Implementation and Evaluation of Discharge Planning for Patients Undergoing Umbilical Cord Blood Transplantation.

BACKGROUND Umbilical cord blood transplantation (UCBT) patients have high rates of unplanned readmissions and poor quality of life (QoL). The aim of this study was to evaluate the effects of discharge planning on unplanned readmissions, self-efficacy, QoL, and clinical outcomes. MATERIAL AND METHODS Patients who received their first UCBT from April 2022 to March 2023 were included. Participants (n=72) were assigned to a control group (CG: received usual care) or an intervention group (IG: received discharge planning from admission to 100 days after UCBT). The cumulative readmission rates 30 days after discharge and 100 days after UCBT were analyzed using the log-rank test. Self-efficacy and QoL were assessed at admission and 100 days after UCBT using the General Self-Efficacy Scale and FACT-BMT version 4, clinical outcomes derived from medical records. RESULTS Sixty-six patients completed the study. Discharge planning did not reduce readmission rates 30 days after discharge (20.59% vs 31.25%, P=0.376) or 100 days after UCBT (29.41% vs 34.38%, P=0.629). However, the IG showed significantly better self-efficacy (P<0.001), and except for social and emotional well-being, all the other dimensions and 3 total scores of FACT-BMT in the IG were higher than for the controls at 100 days after UCBT (P<0.05). CONCLUSIONS The discharge planning program can improve self-efficacy and QoL of UCBT recipients. The implementation of discharge planning for patients undergoing UCBT was necessary for successful hospital-to-home transitions.

The mediating role of psychological capital on the relationship between authentic leadership and innovative behaviour among Chinese nurses.

AIM: To explore the mediating role of psychological capital between authentic leadership and innovative behaviour among Chinese nurses. DESIGN: A cross-sectional study. METHODS: In December 2021, online surveys were delivered among nurses from 37 hospitals in Anhui Province by convenience sampling approach. The data was collected using the Chinese version of the Authentic Leadership Questionnaire, Nurse Psychological Capital Questionnaire and Nurse Innovative Behaviour Scale. The structural equation model and bootstrap test examined the mediating role of psychological capital between authentic leadership and innovative behaviour. RESULTS: 3495 Chinese nurses from 37 Anhui Province hospitals participated in this study. The mean item score of authentic leadership was 3.25 (SD 0.83), psychological capital was 4.85 (SD 0.89), and innovative behaviour was 2.82 (SD 0.84). Authentic leadership perceived by nurses, psychological capital, and innovative behaviour were statistically significant and positively correlated with each other (r = 0.524 ~ 0.806, p < 0.01). Psychological capital significantly mediated the association between authentic leadership and innovative behaviour (ß = 0.449, p < 0.001), and its mediating effect accounted for 76.75% of the total effect. CONCLUSION: Results suggest the importance of developing nurse managers' authentic leadership to foster nurses' psychological capital and innovation behaviour.

Psychological Effects of a Structured Exercise Intervention During Umbilical Cord Blood Transplantation in Children and Adolescents.

BACKGROUND: Children and adolescents undergoing umbilical cord blood transplantation (UCBT) are faced with severe fatigue and a decline in quality of life (QoL) during the inpatient period. OBJECTIVE: To investigate the effect of a structured exercise intervention on fatigue, QoL and clinical outcomes among children and adolescents during UCBT. METHODS: In this randomized controlled trial, participants (n = 48) were randomized to a control group (CG: usual care) or an intervention group (IG: a structured exercise intervention). Fatigue and QoL were assessed at hospital admission, 14 days after UCBT, and at discharge using linear mixed model analysis. In addition, engraftment kinetics, supportive treatment, transplant-related complications, and hospital length of stay were derived from medical records. RESULTS: 4 patients completed the study, the IG participated in an average of 2.12 (1.36-2.8) sessions with a duration of 24 (16-34) min weekly, and the total rate of adherence to the training program was 70.59%. For fatigue and QoL, there was a significant effect of time in the control group, with the total score of fatigue decreased from T1 to T2 (73.9vs 60.9, P = .001) and T1 to T3 (73.9vs 65.6, P = .049), and the QoL scores decreased from T1 to T2 (73.9vs 66.1, P = .043). The hospital length of stay was less in the intervention group (P = .034). CONCLUSION: Our randomized study indicated that structured exercise interventions might exert a protective effect by attenuating the decline in fatigue and QoL, and shortening duration of hospitalization.

The mediating role of psychological capital on the relationship between authentic leadership and nurses' caring behavior: a cross-sectional study.

