Latent profiles of academic resilience in undergraduate nursing students and their association with resilience and self-efficacy.

AIM: This study aimed to investigate the heterogeneity of academic resilience among nursing students using latent profile analysis and its associated influencing factors. BACKGROUND: Nursing students experience higher levels of stress compared to their peers in other professions, and the cultivation of academic resilience plays a pivotal role in their ability to effectively cope with this stress. Academic resilience not only facilitates success in the face of academic adversity but also contributes to the promotion of mental well-being among nursing students. However, the current research on the academic resilience of nursing students has predominantly focused on a scale-centered total score approach, disregarding individual variability, and hindering the development to inform personalized interventions for enhancing academic resilience. DESIGN: A cross-sectional study. METHODS: A convenience sampling method was used to collect a total of 644 nursing students from two medical schools in Guangzhou City. The participants were recruited through an online survey conducted from January to March 2023. The questionnaires consisted of a general information form, the Chinese version of the Academic Resilience Scale-30 (C-ARS-30), the 10-item Connor Davidson Resilience Scale (CD-RISC-10), and the General Self-Efficacy Scale (GSES). Latent profile analysis was used to identify distinct categories of academic resilience among nursing students, and influencing factors were examined through ordinal logistic regression analysis. RESULTS: The academic resilience levels of nursing students can be divided into three potential categories: 'low academic resilience' (13.0%), 'moderate academic resilience' (70.0%), and 'high academic resilience' (17.0%). Level of grade, GPA, self-reported physical health level, resilience and self-efficacy were significantly influenced the different categories of academic resilience of nursing students (P<0.05). CONCLUSIONS: The majority of undergraduate nursing students were placed in the moderate academic resilience group, however, educational institutions should pay special attention to nursing students demonstrating low levels. Regular assessments of academic resilience are recommended, and personalized interventions should be tailored to address specific academic resilience characteristics across different grades of nursing students. Strategies aimed at enhancing academic resilience among nursing students may include improvements in GPA performance, attention to physical health, and the reinforcement of resilience and self-efficacy.

Women's Knowledge of Future Cardiovascular Risk Associated With Complications of Pregnancy: A Systematic Review.

Background: Several common pregnancy conditions significantly increase a woman's risk of future cardiovascular diseases (CVD). Patient education and interventions aimed at awareness and self-management of cardiovascular risk factors may help modify future cardiovascular risk. The aim of this systematic review was to examine education interventions for cardiovascular risk after pregnancy, clinical measures/scales, and knowledge outcomes in published qualitative and quantitative studies. Methods: Five databases were searched (from inception to June 2023). Studies including interventions and validated and nonvalidated measures of awareness/knowledge of future cardiovascular risk among women after complications of pregnancy were considered. Quality was rated using the Mixed Methods Appraisal Tool. Results were analyzed using the Synthesis Without Meta-analysis reporting guideline. Characteristics of interventions were reported using the Template for Intervention Description and Replication. Fifteen studies were included; 3 were randomized controlled trials. Results: In total, 1623 women had a recent or past diagnosis of hypertensive disorders of pregnancy, gestational diabetes mellitus, and/or premature birth. Of the 7 studies that used online surveys or questionnaires, 2 reported assessing psychometric properties of tools. Four studies used diverse educational interventions (pamphlets, information sheets, in-person group sessions, and an online platform with health coaching). Overall, women had a low level of knowledge about their future CVD risk. Interventions were effective in increasing this knowledge. Conclusions: In conclusion, women have a low level of knowledge of risk of CVD after pregnancy complications. To increase this level of knowledge and self-management, this population has a strong need for psychometrically validated tailored education interventions.

