Driving the implementation of hospital examination reservation system through hospital management.

BACKGROUND: Hospital Examination Reservation System (HERS) was designed for reducing appointment examination waiting time and enhancing patients' medical satisfaction in China, but implementing HERS would encounter many difficulties. This study would investigate the factors that influence patients' utilization of HERS through UTAUT2, and provide valuable insights for hospital managements to drive the effective implementation of HERS. It is helpful for improving patients' medical satisfaction. METHODS: We conducted a survey through the Sojump platform, targeting patients were who have already used HERS. We collected questionnaire information related to factors behavior intention, performance expectancy, and effort expectancy. Subsequently, we employed a structural equation model to analyze the factors influencing patients' utilization of HERS. RESULTS: A total of 394 valid questionnaires were collected. Habit was the main direct positive factor influencing the behavioral intention of HERS (ß = 0.593; 95%CI: 0.072, 1.944; P = 0.002), followed by patient innovation (ß = 0.269; 95%CI: 0.002, 0.443; P < 0.001), effort expectancy (ß = 0.239; 95%CI: -0.022, 0.478; P = 0.048). Patient innovation and facilitating conditions also have an indirect effect on behavioral intention. Perceived privacy exposure has a significantly negative effect on behavioral intention (ß=-0.138; 95%CI: -0.225, -0.047; P < 0.001). The above variables explained 56.7% of the variation in behavioral intention. CONCLUSIONS: When HERS is implemented in hospitals, managements should arrange volunteers to guide patients to bring up the habit and solve the using difficulties, and managements could invite patients with high innovation to recommend HERS to others, what's more, it is a valid way to retain the old form of appointment to pass the transition period to the new system. HERS utilization and patients' medical satisfaction will be enhanced through the guidance of hospital management means.

Latent class analysis of healthcare workers' perceptions of workers' job demands in mobile cabin hospitals in China.

BACKGROUND: Owing to the outbreak of the Omicron variant of SARS-CoV-2 in Shanghai, China, partitioned dynamic closure and control management plans were implemented on March 28, 2022. This created huge emergency pressure on Shanghai's medical and healthcare systems. However, the perceptions of job demands of healthcare workers (HCWs) and classification of frontline HCWs in mobile cabin hospitals are unknown. METHODS: In this study, we investigated the job demands of 1223 frontline HCWs working in mobile cabin hospitals during the COVID-19 pandemic April 2022 to May 2022. We performed latent class analysis to identify classification features of job demands. A binary multivariate logistic regression model was used to explore the influencing factors of latent class. RESULTS: The total mean job demand score was 132.26 (SD = 9.53), indicating a high level of job demand. A two-class model provided the best fit. The two classes were titled "middle-demand group" (17.66%) and "high-demand group" (82.34%). A regression analysis suggested that female HCWs, HCWs satisfied with the doctor/nurse-patient relationship, HCWs who believed that the risk of working in mobile cabin hospitals was high, and HCWs without physical discomfort during the pandemic were more likely to be in the "high-demand group". CONCLUSION: Characteristics of the "high-demand group" subtype suggest that attention should be paid to the physical condition of frontline HCWs and the job demands of female HCWs. Managers should strengthen the training of HCWs in terms of their communication skills as well as their knowledge and technical skills to aid epidemic prevention and control.

Patterns of home care and community support preferences among older adults with disabilities in China: a latent class analysis.

