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It has always been a challenging issue to develop complex professional skills accompanied with sufficient professional knowledge and correct judgement. Previous studies have indicated that students have more opportunities for practice in flipped learning contexts. Basically, complex professional skills training is often risky in different real-world applications. Therefore, most medical training lessons are done through case discussions, interpretation of mannequins, and watching videos. Such learning models are, however, not only ineffective, but students fail to solve real problems without sufficient drills. The advanced progress of 3D simulation technology provides good opportunities to solve these problems. Virtual reality (VR) provides simulations for real clinical scenarios, offering medical students the chance to practice standard complex medical skills repeatedly, as well as thinking about and responding to clinical problems in VR, where they can obtain immediate feedback from VR learning systems. Thus, to enhance medical students' complex medical skills, the study proposes a virtual reality-based flipped learning approach. To investigate the effectiveness of the proposed approach, a quasi-experimental design was conducted with two groups in a lumbar puncture course for postgraduate year (PGY) residents of a hospital The experimental group with 39 students was conducted with virtual reality-based flipped learning (VR-FL), while the control group with 37 students was managed by traditional flipped learning (T-FL). The results showed that the complex medical skills of the experimental group were significantly better than those of the control group. In addition, the experimental group showed higher learning motivation and self-efficacy. It can be inferred that VR-FL has a positive impact on complex medical skills for PGY residents. Educators and researchers should consider integrating VR technology with learning strategies in medical simulation training.

Fostering students' abilities to deal with practical problems is an important objective of professional training. To enable students to have more practicing time under the supervision of trainers in class, flipped learning has been adopted to shift the lecture time to the before-class stage, and hence more time is available for in-class practicing. Although flipped learning has been recognized by scholars as an effective teaching mode, researchers have also indicated the challenges of implementing it; in particular, many students have difficulty learning before the class on their own. In this research, a self-regulated flipped learning approach was proposed to cope with this problem by guiding students to set their learning goals, and supporting them in monitoring their learning status in five stages, namely, goal setting, flipped learning (including pre-class video-based instruction and in-class discussion), task sharing, self-evaluation, and self-regulation feedback. In addition, an experiment was conducted in a professional training program to examine the effectiveness of the proposed approach. From the experimental results, it was found that the approach significantly improved the students' learning achievement, self-efficacy, self-regulation, and critical thinking, which could be a good reference for future research related to flipped professional training.

The global leading cause of death is cardiovascular disease (CVD). Although advances in prevention and treatment have been made, the role of RNA epigenetics in CVD is not fully understood. Studies have found that RNA modifications regulate gene expression in mammalian cells, and m5C (5-methylcytosine) is a recently discovered RNA modification that plays a role in gene regulation. As a result of these developments, there has been renewed interest in elucidating the nature and function of RNA “epitranscriptomic” modifications. Recent studies on m5C RNA methylomes, their functions, and the proteins that initiate, translate and manipulate this modification are discussed in this review. This review improves the understanding of m5C modifications and their properties, functions, and implications in cardiac pathologies, including cardiomyopathy, heart failure, and atherosclerosis.

Precision medicine has become an essential issue in the medical community as the quality of medical care is being emphasized nowadays. The technological data analysis and predictions made by Artificial Intelligence (AI) technologies have assisted medical staff in designing personalized medicine for patients, making AI technologies an important path to precision medicine. During the implementation of the new emerging technology, medical staff's learning intentions will have a great influence on its effectiveness. With reference to the Technology Acceptance Model, this study explored medical staff's attitudes, intentions, and relevant influencing factors in relation to AI application learning. A total of 285 valid questionnaires were collected. Five major factors, perceived usefulness (PU), perceived ease of use (PEU), subjective norms (SN), attitude towards AI use (ATU), and behavioral intention (BI), were used for analyzing the AI learning of medical staff in a hospital. Based on the SEM analytical results and the research model, the four endogenous constructs of PU, PEU, SN, and ATU explained 37.4% of the changes in BI. In this model, SN and PEU were the determining factors of BI. The total effects of SN and PEU were 0.448 and 0.408 respectively, followed by PU, with a total effect of 0.244. As a result, the intentions of medical staff to learn to use AI applications to support precision medicine can be predicted by SN, PEU, PU, and ATU. Among them, subjective norms considering the influences of both supervisors and peers, such as encouragement, communication, and sharing, may assist precision education in supporting the learning attitudes and behavior regarding precision medicine. The research results can provide recommendations for examining medical staff's intention to use AI applications.

