Enhancing nursing students' clinical competency using a multi-patient simulation learning model: A randomized controlled study.

BACKGROUND: For nurses, clinical competency is paramount in ensuring that patients receive safe, high-quality care. Multi-patient simulation (MPS) in nursing education is gaining attention, and evidence shows its suitability for real-life situations. MPS can be an effective solution for nurses' continuing clinical education. OBJECTIVES: This project compares the effectiveness of MPS (involving both a standardized patient and a high fidelity simulator) and a single high-fidelity simulation (single HFS; only involving a high fidelity simulator) for enhancing the clinical competency of nursing students. DESIGN: A stratified, permuted, block randomized controlled study design was used. SETTINGS AND PARTICIPANTS: Sixty undergraduate nursing students in years 3, 4, and 5 were selected to participate. Subgroups with each comprising three undergraduate nursing students from different years were formed. METHODS: The participants were randomized to receive either an MPS (intervention group) or single HFS (control group) for 1 day; they later received the same intervention after a 30-day washout period. One objectively measured questionnaire and two self-reported questionnaires were used to measure clinical competency: the Creighton Competency Evaluation Instrument (CCEI), Clinical Competence Questionnaire (CCQ), and Simulation Effectiveness Tool - Modified Questionnaire (SET-M). RESULTS: The results revealed significant between-group differences. Specifically, the intervention group showed greater improvement than the control group in both the CCQ (linear contrast [d] = 71.4; 95 % confidence interval [CI] = 53.407, 89.393; P < 0.001) and CCEI total scores (d = 7.17; 95 % CI = 5.837, 8.503; P < 0.001). The SET-M results indicated that 85 % of the participants (n = 51) strongly agreed that they felt more confident about performing a patient handover to the healthcare team after the simulation. CONCLUSIONS: The study findings indicated that both the MPS and single HFS effectively enhanced students' clinical competency. However, MPSs have superior educational outcomes relative to traditional single HFSs.

Effectiveness of Very Brief Advice on Tobacco Cessation: A Systematic Review and Meta-Analysis.

BACKGROUND: Very brief advice (VBA; ≤ 3 min) on quitting is practical and scalable during brief medical interactions with patients who smoke. This study aims to synthesize the effectiveness of VBA for smoking cessation and summarize the implementation strategies. METHODS: We searched randomized controlled trials aiming at tobacco abstinence and comparing VBA versus no smoking advice or no contact from Medline, Embase, CINAHL, Cochrane Library, PsycInfo databases, six Chinese databases, two trial registries ClinicalTrials.gov and WHO-ICTRP from inception to September 30, 2023. Grading of Recommendations, Assessment, Development, and Evaluations framework was used to assess the certainty of the evidence of the meta-analytic findings. The outcomes were self-reported long-term tobacco abstinence at least 6 months after treatment initiation, earlier than 6 months after treatment initiation, and quit attempts. Effect sizes were computed as risk ratio (RR) with 95% CI using frequentist random-effect models. DATA SYNTHESIS: Thirteen randomized controlled trials from 15 articles (n = 26,437) were included. There was moderate-certainty evidence that VBA significantly increased self-reported tobacco abstinence at ≥ 6 months in the adjusted model (adjusted risk ratio ARR 1.17, 95% CI: 1.07-1.27) compared with controls. The sensitivity analysis showed similar results when abstinence was verified by biochemical validation (n = 6 studies, RR 1.53, 95% CI 0.98-2.40). There was high-certainty evidence that VBA significantly increased abstinence at < 6 months (ARR 1.22, 95% CI: 1.01-1.47). Evidence of effect on quit attempts (ARR 1.03, 95% CI 0.97-1.08) was of very low certainty. DISCUSSION: VBA delivered in a clinical setting is effective in increasing self-reported tobacco abstinence, which provides support for wider adoption in clinical practice.

Efficacy of simple and very brief handgrip and isometric exercises for reducing withdrawal symptoms in cigarette smokers: A pilot randomized controlled trial.

INTRODUCTION: Withdrawal symptoms lead to smoking relapse and reduce the intention to quit. The present pilot RCT examined the effect of simple and very brief handgrip and isometric exercises on reducing withdrawal symptoms, measured by the strength of tobacco craving, Questionnaire of Smoking Urges-Brief (QSU-B), Mood and Physical Symptoms Scale (MPSS), and Positive and Negative Affect Schedule (PANAS). METHODS: In this 2-arm, open-labeled pilot RCT, 30 current smokers who had abstained from tobacco for at least 9 hours were randomly assigned (allocation ratio 1:1) to either the intervention group that watched a 5-minute video and did 5-minute handgrip and isometric exercises (pulling and pushing) or control group that watched 10-minute healthy-diet videos. Measurements were taken before, immediately after, and 10 minutes post-intervention. Outcomes were self-reported strength of tobacco craving, QSU-B, MPSS, and PANAS scores. The effect size for group-by-time interaction was assessed using Cohen's f2 (small=0.02, medium=0.15, large=0.35). RESULTS: Group-by-time interactions showed that the intervention group showed larger reductions than the control group in the strength of tobacco craving (Cohen's f2=0.54, 95% CI: 0.52-0.57), QSU-B (Cohen's f2=0.77; 95% CI: 0.74-0.80), and MPSS (Cohen's f2=0.51; 95% CI: 0.46-0.56) over the three measurement points. CONCLUSIONS: This RCT showed that simple and brief handgrip and isometric exercises could immediately reduce withdrawal symptoms and up to 10 minutes. CLINICAL TRIAL REGISTRATION: in https://clinicaltrials.gov/. IDENTIFIER: NCT04059497.

Trans-fat labelling information on prepackaged foods and beverages sold in Hong Kong in 2019.

OBJECTIVE: To examine the labelling status of trans-fat of pre-packaged foods sold in Hong Kong. DESIGN: Data from 19 027 items in the 2019 FoodSwitch Hong Kong database were used. Ingredient lists were screened to identify specific (e.g. partially hydrogenated vegetable oil, PHVO) and non-specific trans-fat ingredient indicators (e.g. hydrogenated oil). Trans-fat content was obtained from the on-pack nutrition labels, which was converted into proportion of total fat (%total fat). Descriptive statistics were calculated for trans-fat content and the number of specific, non-specific and total trans-fat ingredients indicators found on the ingredients lists. Comparisons were made between regions using one-way ANOVA and χ2 for continuous and categorical variables, respectively. SETTING: Cross-sectional audit. PARTICIPANTS: Not applicable. RESULTS: A total of 729 items (3·8 % of all products) reported to contain industrially produced trans-fat, with a median of 0·4 g/100 g or 100 ml (interquartile range (IQR): 0·1-0·6) and 1·2 %totalfat (IQR: 0·6-2·9). 'Bread and bakery products' had the highest proportion of items with industrially produced trans-fat (18·9 %). 'Non-alcoholic beverages' had the highest proportion of products of 'false negatives' labelling (e.g. labelled as 0 trans-fat but contains PHVO; 59·3 %). The majority of products with trans-fat indicator originated from Asia (70 %). CONCLUSIONS: According to the labelling ∼4 % of pre-packaged food and beverages sold in Hong Kong in 2019 contained industrially produced trans-fat, and a third of these had trans-fat >2 %total fat. The ambiguous trans-fat labelling in Hong Kong may not effectively assist consumers in identifying products free from industrially produced trans-fat.