RESUMO
BACKGROUND: Hypertension and prehypertension have been widely recognized as the main contributors of global mortality. Evidence shows mindfulness-based interventions may reduce blood pressure and improve mental health. However, the effect of mindfulness-based interventions on blood pressure and mental health has not been fully understood. METHODS: Potential studies published before May 24th 2023 were identified by searching Embase, Ovid Emcare, PsycINFO, CINAHL, Web of Science, Cochrane, PubMed, China National Knowledge Infrastructure, Wanfang database, and VIP China Science. Additionally, two grey databases were searched: Mednar, WorldWideScience.org. The risk of bias in the included studies was assessed using the Cochrane Risk of Bias Assessment tool. The random-effects meta-analyses were conducted using Review Man 5.4 software and the key outcomes are presented as mean difference or standard mean difference and the 95% confidential interval. RESULTS: Searches returned 802 studies in total, of which 12 were included (N = 715). The duration of interventions was 8 weeks in 10 trials and 6 weeks in one trial. Pooled effect sizes indicated reductions in systolic blood pressure (MD = - 9.12, 95% CI [- 12.18, - 6.05], p < 0.001), diastolic blood pressure (MD = - 5.66, 95% CI [- 8.88, - 2.43], p < 0.001), anxiety (SMD = - 4.10; 95% CI [- 6.49, - 1.71], p < 0.001), depression (SMD = - 1.70, 95%CI [- 2.95, - 0.44], p < 0.001) and perceived stress (SMD = - 5.91, 95%CI [- 8.74, - 3.09], p < 0.001) at post-intervention. The findings from subgroup analyses are favorable for mindfulness-based interventions regardless of gender and baseline blood pressure with regard to BP reduction, with a more profound effect observed in participants with higher pre-intervention blood pressure. CONCLUSIONS: The results provide evidence for the positive role of mindfulness-based interventions in hypertension management. More large randomized control trials with sufficient statistical power and long-term follow-up are needed. TRIAL REGISTRATION: The protocol had been registered with Prospero on October 2nd 2021 (registration NO. CRD42021282504 ).
Assuntos
Pressão Sanguínea , Hipertensão , Saúde Mental , Atenção Plena , Pré-Hipertensão , Ensaios Clínicos Controlados Aleatórios como Assunto , Humanos , Hipertensão/fisiopatologia , Hipertensão/terapia , Hipertensão/diagnóstico , Hipertensão/psicologia , Pré-Hipertensão/terapia , Pré-Hipertensão/fisiopatologia , Pré-Hipertensão/diagnóstico , Pré-Hipertensão/psicologia , Resultado do Tratamento , Masculino , Pessoa de Meia-Idade , Feminino , Adulto , IdosoRESUMO
AIM: To understand the implementation process and outcomes of nurses' work related low back pain (WLBP) prevention and care guideline. BACKGROUND: WLBP is a common occupational injury for clinical nurses. We developed the first evidence-based guideline of nurses' WLBP prevention and care of its kind both at home and abroad, and it is necessary for us to explore its feasibility, appropriateness and effectiveness in practice. METHODS: Based on the model of the integrated Promoting Action on Research Implementation in Health Services, we performed a four-phase implementation study in a tertiary hospital. The study was a non-randomized concurrent controlled trial designï¼and multilevel measures were examined including implementation outcomes and clinical outcomes. RESULTS: For the implementation outcomes, the tailored recommendations of the guideline were found to be acceptable, appropriate, feasible, and well adopted both at the unit level and the hospital level. The clinical outcomes indicated that, compared with the control unit, nurses of the treatment unit performed better in awareness, knowledge, practice of WLBP prevention and care. CONCLUSIONS: The implementation study supports the successful application of the guideline, which can serve as a valuable evidence-based document to improve back health of nursing personnel.
