Summary of evidence to facilitate the implementation of advance care planning among advanced cancer patients. / ä¿ƒè¿›æ™šæœŸç™Œç—‡æ‚£è€ é¢„ç«‹åŒ»ç–—ç §æŠ¤è®¡åˆ’å®žæ–½çš„è¯æ®æ€»ç»“.

Advance care planning (ACP) is designed to ensure that patients lacking autonomous decision-making capacity receive medical services in accordance with their expectations and preferences. Individuals with advanced cancer are a crucial target for ACP implementation. However, the current practice of ACP in this group in China is suboptimal, demanding high-quality implementation evidence to strengthen ACP in the clinical practice of patients with advanced cancer. The existing literature can be summarized into 27 pieces of evidence across 7 dimensions, including initiation time, intervention content, intervention providers, intervention modalities, communication skills, outcome indicators, and environmental support. The aforementioned evidence could provide crucial support for improving ACP implementation for patients with advanced cancer. Subsequent research efforts should integrate patient preferences and explore the most suitable implementation strategies for ACP in the Chinese population with advanced cancer, considering diverse aspects such as traditional culture, ACP education and training, legislative support, and healthcare system refinement.

Transition shock among nursing interns and its relationship with patient safety attitudes, professional identity and climate of caring: a cross-sectional study.

BACKGROUND: Nursing interns often experience lots of challenges during their clinical nursing internships, which can adversely affect career decisions and result in a squandering of nursing education resources. Patient safety attitudes, professional identity and climate of caring may affect nursing interns' clinical experience. However, more evidence is requested to validate these relationships for nursing educators to develop effective education programs and facilitate interns' successful transition. METHODS: This was a cross-sectional study, which used a convenience sampling method to recruit 387 nursing interns during December 2022 to April 2023 in university affiliated hospital in Hunan province, China. Data were collected using standardized scales. Spearman correlation and multiple regression analysis were employed to examine the relationship between transition shock, patient safety attitudes, professional identity, and climate of caring. RESULTS: Nursing interns experienced transition shock at a moderate level and the highest levels of transition shock in response to overwhelming practicum workloads, with the second being related to the conflict between theory and practice. Transition shock was negatively correlated with patient safety attitudes, professional identity and climate of caring among nursing interns. CONCLUSIONS: Nursing managers and educators need to value the transition shock experienced by nursing interns. Our study suggests that developing a strong sense of professional identity and a positive attitude toward patient safety can be effective in reducing the level of transition shock among nursing interns. In addition, a caring climate within the nursing unit can significantly enhance the overall experience of nursing interns. This can be achieved by enhancing the support of clinical mentors, providing patient safety-focused education, and facilitating team communication among nurses.

Evaluation of niche, diversity, and risks of microplastics in farmland soils of different rocky desertification areas.

The occurrence, sources, effects, and risks of microplastics (MPs) in farmland soils have attracted considerable attention. However, the pollution and ecological characteristics of MPs in farmland soils at different levels of rocky desertification remain unclear. We collected and analyzed farmland soil samples from rocky desertification areas in Guizhou, China, ranging from no to heavy risks. We explored differences and migration of MPs across these areas, unveiled the relationship between diversity, niche, and risks of MPs, and determined influencing factors. The average abundance of soil MPs was 8721 ± 3938 item/kg, and the abundance and contamination factor (CF) of MPs escalated with the increase in rocky desertification level. Diversity, niche, and risk of soil MPs in different rocky desertification areas were significantly different. Rocky desertification caused both MP community differences and linked MP communities at different sites. Diversity and niche significantly affected MP risk (p < 0.05). Environmental factors with significant correlations (p < 0.05) with the abundance and ecological characteristics of MPs varied significantly in soils of different rocky desertification areas. This study advances our comprehension of MP pollution in farmland soils within rocky desertification areas, offering essential data and theoretical insights for the development of control strategies.

Estimation of forest canopy closure in northwest Yunnan based on multi-source remote sensing data colla-boration.

