A Multisample Path Analysis Including a Novel Psychological Indicator, Attitude Toward Life, After the First Wave of COVID-19.

Introduction: During the COVID-19 outbreak, China applied a unique volunteerism system in which nurses and physicians traveled to the epicenter to care for patients. During the same period, another group, nurse and physician nonvolunteers, stayed at their home hospitals outside of the epicenter and cared for patients without COVID-19. Yet only one Chinese study examined psychological responses comparing these groups. Objective: To explore whether relationships among compassion satisfaction, general health, attitude toward life, satisfaction with life, perceived stress, and posttraumatic stress disorder (PTSD) symptomatology differ between volunteers and nonvolunteers. Attitude toward life is examined for the first time in COVID-19 research. Methods: A cross-sectional study was conducted (259 nurse and physician volunteers, 330 nurse and physician nonvolunteers). Online survey data were analyzed using multisample path analysis. Results: There was no significant difference between volunteer and nonvolunteer models. In the volunteer model, paths significantly related to PTSD symptomatology included compassion satisfaction (total effect, ß = -0.12), general health (total effect, ß = -0.09), attitude toward life (direct effect, ß = -0.30; total effect, ß = -0.30), and perceived stress (direct effect, ß = 0.30; total effect, ß = 0.30), and in nonvolunteers included general health (direct effect, ß = -0.11; total effect, ß = -0.11) and attitude toward life (direct effect, ß = -0.47; total effect, ß = -0.47). Conclusion: No significant difference between models means both groups could benefit from psychological intervention. Within each model, significant paths were identified. For volunteers, counselors might focus on compassion satisfaction and perceived stress and, for both volunteers and nonvolunteers, on health and attitude toward life. Delivering counseling based on key indicators in China may help prevent or mitigate PTSD. Globally, researchers could identify factors to target and determine to whom long-term counseling might be directed. Findings about attitude toward life lay the groundwork for future research.

For the Good of the People: an interpretive analysis of Chinese volunteerism in the critical matter of care at the start of the pandemic.

PURPOSE: China employed a unique volunteerism system where health care providers outside of Hubei Province, the epicentre, travelled to reverse the devastation wrought by coronavirus disease 2019 (COVID-19) at its global onset. The aim is to study the unique circumstances of Chinese volunteerism in the context of continuing pandemic threats, specifically exploring the experiences of 20 Chinese nurse and physician volunteers fighting COVID-19 during the outbreak. METHODS: Interviews were done through video calling. RESULTS: Using content analysis with a hermeneutic perspective, emerging patterns showed the ways in which China's particular manifestation of volunteerism teaches us how to engage global threats of this nature. The overarching lesson, For the Good of the People, was manifested in several dynamic and overlapping themes: 1) Reaching for Professional Standards Even in Crisis; 2) Constantly Caring Through Failures and Successes; and 3) Holding Fast to the Common Good. The devastation was met by the resilience of volunteers, who overcame profound challenges managing patient care. CONCLUSIONS: Volunteerism required sacrifice and tremendous support in the form of training and administrative direction, family support, and peer collaboration. Volunteers' physical and psychosocial wellbeing was a priority. Recognizing the representative themes can help societies plan for continuing and future events.

Factor Structure and Construct Validity of a Hospital Survey on Patient Safety Culture Using Exploratory Factor Analysis.

OBJECTIVE: Nurses' voluntary reporting of adverse events and errors is critical for improving patient safety. The operationalization and application of the concept, patient safety culture, warrant further study. The objectives are to explore the underlying factor structure, the correlational relationship, between items of the Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture and examine its construct validity. METHODS: Exploratory factor analysis was conducted using secondary data from the instrument's database. Using pattern matching, factors obtained through exploratory factor analysis were compared with the 6-component Patient Safety Culture Theoretical Framework: degree of psychological safety, degree of organizational culture, quality of culture of safety, degree of high reliability organization, degree of deference to expertise, and extent of resilience. RESULTS: 6 exploratory factors, explaining 51% of the total variance, were communication lead/speak out/resilience, organizational culture and culture of safety-environment, psychological safety-security/protection, psychological safety-support/trust, patient safety, communication, and reporting for patient safety. All factors had moderate to very strong associations (range, 0.354-0.924). Overall, construct validity was good, but few exploratory factors matched the theoretical components of degree of deference to expertise and extent of resilience. CONCLUSIONS: Factors essential to creating an environment of transparent, voluntary error reporting are proposed. Items are needed, specifically focusing on deference to expertise, the ability of the person with the most experience to speak up and lead, despite hierarchy or traditional roles, and resilience, which is coping and moving forward after adversity or mistakes. With future studies, a supplemental survey with these items may be proposed.