Assuntos
Dor Lombar , Humanos , Dor Lombar/prevenção & controle , Dor Lombar/enfermagem , Adulto , Feminino , Masculino , Recursos Humanos de Enfermagem Hospitalar/psicologia , Guias de Prática Clínica como Assunto , Pessoa de Meia-Idade , Doenças Profissionais/prevenção & controleRESUMO
OBJECTIVE: The goal of this research was to review the literature from randomized controlled trials (RCTs) on the impacts of moxibustion on cancer-related fatigue (CRF) as well as provide credible evidence to guide clinical practice. METHODS: Three English electronic medical databases (PubMed, Embase, and the Cochrane Library) and two Chinese databases (China National Knowledge Infrastructure and Wanfang) were searched. Only randomized controlled trials on the effect of moxibustion on CRF were included in this systematic review. Study selection, data extraction, and validation were all carried out independently by two reviewers. The revised Cochrane Risk of Bias tool was used to assess the quality of the RCTs (RoB 2.0). The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was applied to assess effect sizes in individual RCTs and pooled effect sizes in meta-analyses. Data were meta-analyzed using Stata (version 14.0). RESULTS: In a random-effects meta-analysis of 24 RCTs with 1894 participants, the aggregated standardized mean difference (SMD) revealed a statistically significant association between moxibustion and alleviation from cancer-related fatigue (SMD = - 1.66, 95% CI = - 2.05, - 1.28, p = 0.000). Pooled results, however, show significant heterogeneity (I2 = 92.5%), and the evidence is insufficient to determine whether this association varies systematically by measuring tools and moxibustion modalities. Furthermore, evidence ranging from very low to low showed that moxibustion had an immediate positive effect on patients with CRF. CONCLUSION: Moxibustion may have a therapeutic effect on cancer-related fatigue. However, further large-scale, multicenter, high-quality RCTs on moxibustion for fatigue relief and safety are still needed because of the handful of studies included and the low methodological quality.
Assuntos
Moxibustão , Neoplasias , Humanos , China , Fadiga/etiologia , Fadiga/terapia , Estudos Multicêntricos como Assunto , Neoplasias/complicações , Neoplasias/terapia , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
PURPOSE: Parastomal hernia (PSH) is a common and serious complication in patients with enterostomy, but there is no current consensus for the risk factors for PSH from previous studies. Therefore, this study systematically analyzed the risk factors for PSH to provide a reference for prevention and treatment of this condition. METHODS: Seven databases and 3 registers were systematically searched from database inception to January, 2021. Study quality was assessed by Newcastle-Ottawa Scale. Review Manager 5.3 software was used for statistical analysis. The data that could not be combined quantitatively were only analyzed qualitatively. RESULTS: Sixteen studies with 2031 patients were included. Higher BMI (OR, 1.29; 95% CI,1.02-1.63), older age (OR, 1.04; 95% CI, 1.02-1.07), female (OR, 2.55; 95% CI,1.39-4.67), lager aperture size (OR, 2.8; 95%CI, 1.78-4.42), transperitoneal stoma creation (OR, 2.4; 95% CI, 1.33-4.35), and lager waist circumference (OR, 1.01; 95% CI,1.0-1.01) were significant risk factors for PSH. The laparoscopic approach was not a risk factor for PSH (OR, 2.09; 95% CI, 0.83-5.27). Other risk factors, including the thickness of abdominal subcutaneous fat, no mesh, a stoma not through the middle of the rectus abdominis, atrophy of left lower medial part of rectus abdominis, α1(III) procollagen expression level, emergency surgery, no preoperative stoma site marking, end colostomy, smoking, diabetes, peristomal infection, severe abdominal distention, severe cough, chronic obstructive pulmonary disease, operation time and hypertension, were significant on the multivariate analysis of each individual study. CONCLUSIONS: The current available evidence showed that higher BMI, older age, female, larger aperture size, the creation of a transperitoneal stoma, and a larger waist circumference were independent risk factors for PSH. For factors without exact cutoff value, further explorations are needed in the future. In addition, reference to the limited number of studies in the pooled analysis, these factors still need to be interpreted carefully.