BACKGROUND: Ageing in place is the preferred choice for most older adults worldwide. The role of the family as a core care resource has diminished as a result of changes in family structure, thus extending the responsibility for caring for older adults from within the family to outside it and requiring considerably more support from society. However, there is a shortage of formal and qualified caregivers in many countries, and China has limited social care resources. Therefore, it is important to identify home care patterns and family preferences to provide effective social support and reduce government costs. METHODS: Data were obtained from the Chinese Longitudinal Healthy Longevity Study 2018. Latent class analysis models were estimated using Mplus 8.3. Multinomial logistic regression analysis was adopted to explore the influencing factors with the R3STEP method. Lanza's method and the chi-square goodness-of-fit test were used to explore community support preferences among different categories of families of older adults with disabilities. RESULTS: Three latent classes were identified based on older adults with disabilities' characteristics (degree of disability, demand satisfaction), caregivers' characteristics (length of providing care, care performance) and living status: Class 1- mild disability and strong care (46.85%); Class 2- severe disability and strong care (43.92%); and Class 3- severe disability and incompetent care (9.24%). Physical performance, geographic region and economic conditions jointly influenced home care patterns (P < 0.05). Home visits from health professionals and health care education were the top two forms of community support that were most preferred by the older adults with disabilities' families (residual > 0). Families in the Class 3 subgroup preferred personal care support more than those in the other two subgroups (P < 0.05). CONCLUSION: Home care is heterogeneous across families. Older adults' degrees of disability and care needs may be varied and complex. We classified different families into homogeneous subgroups to reveal differences in home care patterns. The findings can be used by decision-makers in their attempts to design long-term care arrangements for home care and to adjust the distribution of resources for the needs of older adults with disabilities.

A Risk Prediction Model for Physical Restraints Among Older Chinese Adults in Long-term Care Facilities: Machine Learning Study.

BACKGROUND: Numerous studies have identified risk factors for physical restraint (PR) use in older adults in long-term care facilities. Nevertheless, there is a lack of predictive tools to identify high-risk individuals. OBJECTIVE: We aimed to develop machine learning (ML)-based models to predict the risk of PR in older adults. METHODS: This study conducted a cross-sectional secondary data analysis based on 1026 older adults from 6 long-term care facilities in Chongqing, China, from July 2019 to November 2019. The primary outcome was the use of PR (yes or no), identified by 2 collectors' direct observation. A total of 15 candidate predictors (older adults' demographic and clinical factors) that could be commonly and easily collected from clinical practice were used to build 9 independent ML models: Gaussian Naïve Bayesian (GNB), k-nearest neighbor (KNN), decision tree (DT), logistic regression (LR), support vector machine (SVM), random forest (RF), multilayer perceptron (MLP), extreme gradient boosting (XGBoost), and light gradient boosting machine (Lightgbm), as well as stacking ensemble ML. Performance was evaluated using accuracy, precision, recall, an F score, a comprehensive evaluation indicator (CEI) weighed by the above indicators, and the area under the receiver operating characteristic curve (AUC). A net benefit approach using the decision curve analysis (DCA) was performed to evaluate the clinical utility of the best model. Models were tested via 10-fold cross-validation. Feature importance was interpreted using Shapley Additive Explanations (SHAP). RESULTS: A total of 1026 older adults (mean 83.5, SD 7.6 years; n=586, 57.1% male older adults) and 265 restrained older adults were included in the study. All ML models performed well, with an AUC above 0.905 and an F score above 0.900. The 2 best independent models are RF (AUC 0.938, 95% CI 0.914-0.947) and SVM (AUC 0.949, 95% CI 0.911-0.953). The DCA demonstrated that the RF model displayed better clinical utility than other models. The stacking model combined with SVM, RF, and MLP performed best with AUC (0.950) and CEI (0.943) values, as well as the DCA curve indicated the best clinical utility. The SHAP plots demonstrated that the significant contributors to model performance were related to cognitive impairment, care dependency, mobility decline, physical agitation, and an indwelling tube. CONCLUSIONS: The RF and stacking models had high performance and clinical utility. ML prediction models for predicting the probability of PR in older adults could offer clinical screening and decision support, which could help medical staff in the early identification and PR management of older adults.

Research on the factors that influence patients with colorectal cancer participating in the prevention and control of surgical site infection: Based on the extended theory of planned behaviour.