Forest canopy closure (FCC) is an important parameter to evaluate forest resources and biodiversity. Using multi-source remote sensing collaborative means to achieve regional forest canopy closure inversion with low cost and high-precision is a research hotspot. Taking ICESat-2/ATLAS data as the main information source and combined with data of 54 measured plots, we estimated FCC value by the Bayesian optimization (BO) algorithm improved random forest (RF), K-nearest neighbor (KNN), and gradient boosting regression tree (GBRT) model at footprint-scale. Combined with multi-source remote sensing image Sentinel-1/2 and terrain factors, we estimated the regional-scale FCC value of Shangri-La in the northwest Yunnan based on deep neural network (DNN) optimized by BO algorithm. The results showed that six characteristic parameters (percentage of tree canopy, standard deviation of relative height of photons at the top of the canopy, minimum canopy height, difference between 98% canopy height and median canopy height in the segment, number of top canopy photons, apparent surface reflectance) out of the 50 parameters that were extracted from ATLAS lidar footprint had higher contribution rate after RF characteristic variable optimization, which could be used as model variable for footprint-scale remote sensing estimation. Among BO-RF, BO-KNN, and BO-GBRT models, the FCC results estimated by the BO-GBRT model were the best at footprint-scale. The coefficient of determination (R2) was 0.65, the root mean square error (RMSE) was 0.10, the mean absolute residual (RS) was 0.079, and the prediction accuracy (P) was 0.792 for leave-one-out cross validation. It could be used as the FCC estimation model of 74808 ATLAS footprints for forest in the study area. We used the ATLAS footprint-scale FCC value of forest as the large sample data of the regional-scale BO-DNN model and combined with multi-source remote sensing factors to estimate FCC in the study area, the accuracy of the 10-fold cross-validation BO-DNN model was R2=0.47, RMSE=0.22, P=0.558. The mean values of FCC in the study area estimated by BO-DNN model and ordinary Kriging (OK) interpolation were 0.46 and 0.52, respectively, and the values mainly distributed in 0.3-0.6, accounting for 77.8% and 81.4%, respectively. The FCC efficiency obtained directly by the OK interpolation method was higher (R2=0.26), but the prediction accuracy was significantly lower than the BO-DNN model (R2=0.49). The FCC high value was distributed from northwest to southeast in the study area, and the northern and southeastern regions were the main distribution areas of high and low FCC values, respectively. It had certain advantages to estimate mountain area FCC based on ICESat-2/ATLAS high-density footprint, and the estimation results of small sample data at footprint-scale could be used as large sample data of deep learning model at region-scale, which would provide a reference for the low-cost and high-precision to FCC estimation on the footprint-scale up to the extrapolated regional-scale.

Literature review and development of pictorial action plan to promote self-management of chronic obstructive pulmonary disease.

OBJECTIVE: This study aimed to review relevant literature and develop a pictorial action plan (PAP) to enhance self-management among older patients with chronic obstructive pulmonary disease (COPD). METHODS: In Stage 1, an integrative review was conducted to identify key elements of respiratory self-management action plans. In Stage 2, cartoon pictograms with plain descriptions were designed. In Stage 3, the PAP was validated by 40 older patients with COPD and an expert panel. RESULTS: While the eight included studies demonstrated positive effects on knowledge and quality of life, key elements identified included: traffic light motif, plain and explicit language, and several action plan topics. The final PAP comprises three traffic light-coloured zones and 24 pictograms that introduce self-management strategies for normal, decreasing, and severely decreased airflow. After revising the cartoon characters, all of the pictograms received guessability ratings above 70% and acceptable mean translucency ratings. DISCUSSION: The integrative review provides evidence about the effectiveness and key elements of PAPs. The PAP developed was found to be valid and feasible for use among older patients with chronic respiratory conditions. PRACTICE IMPLICATIONS: This study offered an example of translating evidence into patient education practice to enhance self-management in older patients with COPD.

Good death from cancer-the patient view: systematic review of qualitative studies.