Patients with long‐term disease experience low resilience, emphasising the importance of psychological interventions to improve resilience. However, there is no comprehensive evidence on the efficacy of resilience‐related psychological interventions (RRPIs) in this population. Therefore, we performed a meta‐analysis to evaluate and extend knowledge from previous meta‐analyses on the efficacy of RRPIs on resilience, stress, anxiety, depression and quality of life among patients with long‐term disease. Cochrane Library, Embase, Ovid‐MEDLINE, PubMed, Scopus, Web of Science and CINAHL electronic databases were searched until 3 February 2023. The pooled effect size of the efficacy of RRPIs was calculated using the Hedges' g (g) with random‐effects model, while Cochrane Q‐statistics and I2 tests assessed heterogeneity in Comprehensive Meta‐Analysis 3.0 software. The Cochrane Risk of Bias 2.0 tool evaluated the quality of studies. Moderator analysis was used to explore sources of heterogeneity. Twenty randomised controlled trial studies were identified, representing a total of 1388 individuals with long‐term disease. RRPIs significantly enhance resilience (g = 0.79), alleviate stress (g = −0.78), decrease anxiety (g = −1.14), mitigate depression (g = −0.96) and improve quality of life (g = 0.48). Positive psychology, mindfulness, cognitive behavioural therapy, acceptance and commitment‐based intervention exhibited medium effects in strengthening resilience. Short‐term effects of RRPIs on enhancing resilience were observed at 3‐month follow‐up period (g = 0.50). The incorporation of RRPIs into the management of patients with long‐term disease shows a positive impact on their resilience, stress, anxiety, depression and quality of life. The results offer an evidence‐based foundation for nurses in promoting resilience among patients with long‐term disease. [ABSTRACT FROM AUTHOR]

The purpose of the study aimed to explore the effects of three different forms of the multimedia teaching materials on the achievements and attitudes of junior high school students in a chemistry laboratory context. The three forms of the multimedia teaching materials, static pictures, video, and animation, were employed to teach chemistry experiments to 54 eighth-grade students in Pingtung County, Taiwan. The research tools included the self-editing questionnaire of learning achievement, the experimental step checklist, and the learning feedback questionnaire. Descriptive statistics and ANCOVA were administered to analyze the collected data. The findings of the study indicate that the video and animation have more significant effects on promoting students' learning achievements in a chemistry laboratory context than static pictures in terms of operating equipment, technical operation, experimental procedures, and observation performance. Additionally, the students indicated that video presentation can best assist them in understanding the experiments. Finally, the findings and suggestions of this study can be useful references for multimedia designers, teachers, and school administrators. (Contains 8 tables and 3 figures.)

Medical education is a domain with fast-changing knowledge and attention to knowledge application and higher order thinking; therefore, how to implement effective teaching is a crucial issue. Based on the technology-based learning model, this study provides a multi-dimensional analysis of published papers on the flipped classroom in medical education from the SCOPUS database, including the form of the learning materials, learning system or player, learning strategies, educational technology, application domains, research issues, participants, and research methods. Based on the results, the application of flipped classrooms in medical education has grown rapidly over the past decade, with the number growing dramatically from 7 papers in 2014, to 16 papers in 2015, and 22 papers in 2016. It was found that a great number of studies adopted instructional videos uploaded on online learning systems or used existing online videos to conduct before-class teaching in the before-class stage of the flipped classroom; moreover, most studies involved no online discussion in the before-class stage. As for learning strategies in the in-class stage, the most frequently adopted strategies were issue discussion, practicing or doing exercises, and problem-based learning. This implies that most studies mainly emphasized basic knowledge understanding and skills training, while little attention was paid to developing learners' higher order thinking skills. In addition, the majority of studies explored students' learning interest/satisfaction, learning experience, and performance on the cognitive aspect, while little research was found to investigate their preparation degree or cognitive loading. Based on the review results, this study provides the research trends and potential research issues of flipped medical education to serve as a reference for researchers, instructors, and decision makers.