Immobility and the High Risk of Not Recovering Function in Older Adults: A Focused Ethnography.

PURPOSE: The objective of the study was to explore the experiences of older adults with immobility posthospitalization. DESIGN: We conducted a focused ethnography qualitative study. METHODS: Data collection included in-depth interviews with 10 individuals ages 69-82 years who had been hospitalized for at least 1 week, field notes, and observations of mobility. An inductive approach was used to analyze the data. FINDINGS: Older adults believe mobility is a central element in their life. Hospitalizations lasting 1 week or longer often result in a loss of the older adult's ability to function as before, a pattern that we identified as The Crushing Assault: Consequences of Immobility. Rehabilitation involves a Rocky Road to Regaining Mobility that is challenging but possible. CONCLUSIONS: Immobility after hospitalization has unexpected and profound consequences that are life-changing and distressing for older adults at home. Recovering function is prolonged and difficult. An individualized training program that includes flexibility and progressive resistance exercises is recommended over longer periods and with extended medical follow-up. CLINICAL RELEVANCE: Lingering problems with immobility at home are frequently overlooked. Active programming promoting preservation of function and an optimistic attitude as well as focusing on milestones to reach are key to optimal function.

Determination of Key Inflection Points for Maladaptive Responses in US Nurses During the Pandemic: A Network Analysis.

Introduction: During the pandemic, the nursing workforce is experiencing overwhelming workloads that carry a heavy psychological burden. A wide variety of psychological responses to the COVID-19 pandemic have been studied in nurses globally, but many are not studied or understudied in US nurses. Theoretical underpinnings of the current study are based on the disaster component of the Middle-Range Theory of Nurses' Psychological Trauma. Objective: To explore the associations of psychological responses (life satisfaction, perceived stress, posttraumatic stress disorder [PTSD] symptomatology, attitude toward life, and compassion satisfaction), years of experience, and general health in US nurses during the COVID-19 pandemic using network analysis. Methods: A cross-sectional study was conducted using an online survey from October to November 2020 in US nurses. Network analysis was used to model the data and analyze the centrality indices of betweenness, closeness, and strength. Data were reported according to the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) checklist. Results: In 128 nurses, 19.35% of nurses had probable PTSD. Network analysis showed strong significant correlations between life satisfaction and perceived stress (negative), between perceived stress and PTSD symptomatology (positive), and between attitude toward life and compassion satisfaction (positive). Conclusion: Low life satisfaction, high perceived stress, and low attitude toward life are key inflection points that signal the need for psychological intervention in the US nursing workforce during the continued pandemic. Based on 2021 Tri-Council of Nursing COVID-19 Report and the 2022 International Council of Nurses guideline, healthcare should implement scalable, system-level interventions to reduce psychological burden during the pandemic. The current study suggests targets for such intervention, which may promote a healthier, more effective US nursing workforce.

Adverse Event Reporting Priorities: An Integrative Review.