Assuntos
Enterostomia , Hérnia Ventral , Estomas Cirúrgicos , Colostomia/efeitos adversos , Enterostomia/efeitos adversos , Hérnia Ventral/etiologia , Hérnia Ventral/prevenção & controle , Humanos , Fatores de Risco , Telas Cirúrgicas/efeitos adversos , Estomas Cirúrgicos/efeitos adversosRESUMO
AIM: To explore the efficacy of acceptance and commitment therapy (ACT) on chronic pain in terms of functioning; and to identify the most promising modes and patterns for implementing ACT. DESIGN: Systematic review and meta-analysis. METHODS: We will include randomized controlled trials which focus on the efficacy of ACT on chronic pain conditions with functioning as the primary outcome. Seven databases have been searched and grey literature will also be systematically searched for. Eligible studies will be screened. The newly revised Cochrane risk of bias tool will be used to assess the quality of the included studies. Data will be extracted, and meta-analyses will be performed within specific condition groups of chronic pain. Meta-regression and subgroup analyses will be employed to identify the efficacious modes and patterns for implementing the therapy. Grading of Recommendations Assessment, Development, and Evaluation approach will be applied to reach a convincing conclusion. The study has been funded since July 2018. DISCUSSION: This systematic review aims to explore the efficacy of ACT for chronic pain on functioning based on the latest evidence. The most promising manners will be identified for designing and delivering the therapy. An accurate, transparent, and standardized review process is expected by adhering to the instructions of relevant guidelines. IMPACT: Chronic pain is prevalent worldwide and reduced functioning is one of the leading consequences. With the anticipated evidence of high level, this research attempts to examine the role of acceptance and commitment therapy, a promising psychological intervention, in the management of chronic pain for improving individual's functioning status. The systematic review may contribute to a more convincing and targeted conclusion compared with the existing studies of its kind.
Assuntos
Terapia de Aceitação e Compromisso , Dor Crônica , Dor Crônica/terapia , Humanos , Metanálise como Assunto , Revisões Sistemáticas como AssuntoRESUMO
This review reports the most current evidence on the effects of exercise interventions on improving physical function, daily living activities and quality of life in community-dwelling frail older adults. CBMdisc, CNKI, Wanfang, VIP, MEDLINE, Cochrane Central Register of Controlled Trials (Central), Pubmed, Embase, Web of Science and EBSCO were searched from inception to July 2019. Exercise interventions were found to improve knee extension strength and normal speed and were beneficial in lower Time up and go test (TUG) and improving semi-tandem, Berg balance scale (BBS), Short Physical Performance Battery (SPPB), Physical Performance Test (PPT) and Activities of daily living (ADL). Further well-designed studies are needed to explore the most effective intervention type and dose.
Assuntos
Atividades Cotidianas , Terapia por Exercício , Idoso Fragilizado , Vida Independente , Qualidade de Vida/psicologia , Idoso , Humanos , Equilíbrio Postural , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos de Tempo e MovimentoRESUMO
BACKGROUND: Primary health care (PHC) is usually the initial point of contact for individuals seeking to access health care and providers of PHC play a crucial role in the healthcare model. However, few studies have assessed the knowledge, ability, and skills (capacity) of PHC providers in delivering care. This study aimed to identify the capacity of PHC providers in countries of the Southeast and East Asian Nursing Education and Research Network (SEANERN). METHODS: A multi-national cross-sectional survey was performed among SEANERN countries. A 1-5 Likert scale was used to measure eight components of knowledge, ability, and skill of PHC providers. Descriptive statistics were employed, and radar charts were used to depict the levels of the three dimensions (knowledge, skill and ability) and eight components. RESULTS: Totally, 606 valid questionnaires from PHC providers were returned from seven countries of SEANERN (China, Myanmar, Indonesia, Thailand, Vietnam, Cambodia, and Malaysia), with a responsive rate of 97.6% (606/621). For the three dimensions the ranges of total mean scores were distributed as follows: knowledge dimension: 2.78~3.11; skill dimension: 2.66~3.16; ability dimension: 2.67~3.06. Furthermore, radar charts revealed that the transition of PHC provider's knowledge into skill and from skill into ability decreased gradually. Their competencies in four areas, including safe water and sanitation, nutritional promotion, endemic diseases prevention, and essential provision of drugs, were especially low. CONCLUSIONS: The general capacity perceived by PHC providers themselves seems relatively low and imbalanced. To address the problem, SEANERN, through the collaboration of the members, can facilitate the appropriate education and training of PHC providers by developing feasible, practical and culturally appropriate training plans.
