Efficacy and safety of cytisine versus nortriptyline for smoking cessation: A multicentre, randomized, double-blinded and placebo-controlled trial.

BACKGROUND AND OBJECTIVE: Cytisine serves as an affordable smoking cessation aid with acceptable safety profile. However, data comparing its efficacy and safety to standard therapies are limited. We aimed to examine efficacy and safety of cytisine compared to nortriptyline, which is the only approved smoking-cessation medication in Thailand. METHODS: A 12-month, multicentre, randomized, double-blinded, placebo-controlled trial was conducted. Participants aged ≥20 years who smoked ≥10 cigarettes/day were randomly assigned to receive a 25-day cytisine or a 12-week nortriptyline treatment course. Brief interventions (BI) for smoking cessation were provided to all participants. The primary outcome was biochemically verified continuous abstinence rate (CAR) at 12 months. Additionally, self-reported abstinence, verified by exhaled carbon monoxide (CO) ≤ 10 ppm, was collected at 2 weeks, 1, 3, 6 and 12 months to assess both CAR and 7-day point prevalence abstinence rate (PAR). RESULTS: A total of 1086 participants were recruited and randomized into cytisine (n = 540) and nortriptyline (n = 546) groups. The 12-month CAR was 12.22% for cytisine and 9.52% for nortriptyline. The relative difference was 0.03 (95% confidence interval [CI]; -0.01 to 0.06) and the relative risk was 1.28 (95% CI; 0.91-1.81). No differences were observed in secondary outcomes between both groups. The incidence of adverse effects from cytisine appeared to be lower than that of nortriptyline. CONCLUSION: At 12 months, cytisine plus BI was as effective as nortriptyline plus BI for smoking cessation. The adverse events for both cytisine and nortriptyline were minimal and well-tolerated.

Evaluation of nursing process competencies, nursing quality, and patient safety using virtual simulation with debriefing: A quasi-experimental study.

Background: Investing in clinical education is important for adult urgent and emergency surgery and traumatology as it promotes registered nurses' competencies by providing professional development training to respond to urgent or emergency surgeries. Objective: To examine registered nurses' self-assessment of the effects of virtual video simulation with an immediate debriefing approach on nursing process competencies, nursing care quality, incomplete care, and patient safety in surgical units. Methods: This study used a quasi-experimental two-group pre- and post-test design. The study was conducted at two provincial hospitals in Cambodia. Participants included registered nurses employed in surgical units. The experimental group (n = 46) completed a virtual video simulation and immediate debriefing. The control group (n = 35) completed virtual training on the nursing process. Data were collected two months after a successful second-week follow-up using Competency of Nursing Process, Cambodian Nursing Care Quality, Care Left Undone, and Patient Safety scales. Wilcoxon signed-rank test and Mann-Whitney U test were used to evaluate the differences before and after the sessions. Generalized linear model was used to compare the differences between the two groups. Results: The results showed statistically significant improvements in the experimental group on competency, nursing care quality, patient safety, and reducing care left undone after the intervention. However, the control group revealed statistically insignificant differences. In addition, the experimental group provided positive feedback, such as experiencing a real patient scenario, developing critical-thinking, improving communication skills, and having an opportunity to ask questions. Conclusion: Our study showed that VVS and immediate debriefing have the potential to support in-service training of RNs from diverse backgrounds. Particularly, integrating virtual video simulation and immediate debriefing may to promote competency in the nursing process and improve care outcomes.

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

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

Factors Related to Professional Self-Concept of Nursing Students and Nurses: A Systematic Review.

Background: Some nurses leave their job because of working conditions, which will affect nurse turnover. Patients perceive that those nurses are distrustful, and feel unsatisfied, with patients' complaints about nursing service. This study explored factors about the professional self-concept of nursing students and nurses. Materials and Methods: A systematic review of cross-sectional studies followed PRISMA guidelines. PubMed, Ovid, Web of Science, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) were used from 1982 to August 2020 with the terms "factors" AND "nurse" AND "professional" AND "self-concept." A total of 19 out of 4,349 articles were used for analysis. Joanna Brings Institute critical appraisal tools for the analytical cross-sectional studies were used in this study, and narrative synthesis was used to analyze data. Results: Professional self-concept of clinical nurses is influenced by including organizational or job factors, and individual and emotional factors. Job factors consist of organizational support, professional ethic, clinical ladder system, nursing experience, position, and time. Besides, sex, age, marital status, education, health status, healthy lifestyle, and experience were categorized as individual factors. Emotional factors were as follows: interpersonal relationships, spiritual growth, management stress, and self-description. Meanwhile, student nurses are influenced by including personal (degree of study and sex), emotions (emotional intelligence, and interest in the nursing profession), and external factors (nursing courses, peer-mentoring experience, and academic burnout). Conclusions: Thus, individual factors and emotions have a vital role in constructing clinical nurses' professional self-concept as student nurses. Improving individual and emotional/personal aspects will positively increase professional self-concept.