BACKGROUND: The most common and severe type of nosocomial infection in patients with colorectal cancer is surgical site infection (SSI). Patient-related factors are an important components of SSI. So it is necessary to participate in SSI prevention and control. It is important to identify the factors that influence patients' participation behaviour and to explore the mechanism of these effects. METHODS: A total of 580 patients with colorectal cancer completed relevant measures. Based on the extended theory of planned behaviour, a structural equation model was used to analyse the relationship among the influencing factors. RESULTS: The factors influencing participation of patients with colorectal cancer in SSI prevention and control were participation intention, participation ability, self-efficacy, participation attitude, perceived medical staff support, trust in physicians and social support. The direct effect coefficients of participation intention, participation ability and physician trust on SSI prevention and control behaviour were 0.67, 0.21 and 0.11, respectively. Self-efficacy, participation attitude, perceived medical staff support and social support indirectly affect participation behaviour through participation intention, and their effect values are 0.21, 0.11, 0.11 and 0.08, respectively. CONCLUSIONS: Based on the structural equation model developed in this study, targeted intervention measures should be implemented to mobilize the intention and enthusiasm of patients with colorectal cancer to participate in the prevention and control of SSI. PATIENT OR PUBLIC CONTRIBUTION: Patients or public contribute to spreading research findings, and promote broad participation in the implementation of policies or strategies.

Risk Prediction Models for Inadvertent Intraoperative Hypothermia: A Systematic Review.

PURPOSES: Inadvertent intraoperative hypothermia (core temperature <36°C) is a common surgical complication with several adverse events. Hypothermia prediction models can be a tool for providing the healthcare staff with information on the risk of inadvertent hypothermia. Our systematic review aimed to identify, demonstrate, and evaluate the available intraoperative hypothermia risk prediction models in surgical populations. DESIGN: This study is a systematic review of literature. METHODS: We systematically searched multiple databases (Ovid MEDLINE, Web of Science, Embase, and Cochrane Center Register of Controlled Trials). Two reviewers independently examined abstracts and the full text for eligibility. Data collection was guided by the CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies (CHARMS checklist), and methodological quality and applicability were assessed by the Prediction model Risk Of Bias ASsessment Tool (PROBAST). FINDINGS: A total of 3,672 references were screened, of which eight articles were included in this study. All the models had a high risk of bias since most of them lacked model validation. Also, they failed to report the model performance and final model presentations, which restricted their clinical application. CONCLUSIONS: The researchers should present models in a more standard way and improve the existing models to increase their predictive values for clinical application.

The use of physical restraints in Chinese long-term care facilities and its risk factors: An observational and cross-sectional study.

AIM: To investigate the use of physical restraints among Chinese long-term care facilities older adults and to identify its risk factors. DESIGN: Observational and cross-sectional study. METHODS: A total of 1,026 older adults from six long-term care facilities in Chongqing were recruited by cluster sampling method from July - November 2019. Data on physical restraint use and older adults' characteristics were collected using physical restraints observation forms and older adults' records. Organizational data were collected by questionnaires asking nursing managers. The independent risk factors for physical restraints use were assessed using chi-square test and binary logistic regression. RESULTS: The study found that the prevalence of physical restraints in six long-term care facilities in China was 25.83%. Waist belt (55.47%) and wrist restraint (52.83%) were most frequently used. Only 61.51% of physical restraints were signed with informed consent. 71.70% of physical restraints were caused by the prevention of falls, 89.06% of physical restraints were without nursing documentation, and 13.58% restrained older adults were observed to have physical complications. According to the binary logistic regression analysis, facility type and ownership, older adults per nursing assistant, length of residence, cognitive impairment, care dependency, mobility restriction, fall risk, physical agitation, and indwelling tubes emerged as important risk factors for the use of physical restraints. CONCLUSION: The use of physical restraints among Chinese long-term care facilities older adults was at a relatively high level and lack standardized and regulated practices. Moreover, Physical restraint use was associated with facility type and ownership, older adults per nursing assistant, length of residence, cognitive impairment, care dependency, mobility restriction, fall risks, physical agitation, and indwelling tube. IMPACT: This study will provide an effective reference for nursing staff in long-term care facilities to assess high-risk older adults in their use of physical restraints, which can support them to implement effective minimized restraint approaches to targeted people.