Assuntos
Competência Clínica , Pessoal de Saúde/normas , Atenção Primária à Saúde , Adulto , Sudeste Asiático , China , Competência Clínica/estatística & dados numéricos , Estudos Transversais , Emprego , Feminino , Pessoal de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e QuestionáriosRESUMO
To assess the efficacy and safety of wet cupping in adults with hypertension, we conducted a systematic review and meta-analysis using 13 databases. Wet cupping alone or in combination with antihypertensive medication or acupuncture was used. Seven randomized trials were included, most not of high methodological quality. A few small studies suggested that wet cupping alone versus antihypertensive medication significantly reduced blood pressure and Traditional Chinese Medicine syndrome (hypertension-related symptoms). However based on current evidence, no firm conclusions can be drawn and no clinical recommendations made. Research projects included need validation. Studies indicate that wet cupping is a safe therapy.
Assuntos
Terapias Complementares/métodos , Hipertensão/terapia , Terapia por Acupuntura , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea , Terapias Complementares/efeitos adversos , Humanos , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
BACKGROUND: Chronic low back pain (CLBP) has become a worldwide health concern, and emotional distress is an important issue for CLBP management. However, it remains poorly understood how emotional distress happens and develops. This study aimed to systematically explore the correlates of emotional distress in patients with CLBP. METHODS: The study was a multisite, cross-sectional survey with a sample of 252 patients with CLBP in urban communities. A battery of questionnaires was used to collect data. Univariate analysis, Pearson correlation analysis, and hierarchical linear regression analysis were performed. RESULTS: The mean score of emotional distress among 252 patients with CLBP was 13.85 ± 6.50. Hierarchical regression analysis indicated that the demographic factors, psychobehavioral factors, and social support of patients with CLBP were associated with their emotional distress, uniquely explaining 16.5%, 18.4%, and 6.2% of the variance, respectively. Five factors were found to be associated with patients' emotional distress: pain intensity (ß = 0.257, P < 0.001), passive coping (ß = 0.297, P < 0.001), active coping (ß = -0.254, P < 0.001), self-efficacy (ß = -0.155, P = 0.005), and social support (ß = -0.268, P < 0.001). CONCLUSIONS: Patients with CLBP suffered from clinically significant emotional distress. Patients' demographics, psychobehavioral factors, and social support were all related to emotional distress. The findings help us to identify the characteristics of patients with CLBP at high risk for emotional distress and to formulate corresponding countermeasures. LAY SUMMARY: This study aimed to explored the correlates of emotional distress of patients with chronic low back pain (CLBP) by hierarchical linear regression analysis. The study found that patients' demographic factors, psycho-behavioral factors, and social support were associated with their emotional distress, uniquely explaining 16.5%, 18.4%, and 6.2% of the variance, respectively. Pain intensity, passive coping, active coping, self-efficacy, and social support were detected as significant correlates.
Assuntos
Dor Lombar/psicologia , Angústia Psicológica , Adaptação Psicológica , Adulto , Estudos Transversais , Emoções , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Autoeficácia , Apoio SocialRESUMO
BACKGROUND: As a bio-psycho-social issue, chronic low back pain (CLBP) has been a significant topic in health management, and patients' quality of life (QOL) is gaining extensive attention. Self-efficacy, pain fear-avoidance belief (FAB), and coping styles play important roles in the QOL of CLBP patients. However, it remains unclear how self-efficacy and FAB influence QOL through specific coping styles. This study aimed to explore the influencing paths of self-efficacy, FAB, and coping styles on the QOL of patients with CLBP. METHODS: This study relies on a multisite, cross-sectional design involving 221 CLBP patients. Stepwise multiple regression and structural equation modeling were employed. RESULTS: CLBP patients lived with a poor global QOL. Self-efficacy played a direct, positive role in predicting QOL for patients with CLBP (ß = 0.35), and it also played an indirect, positive role in predicting QOL (ß = 0.19) through active coping styles (ß = 0.31). FAB played a direct, negative role in predicting QOL (ß = -0.33), and it also played an indirect, negative role in predicting QOL (ß = -0.32) through passive coping styles (ß = 0.32). CONCLUSIONS: Self-efficacy and FAB are both directly and indirectly related to global QOL, and coping styles are important mediating variables. Self-efficacy and active coping are protective factors for the QOL of CLBP patients, while FAB and passive coping are risk factors. Health education strategies are recommended by medical personnel to enhance CLBP patients' pain self-efficacy, decrease pain FAB, and modify pain coping styles, so that their global QOL can be improved.