BACKGROUND AND OBJECTIVE: An in-depth understanding of what constitutes a good death among patients with cancer is vital to providing patient-centred palliative care. This review aimed to synthesise evidence on the perceptions of a good death among patients with cancer. METHODS: This systematic review involved a synthesis of qualitative data. A three-step process suggested by the Joanna Briggs Institute was used to synthesise the data. RESULTS: A total of 1432 records were identified, and five articles met the inclusion criteria. Seven synthesised findings emerged: (1) being aware of cancer, (2) pain and symptom management, (3) dying well, (4) being remembered after death, (5) individual perspectives of a good death, (6) individual behaviours leading to a good death, and (7) culture and religions. A structural framework was developed to elicit two layers that could be regarded as determinants of a good death. One layer suggested how multiple external issues impact a good death, whereas the other layer involves patients' internal attributes that shape their experiences of a good death. The elements in the two layers were inter-related to exert a crossover effect on good death in specific cultural and religious contexts. CONCLUSION: A good death is a process initiated from the time of awareness of cancer and extends beyond demise. Holistic approaches encompassing the management of physical and psychological distress along with psychosocial behavioural interventions to enhance patients' positive perspectives and behaviours are recommended to improve their quality of life and death.

Virtual simulation and problem-based learning enhance perceived clinical and cultural competence of nursing students in Asia: A randomized controlled cross-over study.

BACKGROUND: Both clinical and cultural competencies are of paramount importance in ensuring patients' safety and high-quality care. While problem-based learning (PBL) is a widely applied pedagogy in nursing education, an emerging technology-based pedagogy, virtual simulation provides a realistic clinical learning experience for students. It can be an effective solution for continuing clinical and cultural learning across countries in the era of the pandemic. OBJECTIVES: This study aimed to compare the effectiveness of virtual simulation and PBL on the perceived clinical and cultural competence for nursing students. DESIGN: A randomized controlled cross-over study design was used. SETTINGS AND PARTICIPANTS: Sixty-one undergraduate and postgraduate nursing students from five Asian regions were selected for participation. METHODS: Participants were randomized to receive either virtual simulation (group A) or PBL (group B) for one day, followed by another intervention on the second day. Three self-reported questionnaires were used: Clinical Competence Questionnaire (CCQ), Inventory for Assessing the Process of Cultural Competence among Healthcare Professionals-Student Version (IAPCC-SV), and demographic questionnaire. RESULTS: The results revealed that students in both arms had significant improvements in CCQ total score (A: d = 21.500, P < 0.001; B: d = 16.710, P = 0.001), nursing professional behavior (A: d = 8.233, P < 0.001; B: d = 6.323, P < 0.001), and advanced nursing skills (A: d = 2.533, P = 0.008; B: d = 2.129, P = 0.029) after two interventions. In addition, both arms demonstrated significant improvements in IAPCC-SV total score (A: d = 3.467, P = 0.037; B: d = 4.032, P = 0.010) and cultural skills (A: d = 0.767, P = 0.012; B: d = 1.000, P = 0.001). No significant differences were observed between the two arms. CONCLUSIONS: The findings indicated that both virtual simulation and PBL were effective in promoting students' perceived clinical and cultural competence. As both education modes have their own uniqueness and effectiveness in both outcomes, the combination of both could enhance the variability of learning modalities. Notably, the use of virtual simulation first could engage students better in learning and achieve better educational outcomes.

Family-oriented dignity therapy for patients with lung cancer undergoing chemotherapy: How does it work better?

Objective: This study aimed to examine the fidelity of intervention delivery and identify precursory factors contributing to the successful delivery and beneficial effects of family-oriented dignity therapy. Methods: This was a process evaluation with quantitative and qualitative methods alongside a randomized controlled trial from March to May 2019. Nonparametric statistics were used to analyze how participants' demographics (n â€‹= â€‹45 dyads) and process variables influenced the intervention effects. Fourteen patients, 11 family caregivers, and 11 nurses were interviewed to explore their perception of the intervention. Conventional content analysis was adopted to analyze the qualitative data. Results: The fidelity was achieved with minor deviations from the protocol. Higher educational level and higher income were significantly correlated with lower levels of existential distress (H â€‹= â€‹12.20, P â€‹= â€‹0.030) and higher spiritual well-being (H â€‹= â€‹-16.310, P â€‹= â€‹0.031), respectively. Higher levels of interest were significantly correlated with lower levels of existential distress (H â€‹= â€‹10.396, P â€‹= â€‹0.035) and peace of mind distress (H â€‹= â€‹-16.778, P â€‹= â€‹0.006) and higher levels of life meaning (H â€‹= â€‹-12.808, P â€‹= â€‹0.047). Patients who had higher response levels to the question were significantly correlated with lower levels of symptom distress (H â€‹= â€‹-13.879, P â€‹= â€‹0.035). Four major categories were identified from the interview data: (1) benefits of the intervention, (2) risks of the intervention, (3) factors that enhance successful dignity-conserving care, and (4) difficulties and barriers to the delivery of dignity-conserving care. Conclusions: Fidelity and precursory factors that enhance the beneficial effects of family-oriented dignity therapy were identified. Reinforcement strategies, such as using supplementary video, audio, and reading materials; developing a flexible approach to expressing feelings; and exploring lessons and achievements from various perspectives, are recommended for future research to enhance intervention effects. Trial registration: The study was registered in the Chinese Clinical Trial Registry (registration number: ChiCTR1900020806).