BACKGROUND: Caring behavior among nurses would have an impact on patient outcomes. External organizational job resources and personal internal psychological resources are correlated to nurses' caring behavior. Authentic leadership and psychological capital were shown to be correlated with nurses' caring behavior in previous studies. However, the relationships among the three are nevertheless unclear. This study aimed to examine if psychological capital could act as a mediator between nursing managers' authentic leadership and nurses' caring behavior. METHODS: In December 2021, a total of 3,662 nurses were recruited from 37 hospitals in Anhui Province, China. They filled out online surveys, including general demographic information, the Authentic Leadership Questionnaire, the Psychological Capital Questionnaire, and the Caring Behavior Inventory. Structural Equation Modeling and the bootstrapping procedure were used to examine the mediating role of psychological capital. RESULTS: The scores of authentic leadership, psychological capital, and caring behavior of 3,495 nurses were 52.04 ± 13.24, 96.89 ± 17.78, and 104.28 ± 17.01, respectively. Psychological capital significantly mediated the relationship between authentic leadership and nurses' caring behavior (ß = 0.378, p < 0.001, 95% confidence interval: 0.350 ~ 0.402), which made up 78.75% of the total impact (0.480). CONCLUSION: The findings of this study suggested that nursing managers should develop an authentic leadership style, which can effectively improve nurses' caring behaviors toward patients in clinical practice. Meanwhile, nursing leaders should strengthen nurses' psychological evaluation and training, and promote nurses' caring behavior in clinical settings.

Psychological coherence, inclusive leadership and implicit absenteeism in obstetrics and gynecology nurses: a multi-site survey.

BACKGROUND: Implicit absenteeism is very common among clinical nurses. We aimed to evaluate the role of psychological coherence in the inclusive leadership and implicit absenteeism among obstetrics and gynecology nurses, to provide evidence to the clinical management of nurses. METHODS: Through the convenience sampling method, a survey of gynecology nurses in tertiary hospitals in 16 cities of Anhui Province, China was conducted using the General Information Questionnaire, the Stanford Implicit Absence Scale, the Inclusive Leadership Scale and the Sense of Coherence Scale. Statistical analysis was performed by SPSS 20. RESULTS: A total of 1080 nurses were included with an effective response rate of 93.5%. The average score of nurses' recessive absenteeism in this study was (16.8 ± 0.15). The average of inclusive leadership score was (34.25 ± 7.23). The average score of psychological coherence score of obstetrics and gynecology nurses was (55.79 ± 8.28). Pearson correlation analysis showed that there was a relationship between implicit absenteeism behavior, inclusive leadership, and the level of psychological coherence in obstetrics and gynecology nurses (all P < 0.05). Linear regression analysis indicated that psychological coherence played a partial mediating role between inclusive leadership and obstetrics and gynecology nurses' implicit absenteeism (all P < 0.05). CONCLUSIONS: Obstetrics and gynecology nurses have serious recessive absenteeism with low sense of psychological coherence and inclusive leadership. Nursing managers should improve the psychological coherence through effective interventions, thereby reducing the incidence of implicit absenteeism.

Accuracy and prognostic ability of the SARC-F questionnaire and Ishii's score in the screening of sarcopenia in geriatric inpatients.

Sarcopenia remains poorly managed in clinical practice due to the lack of simple and accurate screening tools. This study aimed to identify the cutoff values of the SARC-F questionnaire and Ishii's score using the variables age, grip strength, and calf circumference in older inpatients in China to compare the accuracy of the two methods and to explore their predictive ability for adverse outcomes (rehospitalization, falls, fracture, and death). Hospitalized patients (n=138) aged ≥60 years were included. The accuracy of the two tools was evaluated using the reference diagnosis recommended by the Asian Working Group on Sarcopenia (assessing patients with measurements of muscle mass, handgrip strength, and usual gait speed). Follow-up data were obtained by telephone and clinical visits combined with the inpatient medical record system after discharge for at least one year. The results showed that the SARC-F score reached the highest Youden's index when a score of 3 was set as the cutoff value. Ishii's score presented a higher accuracy than SARC-F (area under the receiver operating curve: 0.78 vs 0.64, P=0.01). The Kaplan-Meier survival analysis demonstrated a higher cumulative incidence of rehospitalization in sarcopenic individuals compared to non-sarcopenic individuals according to SARC-F (log-rank test, P<0.001). Cox analysis revealed that SARC-F was an independent risk factor for rehospitalization (adjusted hazard ratio: 4.23, 95%CI: 2.12-9.79, P<0.001). The SARC-F and Ishii's scores might facilitate the early detection of sarcopenia and help identify older adults at risk for adverse outcomes in clinical practice.

