Effectiveness of the flipped classroom on the development of self-directed learning in nursing education:a meta-analysis

Objectives: To examine the best practice evidence of the effectiveness of the flipped classroom(FC) as a burgeoning teaching model on the development of self-directed learning in nursing education.Data sources: The relevant randomized controlled trial(RCT) and non-RCT comparative studies were searched from multiple electronic databases including PubMed, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature(CINAHL), Cochrane Central Register of Controlled Trials(CENTRAL), Wanfang Data, China National Knowledge Infrastructure(CNKI), and Chinese Science and Technology Periodical Database(VIP) from inception to June 2017.Review methods: The data were independently assessed and extracted for eligibility by two reviewers. The quality of included studies was assessed by another two reviewers using a standardized form and evaluated by using the Cochrane Collaboration's risk of bias tool. The self-directed learning scores(continuous outcomes) were analyzed by using the 95% confidence intervals(Cls) with the standard deviation average(SMD) or weighted mean difference(WMD). The heterogeneity was assessed using Cochran's I^2 statistic.Results: A total of 12 studies, which encompassed 1440 nursing students(intervention group = 685, control group = 755), were eligible for inclusion in this review. Of 12 included studies, the quality level of one included study was A and of the others was B. The pooled effect size showed that compared with traditional teaching models, the FC could improve nursing students' selfdirected learning skill, as measured by the Self-Directed Learning Readiness Scale(SDLRS), Self-Directed Learning Readiness Scale for Nursing Education(SDLRSNE), Self-Regulated Learning Scale(SRL), Autonomous Learning Competencies scale(ALC), and Competencies of Autonomous Learning of Nursing Students(CALNS). Overall scores and subgroup analyses with the SRL were all in favor of the FC.Conclusions: The result of this meta-analysis indicated that FCs could improve the effect of self-directed learning in nursing education.Future studies with more RCTs using the same measurement tools are needed to draw more authoritative conclusions.

Relationship between self-directed learning readiness, learning attitude, and self-efficacy of nursing undergraduates

Objective: The purposes of this study were to analyze the influencing factors of self-directed learning readiness(SDLR) of nursing undergraduates and explore the impacts of learning attitude and self-efficacy on nursing undergraduates.Methods: A total of 500 nursing undergraduates were investigated in Tianjin, with the Chinese version of SDLR scale, learning attitude questionnaire of nursing college students, academic self-efficacy scale, and the general information questionnaire.Result: The score of SDLR was 149.99±15.73. Multiple stepwise regressions indicated that academic self-efficacy, learning attitude, attitudes to major of nursing, and level of learning difficulties were major influential factors and explained 48.1% of the variance in SDLR of nursing interns.Conclusions: The score of SDLR of nursing undergraduates is not promising. It is imperative to correct students' learning attitude, improve self-efficacy, and adopt appropriate teaching model to improve SDLR.

Early mobilization for mechanically ventilated patients in the intensive care unit:a systematic review and meta-analysis

Background: Early mobilization(EM) is a regimen that was carried out by physiotherapists in a relatively early stage. It has been investigated by an increasing number of researchers. However, there has not been a meta-analysis concerning whether EM could benefit the clinical outcomes of critically ill patients requiring mechanical ventilation(MV). The present systematic review aims to evaluate the effect of EM compared with immobilization for mechanically ventilated patients.Methods: A computerized literature search was performed in six databases for related articles from inception to June 2017. We included randomized controlled trials and controlled clinical trials and used the Physiotherapy Evidence Database scale to assess the quality of included studies. Primary outcomes were measures of muscle function, duration of MV, and incidence of mortality.Secondary outcomes were adverse effects and length of stay(LOS) in intensive care unit(ICU) and hospital.Results: Eight trials were included; of those, only one study without standard EM reported that the intervention was invalid to improve the outcomes. The result of meta-analysis indicated that EM shortened the duration of MV; however, it had no positive effect on mortality and LOS in ICU.Conclusions: This review suggests that EM improves the muscle function and ventilation duration. Further research highlighting standard intervention and specific groups is needed.

Effects of parental involvement in infant care in neonatal intensive care units:a meta-analysis

Objective： This meta-analysis aimed to examine the effects of parental involvement in infant care in neonatal intensive care units （NlCUs）. Methods： PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure （CNKI）, Wanfang database, and VIP database were searched till November 2017. Randomized controlled trials （RCTs） and controlled clinical trials （CCTs） examining the effect of parental involvement in the NICU were considered for inclusion. Resulls： We included 10 studies （three RCTs, seven CCTs） with a total of 1,851 participants. The meta-analysis demonstrated that there were no statistically significant differences on nosocomial infection between two groups （risk ratio [RR] = 0.90, 95% CI 0.63-1.30, P = 0.58）. Compared with no parental involvement groups, parental involvement groups showed more weight gain （mean difference [MD] = 1.47, 95% CI 0.65-2.29, P 〈 0.05）, higher breast-feeding rate （RR = 1.38, 95% CI 1.25-1.53, P 〈 0.05）, lower readmission rate （RR = 0.35, 95% CI 0.15-0.80, P 〈 0.05）, and higher satisfaction rate （RR = 1.09, 95% CI 1.02-1.16, P 〈 0.05）.Conclusions： Parentaiinvolvement in the NICU interventions could not increase the rate of nosocomial infection of neonates, but could improve their weight gain, breast-feeding and parental satisfaction and decrease their readmission. However, since the conclusion of this meta-analysis was drawn based on the limited number of high-quality RCTs, more hioh-quality studies should be conducted in the future to confirm its positive intervention effects.