Contexte: Plusieurs problèmes médicaux liés à la grossesse augmentent significativement le risque d'une maladie cardiovasculaire (MCV) ultérieure chez les femmes. L'éducation des patients et les interventions axées sur la sensibilisation aux facteurs de risques cardiovasculaire et sur l'autoprise en charge pourraient aider à limiter le risque de MCV. La présente analyse des études qualitatives et quantitatives publiées visait à examiner les interventions éducatives au sujet des risques cardiovasculaires après la grossesse, les mesures et échelles cliniques qui y sont associées, et les résultats de ces interventions sur le plan des connaissances. Méthodologie: Des recherches ont été réalisées dans cinq bases de données (de leur date de création jusqu'à juin 2023). Les études considérées incluaient des interventions et des mesures validées ou non de la sensibilisation des femmes au sujet des risques de MCV après des complications liées à la grossesse ou de leurs connaissances à ce sujet. La qualité des études a été évaluée avec l'Outil d'évaluation de la qualité méthodologique des études incluses dans une revue mixte, et les résultats ont été évalués à l'aide de la méthodologie Synthesis Without Meta-analysis. Les caractéristiques des interventions ont été relevées selon le modèle Template for Intervention Description and Replication. Quinze études ont été retenues, dont 3 essais contrôlés randomisés. Résultats: Au total, 1623 femmes avaient reçu récemment ou auparavant un diagnostic de trouble hypertensif lié à la grossesse, de diabète gestationnel et/ou de travail prématuré. Parmi les 7 études ayant eu recours à des questionnaires ou des sondages en ligne, 2 mentionnaient l'évaluation des propriétés psychométriques des outils. Dans 4 études, plusieurs interventions éducatives ont été utilisées (dépliants, feuillets informatifs, séances de groupe en personne et plateforme en ligne offrant un accompagnement en matière de santé). De manière générale, le niveau de connaissance des femmes au sujet de leur risque de MCV était faible, mais les interventions se sont révélées efficaces pour améliorer ces connaissances. Conclusions: En conclusion, les femmes ne connaissent pas bien les risques de MCV associés aux complications survenues au cours de la grossesse. Pour améliorer le niveau des connaissances et l'autoprise en charge, des interventions conçues pour cette population et validées sur le plan psychométrique sont indispensables.

A case-based narrative review of pregnancy-associated atypical hemolytic uremic syndrome/complement-mediated thrombotic microangiopathy.

Atypical hemolytic uremic syndrome is a complement-mediated thrombotic microangiopathy caused by uncontrolled activation of the alternative complement pathway in the setting of autoantibodies to or rare pathogenic genetic variants in complement proteins. Pregnancy may serve as a trigger and unmask atypical hemolytic uremic syndrome/complement-mediated thrombotic microangiopathy (aHUS/CM-TMA), which has severe, life-threatening consequences. It can be difficult to diagnose aHUS/CM-TMA in pregnancy due to overlapping clinical features with other thrombotic microangiopathy syndromes including hypertensive disorders of pregnancy. However, the distinction among thrombotic microangiopathy etiologies in pregnancy is important because each syndrome has specific disease management and treatment. In this narrative review, we discuss 2 cases to illustrate the diagnostic challenges and evolving approach in the management of pregnancy-associated aHUS/CM-TMA. The first case involves a 30-year-old woman presenting in the first trimester who was diagnosed with aHUS/CM-TMA and treated with eculizumab from 19 weeks' gestation. Genetic testing revealed a likely pathogenic variant in CFI. She successfully delivered a healthy infant at 30 weeks' gestation. In the second case, a 22-year-old woman developed severe postpartum HELLP syndrome, requiring hemodialysis. Her condition improved with supportive management, yet investigations assessing for aHUS/CM-TMA remained abnormal 6 months postpartum consistent with persistent complement activation but negative genetic testing. Through detailed case discussion describing tests assessing for placental health, fetal anatomy, complement activation, autoantibodies to complement regulatory proteins, and genetic testing for aHUS/CM-TMA, we describe how these results aided in the clinical diagnosis of pregnancy-associated aHUS/CM-TMA and assisted in guiding patient management, including the use of anticomplement therapy.

Ataxia-Telangiectasia Mutated Loss-of-Function Displays Variant and Tissue-Specific Differences across Tumor Types.

