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.

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;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.

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

Objective： To evaluate the efficacy and safety of the heated gel mattress for prevention of heat loss on preterm infants with hypothermia during the transport systematically and objectively. Methods： Systematic searches on PubMed, EM- BASE, Cochrane Library, Web of Science, CBM, CNKI, Wanfang and VIP were performed for randomized controlled trials （RCTs） or quasi-RCTs which explored the effects of heated gel mattress on prevention of hypothermia in premature infants relative to conventional alternatives. Studies were screened according to inclusion and exclusion criteria, extracted data and assessed quality. Then, meta-analysis and trial sequential analysis were performed by RevMan 5.3 and TSA vO.9 software developed at the Copenhagen Clinical Trials Center in Denmark, independently. Results： This systematic review included 10 studies which comprised 7 RCTs and 3 quasi-RCTs, encompassing 773 patients. The results of meta-analysis showed that in heated gel mattress group admission temperature on neonatal intensive care unit （SMD, 0.63; 95% CI, 0.40 to 0.87; P = 0.00）, incidence of hypothermia （RR, 0.73; 95% CI, 0.57 to 0.93; P = 0.01） and hyperthermia （RR, 1.82; 95% CI, 1.31 to 2.541 P = 0.00） compared with the control group had significantly statistical difference; however, there was no significant difference in admission temperature on exothermic mattresses or TransWarmer mattress group, mortality, sepsis, retinopathy of prematurity, intraventricular hemorrhage Ⅲ/Ⅳ between two groups, trial sequential analysis confirmed that the pooled results of admission temperature on neonatal intensive care unit and hyperthermia were stable and reliable; but the combination of low-temperature incidence and mortality indicators suggested that the sample size was insufficient. Conclusion： Heated gel mattress is a safe and effective re- warming intervention that can improve body temperature of hypothermic preterm infants during transport, reduce the incidence of hypothermia and does not increase the incidence of morbidity and complications. However, it is recommended that clinical monitoring of body temperature should be performed dynamically to decrease the potential risk of high fever. In addition, due to the limitation of quantity and quality of included studies, its cost-effectiveness and far-reaching influence on long-term follow-up outcomes need further evaluation through clinical multicenter, large sample, and high-quality research.

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

Objective： To evaluate the effects of core stability exercise （CST） on rehabilitation in stroke patients with hemiplegia. Methods： Randomly controlled trials about the effects of CST on rehabilitation in stroke patients with hemiplegia were searched in the database, including PubMed, Embase, Web of Science, Cochrane Library, CNKI, Wanfang, CBM and VIP. Search terms include “core stability training / core stability exercise / core stabilization training / core stabilization exercise/ core strength training / core strength exercise” and “stroke / brain ischemia / cerebral infarction / cerebral hemorrhage / intracranial thrombosis / brain hemorrhage / cerebrovascular disorder /cerebrovascular accident, cerebrovascular disease / hemiplegia / hemiparesis/ stroke rehabilitation”. Study screening, data extraction and quality assessment were conducted by two researchers independently. Data was analyzed using RevMan 5.3 software. Results： Totally 11 studies and 704 patients were included with 352 patients in experiment group and 352 in control group. Results of meta-analysis showed that combination of CST and conventional rehabilitation had better effects on trunk control [MD = 10.44, 95% CI （8.83-12.04）, P 〈 0.001], banlace [MD = 5.6, 95% CI （4.81-6.39）, P 〈 0.001], activities of daily living [MD = 12.06, 95% CI （7.65-16.46）, P 〈 0.001], ambulation functional [MD = 0.72, 95% CI （0.32-1.12）, P 〈 0.001] and walking speed [MD = 3.39, 95% CI （2.03-4.76）, P 〈 0.001] than conventional rehabilitation, but there is no clear difference on walking stride [MD = 2.52, 95% CI （-0.25-5.29）, P = 0.07] between two groups. Conclusion： CST together with conventional rehabilitation can better improve trunk control, banlace, activities of daily living, ambulation functional and walking speed in stroke patients compared with conventional rehabilitation, but can not make the walking stride better significantly. However, since the conclusion of this meta-analysis was drawn based on middle quality RCTs, future high quality researchs should be conducted to confirm its positive intervention effects.

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

Objective： To evaluate the correlation between time management disposition and ability confidence of Nursing Students in China through the Pearson correlation coefficient. Methods： Electronic databases including the Cochrane library, PubMed, EMBASE, the Web of Science, CBM, Wanfang, VIP and CNKI were searched from inception to October 2017 to collect literature on the correlation between time manage-ment disposition and ability confidence of Chinese nursing students. The studies were examined according to the inclusion and exclusion criteria. After extracting data and evaluating the quality of the included studies. Meta-analysis was carried out using Stata 12.0 software. Results： A total of 7 articles with 1632 nursing students were included, and the quality of the literature was at medium level. Meta-analysis shown the total score of time management disposition of Chinese nursing students and its three dimensions were related to ability confidence. The summary correlation coefficient between time management disposition and ability confidence was 0.52 （0.43 to 0.59） ; There is a weak correlation between time value and ability confidence （r, 0.33; 95% CI, 0.25 to 0.39）; There was a moderate level of correlation between time control and ability confidence （r, 0.49; 95% CI, 0.43 to 0.54）; There was a moderate level of correlation between time efficacy and ability confidence （0.47, 0.41, 0.53）.And the relevance of nursing time management disposition and behavioral confidence varies with the nursing student＇s area, nursing student＇s diploma, measurement tools and sample size. Conclusion： The time man- agement disposition of Chinese nursing students is moderately related to ability confidence. When there are different in nursing students in the area, nursing diploma, measurement tools and sample size, the relevance is very different. The time management disposition of Chinese nursing students and their ability confidence are mutually reinforcing, and the time management disposition and their ability confidence should be further strengthened in the future.

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

Objective:To systematically evaluate the effects of interventions with mindfulness-breathing-stretching components on lung neoplasms.Methods:Multiple electronic databases were used to search for research on the effects of interventions with mindfulness-breathing-stretching components on lung neoplasms.The randomized controlled trails and self-control trails were included.Electronic databases include:Cochrane library,Pub Med,EMBASE,Web of Science,China Biology Medicine disc(CBM),VIP,WANFANG and CNKI.Studies were selected according to certain inclusion and exclusion criteria,and data were analyzed by Rev Man 5.3.Results:10 randomized controlled trials and 5 self-control trails were included.The results of meta-analysis were as follows:There was statistically significant difference between two groups in self-perceived burden,quality of life,sleep quality of patients and caregivers,medical coping modes and catecholamine;there was no statistically significant difference between two groups in psychological pressure,mental well-being,fatigue of patients and caregivers,cortisol,endorphins,immunological indexes and complement regulatory proteins.Conclusion:Compared with conventional treatment and nursing,interventions with mindfulness-breathing-stretching components can decrease improve the state of mind,quality of life,quality of sleep,medical coping style and some hormone indexes.However,because of the heterogeneity of indicators and inadequate included studies,larger sample size and high-quality studies are needed.