Experiences and responses of nursing students as second victims of patient safety incidents in a clinical setting: A mixed-methods study.

AIM: To investigate the degree of second victim syndrome among nursing students in clinical practice and determine the rehabilitation process. BACKGROUND: Empirical evidence suggests that health care providers who are considered second victims suffer from various difficulties. Nursing students in a clinical setting could be potential second victims, but few studies have quantitatively investigated the experiences and explored their response processes. METHODS: A mixed-methods design was used. A questionnaire was sent to nursing students via a link to an electronic survey, and a semi-structured interview was conducted to explore their response process as second victims. RESULTS: The quantitative results showed that nursing students in the clinical setting suffered second victim-related distress and that the most significant influences were psychological distress and professional efficacy. Four stages of rehabilitation experiences emerged from the qualitative data. CONCLUSION: Being a second victim for nursing students in a clinical setting is psychological suffering, and although they can be expected to recover, an impact on professional efficacy is inevitable. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing managers must be aware that nursing students in a clinical setting might experience difficult situations after patient safety incidents and that developing appropriate programmes to support at-risk students is important.

Development and validation of two aspiration prediction models in patients receiving nasogastric feeding.

AIM: To develop and validate two aspiration prediction models in patients receiving nasogastric feeding. BACKGROUND: Aspiration is one of the most serious complications of nasogastric feeding. However, there is a lack of aspiration prediction models for nasogastric feeding. METHODS: A total of 515 patients receiving nasogastric feeding were randomly selected for this unmatched case-control study, with 103 patients in the case group and 412 patients in the control group. Logistic regression was used to develop nomogram and Classification And Regression Tree (CART) models. The performances of the models were internally validated using 1,000 bootstrapped samples. RESULTS: The predictive accuracy of the CART model (94.5%) was higher than that of the nomogram model (89.1%). The area under the receiver operating characteristic curve of the CART model (0.96) was slightly higher than that of the nomogram model (0.93). CONCLUSIONS: The intubation depth, number of comorbidities, aspiration history, indwelling days, food type and the use of sedative-hypnotics may be used to identify aspiration risk. IMPLICATIONS FOR NURSING MANAGEMENT: Two aspiration prediction models are provided for nurses to evaluate aspiration risk and increase the quality of nursing management.

Psychometric validation of the Chinese version of the Second Victim Experience and Support Tool (C-SVEST).

AIM: To translate and assess the reliability and validity of the C-SVEST scale. BACKGROUND: Nurses in patient safety incidents, the second victim, may also be traumatized in Western studies, but there is a lack of relevant researches and validated scales in China. METHODS: A cross-sectional study of 1,442 nurses in China was conducted with the C-SVEST questionnaire. Raw data were randomly divided into two parts for exploratory factor analysis and confirmatory factor analysis, to evaluate the construct validity. Content validity and reliability were tested by content validity index and Cronbach's α coefficients, respectively. RESULTS: Six-factor structure was emerged, and it explained 68.62% of the total variance. The good fit of the six-factor model was acceptable, and standardized factor loading ranged from 0.62 to 0.89. Cronbach's α coefficient of the scale was 0.866, and each dimension ranged from 0.713 to 0.896. Content validity index at the scale level was 0.99, and content validity index at the item level was 0.89-1. CONCLUSIONS: The C-SVEST scale has excellent psychometric properties, which can be applied to measure second victims experience and support level in patient safety incidents. IMPLICATIONS FOR NURSING MANAGEMENT: A reliable and valid instrument is available for leaders to identify the impact of patient safety incidents in nurses, and promote their health through effective interventions.

The prevalence and clinical risk factors of insomnia in the Chinese elderly based on comprehensive geriatric assessment in Chongqing population.