PURPOSE: Mutations in the ATM gene are common in multiple cancers, but clinical studies of therapies targeting ATM-aberrant cancers have yielded mixed results. Refinement of ATM loss of function (LOF) as a predictive biomarker of response is urgently needed. EXPERIMENTAL DESIGN: We present the first disclosure and preclinical development of a novel, selective ATR inhibitor, ART0380, and test its antitumor activity in multiple preclinical cancer models. To refine ATM LOF as a predictive biomarker, we performed a comprehensive pan-cancer analysis of ATM variants in patient tumors and then assessed the ATM variant-to-protein relationship. Finally, we assessed a novel ATM LOF biomarker approach in retrospective clinical data sets of patients treated with platinum-based chemotherapy or ATR inhibition. RESULTS: ART0380 had potent, selective antitumor activity in a range of preclinical cancer models with differing degrees of ATM LOF. Pan-cancer analysis identified 10,609 ATM variants in 8,587 patient tumors. Cancer lineage-specific differences were seen in the prevalence of deleterious (Tier 1) versus unknown/benign (Tier 2) variants, selective pressure for loss of heterozygosity, and concordance between a deleterious variant and ATM loss of protein (LOP). A novel ATM LOF biomarker approach that accounts for variant classification, relationship to ATM LOP, and tissue-specific penetrance significantly enriched for patients who benefited from platinum-based chemotherapy or ATR inhibition. CONCLUSIONS: These data help to better define ATM LOF across tumor types in order to optimize patient selection and improve molecularly targeted therapeutic approaches for patients with ATM LOF cancers.

Reconsidering Routine Repeat Group and Screens During Pregnancy-Personalizing Pregnancy Care.

The group and screen (G&S) are performed in early pregnancy to identify clinically significant antibodies (CSA) that may necessitate fetal monitoring for hemolysis/anemia or affect RhIg eligibility. Guidelines vary, including differences between RhD-positive and negative patients, but typically, the G&S is repeated at 28 weeks, and sometimes pre-delivery. We reviewed data showing a low risk (0.01%-0.43%) of detecting a new CSA in late gestation (late alloimmunization) and the risk of late alloimmunization causing severe hemolysis/anemia is even lower at <0.01%. Routinely repeating a G&S at 28 weeks and delivery may not be necessary for healthy, low-risk pregnancies.

Assessing cardiovascular disease risk in women with a history of hypertensive disorders of pregnancy: A guidance paper for studies using administrative data.

BACKGROUND: Hypertensive disorders of pregnancy (HDP) are a major cause of maternal morbidity and mortality, and their association with increased cardiovascular disease (CVD) risk represents a major public health concern. However, assessing CVD risk in women with a history of these conditions presents unique challenges, especially when studies are carried out using routinely collected data. OBJECTIVES: To summarise and describe key challenges related to the design and conduct of administrative studies assessing CVD risk in women with a history of HDP and provide concrete recommendations for addressing them in future research. METHODS: This is a methodological guidance paper. RESULTS: Several conceptual and methodological factors related to the data-generating mechanism and study conceptualisation, design/data management and analysis, as well as the interpretation and reporting of study findings should be considered and addressed when designing and carrying out administrative studies on this topic. Researchers should develop an a priori conceptual framework within which the research question is articulated, important study variables are identified and their interrelationships are carefully considered. CONCLUSIONS: To advance our understanding of CVD risk in women with a history of HDP, future studies should carefully consider and address the conceptual and methodological considerations outlined in this guidance paper. In highlighting these challenges, and providing specific recommendations for how to address them, our goal is to improve the quality of research carried out on this topic.

Navigating changes: A qualitative study exploring the health-related quality of life of breast cancer survivors during the coronavirus disease 2019 pandemic.

