Demand analysis of health care services for community-dwelling breast cancer survivors based on the Kano model: A cross-sectional study.

Objectives: Providing satisfactory healthcare services for breast cancer survivors can effectively reduce their burden and the pressure on medical resources. The aim of this study was to explore health care service demands for community-dwelling breast cancer survivors using the Kano model. Methods: A cross-sectional survey was conducted from January to March 2023 among breast cancer survivors discharged from a tertiary cancer hospital. Participants were asked to fill out a self-designed questionnaire involving the Kano model, which helped to categorize and prioritize the attributes of healthcare services. The questionnaire included 30 health care services. Additionally, their social demographic characteristics were collected during the survey. Results: A total of 296 valid questionnaires were collected, and demand attributes of the 30 health care services were evaluated. The findings revealed that one of 30 services was classified as "must-be attributes" (body image management), 13 as "one-dimensional attributes" (focused on medical security support, health management, and health counseling), 3 as "attractive attributes" (focused on communication needs and telehealth services), and 11 as "indifferent attributes" (mainly in the area of psycho-social services). Conclusions: Breast cancer survivors in the community have different levels of need for various health care services. It's crucial for healthcare providers to identify these needs and devise effective strategies to deliver the appropriate services. Services with must-be and one-dimensional attributes should be given priority, and efforts should be made to provide services with attractive attributes, hence improving the quality of life of breast cancer survivors.

The impact of work environment on caring behavior among Chinese hospice nurses: the chain mediating effect of psychological capital and empathy.

Introduction: The caring behavior of hospice nurses toward patients positively impacts their professional careers and significantly improves the quality of hospice services. A positive and supportive work environment may protect nurses against negative emotions that may affect the humanistic care they provide, and their job satisfaction. This study aimed to explore the impact of the nursing work environment on caring behavior. We also investigated the chain mediating effect of psychological capital and empathy on this relationship among Chinese hospice nurses. Methods: The Practice Environment Scale (PES), the Psychological Capital Questionnaire (PCQ), the Empathy Ability Scale for Hospice Nurses, and the Caring Behaviors Inventory (CBI) were used to survey 393 Chinese hospice nurses. SPSS 27.0 and Mplus 8.0 were used for statistical processing to analyze the mediating effects. Results: The nursing work environment positively predicted caring behavior. Furthermore, it was found that psychological capital and empathy jointly mediate the relationship between the nursing work environment and caring behavior. Conclusion: This study reveals how the nursing work environment affects the caring behavior of hospice nurses. Hospital managers need to provide hospice nurses with a favorable working environment from the perspective of positive psychology, continuously monitor their psychological state, improve their caring behavior, and provide references for developing intervention plans to promote the caring behavior of hospice nurses in the future.

Implementing a Barcode-Based Whole-Life Cycle Management Process to Improve Robotic Instrument Tracking.

Minimally invasive surgery can involve the use of robotics to improve patient outcomes. Some robotic systems require special instruments with a designated number of uses. In China, during the reprocessing of the robotic instruments, health care personnel determined that the existing tracking processes were inadequate. They conducted a quality improvement project with the goal of establishing a barcode-based standardized process for tracking robotic instruments. They implemented technology that generated a unique identifier each time a robotic instrument was reprocessed after use. Nurses scanned the identifier when surgeons used the instrument. The findings included the increased accuracy of use documentation and decreases in untraceable sterilization and use records, charging concerns, and average daily and monthly inventory times. An increase in adverse event reports associated with robotic instruments also was noted. The use of barcode technology for robotic instrument tracking continues at the facility and may be expanded for additional specialty instruments.

Effects of the low-speed continuous infusion catheter technique on double-lumen central venous catheters: A randomized controlled trial.