BACKGROUND: Insomnia is a major public health problem affecting older people. This study aimed to investigate the prevalence and clinical risk factors of insomnia in a representative sample of Chinese elderly (≥ 60 years) in Chongqing. METHODS: A cross-sectional study based on comprehensive geriatric assessment was conducted from January 2013 to February 2014. A questionnaire on sleep status was provided to each patient and insomnia was assessed according to the Diagnostic and Statistical Manual of Mental Disorders 4th edition criteria. A multivariate logistic regression model was used to illustrate risk factors correlated with insomnia. RESULTS: Of the total 597 participants, 55.4% suffered from insomnia. The prevalence of insomnia in men and women was 48.2% and 63.2%, respectively. Coronary heart disease, dizziness, chronic pain, anorexia, malnutrition, depression and cognitive decline were identified as risk factors associated with insomnia. Hypertension, diabetes, hyperlipidaemia, headache, age and education level were not observed to be significantly associated with insomnia. CONCLUSIONS: Insomnia is highly prevalent among the elderly in Chongqing, and shows a positive correlation to coronary heart disease, dizziness, chronic pain, anorexia, malnutrition, depression, cognitive impairment. Moreover, women are more likely to experience insomnia than men.

The effectiveness of exercise for fall prevention in nursing home residents: A systematic review meta-analysis.

AIM: The aim of this study was to determine the effectiveness of exercise on fall prevention in nursing home residents. BACKGROUND: Nursing home residents have a high risk of falling. No conclusive evidence exists on the effectiveness of exercise on fall prevention in nursing home residents. DESIGN: Systematic review and meta-analysis of randomized controlled trials. DATA RESOURCES: Databases of PubMed, Web of Science, EMBASE, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature and China Biology Medicine were searched from inception to March 2017, with no language limitation. REVIEW METHODS: The review was conducted according to the guidelines of the Cochrane Collaboration. Studies on exercise interventions to prevent falls in nursing home residents were eligible. The primary outcome was the odds ratio with 95% confidence intervals of falls. RESULTS: Nine studies were included in the meta-analysis where exercise was compared with daily routine, social activities, and other methods in preventing falls. About falls, the pooled effect size of seven studies showed that exercise had no effect on fall prevention in nursing home residents. There was low heterogeneity. No significant publication bias was observed. CONCLUSIONS: The results of the systematic review and meta-analysis suggested that exercise did not play a role in preventing falls. Further studies with high quality and larger samples are required to support or counter the results.

Prevalence and risk factors for Helicobacter pylori infection in southwest China: a study of health examination participants based on 13C-urea breath test

Background/aim: Helicobacter pylori (H. pylori) has a high prevalence in developing countries. We aimed to investigate the current prevalence of H. pylori, as well as its potential serum risk factors, in a population from southwest China.Materials and methods: This cross-sectional study included 10,912 subjects who received medical examinations at the First Affiliated Hospital of Chongqing Medical University in 2014. Data regarding physical examinations and biochemical measurements were collected, and H. pylori infection was diagnosed with a 13C-urea breath test. Logistic regression was conducted to identify the risk factors for H. pylori infection.Results: The infection rate of H. pylori was 34.4% (3750/10,912). Older age, lower albumin levels, and higher total cholesterol, LDL-cholesterol, and fasting blood sugar were significantly associated with increased incidence of H. pylori infection. Moreover, logistic regression analysis showed that older age, low albumin, and hyperglycemia were independent risk factors for H. pylori infection after adjusting for other covariables.Conclusion: The results from our study showed that H. pylori was prevalent in southwest China. Older age, low albumin levels, and hyperglycemia were significant risk factors associated with H. pylori infection.

The Application of ChatGPT in Medicine: A Scoping Review and Bibliometric Analysis.