AIMS: To explore the impact of the coronavirus disease 2019 pandemic on the health-related quality of life (HRQoL) of breast cancer survivors. DESIGN: We utilized a qualitative descriptive approach to facilitate interviews among 25 participants, all of whom are survivors of breast cancer and have received treatment in Hong Kong within the preceding 3 years. METHODS: Content analysis was performed to understand how patients' HRQoL views and experiences changed during coronavirus disease 2019 pandemic. RESULTS: The results included six themes delineating the impact of the coronavirus disease 2019 pandemic: (i) survivor sensitivities in pandemic times, (ii) coping and conditioning in pandemic times, (iii) transforming work and home dynamics in pandemic times, (iv) cognitive resilience and adaptation to the COVID-19 protective measures, (v) social resilience in pandemic times and (vi) healthcare adaptation and coping in pandemic times. CONCLUSION: This study provides insights into the experiences and challenges of breast cancer survivors during the coronavirus disease 2019 pandemic. Some survivors had new physical and psychological symptoms, including fear and anxiety, isolation, pain, lymphoedema and burnout, which potentially have long-term impact upon HRQoL. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: This study highlights the unique challenges faced by breast cancer survivors during the coronavirus disease 2019 pandemic, including accessing healthcare services and the impact of social isolation. Healthcare providers should consider the holistic needs of breast cancer survivors in the provision of health care and develop supportive interventions, including telehealth services and online support groups, to address these challenges and improve their HRQoL. IMPACT: Surgery aimed at treating breast cancer or reducing its risk generally influences the appearance of breast areas and donor sites. The continuing effects of these changes on body image and HRQoL are well-reported, although studies have ineffectively examined the initial experiences of women regarding their postoperative appearance, particularly during the pandemic. REPORTING METHOD: The checklist of consolidated criteria for reporting qualitative research (COREQ) was utilized. PATIENT OR PUBLIC CONTRIBUTION: A small selection on breast cancer survivors contributed to the design of this study, in particular the content of the semi-structured interviews.

Pregnancy-associated cardiovascular risks and postpartum care; an opportunity for interventions aiming at health preservation and disease prevention.

Cardiovascular disease (CVD) is the leading cause of premature death and disability for female individuals around the world and the rates are increasing in those aged 35-44 years. Certain pregnancy complications (Pregnancy-associated Cardiovascular Risks (P-CVR))are linked to an increased risk of future CVD making pregnancy and the postpartum period as an ideal time to screen individuals for underlying, often unrecognized, cardiovascular risk factors. Pregnancy complications associated with an increased risk of future CVD including the hypertensive disorders of pregnancy, gestational diabetes, idiopathic preterm birth, delivery of a growth restricted baby and a placental abruption that leads to delivery. A number of guidelines and research groups recommend postpartum CVR screening, counseling and lifestyle intervention for all those who have had one or more of P-CVRs starting within the first six months postpartum. An individualized plan for postpartum screening should be created with the individual and lifestyle interventions discussed.

Quantitative, titratable and high-throughput reporter assays to measure DNA double strand break repair activity in cells.

Repair of DNA damage is essential for the maintenance of genome stability and cell viability. DNA double strand breaks (DSBs) constitute a toxic class of DNA lesion and multiple cellular pathways exist to mediate their repair. Robust and titratable assays of cellular DSB repair (DSBR) are important to functionally interrogate the integrity and efficiency of these mechanisms in disease models as well as in response to genetic or pharmacological perturbations. Several variants of DSBR reporters are available, however these are often limited by throughput or restricted to specific cellular models. Here, we describe the generation and validation of a suite of extrachromosomal reporter assays that can efficiently measure the major DSBR pathways of homologous recombination (HR), classical nonhomologous end joining (cNHEJ), microhomology-mediated end joining (MMEJ) and single strand annealing (SSA). We demonstrate that these assays can be adapted to a high-throughput screening format and that they are sensitive to pharmacological modulation, thus providing mechanistic and quantitative insights into compound potency, selectivity, and on-target specificity. We propose that these reporter assays can serve as tools to dissect the interplay of DSBR pathway networks in cells and will have broad implications for studies of DSBR mechanisms in basic research and drug discovery.

The Shift from Individual to Organizational Health Literacy: Implications for Kidney Healthcare Leaders and Clinicians.

BACKGROUND: As a social determinant of health, health literacy has a vital role in the management of chronic disease management, including chronic kidney disease (CKD). SUMMARY: To be able to manage their condition, patients with CKD need to be able to assess, comprehend, appraise, and utilize complex health-related information. Those patients are much more likely to understand and use health information appropriately, if it addresses their personal needs related to language, culture, educational background, and socioeconomic status. One aspect of health literacy, organizational health literacy (OHL), relates to the degree with which health organizations justifiably empower patients to locate, understand, and utilize health information and facilities to inform their decision-making and health behaviours. With increasing evidence-based about OHL as a way to improve healthcare, it is a new concept for kidney clinicians. KEY MESSAGES: As producers of health-related information, the multidisciplinary kidney healthcare team have a responsibility to meet the needs of those in their care, as such, priority should be given to implementation of OHL initiatives. Through enhancing the clarity of information, OHL initiatives may provide a game plan for person-centred care for those with CKD.