Assuntos
Adaptação Psicológica , Medo/psicologia , Dor Lombar/psicologia , Qualidade de Vida , Autoeficácia , Adulto , Povo Asiático , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise MultivariadaRESUMO
OBJECTIVES: For patients with endometrial cancer (EC), the screening value of serum human epididymis protein 4 (HE4) remains controversial. We performed meta-analyses to compare the screening accuracy of serum HE4 and carbohydrate antigen 125 (CA125) for EC. MATERIALS AND METHODS: A search of diagnostic test studies was performed in 5 English databases: Pubmed, Cochrane Library, Web of Science, Science Direct, and Elton Bryan Stephens Co or EBSCO; and 2 Chinese databases including China National Knowledge Infrastructure or CNKI and VIP (Weipu Database), from their inception dates to early July 2015. Two reviewers independently selected trials, conducted critical appraisal, and extracted data. Meta-analyses were performed to compare the screening accuracy between HE4 and CA125. Summary receiver operating characteristic curve and the area under the summary receiver operating characteristic curve were performed. Subgroup analysis, meta-regression, sensitivity analysis, and Egger plot and the Egger test were also conducted. RESULTS: Twenty-one studies were identified, and the methodological quality was generally fair. Meta-analyses revealed that the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratios for HE4 in screening EC were 0.56, 0.89, 6.41, 0.49, and 14.82, respectively, whereas the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio for CA125 in screening EC were 0.32, 0.81, 2.15, 0.83, and 2.74, respectively. The areas under the summary receiver operating characteristic curves for HE4 and CA125 were 0.7778 and 0.5474, respectively. CONCLUSIONS: This study indicates that serum HE4 may be superior to CA125 in screening accuracy of EC. This conclusion has to be interpreted cautiously owing to high heterogeneity and some limitations.
Assuntos
Antígeno Ca-125/sangue , Neoplasias do Endométrio/sangue , Proteínas de Membrana/sangue , Proteínas/metabolismo , Feminino , Humanos , Proteína 2 do Domínio Central WAP de Quatro DissulfetosRESUMO
AIMS AND OBJECTIVES: The purpose of this review was to identify and categorise the components of the content and structure of effective self-management interventions for patients with inflammatory bowel disease. BACKGROUND: Inflammatory bowel diseases are chronic gastrointestinal disorders impacting health-related quality of life. Although the efficacy of self-management interventions has been demonstrated in previous studies, the most effective components of the content and structure of these interventions remain unknown. DESIGN: A systematic review, meta-analysis and meta-regression of randomised controlled trials was used. METHODS: A systematic search of six electronic databases, including Pubmed, Embase, Cochrane central register of controlled trials, Web of Science, Cumulative Index of Nursing and Allied Health Literature and Chinese Biomedical Literature Database, was conducted. Content analysis was used to categorise the components of the content and structure of effective self-management interventions for inflammatory bowel disease. Clinically important and statistically significant beneficial effects on health-related quality of life were explored, by comparing the association between effect sizes and various components of self-management interventions such as the presence or absence of specific content and different delivery methods. RESULTS: Fifteen randomised controlled trials were included in this review. Distance or remote self-management interventions demonstrated a larger effect size. However, there is no evidence for a positive effect associated with specific content component of self-management interventions in adult patients with inflammatory bowel disease in general. CONCLUSIONS: The results showed that self-management interventions have positive effects on health-related quality of life in patients with inflammatory bowel disease, and distance or remote self-management programmes had better outcomes than other types of interventions. RELEVANCE TO CLINICAL PRACTICE: This review provides useful information to clinician and researchers when determining components of effective self-management programmes for patients with inflammatory bowel disease. More high-quality randomised controlled trials are needed to test the results.
