Nomograms Predicting Self-Regulated Learning Levels in Chinese Undergraduate Medical Students.

PURPOSE: The purpose of this study was to construct a multi-center cross-sectional study to predict self-regulated learning (SRL) levels of Chinese medical undergraduates. METHODS: We selected medical undergraduates by random sampling from five universities in mainland China. The classical regression methods (logistic regression and Lasso regression) and machine learning model were combined to identify the most significant predictors of SRL levels. Nomograms were built based on multivariable models. The accuracy, discrimination, and generalization of our nomograms were evaluated by the receiver operating characteristic curves (ROC) and the calibration curves and a high quality external validation. RESULTS: There were 2052 medical undergraduates from five universities in mainland China initially. The nomograms constructed based on the non-overfitting multivariable models were verified by internal validation (C-index: learning motivation: 0.736; learning strategy: 0.744) and external validation (C-index: learning motivation: 0.986; learning strategy: 1.000), showing decent prediction accuracy, discrimination, and generalization. CONCLUSION: Comprehensive nomograms constructed in this study were useful and convenient tools to evaluate the SRL levels of undergraduate medical students in China.

The patient-provider discordance in patients' needs assessment: a qualitative study in breast cancer patients receiving oral chemotherapy.

AIMS AND OBJECTIVES: To explore the differing perspectives of patients and providers and their assessment of supportive care needs in breast cancer patients receiving oral chemotherapy. BACKGROUND: The patient-provider concordance in patients' needs assessment is critical to the effective management of cancer. Self-administered oral chemotherapy greatly shifts responsibilities for side-effect monitoring, symptom management and dose adjustments from the provider to the patient. Home-based care plans will be central to the effective management of these patients. DESIGN: A descriptive qualitative design was used. METHODS: A purposive sample of nine breast cancer patients, four oncologists and four oncology nurses were recruited in Shanghai, China. Semi-structured and in-depth interviews were conducted to collect data. A qualitative content analysis aimed at finding manifest and latent meanings of data was applied to analyse the information. RESULTS: Four themes of needs emerged from the interviews with patients and providers: information/knowledge, communication, social support and symptom management, but patients and providers only agreed on the assessment of symptom and side-effects management needs. Patients want more positive encouraging information from providers, but providers think patients need more information of efficacy and safety. Patients appreciate support from other peer patients with similar experiences, but providers think the support from families and friends are readily available to them. Patients discussed their spiritual needs, while oncologists see the need to improve patient adherence to medication. CONCLUSION: Breast cancer patients differed from their providers in assessment of healthcare needs. Further investigation of the relationships between patient-provider discordance and patient outcomes may guide interventions to improve care for cancer patients receiving oral chemotherapy. RELEVANCE TO CLINICAL PRACTICE: Oncology nurses should develop a holistic home-based care plan by exploring and integrating the discordance of needs assessment of both patients and health providers.

Testing measurement invariance of the Chinese version of the Strategies Used by Patients to Promote Health among patients with cancer.

BACKGROUND AND PURPOSE: The Chinese version of the Strategies Used by Patients to Promote Health (C-SUPPH) is a self-report instrument used to measure self-efficacy among patients with cancer. The purpose of this article is to examine measurement invariance of C-SUPPH using data of 764 cancer patients recruited in China. METHODS: Multigroup confirmatory factor analysis (CFA) models were applied across the selected sociodemographic groups of gender, age, education, and monthly income levels. RESULTS: The factorial structure and factor loadings (relationships between items and their underlying factors) of C-SUPPH were invariant across all sociodemographic groups. CONCLUSIONS: The findings showed that the C-SUPPH measures the same latent constructs/factors in the same way when administered to different sociodemographic groups and thus can be readily applied to studying self-efficacy of cancer patients in China.

Smartphone interventions for long-term health management of chronic diseases: an integrative review.

INTRODUCTION: Long-term health management is challenging for the rapidly growing number of patients with chronic diseases. Smartphone interventions offer promising solutions. This article presents features of smartphone interventions for long-term chronic condition management, illustrating how these applications benefit patients with chronic diseases. MATERIALS AND METHODS: Systematic searches for smartphone health interventions were conducted in five publication databases. Articles were included only if (1) the smartphone application (app) was exclusively developed for patients with chronic diseases and (2) the article incorporated a defined outcome measurement to evaluate the effects of the implemented intervention. Sixteen articles were included in the final review, including studies in diabetes, mental health problems, overweight, cancer, and chronic obstructive pulmonary disease. RESULTS: These studies found that the smartphone intervention was a completely or at least partially effective tool to assist in managing some chronic diseases. With the help of health-related smartphone apps, patients with chronic conditions (1) felt secure in the knowledge that their illnesses were closely monitored, (2) participated in their own health management more effectively, and (3) felt that they had not been forgotten by their doctors and were taken good care of even outside the hospital/clinic. CONCLUSIONS: However, there are limited smartphone apps for the long-term health management of chronic diseases. More smartphone apps need to be developed to help people manage chronic diseases.