Rapid progression of atherosclerosis in a patient with acute coronary syndrome and ANCA-associated vasculitis:split or confluence?

A59-year-old female patient was admitted to our hospital on 9 March 2021,due to recurrent chest pain.She underwent percutaneous coronary intervention,with a focus on the proximal segment of the left anterior descending(LAD)artery,six months prior to admission.The patient had a long-term history of hyperlipidaemia and obstructive sleep apnoea syndrome(OSAS).She also had rheumatoid arthritis and ANCA-associated vasculitis that lasted for more than 10 years and a 9-year history of concomitant hypertension.She was on long-term oral leflunomide and intermittent oral prednisone.The patient underwent a computed tomography angiogram(CTA)six years ago(2015),which showed minor atherosclerotic plaque build-up in the LAD artery and the right coronary artery(RCA)(Figure 1).

Efficacy of Liuzijue respiratory exercise in patients with chronic obstructive pulmonary disease:a meta-analysis

Objective:To evaluate the effects of Liuzijue respiratory exercise in patients with chronic obstructive pulmonary disease(COPD).Method:Randomly controlled trials of Liuzijue respiratory exercise in the treatment of COPD were searched in the database,including PubMed,Embase,Web of Science,Cochrane Library,CNKI,Wanfang,CBM,and VIP.Study screening,data extraction,and quality assessment were conducted by two researchers independently.Data were analyzed using RevMan 5.3 software.Results:11 studies with 915 COPD patients were included.Results of meta-analysis showed that compared with conventional care,Liuzijue respiratory exercise had shown better effects on FEV1(Forced expiratory volume in 1 second)[MD=0.18,95%CI(0.06,0.30),P=0.004],FEV1%pred[MD=10.21,95%CI(7.25,13.18),P<0.001],FEV1/FVC%(Forced vital capacity)[MD=8.32,95%CI(3.23,13.40),P<0.001],6-minute walk distance[MD=10.97,95%CI(5.81,16.12),P<0.001]and life quality[MD=-10.07,95%CI(-12.84,-7.30),P<0.001].However,no difference was observed in the effective rate between these two groups.Compared with whole body respiratory exercise,except for the better effects on 6-minute walk distance[MD=37.82,95%CI(6.51,69.13),P=0.02],no difference in FEV1,FEV1%pred,FEV1/FVC%and life quality were observed between these two groups.Conclusion:Liuzijue respiratory exercise can better improve lung function,functional capacity,and life quality of COPD patients compared with conventional care.Compared with the whole body respiratory exercise,Liuzijue could improve the functional capacity of COPD patients significantly and showed similar effcets on lung function and life quality.

Efficacy and safety of the heated gel mattress for prevention of hypothermia in preterm infants during intra-hospital transport： a meta-analysis

目的：系统评价转运中加热凝胶床垫对低体温早产儿复温效果的有效性和安全性。方法：计算机检索PubMed、EMBASE、Cochrane Library、Web of Science，中国生物文献数据库、中国学术期刊全文数据库、万方和维普等国内外数据库中有关加热凝胶床垫应用于早产儿低体温复温的随机对照试验或半随机试验。对获得文献根据纳入与排除标准进行文献筛查、资料提取、文献质量评价，采用RevMan513统计软件进行Meta分析，采用丹麦哥本哈根临床试验中心开发的TSA v0．9软件进行试验序贯分析。结果：共纳入7篇随机对照试验，3篇类试验，共包括773例患儿。Meta分析结果显示，使用加热凝胶床垫入新生儿重症监护治疗病房（NICU）时体温[SMD=0．63，95％CI（0．40，0．87），P=0．00]、低体温发生率[RR=0．73，95％CI（0．57，0．93），P=0．01]、高热[RR=1．82，95％ClI（1．31，2．54），P=0．00]，合并效应有统计学意义；而在使用放热床垫、超温床垫进入NICU时体温，死亡率，脓毒血症，早期视网膜病变，3至4级脑室内出血方面并无统计学意义。试验序贯分析显示，入NICU时体温和高温指标Meta分析结果稳定且可靠，但低温发生率、死亡率指标合并结果提示样本量不足。结论：加热凝胶类型床垫是安全有效的复温辅助干预措施，可提高转运过程中低温早产儿入NICU时体温，降低低体温发生率且不增加死亡率和并发症的发生率，但建议临床使用时应动态监测体温以降低高热的潜在风险。此外，其成本效益和对远期结局指标的长期影响需要通过临床多中心、大样本、高质量的研究进一步评价。