OBJECTIVES: Adverse events remain the third leading cause of death in hospitals today, after heart disease and cancer. However, adverse events remain underreported. The purpose of this integrative review is to synthesize adverse event reporting priorities in acute care hospitals from quantitative, qualitative, and mixed-methods research articles. METHODS: A comprehensive review of articles was conducted using nursing, medicine, and communication databases between January 1, 1999, and May 3, 2021. The literature was described using standard reporting criteria. RESULTS: Twenty-nine studies met the eligibility criteria. Four key priorities emerged: understanding and reducing barriers, improving perceptions of adverse event reporting within healthcare hierarchies, improving organizational culture, and improving outcomes measurement. CONCLUSIONS: A paucity of literature on adverse event reporting within acute care hospital settings was found. Perceptions of fear of blaming and retaliation, lack of feedback, and comfort level of challenging someone more powerful present the greatest barriers to adverse event reporting. Based on qualitative studies, obtaining trusting relationships and sustaining that trust, especially in hierarchical healthcare systems, are difficult to achieve. Given that patient safety training is a common strategy clinically to improve organizational culture, only 4 published articles examined its effectiveness. Further research in acute care hospitals is needed on all 4 key priorities. The findings of this review may ultimately be used by clinicians and researchers to reduce adverse events and develop future research questions.

Implementing a novel self-care clock strategy as part of a trauma awareness intervention in a university setting.

PURPOSE: This study compared post- and preintervention trauma-informed care attitudes, explored relationships among outcomes, and identified self-care behavior changes participants are willing to make. DESIGN AND METHODS: A quasi-experimental study with content analysis was conducted with 96 adults that took part in a Trauma Awareness Intervention including a novel self-care clock. CONCLUSIONS: Participants' trauma-informed care attitudes improved (p ≤ 0.05) compared to baseline and were positively related to their post-intervention compassion scores (p < 0.05). Qualitative analyses revealed self-awareness, self-care, empathy, applying a trauma lens, changing the narrative, and student-centeredness as the main themes in participants' responses. PRACTICAL IMPLICATIONS: This university-based initiative had a positive impact on attitudes toward trauma and should be explored in other settings, as there is an unmet need for trauma-informed care strategies at the community level.

Best Practices for Meta-Reviews in Physical Activity and Health Research: Insights From the Physical Activity Guidelines for Americans Advisory Committee Scientific Report.

BACKGROUND: Systematic reviews (SRs) and meta-analyses (MAs) have proliferated with a concomitant increase in reviews of SRs/MAs or "meta-reviews" (MRs). As uncovered by the 2018 US Physical Activity Guidelines Advisory Committee (PAGAC), there is a paucity of best practice guidance on MRs on physical activity health-related research. This manuscript aims to fill this gap. METHODS: In total, the PAGAC conducted 38 literature searches across 3 electronic databases and triaged 20,838 titles, 4913 abstracts, and 2139 full texts from which 1130 articles qualified for the PAGAC Scientific Report. RESULTS: During the MR process, the following challenges were encountered: (1) if the SR/MA authors had limited experience in synthesis methodology, they likely did not account for risk of bias in the conclusions they reached; (2) many SRs/MAs reviewed the same primary-level studies; (3) many SRs/MAs failed to disclose effect modifier analyses; (4) source populations varied; (5) physical activity exposures were nonstandardized; and (6) dose-response effects or effect modification of the physical activity exposure could not be identified. CONCLUSIONS: Using examples from the PAGAC Scientific Report, we provide (1) a high-level introduction to MRs; (2) recommended steps in conducting a MR; (3) challenges that can be encountered; and (4) guidance in addressing these challenges.

Evaluation of a New Test for the Diagnosis of Congenital Dyschromatopsia in Children: the Color Vision Evaluation Test.

PURPOSE: To evaluate the validity, reproducibility, and feasibility of the "Color Vision Evaluation Test" (CVET) for the diagnosis of congenital dyschromatopsia. DESIGN: Prospective, monocentric, sensitivity, and specificity analysis study comparing the CVET with the Farnsworth 15 Hue standard test (15 Hue STF). METHODS: A total of 155 children from the Paediatric University Hospital of Nice were screened (both eyes) using Ishihara's pseudoisochromatic cards, which allowed dividing them into a dyschromatic group and a control group. All children underwent twice the 15 Hue STF and the CVET with at least 7 days between both series of tests. RESULTS: Patients' mean age was 7.56 ± 3.51 years in the dyschromatic group and 8.92 ± 2.9 years in the control group. At the first evaluation, the sensitivity and specificity were 95.7% and 96.4%, respectively, for the CVET and 75% and 58.9%, respectively, for the 15 Hue STF (P < .001). The reproducibility of the CVET was 100%, whereas that of the 15 Hue STF was 88.4% (P = .01). The mean test explanation duration was 18.8 seconds for the CVET and 17.7 seconds for the 15 Hue STF (P = .3). In the dyschromatic group, the mean duration of the CVET was always significantly longer than that of the 15 Hue STF (P < .001). The children subjectively preferred to undergo the CVET rather than the 15 Hue STF in 84.6% of cases (P < .001). CONCLUSIONS: The CVET is a rapid, reliable, and reproducible test for the diagnosis of congenital dyschromatopsia. It is accessible to young children.