Self-efficacy difference among patients with cancer with different socioeconomic status: application of latent class analysis and standardization and decomposition analysis.

INTRODUCTION: Although the relationship between partial socioeconomic status (SES) and self-efficacy has been studied in previous studies, few research have examined self-efficacy difference among patients with cancer with different SES. METHODS: A cross-sectional survey involving 764 patients with cancer was completed. Latent class analysis (LCA) was applied to identify distinct groups of patients with cancer using four SES indicators (education, income, employment status and health insurance status). Standardization and decomposition analysis (SDA) was then used to examine differences in patients' self-efficacy among SES groups and the components of the differences attributed to confounding factors, such as gender, age, anxiety, depression and social support. RESULTS: Participants were classified into four distinctive SES groups via using LCA method, and the observed self-efficacy level significantly varied by SES groups; as theorized, higher self-efficacy was associated with higher SES. The self-efficacy differences by SES groups were decomposed into "real" group differences and factor component effects that are attributed to group differences in confounding factor compositions. CONCLUSION: Self-efficacy significantly varies by SES. Social support significantly confounded the observed differences in self-efficacy between different SES groups among Chinese patients with cancer.

Effects of psychological stress on serum iron and erythropoiesis.

There are about one billion patients with iron deficiency anaemia all over the world. Recently, researchers have reported successively that stress can cause decrease of serum iron, in consistent with our studies showing that heat exposure and acceleration stress led to significant decrease of serum iron in rats. However, so far whether pure psychological stress can cause decrease of serum iron and consequently affect erythropoiesis has not been reported. To study the characteristic effects of psychological stress on serum iron and erythropoiesis, and to establish an useful experimental basis for further study involving how sufficient intake of dietary iron causes decrease of serum iron and the consequent effects on physiological function of the human body. Psychological stress was administered to 20 rats with Communication Box system. On the 7th and 14th day after administration, 10 rats were executed, respectively, and the rat blood and femoral bone marrow were collected for analysis of serum iron (SI), serum ferritin (SF), serum transferrin receptor (sTfR), haemoglobin (Hb), red blood cell count (RBC), RBC distribution width (RDW), mean corpuscular volume (MCV), serum erythropoietin (EPO) and bone marrow iron. Experimental data were statistically analysed with SPSS 11.0. For rats analysed on the 7th and 14th day in psychological stress group, (1) femoral bone marrow iron was significantly decreased; (2) serum iron was decreased by 28.6% (P < 0.01) and 27.5% (P < 0.01); (3) Hb was decreased by 10.0% (P < 0.01) and 12.8% (P < 0.01), RBC count was decreased by 5.1% (P < 0.05) and 9.8% (P < 0.01), MCV was decreased by 1.7% (P < 0.05) and 7.3% (P < 0.01), RDW was increased by 10.7 and 22.5%; (4) serum ferritin, transferrin receptor and EPO showed no significant changes in comparison with controls after 7-day administration, but serum ferritin and EPO were decreased by 23.8 and 12.3% while transferrin receptor increased by 31.5% after 14-day administration. For rats receiving different period of pure psychological stress: (1) serum iron and bone marrow iron showed significant decrease compared with the controls; (2) erythropoiesis was significantly inhibited; however, (3) how psychological stress affects serum iron and erythropoiesis need to be further investigated.

[Studies on germination characteristics of Platycodon grandiflorum seed].

OBJECTIVE: To find out the optimal condition for the germination by studying the effects of light, temperature, seed soaking and cultivation condition on Platycodon grandiflourm, and offer the basis for standardized culture of P. grandflorum. METHOD: The rate of water absorption of the seed was determined. The germination of P. grandiflorum seed was tested under following conditions: treatments under different temperature (10,15,20,25,30 degrees C), light treatments (light and dark), seed soaking time (12,24,36 h) and different germination cultivation conditions (on filter paper, between filter paper, between gauze,on gauze). RESULT: The water absorption of the seeds reached the maximal 120% within 36 h at 25 degrees C. The time of seeds soaking had limited effect on the germination of the seed, while temperature and light condition showed significant effects on the germination. CONCLUSION: The optimal condition for the germination of the seed of P. grandiflorum is as follow:seed soaking for 12 h, and 25 degrees C underlight.