Assuntos
Doenças Inflamatórias Intestinais/psicologia , Qualidade de Vida , Autocuidado , Humanos , Doenças Inflamatórias Intestinais/enfermagemRESUMO
Background: Evidence indicates that medical students have had high rates of mental health problems, especially during the COVID-19 pandemic, which could be affected by alexithymia-a marked dysfunction in emotional awareness, social attachment and interpersonal relationships-and stress. However, psychological resilience might relieve alexithymia and stress levels. Aims: This study aimed to investigate the role of resilience in alexithymia and stress in medical students. Methods: A total of 470 medical students completed online and offline surveys, including the Toronto Alexithymia Scale-20 (TAS-20), the Connor-Davidson Resilience Scale (CD-RISC) and the College Student Stress Questionnaire (CSSQ). The data of five participants were excluded because of a lack of integrity. Mann-Whitney U test or Kruskal-Wallis test was used to compare group differences in the CD-RISC scores among categorical variables. Spearman correlation analysis was employed to evaluate the associations between resilience and alexithymia and between resilience and stress. Mediation analysis was used to test the mediating effect of resilience between alexithymia and stress. Results: Of the medical students considered in the analysis, 382 (81.28%) were female and 88 (18.72%) were male. There was a significant negative correlation between the TAS-20 scores and the total and subtotal CD-RISC scores (p<0.001). The CSSQ scores also significantly negatively correlated with the total and subtotal CD-RISC scores (p<0.001). Resilience mediated the relationship between alexithymia and stress (total effect=1.044 7, p<0.001). The indirect effect of alexithymia significantly impacted stress through resilience (effect=0.167 0, 95% CI: 0.069 to 0.281). Conclusions: Our findings suggest that resilience might effectively reduce alexithymia and stress. They also contributed to a better understanding of the mediating effects of resilience on alexithymia and stress during the COVID-19 pandemic. The evidence from these results encourages universities to focus on improving students' resilience.
RESUMO
AIM: To examine the effect of incorporating evidence-based practice (EBP) in Nursing Research curriculum on undergraduate nursing students. BACKGROUND: The competence of EBP is essential for nurses and it is an essential task for educators to implement EBP education in nursing students. DESIGN: A quasi-experimental study. METHODS: Based on Astin's Input-Environment-Outcome model, the study was conducted among 258 third-grade students of a four-year nursing bachelor's program between September through December 2022. The students were divided into two groups. Students in the intervention group received innovative teaching where EBP elements were incorporated in Nursing Research course in a natural, gradual and spiral way, while students in the control group attended conventional teaching. Effect of EBP teaching was examined in terms of students' EBP competence, learning experience and satisfaction and score of team-based research protocol assignment. RESULTS: Compared with conventional teaching, the innovative teaching characterized by EBP improved students' EBP competence in terms of attitudes and skills and enhanced student's comprehensive ability in nursing research. Students' learning experience and satisfaction were similarly favorable between the two groups. CONCLUSIONS: For undergraduate nursing students, the teaching strategy characterized by EBP is an appropriate and effective way to improve their EBP competence of attitudes and skills, as well as their nursing research ability.
Assuntos
Bacharelado em Enfermagem , Pesquisa em Enfermagem , Estudantes de Enfermagem , Humanos , Bacharelado em Enfermagem/métodos , Enfermagem Baseada em Evidências/educação , Prática Clínica Baseada em Evidências , CurrículoRESUMO
Background The vast majority of women with perinatal depression (PND) live in low- and middle-income countries (LMICs). Task sharing is an alternative delivery strategy to implement PND services. However, the exploration of influencing factors for task sharing in PND services is poor. Therefore, this study aimed to identify factors affecting LMICs to implement PND task-sharing interventions from the perspective of stakeholders and weigh their levels of evidence. Methods A comprehensive literature search was carried out through six English and Chinese databases on qualitative data. We used Critical Appraisal Skills Programme (CASP)/Meta Quality Appraisal Tool (MetaQAT) to appraise included studies, extracted data according to the Consolidated Framework for Implementation Research (CFIR), and assigned levels of confidence in the factors through Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual). Results 17 studies met the eligibility criteria, factors identified with high levels of evidence were coded to the CFIR constructs, including "Knowledge and Attitudes of Those Served by the Organization", "Available Resources", "Compatibility", "Access to knowledge and information", "Resources of Those Served by the Organization" and "Alignment". Conclusion This metasynthesis highlights task sharing in PND interventions is influenced by multiple factors. We synthesized and developed implementation recommendations for practice. Strategies must be actively developed to enable women and their families to enjoy the benefits of good perinatal mental health.