Development of an evidence­based, theory­driven, and culturally appropriate character strengths-based intervention for breast cancer patients, following the Medical Research Council Framework.

PURPOSE: To design and develop a complex, evidence­based, theory­driven, and culturally appropriate character strengths-based intervention (CSI) for breast cancer patients, following the Medical Research Council (MRC) framework. METHODS: From 2018 September to 2020 November, a complex intervention perspective was adopted. The rationale, methods, and processes employed in carrying out the study were reported. The acceptability and feasibility of intervention program were evaluated as a part of subsequent pilot study. Based on piloting, a refined and optimized definitive intervention was obtained. The development of the intervention is an iterative process involving input from three key stakeholders: experts, medical staff, and patient representatives. RESULTS: The systematic review revealed CSIs were effective and the selected theory served as a guide and indicated theory-inspired modifications. A representative team of breast cancer patients and oncology nurses collaboratively developed and tailored the intervention content and format with attention to the acceptability and feasibility. Five main strategies, including peripheral, evidential, linguistic, constituent-involving, and sociocultural strategies, were used to achieve and strengthen the cultural appropriateness. After the pilot phase, several refinements were made on the CSI program, such as editorial changes in the booklet or alternative suggestions for difficult strengths-based activities (e.g., outdoor activities). All participants not only expressed satisfaction with the program in process evaluation, but also reported perceived benefits such as enjoyable and sociable experience, better well-being, and increased confidence. CONCLUSION: Consideration of the MRC framework, theory guidance, and suggestions from stakeholders during intervention development can optimize uptake and sustainability in the clinical setting. It is recommended that randomized controlled trial be used in future studies to assess the intervention, the process and the mechanisms of the intervention. Our approach may offer implications for the design and implementation of similar initiatives to support cancer patients. TRIAL REGISTRATION: ClinicalTrials.gov Register Identifier: NCT04219267, 07/01/2020, retrospectively registered.

Development and feasibility of culturally sensitive family-oriented dignity therapy for Chinese patients with lung cancer undergoing chemotherapy.

Objective: It is well-documented in the literature that dignity therapy is feasible and effectively improves the end-of-life experience of the terminally ill. In a similar vein, this study aimed to develop and investigate the feasibility of evidence-based and culturally sensitive family-oriented dignity therapy for Chinese patients with lung cancer undergoing chemotherapy. Methods: Three phases of the Medical Research Council framework were adopted to guide the development of the novel dignity therapy intervention. It was preliminarily designed based on a qualitative study and a systematic review, Erikson's eighth stage of psychosocial development, and the dignity model. The feasibility and acceptability of the intervention were examined in a pilot randomized controlled trial with 12 recruited dyads of patients and family caregivers. Results: The intervention consists of three face-to-face sessions that facilitate participants' reminiscences and promote their communication. Recruitment and response rates for the feasibility study of the intervention were 92.3% and 75%, respectively. Both patients and family caregivers reported that the intervention alleviated their psychological distress and improved communication. Conclusions: The Medical Research Council framework serves as a useful scientific basis for modifying dignity therapy with a culturally sensitive approach. The results of the feasibility study suggest that the family-oriented dignity therapy intervention is feasible, acceptable and has the potential to enhance the effects of dignity therapy.

Notion of a good death for patients with cancer: a qualitative systematic review protocol.