Dementia patients may have language barriers and decreased comprehension ability. Their family caregivers can feel frustrated when communicating with them. Poor communication hinders family caregivers from obtaining accurate health information about patients, and may also increase their emotional burden, affecting patient care quality. The present study developed a virtual reality‐based simulated communication training (VRSCT) system and applied it to a training course for family caregivers of dementia patients. It allowed family caregivers to simulate real‐world situations in a VR environment, experience the daily communication barriers and stress with dementia patients, and apply their acquired knowledge and skills to solve related problems. This study used a randomised control experimental design with mixed analysis methods. A total of 63 family caregivers were recruited and randomly divided into the experimental group (N = 32) learning with the VRSCT system to interact with virtual dementia patients and practice communication skills, and the control group (N = 31) using the traditional role‐playing method for practice. Quantitative data were analysed to determine participants' knowledge of dementia care, attitudes, communication confidence and skills. In addition, the qualitative method was used to analyse the participants' discussion records. The results showed that by using the VRSCT approach, participants significantly improved their knowledge of dementia care, attitudes, communication confidence and communication skills compared to the control group. In addition, participants reported that through the real‐time feedback of the VRSCT system, they could recognise their previous incorrect communication approach. As a result, they adjusted their communication strategies and increased their self‐confidence. Practitioner notes What is already known about this topic Situational simulation helps learners improve their communication skills in a safe environment. Virtual reality (VR) creates a realistic, highly interactive learning environment, allowing users to be deeply immersed in the learning experience. What this paper adds This study proposed a VR‐based simulated communication training (VRSCT) approach; moreover, seven dementia cases of different degrees of severity were designed in the VR system to enable family members to experience possible challenges of taking care of dementia patients they might encounter in their daily lives. Each case in the VRSCT system has its unique symptoms and communication barriers. The learner in the story plays a caregiver, experiencing and solving the problems and challenges posed by the system. The experimental results show that the proposed method improves learners' knowledge, attitudes, communication confidence, and communication skills related to dementia care. Implications for practice and/or policy Utilising VR training can amplify awareness and secure enhanced social support for dementia‐related challenges. Using VRSCT, as governments and institutions recognise the effectiveness of VR training, they will provide more resources and promote its widespread application. What is already known about this topic Situational simulation helps learners improve their communication skills in a safe environment. Virtual reality (VR) creates a realistic, highly interactive learning environment, allowing users to be deeply immersed in the learning experience. What this paper adds This study proposed a VR‐based simulated communication training (VRSCT) approach; moreover, seven dementia cases of different degrees of severity were designed in the VR system to enable family members to experience possible challenges of taking care of dementia patients they might encounter in their daily lives. Each case in the VRSCT system has its unique symptoms and communication barriers. The learner in the story plays a caregiver, experiencing and solving the problems and challenges posed by the system. The experimental results show that the proposed method improves learners' knowledge, attitudes, communication confidence, and communication skills related to dementia care. Implications for practice and/or policy Utilising VR training can amplify awareness and secure enhanced social support for dementia‐related challenges. Using VRSCT, as governments and institutions recognise the effectiveness of VR training, they will provide more resources and promote its widespread application. [ABSTRACT FROM AUTHOR]