Effectiveness of an integrated smoking cessation service model on smoking status: A preliminary study.

INTRODUCTION: Smoking cessation has been considered a benefit for smokers. This study aimed to investigate the effect of an integrated smoking cessation service model (ISCSM) on enhancing cessation among smokers in a community setting. METHODS: The participants were 144 smokers allocated into two groups, experimental and control with 72 participants each. The ISCSM comprised two sessions: 1) smoking cessation service design and training smoking cessation capacity for the Community Health Workers (CHWs) by nurses; and 2) integrated smoking cessation service delivery. The CHWs offered brief advice for smoking cessation for smokers through home visits under supervision by nurses, then referred to proactive multisession intensive telephone counselling that was behavioral therapy with follow-up. In contrast, the control group received Thai therapy, which was mouthwash. The 7-day point prevalence abstinence (PPA) was assessed 30 days after the quit date. The probability of quitting between the experimental and control groups was calculated by the risk ratio (RR). Propensity score matching was performed to analyze the treatment effect after balancing the covariate factors. RESULTS: The probability of quitting smoking successfully among the participants in the experimental group was 7.5 times higher than the control group (χ2=46.18, RR=7.50, p<0.001). For the treatment effect tested by the PSM, the ISCSM efficiently impacted the 7-day PPA at 30 days among smokers in the experimental group after balancing the covariates (SS=0.281, MS=0.281, df=1, F=13.20, p<0.001). CONCLUSIONS: The findings of this study indicate that the ISCSM is an efficient, powerful intervention for enhancing smoking cessation.

Translation and Validation of the Thai Version of a Modified Brief Pain Inventory: A Concise Instrument for Pain Assessment in Postoperative Cardiac Surgery.

BACKGROUND: Acute pain after cardiac surgery can be assessed using validated instruments such as the modified interference subscale of the Brief Pain Inventory (mod-BPI). Despite the available knowledge, the Thai version of a mod-BPI has not yet been presented. OBJECTIVES: To translate a mod-BPI into the Thai language (BPI-T) and to validate it in acute pain after cardiac surgery. METHODS: This multisetting, cross-sectional study was done from 4 cardiac centers. With a convenience sampling technique, 132 cardiac surgery patients were enrolled during the first 72 postoperative hours. A BPI-T composed of 4 items on the intensity subscale and 6 items on the interference subscale was translated following Brislin's model. Convergent validity against the numeric rating scale (NRS), confirmatory factor analysis (CFA), and internal consistency reliability were examined. RESULTS: Of the total sample, 70% experienced moderate to severe pain (cutoff points of worst pain ≥ 4/10), and 65% had moderate to severe interference with deep breathing and coughing, 53% with general activity, and 49% with walking. The CFA confirmed the 2-factor structure of intensity and interference subscales consistent with the original version (root-mean-square error of approximation = 0.08, comparative fit index = 0.95, χ2 = 39.00, df = 27, χ2 /df = 1.44, P = 0.06). The physical and mental subdimensions under the interference subscale were determined (standardized factor loading = 0.70 and 0.42, respectively). The BPI-T also has good internal consistency (Cronbach's alpha coefficients 0.76 and 0.85). Pearson's correlation coefficients at 0.35 to 0.70 supported the convergent validity to the NRS. CONCLUSIONS: The BPI-T is a concise instrument for pain assessment in postoperative cardiac surgery.

Randomized controlled trial of a self-efficacy enhancement program for the cardiac rehabilitation of Thai patients with myocardial infarction.

This study examined the effects of a self-efficacy enhancement program for the cardiac rehabilitation of Thai patients who had a myocardial infarction. Sixty-six hospitalized patients of various ages and both genders were randomly assigned to either an experimental or a control group. Participants in the experimental group took part in three individualized in-hospital education sessions and three weekly sessions of telephone counseling. The control group primarily engaged in a supervised exercise and activities of a daily living performance regimen, and received education in this regard. Self-efficacy and functional status were measured via questionnaire. Four weeks after discharge, the experimental group was found to have significantly higher total self-efficacy and functional status scores than the control group. In addition, the experimental group exhibited significantly higher subscale scores on social activity, household tasks, occupation, and exercise self-efficacy than the control group. These results indicate that the program is effective in improving the self-efficacy and functional status of Thai patients who have had a myocardial infarction.

Success counteracting tobacco company interference in Thailand: an example of FCTC implementation for low- and middle-income countries.