BACKGROUND: Central venous catheters are widely used in clinical practice, and the incidence of central venous catheter occlusion is between 25 % and 38 %. The turbulence caused by the pulsatile flushing technique is harmful to the vascular endothelium and may lead to phlebitis. The low-speed continuous infusion catheter technique is a new type of continuous infusion that ensures that the catheter is always in a keep-vein-open state by continuous low-speed flushing; hence, avoiding the problem of catheter occlusion. OBJECTIVE: To investigate the effectiveness of the low-speed continuous infusion catheter technique and the routine care of double-lumen central venous catheters. DESIGN: This was a prospective, randomized, controlled, open-label trial. SETTING: Patients were recruited from 14 medical institutions in China between February and June 2023. PARTICIPANTS: In total, 251 patients were recruited, with 125 in the intervention group and 126 in the control group. METHODS: Patients who used double-lumen central venous catheters for infusion treatment were selected, and those who met the sampling criteria were randomly divided into intervention and control groups using the random envelope method. The intervention group used the low-speed continuous infusion catheter technique to maintain catheter patency, whereas the control group used routine care with a trial period of 7 days. The primary outcome was the occlusion rate. The secondary outcomes included nursing satisfaction and complication rates of the two groups. RESULTS: After 7 days, the rate of catheter occlusion was 28.0 % (35/125, 95 % confidence interval (CI):0.203, 0.367) in the intervention group and 53.97 % (68/126, 95 % CI: 0.449-0.629) in the control group, with a statistically significant difference (χ2 = 17.488, p < 0.001); at 3 days of intervention, the rate of catheter blockage was 8.0 % (10/125, 95 % CI: 0.039-0.142) in the intervention group and 23.8 % (30/126, 0.167-0.322) in the control group, with a statistically significant difference (χ2 = 11.707, p < 0.001). Nurse satisfaction was significantly higher in the intervention group (115/125, 92.0 %, 95 % CI: 0.858-0.961) than in the control group (104/126, 82.54 %, 95 % CI: 0.748-0.887) (χ2 = 5.049, p = 0.025). There were no statistically significant complication rates in either group (p = 0.622). CONCLUSION: The low-speed continuous infusion catheter technique helps maintain catheter patency, improves nurse satisfaction, and provides a high level of safety. REGISTRATION: Chinese Clinical Trial Registry (ChiCTR2200064007, www.chictr.org.cn). The first recruitment was conducted in February. https://www.chictr.org.cn/showproj.html?proj=177311.

[Direct and Indirect Effects of Land Use on Dissolved Organic Matter in a Typical Karst River].

Land use can directly affect the abundance of riverine dissolved organic matter (DOM) by transporting terrestrial organic matter to rivers and can also indirectly enhance local production of DOM by increasing riverine nutrient loading. This study investigated the characteristics and spatial distribution of DOM components in the Furong River during the rainy season (July) using ultraviolet-visible light absorption spectroscopy (UV-VIS) and three-dimensional excitation emission matrix fluorescence spectroscopy-parallel factor analysis (EEM-PARAFAC) techniques. Furthermore, correlation analysis and the partial least squares path model (PLS-PM) were used to identify and quantify the direct and indirect impacts of land use on DOM at multiple scales. The results revealed that:① the direct effects of land use on DOM were generally stronger than the indirect effects. ② The responses of different DOM components to riverine nutrient status and land use varied, with dissolved organic carbon (DOC) and colored dissolved organic matter (CDOM) components being more susceptible to riverine nutrient status and fluorescent dissolved organic matter (FDOM) being more sensitive to land use. ③ The direct impact intensity of land use on DOC and CDOM fluctuated slightly with the spatial scale, but the total impact intensity had no visible spatial scale difference, and the direct impact intensity on the FDOM component decreased with the increase in spatial scale. ④ Dryland, urban and other construction land, patch density (PD), edge density (ED), and Shannon's diversity index (SHDI) were typical land use metrics that exacerbated DOM abundance, whereas paddy field, shrubland, largest patch index (LPI), and aggregation index (AI) were typical land use metrics that effectively mitigated DOM abundance. Total nitrogen (TN), nitrate nitrogen (NO3--N), and dissolved total phosphorus (DTP) were water quality parameters that were significantly affected by land use and were closely related to DOM components, that is, nitrogen and phosphorus played an important "intermediary" role in "land use-riverine DOM." FDOM could be used as indicators to measure the strength of terrestrial organic matter directly input to rivers by land use.