Background Ageing process and abnormal protein accumulation in dementia damage neural pathways affecting the swallowing process and leading to swallowing disorder. Objective To estimate the prevalence of swallowing disorder among older adults with different dementia subtypes. Methods We conducted a systematic search across multiple databases, including PubMed, Embase, Scopus, Web of Science and OVID Medline. The meta-analysis employed R (version 4.0.2) and utilised a generalised linear mixed model with a random-effect approach to estimate the pooled prevalence of swallowing disorder among older adults, considering various dementia subtypes. The quality of included studies was assessed using Hoy's criteria. Heterogeneity was identified through Cochrane's Q and I 2 statistics. To further explore heterogeneity, moderator analysis was performed to identify the contributing variables among the included studies. Results Eighteen studies with 12,532 older adults with different dementia subtypes were enrolled in our meta-analysis. The pooled prevalence of swallowing disorder among older adults with dementia was 58%, with 46.5% for Alzheimer's dementia, 34.9% for Parkinson's dementia, 18.8% for vascular dementia, 16.3% for mixed dementia and 12.2% for Lewy body dementia. According to assessment tools, Alzheimer's dementia had the highest prevalence, with 58% in instrumental assessments and 39% in clinical assessments. Medical history, Alzheimer's dementia, moderate-to-severe Clinical Dementia Rating, delayed oral phase, delayed pharyngeal phase and poor tongue motility contributed to the heterogeneity of the included studies. Conclusions More than half of older adults with dementia demonstrate to have swallowing disorder. Our findings offer valuable insights to healthcare professionals for the identification of swallowing disorder in ageing population with dementia. [ABSTRACT FROM AUTHOR]

Atherosclerosis is one of the most common type of cardiovascular disease and the prime cause of mortality in the aging population worldwide. However, the detail mechanisms and special biomarkers of atherosclerosis remain to be further investigated. Lately, long non-coding RNAs (lncRNAs) has attracted much more attention than other types of ncRNAs. In our work, we found and confirmed differently expressed lncRNAs and mRNAs in atherosclerosis by analyzing GSE28829. We performed the weighted gene co-expression network analysis (WGCNA) by analyzing GSE40231 to confirm highly correlated genes. Gene Ontology (GO) analysis were utilized to assess the potential functions of differential expressed lncRNAs in atherosclerosis. Co-expression networks were also constructed to confirm hub lncRNAs in atherosclerosis. A total of 5784 mRNAs and 654 lncRNAs were found to be dysregulated in the progression of atherosclerosis. A total of 15 lncRNA-mRNA co-expression modules were identified in this study based on WGCNA analysis. Moreover, a few lncRNAs, such as ZFAS1, LOC100506730, LOC100506691, DOCK9-AS2, RP11-6I2.3, LOC100130219, were confirmed as important lncRNAs in atherosclerosis. Taken together, bioinformatics analysis revealed these lncRNAs were involved in regulating the leukotriene biosynthetic process, gene expression, actin filament organization, t-circle formation, antigen processing, and presentation, interferon-gamma-mediated signaling pathway, and activation of GTPase activity. We believed that this study would provide potential novel therapeutic and prognostic targets for atherosclerosis.

Background: In situ simulation is the practice of using simulated scenarios to improve skill implementation, train critical thinking and problem-solving abilities, and enhance self-efficacy. This study aimed to enhance nursing knowledge, skills, and attitudes toward clinical work by applying in situ simulation training to improve the healthcare of critically ill patients. Methods: This study was conducted from a medical center in northern Taiwan and included 86 trainees who received intensive care training courses from 1 June 2017 to 31 May 2019. The self-report knowledge assessment, empathetic self-efficacy scale, skill assessment, and attitudes of instructors before and after training were collected. The statistical analysis used the Wilcoxon test for knowledge and attitudes, and chi-square tests were used for skills to evaluate the learning effect. Results: The results showed a statistically significant improvement in knowledge, skills, attitudes, and empathy in nursing care. Conclusions: In situ simulation learning can be an accepted method for nursing skills in the intensive care unit. Through this study, we understood that the in situ simulation method was beneficial to nurses' care and care thinking processes. It is worth developing and evaluating integrated simulation education to enhance learning, change behavior, and promote holistic care in the nursing field. [ABSTRACT FROM AUTHOR]