Accuracy and prognostic ability of the SARC-F questionnaire and Ishii's score in the screening of sarcopenia in geriatric inpatients

Sarcopenia remains poorly managed in clinical practice due to the lack of simple and accurate screening tools. This study aimed to identify the cutoff values of the SARC-F questionnaire and Ishii's score using the variables age, grip strength, and calf circumference in older inpatients in China to compare the accuracy of the two methods and to explore their predictive ability for adverse outcomes (rehospitalization, falls, fracture, and death). Hospitalized patients (n=138) aged ≥60 years were included. The accuracy of the two tools was evaluated using the reference diagnosis recommended by the Asian Working Group on Sarcopenia (assessing patients with measurements of muscle mass, handgrip strength, and usual gait speed). Follow-up data were obtained by telephone and clinical visits combined with the inpatient medical record system after discharge for at least one year. The results showed that the SARC-F score reached the highest Youden's index when a score of 3 was set as the cutoff value. Ishii's score presented a higher accuracy than SARC-F (area under the receiver operating curve: 0.78 vs 0.64, P=0.01). The Kaplan-Meier survival analysis demonstrated a higher cumulative incidence of rehospitalization in sarcopenic individuals compared to non-sarcopenic individuals according to SARC-F (log-rank test, P<0.001). Cox analysis revealed that SARC-F was an independent risk factor for rehospitalization (adjusted hazard ratio: 4.23, 95%CI: 2.12-9.79, P<0.001). The SARC-F and Ishii's scores might facilitate the early detection of sarcopenia and help identify older adults at risk for adverse outcomes in clinical practice.

Optimal length of time of cryopreserved umbilical cord blood infusion after thawing.

OBJECTIVE: Dimethyl sulfoxide (DMSO) can damage hematopoietic progenitor cells (HPCs) at room temperature. To minimize the time of contact between DMSO and the thawed umbilical cord blood (UCB), there is an incentive to infuse the UCB as quickly as possible. However, the infusion of cryopreserved UCB also results in side effects. Currently, it is difficult to determine the optimal length of time for cryopreserved UCB infusion, not only to ensure the maximum effect of engraftment but also to reduce the toxicity of the cord blood infusion. METHODS: Ten units of cord blood were thawed to assess viability, apoptotic events of CD34(+) cells and CD45(+) cells, and the number of colony-forming units (CFUs) at four time points: 0, 10, 20, and 30 minutes post-thaw (PT). The infusion time, side effects, and the speed of platelet and neutrophil engraftment of the 10 patients were monitored. RESULTS: Within 30 minutes, the viability decreased (P < 0.01), the percentage of early apoptotic CD34(+) cells and CD45(+) cells was unchanged. At time point PT30, the number of CFUs was decreased compared to PT0 (P < 0.05), but it was unchanged within 20 minutes. All the 10 UCB cells engrafted well in patients. CONCLUSION: This study indicates that post-thawed UCB HPCs are preserved for less than 30 minutes at room temperature; thus, the optimal length of time of cryopreserved cord blood infusion should be no more than 20 minutes after thawing.

[Effect of different cryopreservation time on quality of umbilical cord blood cells].

This study was aimed to explore the effect of different cryopreservation time on recovery rate of cord blood stem cells, and analyze the influence of cord blood cells after thawing on the engraftment speed of cord blood cells in patients. 20 cord blood units were stored at -196°C for 1 - 10 years. The cell viability, content of total nucleated cell (TNC), CD34(+) cells and the colony forming units of granulocyte/macrophage (CFU-GM) were assessed after thawing, the impact of cell recovery on engraftment speed in patients was analyzed. The results showed that as compared with data provided by Umbilical Cord Blood Bark, the different cryopreservation time had no effect on yield of cord blood stem cells after thawing. The cell viability was (92.75 ± 2.55)% after thawing, the yields of TNC, CD34(+) cells and CFU-GM were 89.9%, 84.8% and 84.3%, compared with that of pre-freezing, their differences were statistically significant (P = 0.000), however, loss of cells had no effect on the time of neutrophils and platelets engraftment. The TNC and CD34(+)cell count after thawing correlated closely with that of pre-freezing (r = 0.954 and r = 0.931, P = 0.000), but CFU-GM content poorly correlated with that (r = 0.285, P = 0.223). It is concluded that cryopreservation and thawing process can damage the cord blood stem cells, leading to cell loss, but not affect transplant results.