Experiences of Chinese advanced cancer patients after attending a "four-stage" death education programme: A qualitative study.

PURPOSE: This study aimed to explore the experiences of cancer patients who participated in and completed a "four-stage" death education programme based on knowledge-attitude-practice theory. METHODS: This study employed a qualitative descriptive design. Semistructured interviews with an interview guide were used to collect data. Fifteen cancer patients who participated in and completed the "four-stage" death education programme (from November 10, 2021, to December 29, 2021) were recruited via purposive sampling. The "four-stage" death education programme model was developed based on knowledge-attitude-practice theory and included eight death education modules. Each interview was audio-recorded and transcribed verbatim. Generic analysis was used to conduct data analysis by coding, classifying, and extracting themes. RESULTS: Five themes were identified: the gradual shift of death cognition towards objective reality, a decrease in death anxiety, patients' early thoughts concerning issues related to death and preparation ahead of death, patients' improved ability to respond to death incidents, and patients' increased focus on cherishing the remainder of their lives and living in the moment. CONCLUSIONS: Cancer patients accept and respond effectively to the implementation of a "four-stage" death education programme based on knowledge-attitude-practice theory. These findings can help cancer patients improve their reasonable perception of death and reduce their doubts and confusion concerning death.

Oncology nurses' and oncologists' experience of addressing sexual health concerns in breast cancer patients: A qualitative study.

PURPOSE: This study aimed to explore the experiences of Chinese oncology nurses and oncologists who provide sexual health education for breast cancer patients in their practical work. METHODS: This was a qualitative study using semistructured face-to-face interviews. Eleven nurses and eight oncologists who provided sexual health education to breast cancer patients were purposively recruited from eight hospitals in seven provinces of China. Data were analyzed using the thematic analysis method. RESULTS: Four main themes emerged: the surface of sexual health, stress and benefit finding, cultural sensitivity and communication, needs and changes. Both oncology nurses and oncologists found it difficult to solve sexual health problems, which were beyond their responsibilities and competencies. They felt helpless about the limitations of external support. Nurses hoped oncologists could participate in more sexual health education. CONCLUSIONS: Oncology nurses and oncologists experienced great challenges in educating breast cancer patients about sexual health. They are eager to obtain more formal education and learning resources for sexual health education. Specific training to improve the sexual health education competence of healthcare professionals is needed. Furthermore, more support is needed to create conditions to encourage patients to reveal their sexual challenges. It is necessary for oncology nurses and oncologists to communicate on sexual health in breast cancer patients, and to promote interdisciplinary communication and share responsibility.

The contribution of perceived death competence in determining the professional quality of life of novice oncology nurses: A multicentre study.

PURPOSE: Novice nurses find it challenging to cope with patient dying and death, especially in a death taboo cultural context, such as mainland China. By taking the example of Chinese novice oncology nurses, this study aimed to explore the contribution of their perceived death competence in determining their professional quality of life. METHOD: A multicentre, cross-sectional study was conducted in six tertiary cancer hospitals in mainland China involving 506 novice oncology nurses. Measurements were the Coping with Death Scale-Chinese version, the Professional Quality of Life Questionnaire, and the Coping Style Questionnaire. Hierarchical multiple regression analyses were used to analyse the data. RESULTS: Death competence was significantly associated with compassion satisfaction (r = 0.509, P < 0.001), burnout (r = -0.441, P < 0.001) and secondary traumatic stress (r = -0.154, P < 0.001) which are the three dimensions of professional quality of life. The results of hierarchical multiple regression analyses demonstrated that death competence positively predicted compassion satisfaction and negatively predicted burnout (P < 0.01), but had no significant impact on secondary traumatic stress after coping style was entered into the model (P > 0.05). CONCLUSIONS: Novice oncology nurses who perceive themselves to be incompetent in dealing with patient dying and death are more likely to experience poor professional quality of life in the death taboo cultural context. Cultural-sensitive interventions and a supportive work environment are important to enhance these nurses' death competence, increasing their professional quality of life and ultimately contributing to better end-of-life cancer care management.