Assuntos
Depressão , Países em Desenvolvimento , Depressão/terapia , Feminino , Humanos , Renda , Pobreza , Gravidez , Pesquisa QualitativaRESUMO
BACKGROUND: Since traditional teaching could not help to develop competences, flipped classroom has caught the sight of researchers. Despite the uptake of flipped classroom in other disciplines, there is a dearth of evidence available about the use in nursing curricula. In addition, there is no consensus on how to best implement a flipped classroom. OBJECTIVE: This study aimed to (1) develop a flipped classroom underpinned by constructivism theory and (2) to verify its effectiveness. DESIGN: This study adopted a quasi-experimental design. SETTING AND PARTICIPANTS: This study was conducted in 2018 spring semester at a University in East China with 6th semester undergraduate nursing students in four parallel classes in Community Nursing Course. METHODS: A flipped classroom characterized by situational and collaborative learning was developed and carried out with two classes (intervention group, n = 98). In-class lectures was applied for the other two classes (control group, n = 90). Course examination score, experience (course experience questionnaire, CEQ), and students' appraisal were used to verify the effectiveness of flipped classroom. RESULTS: Compared to control group, the examination score was higher for intervention group. As for the four domains of CEQ, good teaching domain rating was lower, learning burden domain rating was higher for the intervention group. There was no statistical difference in classroom quality and harvest domains. More students in intervention group chose the course helped them in developing "critical thinking" and "self-cognition and evaluation" abilities. Satisfaction rating of groups was not statistically different. CONCLUSIONS: Flipped classroom was efficient in improving students' academic performance and promoting development of higher-level thinking abilities; however, it failed in improving students' satisfaction and course experience. These findings suggest that active learning strategies such as situational and collaborative learning of group problem solving and discussion should be integrated into nursing curriculum and refinement to flipped classroom are needed to create students' buy-in.
Assuntos
Bacharelado em Enfermagem , Práticas Interdisciplinares , Estudantes de Enfermagem , Currículo , Humanos , Aprendizagem Baseada em Problemas , Projetos de PesquisaRESUMO
Chronic pain is a worldwide health problem, Acceptance and Commitment Therapy (ACT) is regarded as one of the promising interventions. ACT aims to help chronic pain patients to create space for pursuing valued life activities in spite of pain. This systematic review of randomized controlled trials (RCTs) examined the efficacy of ACT on functioning for chronic pain. Literature search was performed among seven databases, and 12 RCTs were retrieved. The revised Cochrane risk of bias tool (RoB 2.0) was employed to assess the quality of the 12 RCTs, of which 10 were rated as "low risks", and 2 as "some concerns". Effect sizes of single RCTs and the pooled effect sizes of meta analyses were all rated by Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. Low to moderate evidence showed that ACT played a positive immediate role in functioning for patients with chronic pain; however, it is inconsistent whether the effect can be sustained. More RCTs are warranted within specific chronic pain conditions.
Assuntos
Terapia de Aceitação e Compromisso , Dor Crônica , Doença Crônica , Dor Crônica/terapia , Humanos , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
The association between the efficacy of mobile health and the occurrence and development of coronary heart disease (CHD) is still unclear. Mobile health can alleviate the risk factors for CHD. PubMed, EMbase, Web of Science, The Cochrane Library, CNKI, WanFang, and VIP databases were searched from inception through May 28, 2020. Randomized controlled trials of the effect of mobile health in alleviating the risk factors of CHD's occurrence and development were included. Risks of bias were assessed by two independent reviewers by using the RevMan 5.3, GRADEpro, and RoB2.0 to generate findings. Meta-analyses were performed to investigate the effects of mobile health on risk factors for CHD. Subgroup analyses were conducted. Sixteen randomized controlled trials, including 3898 patients with CHD, were included. Meta-analysis results showed that mobile health can reduce BMI (mean difference [MD] = - 1.24, 95% CI = - 2.02 to - 0.45, p < .05), waist circumference (MD = - 4.40, 95% CI = - 4.72 to - 4.08, p < .00001), total cholesterol (TC) level (MD = - 0.43, 95% CI = - 0.64 to - 0.22, p < 0.00001), low-density lipoprotein cholesterol (LDL-C) level (MD = - 0.31, 95% CI = - 0.48 to - 0.15, p < .05), diastolic blood pressure (MD = - 2.01, 95% CI = - 3.40 to - 0.623, p < .05), and depression (MD = - 8.32, 95% CI = - 12.83 to - 3.81, p < .05) and increase high-density lipoprotein cholesterol level (MD = 0.16, 95% CI = 0.01 to 0.32, p < .05) with statistically significant differences. The results of subgroup analyses indicated that the simple mobile health intervention has more remarkable advantages in reducing BMI, TC, LDL-C, and systolic blood pressure than the complex mobile health intervention. Mobile health can alleviate the risk factors for CHD and has a certain effect on the prevention and recovery of CHD. Simple mobile health has a remarkable advantage. Limited by the quantity and quality of included studies, future research enrolling high-quality studies should be taken to verify the above conclusions.