Quality of life profiles and its association with predictors amongst Chinese older adults in nursing homes: a latent profile analysis.

BACKGROUND: Recently developments in the field of positive psychology have provided new perspectives for understanding the connection between individual variation in Quality of life (QoL) and positive aspects of human potential, strengths, and resources, commanding increasing attention. This study aimed to examine self-reported quality of life (QoL) profiles and the association of QoL profiles with positive psychosocial characteristics in Chinese older adults. METHODS: A convenient sample of 354 older adults in nursing homes was recruited from Guangdong Province, China, between November 2020 and January 2021. Latent Profile Analysis (LPA) was conducted to explore QoL profiles using the four WHOQOL-BREF domains as input variables. Multinomial logistic regression was performed to explore the association between latent profiles and predictors. RESULTS: LPA identified three latent QoL profiles: "low QoL with poor psychological health" (18.1%), "moderate QoL" (46.0%) and "high QoL" (35.9%). Frequency of weekly activity, optimism, gratitude, and social support were associated with the increased likelihood of belonging to the moderate-to-high QoL classes. Furthermore, Class 2 (moderate QoL group, reference) was compared with Class3 (high QoL group), higher frequency of weekly physical activity and spending more time on physical activity exhibited higher odds of belonging to high QoL class. CONCLUSION: Using the domains of the WHOQOL-BREF scale, the QoL profiles Chinese older adults can be identified. We found that psychosocial variables and demographic characteristic, including lower level of optimism and gratitude, lack of social support, low frequency of physical activity, and shorter activity duration time, heighten the risk for lower levels of QoL. Identifying classification may help focus on those at elevated risk for poor QoL and for developing tailored QoL improvement programs.

Targeting ATR in Cancer Medicine.

As a key component of the DNA Damage Response, the Ataxia telangiectasia and Rad3-related (ATR) protein is a promising druggable target that is currently widely evaluated in phase I-II-III clinical trials as monotherapy and in combinations with other rational antitumor agents, including immunotherapy, DNA repair inhibitors, chemo- and radiotherapy. Ongoing clinical studies for this drug class must address the optimization of the therapeutic window to limit overlapping toxicities and refine the target population that will most likely benefit from ATR inhibition. With advances in the development of personalized treatment strategies for patients with advanced solid tumors, many ongoing ATR inhibitor trials have been recruiting patients based on their germline and somatic molecular alterations, rather than relying solely on specific tumor subtypes. Although a spectrum of molecular alterations have already been identified as potential predictive biomarkers of response that may sensitize to ATR inhibition, these biomarkers must be analytically validated and feasible to measure robustly to allow for successful integration into the clinic. While several ATR inhibitors in development are poised to address a clinically unmet need, no ATR inhibitor has yet received FDA-approval. This chapter details the underlying rationale for targeting ATR and summarizes the current preclinical and clinical landscape of ATR inhibitors currently in evaluation, as their regulatory approval potentially lies close in sight.

Chinese cross-cultural adaptation and validation of the Well-being Numerical Rating Scales.

Introduction: Well-being is a multi-domain concept that involves measuring physical, psychological, social, and spiritual domains. However, there are currently few multi-domain and comprehensive well-being instruments available. In addition, measures that do exist customarily contain a vast number of items that may lead to boredom or fatigue in participants. The Well-being Numerical Rating Scales (WB-NRSs) offer a concise, multi-domain well-being scale. This study aimed to perform the translation, adaptation, and validation of the Chinese version of WB-NRSs (WBNRSs-CV). Methods: A total of 639 clinical participants and 542 community participants completed the WB-NRSs-CV, the Single-item Self-report Subjective Well-being Scale (SISRSWBS), the World Health Organization Five-item Well-Being Index (WHO-5), the 10-item Perceived Stress Scale (PSS-10), and the Kessler Psychological Distress Scale (K10). Results: High internal consistency and test-retest reliability were obtained for both samples. Additionally, WB-NRSs-CV was positively associated with SISRSWBS and WHO-5 and negatively associated with PSS-10 and K10. In the item response theory analysis, the model fit was adequate with the discrimination parameters ranging from 2.73 to 3.56. The diffculty parameters ranged from -3.40 to 1.71 and were evenly spaced along the trait, attesting to the appropriateness of the response categories. The invariance tests demonstrated that there was no difference in WB-NRSs-CV across groups by gender or age. Discussion: The WB-NRSs-CV was translated appropriately and cross-culturally adapted in China. It can be used as a rapid and relevant instrument to assess well-being in both clinical and non-clinical settings, with its utility for well-being measurement and management among the Chinese people.