Adaptive Decentralized Control for Interconnected Time-Delay Uncertain Nonlinear Systems With Different Unknown Control Directions and Deferred Full-State Constraints.

In this article, the problem of adaptive decentralized control is investigated for a class of interconnected time-delay uncertain nonlinear systems with different unknown control directions and deferred asymmetric time-varying (DTV) full-state constraints. By constructing the novel time-varying asymmetric integral barrier Lyapunov function (TVAIBLF), the conservative limitation of constant integral barrier Lyapunov function (IBLF) or symmetric IBLF is reduced and the need on the prior knowledge of control gains is also avoided, while the deferred constraints directly imposed on the states of system are achieved by introducing the shifting function into the controller design. Furthermore, based on the Nussbaum-type functions, a new adaptive decentralized control strategy for interconnected time-delay nonlinear systems with subsystems having different control directions is proposed via backstepping method. And it is proven that the proposed control method can guarantee that all signals in closed-loop system are bounded and the transform errors asymptotically converge to zero. Finally, the effectiveness of the proposed control strategy is illustrated through the simulation results.

Clinical Efficacy of Bevacizumab Plus XELOX Chemotherapy in Colorectal Cancer and Application Value of Mindfulness-Based Stress Reduction Intervention.

Background and Objectives: Colorectal cancer (CRC) is a malignant tumor with an extremely high incidence rate worldwide. This study explores the influence of mindfulness-based stress reduction (MBSR) in the care of patients with CRC undergoing bevacizumab (BVZ) plus XELOX chemotherapy, aiming at providing reliable reference and guidance for further improving their rehabilitation and prognosis. Methods: Between January 2019 and March 2020, 88 patients with CRC admitted consecutively to Jiangsu Cancer Hospital in China were enrolled in the study. Of them, 42 patients receiving BVZ plus XELOX chemotherapy, conventional care and MBSR intervention were assigned to the intervention group, and the remaining 46 patients receiving XELOX chemotherapy and conventional care were included in the control group. Clinical efficacy, safety and improvement in functional status were compared. Patients' psychological state, treatment compliance and self-care ability were evaluated. Finally, prognostic quality of life (QoL) was recorded at 1-year follow-up. Results: The overall response rate and incidence of adverse events in the intervention group were not different in the control group, but the total control rate and improvement rate in the intervention group were higher. After treatment, Sedation-Agitation Scale (SAS) and Self-Rating Depression Scale (SDS) scores in the intervention group were decreased, compliance and self-care ability were improved, all of which were better than in the control group. Prognostic follow-up showed that the QoL in the intervention group was also higher than in the control group. Conclusions: The combined use of BVZ in XELOX-based chemotherapy can improve the clinical outcome and functional status of patients with CRC. In addition, MBSR intervention implemented during chemotherapy can effectively optimize patients' psychological state and treatment compliance, strengthen their self-care ability and improve their prognostic QoL.

Risk factors for the development of a parastomal hernia in patients with enterostomy: a systematic review and meta-analysis.