Assuntos
Doença das Coronárias , Telemedicina , Pressão Sanguínea , LDL-Colesterol , Doença das Coronárias/diagnóstico , Doença das Coronárias/epidemiologia , Doença das Coronárias/prevenção & controle , Humanos , Fatores de RiscoRESUMO
METHODS: PubMed, Embase, Cochrane Library, and three Chinese databases, namely, China National Knowledge Network, Wanfang, and China Biomedical Network, were searched from the time of their inceptions through August, 2021. We retrieved the studies on the application of TCE-based cardiac rehabilitation in patients with HF. Based on the standard evaluation methods of Cochrane Reviewer's Handbook 5.1.0, two authors independently assessed the risk of bias and evaluated the methodological quality of the studies included. The RevMan 5.3 software was used for further meta-analysis. Additionally, the GRADEpro GDT web version was used to assess the quality of the evidence in these studies. RESULTS: Nine randomized controlled trials involving 721 patients were included in this analysis. The meta-analysis revealed that the TCE (experimental group) effectively improved the patient's motor function and endurance compared to walking or other activities (control group) (mean difference, MD = 68.23, 95% CI [54.55, 81.91]; P < 0.00001). From each subgroup analysis, the exercising ability of the experimental group was higher than that of the control group. The quality of life's score in the experimental group was lower than that of the control group (MD = -9.51, 95%CI [-17.84, -1.18]; P=0.03). The plasma B-type natriuretic peptide content in the experimental group was lower than that in the control group (MD = -59.77, 95%CI [-82.85, -36.7]; P < 0.00001). The number of hospitalizations (MD = -0.83, 95%CI [-0.98, -0.68]; P < 0.00001) and hospital costs in the experimental group (MD = -1.6, 95%CI [-1.89, -1.31]; P < 0.00001) were lower than those in the control group. However, no significant differences were observed in the left ventricular ejection fraction and maximal oxygen consumption between the two groups (MD = 1.38, 95%CI [-3.08, 5.84] and P=0.54; MD = -0.04, 95%CI [-1.62, 1.54] and P=0.96, respectively). From the current analysis, TCE can be considered a relatively safe exercise method. According to the GRADE evaluation results on the evidence level, the studies included were of moderate quality, low quality, or very low quality. CONCLUSIONS: Our systematic review showed that TCE had potential benefits in improving patients' cardiac function, motor function, and quality of life. Therefore, TCE might be an effective adjuvant therapy in patients with HF. However, given the inclusion of the low-quality elucidations, further rigorous studies are urgently needed to confirm these results.
RESUMO
OBJECTIVE: English for Specific Purpose (ESP) is the essence for developing scientific research capacity, which is a core component for postgraduate education. The objective of this article is to develop a curriculum model for ESP of Master's level nursing education in a Chinese medicine university. METHOD: A three-year action research approach with continuous reflection and modification was used to develop an ESP curriculum based on the RICH model. A total of 78 students of Master's Science in Nursing enrolled in 2016-2018 and three course teachers in Nanjing University of Chinese Medicine participated in the study. The ESP curriculum based on the RICH model involved research-based learning topics (R), integrated curriculum(I), cooperative learning methods(C), and humanistic outcome (H). RESULTS: The passing rate of the students was 100%, the excellent rate was 79.5%, with an average score of 83.16 ± 3.43. All students were satisfied with the ESP course design and acknowledged the process of "growing up under the pressure". Four students have published five articles in the journals included by Science Citation Index (SCI). CONCLUSIONS: The study exerted a positive effect on the ESP teaching and learning and provided new ideas for the ESP curriculum integration of Master's Science in Nursing in China.