Transnational tobacco companies (TTCs) interfere regularly in policymaking in low- and middle-income countries (LMICs). The WHO Framework Convention for Tobacco Control provides mechanisms and guidance for dealing with TTC interference, but many countries still face 'how to' challenges of implementation. For more than two decades, Thailand's public health community has been developing a system for identifying and counteracting strategies TTCs use to derail, delay and undermine tobacco control policymaking. Consequently, Thailand has already implemented most of the FCTC guidelines for counteracting TTC interference. In this study, our aims are to describe strategies TTCs have used in Thailand to interfere in policymaking, and to examine how the public health community in Thailand has counteracted TTC interference. We analyzed information reported by three groups with a stake in tobacco control policies: Thai tobacco control advocates, TTCs, and international tobacco control experts. To identify TTC viewpoints and strategies, we also extracted information from internal tobacco industry documents. We synthesized these data and identified six core strategies TTCs use to interfere in tobacco control policymaking: (1) doing business with 'two faces', (2) seeking to influence people in high places, (3) 'buying' advocates in grassroots organizations, (4) putting up a deceptive front, (5) intimidation, and (6) undermining controls on tobacco advertising, promotion and sponsorship. We present three case examples showing where TTCs have employed multiple interference strategies simultaneously, and showing how Thai tobacco control advocates have successfully counteracted those strategies by: (1) conducting vigilant surveillance, (2) excluding tobacco companies from policymaking, (3) restricting tobacco company sales, (4) sustaining pressure, and (5) dedicating resources to the effective enforcement of regulations. Policy implications from this study are that tobacco control advocates in LMICs may be able to develop countermeasures similar to those we identified in Thailand based on FCTC guidelines to limit TTC interference.

The influence of symptoms, social support, uncertainty, and coping on health-related quality of life among cholangiocarcinoma patients in northeast Thailand.

BACKGROUND: Health-related quality of life (HRQOL) is an important outcome for evaluating the effectiveness of cancer care. Cholangiocarcinoma (CCA) is a major public health problem in northeast Thailand. There is little information regarding factors influencing HRQOL in CCA patients. Understanding the factors affecting HRQOL in CCA patients is necessary to develop nursing interventions to improve the HRQOL. OBJECTIVE: The purpose of this study was to develop and test a model that explained the influence of symptoms, social support, uncertainty, and coping on the HRQOL in CCA patients. METHODS: Using a cross-sectional descriptive design, a convenience sample of 260 CCA patients were consecutively recruited from a regional hospital and a university hospital in northeast Thailand. All participants responded to a set of 6 questionnaires in structured interview format. A linear structural relationship was used to test the hypothesized model. RESULTS: Findings revealed the hypothesized model fit the empirical data and explained 69.4% of the variance of HRQOL. Symptoms were the most influential factor affecting HRQOL directly and indirectly through uncertainty. Social support had a direct effect on HRQOL and an indirect effect on HRQOL through uncertainty. Uncertainty had a direct effect on coping and HRQOL. Coping had a nonsignificant direct effect on HRQOL. CONCLUSION: Symptoms, social support, and uncertainty were important factors influencing HRQOL in CCA patients. IMPLICATIONS FOR PRACTICE: Cholangiocarcinoma is a unique yet understudied condition. Further work in developing CCA-specific HRQOL interventions is warranted.

Relationships of family functioning, self-esteem, and resourceful coping of Thai adolescents with asthma.

Within the context of Rosenbaum's theory of learned resourcefulness, this correlational study examined the relationships among family functioning, self-esteem, and resourceful coping in Thai adolescents with asthma. A convenience sample of 132 Thai adolescents (aged 12-17 years) with asthma was recruited from the outpatient asthma clinics of four hospitals in Bangkok. Self-administered questionnaires included an assessment of demographic information and asthma status, the revised Family APGAR, the Rosenberg Self-Esteem Scale, and the Children's Self-Control Scale. Hierarchical multiple regression analysis was used to examine the relationships among variables. Effective family functioning had a significant positive effect on self-esteem (beta = .27, p < .01) and resourceful coping (beta = .30, p < .01), controlling for gender and age. However, self-esteem was not significantly correlated with resourceful coping (beta = .15, p = .08). The findings suggest that nursing interventions should take into account the role of family functioning in promoting self-esteem and resourceful coping in Thai adolescents with asthma. Recommendations for future research include replication of the study with a larger sample of adolescents with asthma and with adolescents with other chronic illnesses.

Reports on depressive symptoms in older adults with chronic conditions.

Depression is the most common mental disorder among older adults in the United States and one of the most disabling conditions worldwide. Chronic conditions and related functional limitations are associated with late-life depression, but assessment of depression is complicated by the absence of measures that capture the range of depressive emotions older adults may express. This descriptive, correlational study of 314 older adults with chronic conditions examined three measures to assess depressive symptoms: the Center for Epidemiological Studies Depression Scale (CES-D), the short form of the Center for Epidemiological Studies Depression Scale (CES-D-10), and an Emotional Symptom Checklist (ESC). The measures were correlated with each other and with a number of chronic conditions and functional impairments. Men and women scored similarly on all measures, though correlations between depressive symptoms and negative emotions were stronger for men. About 12% of the older adults exceeded the CES-D criteria for severe depressive symptoms, with the greatest percentage among those aged 75 to 84. The most frequently reported negative emotions were sadness (by women and elders through age 84) and loneliness (by men and elders age 85 and over). The findings suggest the need for multiple assessment strategies to identify older adults at risk for late-life depression.