INTRODUCTION: Promoting the quality of death and achieving a good death is one of the most important goals of palliative care in cancer care. Few studies synthesised views of patients with cancer on the notion of a good death and its associated factors. By eliciting the core elements of a good death, the review aims to identify potential unmet needs of patients with cancer and reveal their common values and care preferences at the end of life. The review also has the potential to inform the development of guidelines for clinical care and shared decision-making in palliative care practice. METHODS AND ANALYSIS: A qualitative systematic review will be conducted and reported according to the Joanna Briggs Institute (JBI) methodology for systematic review and synthesis of qualitative data and the Preferred Reporting Items for Systematic Review and Meta-Analysis. Comprehensive search will be performed in six English and two Chinese databases from inception to 30 April 2022 to retrieve relevant qualitative articles focusing on the notion of a good death from the perspective of patients with cancer. Data will be extracted using the JBI standardised data extraction tool for qualitative research. The quality of the included studies will be critically appraised using the JBI Qualitative Assessment and Review Instrument. Data extraction and quality appraisal will be conducted by two reviewers independently. A meta-aggregative approach and narrative summary will be used to synthesise data. ETHICS AND DISSEMINATION: Ethical approval is not needed. We will disseminate the findings through international conferences related to cancer care or palliative care. The final review will be submitted and published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER: CRD42021266629.

Kindlin-2 protects pancreatic ß cells through inhibiting NLRP3 inflammasome activation in diabetic mice.

Diabetes mellitus has been a major public health problem worldwide, characterized by insulin resistance and dysfunction of ß-cells. A previous study showed that Kindlin-2 loss in ß-cells dramatically reduces insulin secretion and decreases ß-cell mass, resulting in severe diabetes-like phenotypes. It suggests that Kindlin-2 in ß-cells play an important role in regulating glucose homeostasis. However, the effect of Kindlin-2 on the function of ß-cells under chronic hyperglycemia in diabetes has not been explored. Here we report that Kindlin-2 overexpression ameliorates diabetes and improves insulin secretion in mice induced by streptozocin. In contrast, Kindlin-2 insufficiency exacerbates diabetes and promotes ß-cells dysfunction and inflammation in ß-cells induced by a high-fat diet (HFD). In vitro, Kindlin-2 overexpression prevented high-glucose (HG)-induced dysfunction in ß-cells. Kindlin-2 overexpression also decreased the expression of pro-inflammatory cytokines and NLRP3 inflammasome expression in ß-cells exposed to HG. Furthermore, the loss of Kindlin-2 aggravates the expression of inflammatory cytokines and NLRP3 induced by HG in ß-cells. Collectively, we demonstrate that Kindlin-2 protects against diabetes by inhibiting NLRP3 inflammasome activation.

Psychometric validation of the Chinese version of the M. D. Anderson Symptom Inventory-Head and Neck Module in patients with nasopharyngeal carcinoma.

Objective: The Chinese version of the M. D. Anderson Symptom Inventory-Head and Neck Module (MDASI-HN-C) has been linguistically validated. However, its psychometric properties have not been established yet. The purpose of the study was to psychometrically validate the MDASI-HN-C in patients with nasopharyngeal carcinoma (NPC). Methods: 130 Chinese NPC patients who were undergoing radiotherapy (RT) participated in this cross-sectional study. The content, convergent, and construct validity of the MDASI-HN-C were examined. The reliability of the instrument was tested by examining the internal consistency and test-retest reliability. Results: Cronbach's α coefficients ranged from 0.85 to 0.91 for the three subscales of the MDASI-HN-C. The 3-day test-retest reliability was acceptable with intraclass correlation coefficients (ICC) ranged from 0.52 to 0.71. The scale content validity index (S-CVI) was satisfactory (0.97). Subscale scores of the MDASI-HN-C were negatively correlated with the total score of the Chinese version of the Functional Assessment of Cancer Therapy-Head and Neck Scale (FACT-H&N-C) as hypothesized (r â€‹= â€‹-0.484 to -0.563, all P â€‹< â€‹0.01). Exploratory factor analysis (EFA) revealed two factors for the 13 core and another two for the nine HNC-specific items. Only one factor was generated for the six interference items. Conclusions: The MDASI-HN-C shows desirable psychometric properties for evaluating symptom burden in NPC patients, which can be used in both clinical and research contexts.