The "seeing place": Teaching nurse practitioners about cultural difference through dramatization.

BACKGROUND: The use of dramatization in health professional education is one method to teach students about implicit bias and cultural difference, yet it has not been widely studied among graduate students of nursing. OBJECTIVES: The purpose of this article is to present a qualitative analysis of data regarding doctoral nursing students' responses to a new dramatic exercise as part of a funded project to facilitate cultural learning in a diversity-enhanced nursing curriculum. DESIGN: We employed a cross-sectional posttest design with qualitative data collection and hermeneutic analysis. Setting and. PARTICIPANTS: Subjects were students from two cohorts in a Doctor of Nursing Practice program at a large metropolitan university in the Midwestern United States (n = 136). METHODS: Following a dramatic exercise facilitated by a local theatre group, students debriefed and provided feedback via paper-based surveys collected by their instructor. The research team reviewed and analyzed student feedback with an eye toward new learning or insights around cultural difference. RESULTS: Students rated the dramatic exercise highly. Their written feedback provided for a deeper exploration of how they internalized messages about cultural difference. These experiences were thematized in the following way: (a) Awareness is facilitated through integrating nonverbal (kinesthetic) and verbal encounters, (b) Hesitancy to participate in unfamiliar activities creates tension, and (c) Safety is a foundational aspect of learning sensitive issues. CONCLUSION: Dramatization of culturally sensitive scenarios for advanced practice nurses can lead to new understanding. Educators who understand the need for thoughtful introduction of dramatization experiences can better prepare nurses for interaction in cross-cultural clinical environments.

The Role of Extracellular Vesicles in ß-Cell Function and Viability: A Scoping Review.

Extracellular vesicles (EVs) released by cells throughout the body have been implicated in diabetes pathogenesis. Understanding the role of EVs in regulation of ß-cell function and viability may provide insights into diabetes etiology and may lead to the development of more effective screening and diagnostic tools to detect diabetes earlier and prevent disease progression. This review was conducted to determine what is known from the literature about the effect of EV crosstalk on pancreatic ß-cell function and viability in the pathogenesis of diabetes mellitus, to perform a gap analysis for future research directions, and to discuss implications of available evidence for diabetes care. The literature search yielded 380 studies from which 31 studies were determined to meet eligibility criteria. The majority of studies had the disease context of autoimmunity in T1DM. The most commonly studied EV crosstalk dynamics involved localized EV-mediated communication between ß-cells and other islet cells, or between ß-cells and immune cells. Other organs and tissues secreting EVs that affect ß-cells include skeletal muscle, hepatocytes, adipocytes, immune cells, bone marrow, vascular endothelium, and mesenchymal stem cells. Characterization of EV cargo molecules with regulatory effects in ß-cells was conducted in 24 studies, with primary focus on microRNA cargo. Gaps identified included scarcity of evidence for the effect on ß-cell function and viability of EVs from major metabolic organs/tissues such as muscle, liver, and adipose depots. Future research should address these gaps as well as characterize a broader range of EV cargo molecules and their activity in ß-cells.

Implementation science: Changing practice in oral health.

Caries remain the most common preventable chronic childhood disease. One state oral health program including fluoride varnish showed a decrease in presence of decay and improvement in overall oral health; however, early childhood caries did not improve. Implementation of an oral health preventive program during well-child medical visits may address this gap.

Correction to: Sex differences in 10-year ischemic cardiovascular disease risk prediction in Chinese patients with prediabetes and type 2 diabetes.

