULT: We included 37 studies, with 21 and 16 having low and medium risk of bias, respectively. The incidence of glucose intolerance in women with GDM 6-12 weeks postpartum was 27% (95% CI: 0.22-0.33). The following risk factors for GDM 6-12 weeks postpartum were identified: insulin use during pregnancy (OR = 3.23; 95% CI: 2.35-4.44), family history of diabetes (OR = 2.94; 95% CI: 1.98-4.33), abnormal fasting glucose levels at 24-28 weeks of gestation (OR = 1.15; 95% CI: 1.07-1.25), high pre-pregnancy BMI (OR = 1.63; 95% CI: 1.23-2.15), abnormal triglyceride levels during 28-40 weeks of gestation (OR = 2.18; 95% CI: 1.18-4.03), abnormal HbA1c levels at 28-40 weeks of gestation (OR = 6.62; 95% CI: 4.71-9.30), history of previous GDM (OR = 2.11; 95% CI: 1.27-3.49), and high 1-h glucose levels at 24-28 weeks of gestation (OR = 1.16; 95% CI:1.06-1.28). CONCLUSION: The incidence of glucose intolerance in GDM patients at 6-12 weeks postpartum was high. To prevent early postpartum glucose intolerance, healthcare providers should develop individualized interventions for GDM patients, depending on existing risk factors.

Effects of a low glycemic index or low glycemic load diet on pregnant women at high risk of gestational diabetes: A meta-analysis of randomized controlled trials.

AIMS: To evaluate the effect of low glycemic index or low glycemic load diets on maternal and neonatal outcomes at high risk of gestational diabetes mellitus (GDM). DATA SYNTHESIS: Several databases (PubMed, Cochrane Library, Web of Science, Embase, OVID, Clinical Trials. gov, China National Knowledge Infrastructure, China Biomedical Database, and Wanfang Database) were searched from January 1990 to January 2022 (updated to November 2022). Randomized controlled trials of low glycemic index diets interventions for women at high risk of GDM were included. From 2131 articles initially were screened, after eliminating duplicates, 1749 titles and abstracts were analyzed. 71 documents that met the inclusion criteria were selected and 3 documents were obtained through searching the reference lists. After reading the full text, 10 studies were retained. Two authors evaluated the studies, extracted data and conducted quality assessment independently. A total of 10 studies with 2304 patients met the inclusion criteria. Compared with the control group, a low glycemic index diet could control the range of weight gain (WMD -1.01, 95% CI -1.41 to -0.61), decrease the incidence of excessive weight gain (OR 0.69, 95% CI 0.54-0.87), lessen the incidence of large-for-gestational-age infants (OR 0.32, 95% CI 0.16-0.62) and reduce the incidence of preterm infants (OR 0.45, 95% CI 0.29-0.71). CONCLUSION: A low glycemic index or low glycemic load diet could control maternal weight gain, reduce the incidence of excessive weight gain, and decrease the incidence of large-for-gestational-age infants and preterm infants in group with high risk of GDM. PROSPERO: CRD42022322697.

Medical staff's perception of factors contributing to accelerated rehabilitation in patients with cervical spinal cord injury: A qualitative research.

AIM: To explore the factors affecting the quality of accelerated rehabilitation for patients with cervical spinal cord injury, therefore, to propose targeted improvement strategies and provide reference for promoting the quality of nursing care for accelerated rehabilitation. DESIGN: This descriptive qualitative inquiry followed the COREQ guidelines. METHODS: From December 2020 to April 2021, 16 subjects including orthopaedic nurses, nursing management experts, orthopaedic surgeons, anaesthesiologists and physical therapists experienced in accelerated rehabilitation were selected by objective sampling method to conduct semi-structured interviews. Thematic analysis was used to analyse the interview content. RESULTS: Through analysis and summary of the interview data, the following two themes and nine sub-themes were finally extracted. Factors related to the quality of accelerated rehabilitation structure include: construction of multidisciplinary teams, thorough system guarantee and adequate staffing. Factors related to the quality of accelerated rehabilitation process include: inadequate training and assessment, lack of medical staff's awareness, incapability of the accelerated rehabilitation team members, poor multidisciplinary communication and collaboration, lack of patient's awareness, and ineffective health education. CONCLUSION: Quality of implementation of accelerated rehabilitation can be improved by maximizing the role of multidisciplinary team, establishing a flawless accelerated rehabilitation system, increasing allocation of nursing resources, enhancing knowledge of medical staff, improving their awareness of accelerated rehabilitation, establishing personalized clinical pathways of accelerated rehabilitation, increasing communication and collaboration among multidisciplinary disciplines, and improving health education of patients.