Pathways from Neuroticism, Social Support, and Sleep Quality to Antenatal Depression during the Third Trimester of Pregnancy.

Background: Antenatal depression is a severe public health problem. Many studies support the concept that neuroticism, social support, and sleep quality are closely related to antenatal depression. However, there is little evidence concerning the influencing pathways of these variables on antenatal depression. The aim of this study is to investigate the pathways from neuroticism, social support, and sleep quality to antenatal depression during the third trimester of pregnancy. Methods: A cross-sectional study design was used. A total of 773 eligible women in the third trimester of pregnancy submitted valid questionnaires from June 2016 to April 2017. Instruments with good reliability and validity were used to measure neuroticism, social support, sleep quality, and antenatal depression. Structural equation modeling was used to explore the pathways from neuroticism, social support, and sleep quality to antenatal depression during the third trimester of pregnancy. Results: Antenatal depression is shown to be positively correlated with neuroticism and negatively correlated with social support and sleep quality. Neuroticism is shown to have a direct effect and indirect effects through social support and sleep quality on antenatal depression. Conclusions: Neuroticism influences antenatal depression directly and indirectly. Social support and sleep quality are the mediators of the indirect relationship between neuroticism and antenatal depression. Our results suggest that a personality test offered to all pregnant women could help detect a vulnerability to depression, whereupon intervention in the domains of sleep and social support could prove preventive.

Effects of family-oriented dignity therapy on dignity, depression and spiritual well-being of patients with lung cancer undergoing chemotherapy: A randomised controlled trial.

BACKGROUND: Enhancing patients' sense of dignity is the core element of high-quality palliative care. In Western countries, dignity therapy has shown promising positive effects on the sense of dignity and end-of-life experience. To apply this therapy in Chinese patients, a theory-driven, culturally relevant family-oriented dignity therapy was developed, guided by the Medical Research Council framework for complex intervention development. OBJECTIVES: This study examined the effectiveness of family-oriented dignity therapy in improving dignity-related distress, depression, and spiritual well-being in Chinese patients with lung cancer undergoing chemotherapy. DESIGN: A randomised controlled trial. SETTINGS AND METHODS: Patients who were diagnosed with lung cancer and undergoing chemotherapy were recruited using convenience sampling from a cancer hospital in Changsha, China. A significant family caregiver of each patient was invited to participate. Patients who met the inclusion criteria and agreed to participate (N = 120) were randomly assigned to receive family-oriented dignity therapy (intervention group, n = 60) or attention (control group, n = 60). The Patient Dignity Inventory, Patient Health Questionnaire-9, and Functional Assessment of Chronic Illness Therapy - Spiritual Well-being Scale were used to assess dignity-related distress, depression, and spiritual well-being, respectively, at baseline and 1- and 4-week follow-up. A generalised estimating equation was used to analyse the intervention effects across the time points. RESULTS: Compared with the control group, the patients in the intervention group showed significantly greater reduction in existential distress (ß: -1.372, 95% CI: -2.269, -0.472; p = 0.003) and depression (ß: -3.430, 95% CI: -5.032, -1.829; p < 0.001) at week one, as well as significantly greater improvement in spiritual well-being at both week one (ß: 3.705, 95% CI: 0.599, 6.811; p = 0.019) and week four (ß: 4.939, 95% CI: 0.476, 9.401; p = 0.030). CONCLUSIONS: Family-oriented dignity therapy has the potential to relieve existential distress and depressive symptoms and improve spiritual well-being. We expect our finding to impact research on family-oriented dignity therapy and enhance its effectiveness. We may also have an impact on nursing practice by providing a means to initiate conversations between nurses and the patients and family caregivers to relieve the psychosocial distress of patients during treatment. This study has been registered in the Chinese Clinical Trial Registry (registration number: ChiCTR1900020806).

Effects of music intervention on anxiety, depression, and quality of life of cancer patients receiving chemotherapy: a systematic review and meta-analysis.