PURPOSE: Parastomal hernia (PSH) is a common and serious complication in patients with enterostomy, but there is no current consensus for the risk factors for PSH from previous studies. Therefore, this study systematically analyzed the risk factors for PSH to provide a reference for prevention and treatment of this condition. METHODS: Seven databases and 3 registers were systematically searched from database inception to January, 2021. Study quality was assessed by Newcastle-Ottawa Scale. Review Manager 5.3 software was used for statistical analysis. The data that could not be combined quantitatively were only analyzed qualitatively. RESULTS: Sixteen studies with 2031 patients were included. Higher BMI (OR, 1.29; 95% CI,1.02-1.63), older age (OR, 1.04; 95% CI, 1.02-1.07), female (OR, 2.55; 95% CI,1.39-4.67), lager aperture size (OR, 2.8; 95%CI, 1.78-4.42), transperitoneal stoma creation (OR, 2.4; 95% CI, 1.33-4.35), and lager waist circumference (OR, 1.01; 95% CI,1.0-1.01) were significant risk factors for PSH. The laparoscopic approach was not a risk factor for PSH (OR, 2.09; 95% CI, 0.83-5.27). Other risk factors, including the thickness of abdominal subcutaneous fat, no mesh, a stoma not through the middle of the rectus abdominis, atrophy of left lower medial part of rectus abdominis, α1(III) procollagen expression level, emergency surgery, no preoperative stoma site marking, end colostomy, smoking, diabetes, peristomal infection, severe abdominal distention, severe cough, chronic obstructive pulmonary disease, operation time and hypertension, were significant on the multivariate analysis of each individual study. CONCLUSIONS: The current available evidence showed that higher BMI, older age, female, larger aperture size, the creation of a transperitoneal stoma, and a larger waist circumference were independent risk factors for PSH. For factors without exact cutoff value, further explorations are needed in the future. In addition, reference to the limited number of studies in the pooled analysis, these factors still need to be interpreted carefully.

Decentralized Adaptive Output Feedback Fault Detection and Control for Uncertain Nonlinear Interconnected Systems.

This paper studies the problem of decentralized adaptive output feedback fault detection and control for a class of uncertain nonlinear interconnected systems. The K-filters are designed to estimate the unmeasured state variables of the system. Moreover, the built-in noise dampening filters are introduced to attenuate the influence caused by the measurement noises. Then the fault detection scheme is proposed by designing the residual and threshold signals. Subsequently, by using the backstepping design method, the decentralized switched control strategies are proposed with the help of the neural network approximation technique. Based on the Lyapunov stability theory, it is proved strictly that all signals of the resulting closed-loop system are bounded. Finally, a simulation example is presented to verify the effectiveness of the theoretical result.

Overexpression of miR-301a-3p promotes colorectal cancer cell proliferation and metastasis by targeting deleted in liver cancer-1 and runt-related transcription factor 3.

Colorectal cancer (CRC) is the third most common type of cancer. MicroRNAs have been reported to participate in the progression of various cancers. In previous studies, miR-301a-3p expression was shown to be upregulated in CRC tissues. However, the underlying mechanism of miR-301a-3p in CRC has not yet been elucidated. Herein, the level of miR-301a-3p was found to be significantly upregulated in CRC clinical tissues and cell lines (HT29 and SW620). In addition, overexpression of miR-301a-3p obviously promoted cell proliferation, migration and invasion, and inhibited cell apoptosis in CRC cells. Meanwhile, upregulated miR-301a-3p expression also enhanced the expressions of Bax, caspase-3, caspase-9, matrix metalloproteinase (MMP)-2, and MMP-9, while the expression of Bax-2 was decreased. Furthermore, deleted in liver cancer-1 (DLC-1) and runt-related transcription factor 3 (RUNX3) were verified to be direct target genes of miR-301a-3p. Furthermore, overexpression of DLC-1 and RUNX3 revealed antitumor effects in CRC cell lines with the inhibition of cell proliferation, migration and invasion, and the induction of cell apoptosis. In addition, the expressions of Bax, caspase-3, caspase-3, MMP-2, and MMP-9 could be decreased after upregulating the expressions of DLC-1 and RUNX3, along with the upregulation of Bax-2. Moreover, overexpression of miR-301a-3p could promote the growth of xenograft tumors and liver metastasis in vivo, along with reducing the expressions of DLC-1 and RUNX3. Overall, miR-301a-3p might act as a tumor inducer in CRC cells through negatively regulating DLC-1 and RUNX3.