Purpose: ChatGPT has a wide range of applications in the medical field. Therefore, this review aims to define the key issues and provide a comprehensive view of the literature based on the application of ChatGPT in medicine. Methods: This scope follows Arksey and O'Malley's five-stage framework. A comprehensive literature search of publications (30 November 2022 to 16 August 2023) was conducted. Six databases were searched and relevant references were systematically catalogued. Attention was focused on the general characteristics of the articles, their fields of application, and the advantages and disadvantages of using ChatGPT. Descriptive statistics and narrative synthesis methods were used for data analysis. Results: Of the 3426 studies, 247 met the criteria for inclusion in this review. The majority of articles (31.17%) were from the United States. Editorials (43.32%) ranked first, followed by experimental studys (11.74%). The potential applications of ChatGPT in medicine are varied, with the largest number of studies (45.75%) exploring clinical practice, including assisting with clinical decision support and providing disease information and medical advice. This was followed by medical education (27.13%) and scientific research (16.19%). Particularly noteworthy in the discipline statistics were radiology, surgery and dentistry at the top of the list. However, ChatGPT in medicine also faces issues of data privacy, inaccuracy and plagiarism. Conclusion: The application of ChatGPT in medicine focuses on different disciplines and general application scenarios. ChatGPT has a paradoxical nature: it offers significant advantages, but at the same time raises great concerns about its application in healthcare settings. Therefore, it is imperative to develop theoretical frameworks that not only address its widespread use in healthcare but also facilitate a comprehensive assessment. In addition, these frameworks should contribute to the development of strict and effective guidelines and regulatory measures.

Examining the Social Networks Types and Their Effects on Caregiving Experience of Family Caregivers for Individuals With Dementia: A Mixed-Methods Study.

Background and Objectives: Social networks are crucial to personal health, particularly among caregivers of individuals with dementia; however, different types of social networks among caregivers of those with dementia and how these differences are associated with caregiver burden and positive appraisal, remain underexamined. This study aims to depict dementia caregivers' social network types, related factors, and impact on caregiving experiences. Research Design and Methods: A questionnaire-based survey was conducted with a total of 237 family caregivers of individuals with dementia nested additional semistructured interviews conducted with 14 caregivers in Chongqing, China. A quantitative study was designed to collect data on personal and situational information, social networks, caregiver burden, and positive aspects of caregiving. Qualitative data were collected via semistructured interviews. Latent class analysis and multivariate regression analyses were applied to quantitative data, and inductive content analysis to qualitative data. Results: The 3 social network types-family-limited (n = 39, 16.46%), family-dominant (n = 99, 41.77%), and diverse network (n = 99, 41.77%)-differed in age and sex of caregivers and individuals with dementia, stage of dementia, and caregiving intensity. Caregivers in family-dominant networks had a lower caregiver burden (ß= -0.299, p = .003) and greater positive aspects of caregiving (ß= 0.228, p = .021) than those in family-limited networks. Three themes-accessibility, reciprocity, and reliance-emerged as facilitators and barriers when asking for support. Caregivers frequently cited the perception of economic, practical, and emotional support, yet reported a lack of adequate formal support from healthcare providers. Discussion and Implication: Family caregivers of individuals with dementia have different social network types that vary considerably among sociocultural contexts and perceive various types of support from social networks. Solid family networks and diverse social networks are contributors to long-term dementia care.

Trends in patient safety education research for healthcare professional students over the past two decades: a bibliometric and content analysis.

Research and practice in patient safety education have garnered widespread attention; however, a comprehensive bibliometric analysis is lacking. This study aimed to provide a comprehensive understanding of the research focus and research trends in the globalization of the field of patient safety education and to describe the general characteristics of publications. Data on articles and reviews about student safety education were extracted from Web of Science. Microsoft Excel 2019, CiteSpace 6.1.R3, VOSviewer 1.6.18, SATI 3.2, Scimago Graphica, and Pajek were used for quantitative analysis. Collaboration networks of countries, institutions, journals, authors, and keywords were visualized based on publications from January 2000 to September 2022. A total of 573 papers were published between 2000 to 2022, showing an overall increasing trend. The USA, England, and Australia are the top three most prolific countries; Johns Hopkins University, the University of Technology Sydney, and the University of Toronto are the top three most productive institutions; Nurse Education Today, Journal of Nursing Education, and BMC Medical Education are the most productive journals; Based on content analysis five research hotspots focused on: (1) Quality Improvement of Patient safety Teaching and Learning; (2) Patient safety Teaching Content; (3)Specialized Teaching in Patient Safety; (4) Integrating Patient Safety and Clinical Teaching; (5)Patient Safety Teaching Assessment Content. Through keyword clustering analysis, five research hotspots and relevant contents were identified. According to this study, simulation, communication, collaboration, and medication may attract more attention from researchers and educators, and could be the major trend for future study.