BACKGROUND: Music may be a safe and effective coping strategy for psychological management. The objectives of this review were to identify the effects of music interventions on anxiety, depression, and quality of life (QoL) among cancer patients receiving chemotherapy. METHODS: Fourteen databases were searched from the inception date to December 2020 to identify eligible randomized controlled trials (RCTs). Gray literature was also examined. The protocol of this systematic review was registered with PROSPERO (registration number: CRD42021223845). Two reviewers independently assessed eligibility, extracted data, and evaluated methodological quality. Meta-analysis was done. Subgroup analysis was conducted for intervention types, the person selecting music, music delivery method, timing, and session duration. RESULTS: Nine RCTs were identified, among which six were eligible for the meta-analysis. All studies were at a high risk of bias, and the overall quality of evidence was low to very low. The pooled results reveal that music intervention could reduce anxiety (SMD: - 0.29, 95% CI - 0.50 to - 0.08) and improve QoL (SMD: 0.42, 95% CI 0.02 to 0.82). However, it fails to affect depression (p = 0.79). The findings demonstrate no significant difference between patient-selected music and researcher-selected music, recorded music, and live music, while a length of 15-20 min/session and offering immediately before chemotherapy are more effective on anxiety than that of 30-45 min and delivering during chemotherapy. CONCLUSIONS: Music intervention may be a beneficial tool for anxiety reduction and QoL among cancer patients receiving chemotherapy. More high-quality RCTs are needed to ascertain the true impact of those outcomes.

Development of a blended emergent research training program for clinical nurses (part 1).

BACKGROUND: Nursing research training is important for improving the nursing research competencies of clinical nurses. Rigorous development of such training programs is crucial for ensuring the effectiveness of these research training programs. Therefore, the objectives of this study are: (1) to rigorously develop a blended emergent research training program for clinical nurses based on a needs assessment and related theoretical framework; and (2) to describe and discuss the uses and advantages of the ADDIE model (Analysis, Design, Development, Implementation, Evaluation) in the instructional design and potential benefits of the blended emergent teaching method. METHODS: This intervention development study was conducted in 2017, using a mixed-methods design. A theoretical framework of blended emergent teaching was constructed to provide theoretical guidance for the training program development. Nominal group technique was used to identify learners' common needs and priorities. The ADDIE model (Analysis, Design, Development, Implementation, Evaluation) was followed to develop the research training program for clinical nurses based on the limitations of current nursing research training programs, the needs of clinical nurses, and the theoretical foundation of blended emergent teaching. RESULTS: Following the ADDIE model, a blended emergent research training program for clinical nurses to improve nursing research competence was developed based on the needs of clinical nurses and the theoretical framework of blended emergent teaching. CONCLUSIONS: This study indicates that nominal group technique is an effective way to identify learners' common needs and priorities, and that the ADDIE model is a valuable process model to guide the development of a blended emergent training program. Blended emergent teaching is a promising methodology for improving trainees' learning initiative and educational outcomes. More empirical studies are needed to further evaluate blended emergent teaching to promote the development of related theories and practice in nursing education.

Psychometric properties of disease-specific health-related quality of life (HRQoL) instruments for food allergy and food intolerance: protocol for a COSMIN-based systematic review.

INTRODUCTION: Food allergies and food intolerances can bring burdens on patients and their caregivers and reduce health-related quality of life (HRQoL). An increasing number of disease-specific HRQoL instruments for food allergies and food intolerances has been developed, and some of them have been adapted for different cultures and languages. This report describes a protocol for a systematic review of the psychometric properties of these instruments. The aims of this systematic review are to: (1) formulate recommendations for the usage of existing validated disease-specific HRQoL instruments for patients with food allergies and/or food intolerances and their caregivers; and (2) identify knowledge gaps to inform future research relating to these instruments. METHODS AND ANALYSIS: This protocol adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol (PRISMA-P) 2015 checklist. The future review will follow the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) guideline for systematic reviews of patient-reported outcome measures (PROMs) and PRISMA 2020 statement guideline. Six databases (PubMed, EMBASE, Web of Science, Scopus, CINAHL and ProQuest -Health & Medical Collection) will be searched to retrieve studies focusing on the development and psychometric properties of disease-specific HRQoL instruments for patients with food allergies and/or food intolerances and their caregivers between 1 December 2021 and 31 December 2021. Two researchers will be responsible for literature screening, data extraction and literature evaluation, independently. Disagreements will be addressed by discussion or the involvement of a third researcher. The methodological quality of the included studies and the quality of the identified instruments will be assessed based on the COSMIN guideline for systematic reviews of PROMs. ETHICS AND DISSEMINATION: Ethical approval is not applicable for this study. We will disseminate the findings through publication in peer-reviewed journals and/or academic conferences. PROSPERO REGISTRATION NUMBER: CRD42021252203.