After the publication of the original article [1], we were notified that one of the corresponding author's name and her related institution were wrongly spelled.

Testing a model of body image in the bariatric surgery patient.

PURPOSE: The purpose was to test a published model of body image in the bariatric surgery patient in the clinical office setting. BACKGROUND: A model was created based on clinical observations during field work and the literature. It focuses on five concepts of body image: body attitude, body checking, appearance orientation, perceived body size, and perceived body space. Testing this model 3 months after surgery is important because morphology changes rapidly influencing early changes in body image, yet there is a paucity of research at this time point. METHODS: For this study of 67 bariatric surgery patients, sequential sampling was used. Body image and anthropometric measures (body mass index and other weight loss indicators) were obtained at baseline and 3-months postoperatively. Established model testing criteria were used. RESULTS: Over 3 months, mean body mass index was significantly reduced. Mean body image was significantly improved regarding all concepts in the model, except body checking. Body image improvement varied widely when individual responses were examined. CONCLUSIONS: The model was successfully tested. Data on the five concepts in the model provided a body image profile at 3 months indicating individuals' degree of improvement. Areas of non-improvement in the early postoperative phase may signal the need for interventions, like support or psychological counseling, for patients who might be struggling with views of themselves after surgery. Preliminary recommendations are made regarding several of the instruments and their use clinically. Researchers should take into consideration the study's short 3-month time frame when designing future studies.

Sex differences in 10-year ischemic cardiovascular disease risk prediction in Chinese patients with prediabetes and type 2 diabetes.

BACKGROUND: Cardiovascular disease has become a serious public health problem in recent years in China. The aim of the study was to examine sex differences in cardiovascular risk factors and 10-year ischemic cardiovascular disease (ICVD) risk in Chinese patients with prediabetes (PreDM) and type 2 diabetes mellitus (T2DM). METHODS: This was a multi-site retrospective case-control study conducted from April-November 2016 using an electronic medical record database, involving 217 PreDM and 900 T2DM patients admitted to endocrinology units in four hospitals in China. CVD risk was estimated using the Chinese 10-year ICVD risk model. The differences in 10-year absolute ICVD risk according to PreDM, T2DM < 1 year, T2DM 1-5 years or T2DM ≥5 years and sex were analyzed using ANOVA. RESULTS: When compared to PreDM females, males with PreDM had significantly higher 10-year ICVD risk In contrast, the opposite pattern of 10-year ICVD risk was observed in T2DM; males had significantly lower 10-year ICVD risk. Moreover, compared to T2DM females, males with T2DM had a lower proportion s with moderate or greater ICVD risk (p < 0.001). When compared to PreDM males, males with T2DM < 1 year, and with T2DM 1-5 years had no difference in 10-year ICVD risk, but had higher ICVD risk with T2DM ≥5 years (p < 0.05). Compared to PreDM females, females with T2DM in all subgroups had higher ICVD risk (p < 0.05). Among those with T2DM, hypertension rates of awareness, treatment and control were 78.60%, 65.38% and 31.10%, respectively; hyperlipidemia rates of awareness, treatment and control were lower (29.15%, 8.30% and 3.47%, respectively). Females with T2DM had higher prevalence, awareness and treatment of hypertension and hyperlipidemia than males with T2DM (p < 0.001). CONCLUSIONS: There is a greater need for cardiovascular risk reduction programs for females with T2DM at diagnosis. Given the low numbers for awareness, treatment and control of hypertension and hyperlipidemia in both males and females, significant resources focused on them must be expended, specifically improving regular assessment of blood pressure and blood lipids. Strengthening the management of chronic diseases through adherence to evidence-based guidelines to enhance clinical treatment may reduce 10-year ICVD in patients with T2DM in China.

Identifying the Complexity of Diagnosing Bipolar Disorder: A Focused Ethnography.