Contribution of rumination and psychological resilience to post-traumatic growth of front-line healthcare workers in mobile cabin hospitals under Normalized epidemic Prevention and Control Requirements.

To understand the level of post-traumatic growth (PTG) and influencing factors among front-line healthcare workers (HCWs) working in mobile cabin hospitals treating patients with Coronavirus Disease 2019 (COVID-19) under the Normalized Epidemic Prevention and Control Requirements adopted in China. A random sampling method was used to select 540 HCWs of the Chongqing-aid-Shanghai medical team from April to May 2022 as the study participants. Participants completed a general information questionnaire, the Post-traumatic Growth Inventory-Chinese version (PTGI-C), the Chinese version of the Connor-Davidson Resilience Scale (CD-RISC) and the Chinese Event Related Rumination Inventory (C-ERRI). Among the 540 included HCWs, 83.15 % were nurses and 78.89 % were women. The average scores for PTG (62.25 ± 16.73) and psychological resilience (64.22 ± 15.38) were at moderate levels, and the average score for rumination was low (21.62 ± 10.77). Pearson correlation analysis showed that CD-RISC and C-ERRI scores were positive with the PTGI-C score (r = 0.528, 0.316, P < 0.001). Multiple linear regression analysis identified psychological training or intervention during the COVID-19 epidemic (ß = 2.353, P = 0.044), psychological resilience (ß = 0.525, P < 0.001) and deliberate rumination (ß = 0.732, P < 0.001) as factors significantly associated with the PTG of front-line HCWs, which together explained 36.8 % of the total variance in PTG (F[5,539] = 63.866, P < 0.001). In general, psychological resilience and deliberate rumination can promote PTG among HCWs and can be improved by strengthening psychological training and interventions for HCWs working under the Normalized Epidemic Prevention and Control Requirements.

Facilitators and barriers to the implementation of dietary nutrition interventions for community-dwelling older adults with physical frailty and sarcopenia: A qualitative meta-synthesis.

Objectives: With the acceleration of an aging society, the prevalence of age-related chronic diseases such as physical frailty and sarcopenia is gradually increasing with numerous adverse effects. Dietary nutrition is an important modifiable risk factor for the management of physical frailty and sarcopenia, but there are many complex influences on its implementation in community settings. This study aimed to summarize the facilitators and barriers to the implementation of dietary nutrition interventions for community-dwelling older adults with physical frailty and sarcopenia, and to provide a reference for the formulation of relevant health management programs. Methods: Searches were conducted in databases including PubMed, Web of Science, Medline (Ovid), Embase (Ovid), and Cochrane Library from inception to January 2023. Searches were completed for a combination of MeSH terms and free terms. The Critical Appraisal Skills Program (CASP) instrument was used to appraise quality. Coding and analysis of the extracted information were performed using the socio-ecological modeling framework. The study protocol for this review was registered on the PROSPERO ( CRD42022381339). Results: A total of 10 studies were included. Of these, four were nutrition-only focused interventions, and six were dietary nutrition and exercise interventions. The facilitators and barriers were summarized based on the socio-ecological model that emerged at three levels: individual trait level, external environment level, and intervention-related level, containing ten subthemes. Conclusion: Individual internal motivation and external support should be integrated with the implementation of diet- and nutrition-related interventions in community-living aged people with physical frailty and sarcopenia. Develop "tailored" interventions for participants and maximize available human and physical resources.