'We can bear it!' Unpacking barriers to hepatocellular carcinoma screening among patients with hepatitis B: A qualitative study.

AIMS AND OBJECTIVES: To explore barriers to hepatocellular carcinoma screening among patients with hepatitis B. BACKGROUND: Hepatitis B-related hepatocellular carcinoma is a major cause of cancer-related mortality globally. A preventive strategy for screening is needed to improve early tumour detection and overall survival. However, utilisation remains suboptimal and barriers are understudied and largely focused on clinical factors. DESIGN: A qualitative study based on the preventive health model using phenomenological hermeneutical approach. METHODS: Face-to-face semi-structured interviews were conducted with 23 hepatitis B patients from November 2020 to February 2021. Interpretative phenomenological analysis was used. The COREQ checklist was followed. RESULTS: Four themes were identified: (i) miscognition, (ii) cultural stigma and taboo, (iii) social norms of enduring hardship and (iv) social barriers at the community, health system and policy levels. Patients had misconceptions about inactive carriers, asymptomatic nature of chronic hepatitis B, hepatocellular carcinoma risks and screening recommendations. Influenced by the taboo of hepatocellular carcinoma, stigma against hepatitis B and enduring hardship norms, they perceived screening as divination, avoided utilisation to hide disease status and endured symptoms until they were intolerable. Insufficient community support, a lack of shared decision-making in health systems, and inadequate rural reimbursement policy and hepatocellular carcinoma detection capacity further precluded utilisation. CONCLUSIONS: Cognitive and sociocultural barriers precluded individuals' intention, utilisation and persistence of hepatocellular carcinoma screening. The results highlight intervention targets for miscognition, stigma, taboo and social norms; propose family-focused, community-based education programs; suggest health systems to introduce decision aids; and inform policymaking and upskilling of physicians in rural areas. RELEVANCE TO CLINICAL PRACTICE: Collaborative efforts are needed to improve real-world hepatocellular carcinoma screening, including education to address knowledge deficiencies, psychological counselling to reduce stigma and taboo beliefs, support for shared decision-making and reimbursement policies.

Development of A Nurse-Led Educational Intervention Program in Managing the Nutrition Impact Symptom Cluster in Patients with Nasopharyngeal Carcinoma following the Medical Research Council Framework.

OBJECTIVE: This article aimed to report the experience of developing a complex nurse-led, theory-driven, and evidence-based educational intervention program intended to manage the nutrition impact symptom cluster experienced by patients with nasopharyngeal carcinoma (NPC) during radiotherapy, based on the Medical Research Council (MRC) framework. METHODS: The "development" and "feasibility and piloting" phases of the MRC framework were used to guide the intervention development. The development phase included identifying the evidence base through a systematic review, exploring the relevant and guiding theory to enhance the effectiveness of the intervention and conducting a qualitative study to identify the intervention modelling. For the feasibility and piloting phase, we conducted a pilot study to examine the feasibility and estimate the effectiveness of the intervention. RESULTS: The systematic review revealed that nurse-led educational interventions were used commonly for symptom cluster management, with promising effectiveness. The theoretical foundation was provided by the Theory of Unpleasant Symptoms, which indicates that an educational intervention can help patients to manage symptom cluster by influencing psychological, situational, and physiological factors. The qualitative study further provided contents of the intervention based on the perspectives of NPC patients and health professionals. The resulting program involves a nurse-led, family caregiver involvement, educational intervention with two sessions that uses a booklet as a medium. The pilot study found that conducting the educational intervention program was feasible and it also had some favorable effects on managing the nutrition impact symptom cluster in NPC patients. CONCLUSIONS: The MRC framework provided a strong structure with which to develop a complex intervention for nutrition impact symptom cluster management through a theory-driven and evidence-based approach. The evaluation of the intervention, the delivery process and the mediation mechanism of change using a rigorous randomized controlled trial design is recommended.