Purpose: To identify and describe the complexity of diagnosing bipolar disorder, including the diagnostic process and patient experiences of being newly diagnosed with bipolar disorder. Design: A mixed-methods focused ethnography was conducted, grounded in a post-positivist foundation. Methods: Medical records (n = 100) of patients whose diagnosis had been switched to bipolar disorder were examined. Six weeks post-hospitalization, ten outpatients with the diagnosis of bipolar disorder underwent an in-depth interview. Findings: Four diagnostic processes were identified during the retrospective record review. Two patterns and five themes were identified from the interviews. The first pattern, living with undiagnosed bipolar disorder, demonstrated common experiences of distinguishing impulsive moods and behavior, suffering life challenges, and seeking relief. The second pattern, acclimating to a new diagnosis of bipolar disorder, demonstrated participants' ways of understanding the diagnosis and reconciling the diagnosis. Patterns in the interviews corroborated data from the record review. Conclusions: The rendering of an appropriate diagnosis is key. Many participants' lives were significantly improved when diagnosis was made, and treatment recommendations for bipolar disorder (BPD) were initiated. These findings offer clinicians and researchers new ways to think about the complexity of the diagnosis of BPD including contrasting decision-making outcomes along a screening, diagnosis, and treatment continuum, as well as using the diagnostic event to instigate meaningful life change in the patient.

Wet cupping for hypertension: a systematic review and meta-analysis.

To assess the efficacy and safety of wet cupping in adults with hypertension, we conducted a systematic review and meta-analysis using 13 databases. Wet cupping alone or in combination with antihypertensive medication or acupuncture was used. Seven randomized trials were included, most not of high methodological quality. A few small studies suggested that wet cupping alone versus antihypertensive medication significantly reduced blood pressure and Traditional Chinese Medicine syndrome (hypertension-related symptoms). However based on current evidence, no firm conclusions can be drawn and no clinical recommendations made. Research projects included need validation. Studies indicate that wet cupping is a safe therapy.

The Compelling and Persistent Problem of Bipolar Disorder Disguised as Major Depression Disorder: An Integrative Review [Formula: see text].

BACKGROUND: Up to 40% of patients with bipolar disorder are misdiagnosed, usually with major depression disorder. OBJECTIVE: The purpose was to describe the current state of the science of the misdiagnosis of bipolar disorder, with the ultimate goal of improving psychiatric diagnostic workups including screening. DESIGN: An integrative review was conducted using standard criteria for evaluating research articles. RESULTS: Forty-nine articles met the eligibility criteria. Articles explored patient-related and health care provider-related factors contributing to the misdiagnosis of bipolar disorder as well as consequences of misdiagnosis. Clinically oriented, reliable, and valid screening tools for bipolar disorder also were reviewed. CONCLUSIONS: Awareness of multiple, challenging patient-related factors and more comprehensive assessment and screening by health care providers may reduce misdiagnosis.

Conceptualization of body image in the bariatric surgery patient.

Bariatric (weight loss) surgery is more popular than ever. The American Society for Metabolic and Bariatric Surgery in 2016 reported that 216,000 bariatric procedures were performed in the United States. Bariatric surgery has major physiological benefits; its use is expected to increase globally. However, patients may not anticipate the profound impact that rapid and massive weight loss may have on their body image after bariatric surgery. The construct of body image in this population needs to be explicated to facilitate continued research regarding this increasingly prevalent healthcare procedure. This article describes the formulation of a model of relevant concepts and dimensions within the construct of body image in the bariatric surgery patient. In the process of creating the model, we identified many factors influencing body image in patients before and after bariatric surgery, summarized eight measures, and developed a new definition based on prior work. Theoretical considerations are discussed. The long-term objective of this model building approach is to encourage researchers and clinicians to test the feasibility of systematic clinical measurement of body image at office visits before as well as multiple times after bariatric surgery.

A Journey with Amyotrophic Lateral Sclerosis.

Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease. Motor neurons are affected in certain patterns, such as cervical, thoracic, lumbar, and bulbar (facial) regions. Although initial presentations can vary, eventually upper and lower motor neurons are lost in the two types of ALS: familial and sporadic. A case study highlighting the reality of living with bulbar ALS relays Sister A's journey from early to late ALS. Etiology, pathophysiology, diagnosis, treatment, and clinical care are discussed.