The impact of COVID-19 on stress and resilience in undergraduate nursing students: A scoping review.

BACKGROUND: Being a nursing student can be a stressful experience, faced with considerable academic and clinical demands. It has been suggested that the Coronavirus Disease 2019 (COVID-19) may have further exacerbated the pressure nursing students face. It has been posited that resilience, a complex psychological concept, may help nursing students overcome stressful situations. AIMS: The aim of this scoping review was to examine the relationship between resilience and stress in nursing students during the COVID-19 pandemic. METHODS: Relevant publications were identified by a comprehensive search of the literature from January 2019 to September 2022 to capture relevant publications during the COVID-19 global pandemic period from the following databases: CINAHL, Medline Complete, APA PsycInfo, Ovid EmCare and Web of Science. Fifteen studies met our inclusion criteria and were included in the review using Arskey & O'Malley's (2005) methodological framework for scoping reviews. RESULTS: Our findings suggest that nursing students from all around the world have experienced high levels of stress during the COVID-19 pandemic. Almost unanimously, resilience was identified as a key protective factor against stress and the development of psychological morbidity. Those nursing students with higher levels of resilience were deemed more likely to stay on track with their studies, despite COVID-related challenges. CONCLUSION: In conclusion, this scoping review adds to the well-established argument to incorporate resilience-building activities in undergraduate nursing curricula. Developing levels of resilience has the potential to empower nursing students for academic and clinical success, whilst facing the challenges of an ever-changing world.

Translation, cross-cultural adaptation, and validation of the Chinese version of the COVID-19 health literacy scale in nursing students.

BACKGROUND: Effective communication is an essential component of high-quality nursing care. Health literacy, the ability to access, describe, evaluate and apply health information to make informed decisions, is an important component of effective communication in nursing. Nurses, including student nurses, with good levels of health literacy (HL) are well positioned to communicate reliable public health-related information effectively, at times like the COVID-19 global pandemic. At this time, many nursing students have been at the frontline of patient education, as such, it would be expected that they have high levels of HL. However, it has been suggested that there is the need to improve HL levels in nursing students. AIMS: The aim of this study was to analyse the structure of item response of a back translated Chinese version of the COVID-HLS-Q22 questionnaire and to assess the coronavirus-related HLof Chinese speaking nursing students in Hong Kong using the COVID-HLS-Q22-CN. METHODS: A cross-sectional study of 97 undergraduate nursing students was conducted using two self-reported questionnaires. The HLS-EU-16 scale, with face validity already established, was used to assess scale equivalence Using a cross-over study approach, student participants were randomly assigned in sequential order. The validation process was performed in five phases: direct translation, translation synthesis, back translation, consolidation with experts, and testing with the students. The intended outcome of this study will be a formally tested model of the Chinese version of the COVID-HLS-Q22-CN, that can be replicated in Chinese population. RESULTS: Factorial equivalence was present across language versions in both questionnaires. Internal consistency was excellent for COVID-HLS-Q22-CN (coefficient alpha for Chinese version of questionnaire, 0.957 and English version, 0.953). This suggested that the four subscale are stable across the two questionnaires. CONCLUSION: The COVID-HLS-Q22-CN has proven to be a feasible and reliable tool in the assessment of Hong Kong based Chinese speaking nursing students. The emergence of issues around COVID-related HL further highlights the need to include the teaching of critical health literacy skills within nurse education, preparing the healthcare professionals of the future for public health emergencies.