Hypolipidemic effect of Fragarianilgerrensis Schlecht. medicine compound on hyperlipidemic rats.

BACKGROUND: Fragarianilgerrensis Schlecht. medicine compound (FN-MC) is a kind of Chinese herbs' compound consisted of Fragarianilgerrensis Schlecht. and Centella asiatica (L.) Urban. The study was to investigate the hypolipidemia effect of FN-MC in a hypolipidemic rat model. METHODS: Male SD rats were randomly divided into five groups: normal-fat diet (NFD) group, high-fat diet (HFD) group, FN-MC (2 g/Kg) group, FN-MC (4 g/Kg) group and simvastatin (PDC) group. After FN-MC treatment, body weight, food intake, serum and hepatic biochemistry parameters of rats were measured and the pathological changes of liver and its cells were observed by optical microscope and transmission electron microscopy. RESULTS: The results showed that FN-MC significantly decreased the levels of serum triglyceride (TG), total cholesterol (TC), low-density lipoprotein (LDL-C), apolipoprotein B (ApoB) and hepatic malondialdehyde (MDA), while increased serum high-density lipoprotein (HDL-C), apolipoprotein A1 (ApoA1) and hepatic Superoxide Dismutase (SOD). FN-MC also improved the structure of liver and decreased the lipid drops in the cytoplasm significantly. In addition, FN-MC significantly decreased the weight gain and had no significant effects on food intake. CONCLUSIONS: The study suggested that FN-MC exhibited strong ability to improve the dyslipidemia and prevent hepatic fatty deposition in rats fed with high-fat diet. Meanwhile, FN-MC exerted anti-obesity and antioxidant properties. HIGHLIGHTS: Fragarianilgerrensis Schlecht. medicine compound possesses a hypolipidemic effect on hyperlipidemic rat model Fragarianilgerrensis Schlecht. medicine compound administration improves the antioxidant capacity of rats Fragarianilgerrensis Schlecht. medicine compound prevents hepatic fatty deposition.

Distributed Adaptive Neural Network Output Tracking of Leader-Following High-Order Stochastic Nonlinear Multiagent Systems With Unknown Dead-Zone Input.

This paper studies the problem of distributed output tracking consensus control for a class of high-order stochastic nonlinear multiagent systems with unknown nonlinear dead-zone under a directed graph topology. The adaptive neural networks are used to approximate the unknown nonlinear functions and a new inequality is used to deal with the completely unknown dead-zone input. Then, we design the controllers based on backstepping method and the dynamic surface control technique. It is strictly proved that the resulting closed-loop system is stable in probability in the sense of semiglobally uniform ultimate boundedness and the tracking errors between the leader and the followers approach to a small residual set based on Lyapunov stability theory. Finally, two simulation examples are presented to show the effectiveness and the advantages of the proposed techniques.

Decentralized Output Feedback Adaptive NN Tracking Control for Time-Delay Stochastic Nonlinear Systems With Prescribed Performance.

This paper studies the dynamic output feedback tracking control problem for stochastic interconnected time-delay systems with the prescribed performance. The subsystems are in the form of triangular structure. First, we design a reduced-order observer independent of time delay to estimate the unmeasured state variables online instead of the traditional full-order observer. Then, a new state transformation is proposed in consideration of the prescribed performance requirement. Using neural network to approximate the composite unknown nonlinear function, the corresponding decentralized output tracking controller is designed. It is strictly proved that the resulting closed-loop system is stable in probability in the sense of uniformly ultimately boundedness and that both transient-state and steady-state performances are preserved. Finally, a simulation example is given, and the result shows the effectiveness of the proposed control design method.