Effects of core stability exercise on rehabilitation in stroke patients with hemiplegia： a meta-analysis

目的：评估核心稳定性训练在脑卒中偏瘫患者康复中的疗效.方法：以“核心稳定性训练/核心稳定训练/核心稳定性力量训练/核心稳定力量训练”,“脑卒中/中风/脑梗死/脑出血/脑血栓/脑栓塞/脑梗/蛛网膜下腔出血/偏瘫”等为关键词检索PubMed、Embase、Webof Science、Cochrane Library、知网、万方、CBM、维普等中英文数据库中有关核心稳定性训练对脑卒中偏瘫患者康复效果的随机对照试验,然后由双人独立进行文献筛选、数据提取和质量评价,采用RevMan5.3软件进行Meta分析.结果：共纳入11篇随机对照试验,包括704名患者,其中实验组和对照组各为352名.Meta分析结果显示,在常规康复的基础上辅以核心稳定性训练对患者躯干控制能力[MD=10.44,95%CI（8.83-12.04）,P〈0.001],平衡能力[MD=5.6,95%CI（4.81-6.39）,P〈0.001],日常生活活动能力[MD=12.06,95%CI（7.65-16.46）,P〈0.001],步行功能[MD=0.72,95%CI（0.32-1.12）,P〈0.001]以及步速[MD=3.39,95%CI（2.03-4.76）,P〈0.001]的作用效果均优于常规康复治疗,但是在步幅方面[MD=2.52,95%CI（-0.25-5.29）,P=0.07]没有显著差异.结论：在常规康复的基础上辅以核心稳定性训练可提高脑卒中偏瘫患者的躯干控制能力,平衡能力,日常生活活动能力、步行功能以及步速,但是对步幅改善方面还缺乏有效证据.由于本研究纳入的随机对照试验质量均为中等水平,未来还需要进行更多高质量的相关研究以进-步评价核心稳定性训练对脑卒中偏瘫患者的康复效果.

Correlation between time management disposition and ability confidence of chinese nursing students： a meta-analysis

目的：采用Meta分析评价基于Pearson相关系数的我国护生时间管理倾向与行为能力自信的相关性。万法：检索Cochrane library、PubMed、EMBASE、WebofScience、中国生物医学文献数据库（CBM）、万方数据资源系统（Wanfang）、维普科技期刊数据库（VIP）和中国期刊全文数据库（CNKI）中关于护生时间管理和行为能力相关的文献，时间限定为建库至2017年10月。按照纳入排除标准对检索出的文献进行筛选、提取资料，对纳入研究进行质量评价后，采用Stata12．0软件进行Meta分析。结果：研究共纳入7篇文献，共包含1632名护生。Meta分析显示，护生时间管理倾向与行为能力自信中度相关[r=0.52，95％CI（0．43，0．59）]。护生时间管理倾向与行为能力自信的相关性大小随着护生所在地区、护生学历、测量工具及研究样本量的不同而不同。时间价值感与行为能力自信存在弱相关[r=0．33，95％CI（0．25，0.39）]；时间监控感与行为能力自信存在中等程度相关[r=0．49，95％CI（0．43，0．54）]；时间效能感与行为能力自信存在中等程度相关[r=0．47，95％CI（0．41，0．53）]。结论：护生的时间管理倾向与行为能力自信存在中等程度相关，且因护生所在地区、护生学历、测量工具及研究样本量的不同而存在差异。护生的时间管理倾向与行为能力自信相互促进，以后应加强对护生时间。

Effects of interventions with mindfulness-breathing-stretching components on physiological and mental function of lung cancer patients: a mata-analysis

目的:系统评价正念-呼吸-伸展锻炼对肺癌患者的影响。方法:文献检索采用计算机检索及辅助检索两种方式,计算机检索Pub Med、EMBASE、Cochrane Library、Web of Science、CBM、CNKI、万方和维普等中英文数据库中有关正念-呼吸-伸展锻炼在肺癌患者中应用效果的随机对照试验和自身前后对照研究。对检索获得的文献根据纳入与排除标准进行筛查,评价文献质量,提取相关资料。采用RevMan 5.3软件对数据进行Meta分析。结果:最终共纳入14项研究,9项随机对照试验和5项自身前后对照试验。Meta分析结果显示,干预组肺癌患者的自我感受负担、睡眠质量、患者医学应对方式及儿茶酚胺与对照组相比,差异具有统计学意义。干预组肺癌患者心理压力、精神幸福感、疲劳程度、皮质醇、内啡肽及免疫学指标与对照组相比,差异具无统计学意义。结论:正念-呼吸-伸展能有效改善肺癌患者的心境状态、睡眠质量、医学应对方式及部分激素指标。本研究在对部分指标进行评价时,纳入的符合标准的研究数量不足。因此,需要更多多中心、大样本、高质量的研究进一步评价正念-呼吸-伸展锻炼在肺癌患者中应用效果。