Background and Objectives: Hearing loss after septicemia has been found in mice; the long-term risk increased 50-fold in young adults in a previous study. Hearing loss after septicemia has not received much attention. The aim of this study was to assess the relationship between septicemia and subsequent hearing loss. Materials and Methods: Inpatient data were obtained from the Taiwan Insurance Database. We defined patients with sensorineural hearing loss and excluded patients under 18 years of age. Patients without hearing loss were selected as controls at a frequency of 1:5. The date of admission was defined as the date of diagnosis. Comorbidities in the 3 years preceding the date of diagnosis were retrieved retrospectively. Associations with hearing loss were established by multiple logistic regression and forward stepwise selection. Results: The odds ratio (OR) for the association between sepsis and hearing loss was 3.052 (95% CI: 1.583–5.884). Autoimmune disease (OR: 5.828 (95% CI: 1.906–17.816)), brain injury (OR: 2.264 (95% CI: 1.212–4.229)) and ischemic stroke (OR: 1.47 (95% CI: 1.087–1.988)) were associated with hearing loss. Conclusions: Our study shows that hearing loss occurred after septicemia. Apoptosis caused by sepsis and ischemia can lead to hair cell damage, leading to hearing loss. Clinicians should be aware of possible subsequent complications of septicemia and provide appropriate treatment and prevention strategies for complications. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine the effect of seat surface inclination on postural stability and forward reaching efficiency in 10 children with spastic cerebral palsy (CP) and 16 typically developing (TD) children. The children performed a static sitting and a forward reaching task while sitting on a height- and inclination-adjustable stool at flat, three anterior-inclined, and three posterior-inclined positions. Postural stability was expressed as normalized (with body weight) peak vertical ground reaction force, center of pressure displacement in the anterior/posterior directions (COP_AP), in the medial/lateral directions (COP_ML), and sway ratio (COP_AP/COP_ML). Reaching efficiency was expressed as reaction time and movement time of arm reaching forward to a target. The results showed that seat inclination affected children's postural stability and the effects were comparable for CP and TD children in all measures except for COP_ML. Children with CP presented much larger COP_ML than TD children at the posterior-inclined positions relative to the flat and the anterior-inclined positions. Seat inclination affected reaching efficiency for both groups of children equally. Efficiency was better at the anterior positions than the posterior positions. Anterior-inclined positions improved postural stability and reaching efficiency. Posterior positions posed greater postural challenge and the challenge was tougher for children with CP. (Contains 2 tables.)

Aim: Examine effectiveness of respiratory rehabilitation and moderating factors on lung function and exercise capacity in post‐COVID‐19 patients. Design: Meta‐analysis. Methods: R software 4.0.2 assessed the effectiveness of respiratory rehabilitation adopting the random‐effects model and presenting standardised mean differences (SMDs). Heterogeneity was determined by Cochran's Q and I2. The Cochrane Risk of Bias 2.0 and MINORS evaluated quality of the included studies. Data Sources: A comprehensive search was undertaken in Cochrane, Embase, Ovid‐MEDLINE, Scopus, NCBI SARS‐CoV‐2 Resources, ProQuest, Web of Science and CINAHL until March 2022. Results: Of the 5703 identified studies, 12 articles with 596 post‐COVID‐19 patients were included. Eleven of our twelve studies had moderate to high quality and one study had high risk of bias assessed with MINORS and RoB 2 tool. Overall, respiratory rehabilitation was effective in improving forced expiratory volume in 1 s (1.14; 95%CI 0.39–1.18), forced vital capacity (0.98; 95%CI 0.39–1.56), total lung capacity (0.83; 95%CI 0.22–1.44), 6‐minute walk distance (1.56; 95%CI 1.10–2.02) and quality of life (0.99; 95%CI 0.38–1.60). However, no significant differences were observed for ratio of the forced expiratory volume in 1 s to the forced vital capacity of the lungs, anxiety and depression. Respiratory rehabilitation for post‐COVID‐19 patients was effective in those without comorbidities, performed four types of exercise programs, frequency ≥3 times/week and rehabilitation time 6 weeks. Conclusions: Respiratory rehabilitation improved lung function, exercise capacity and quality of life in post‐COVID‐19 patients. The findings suggest rehabilitation programs for post‐COVID‐19 patients should use multiple respiratory exercise programs with frequency of ≥3 times per week for longer than 6 weeks. Impact: These findings will help improve the implementation of respiratory rehabilitation programs for post‐COVID‐19 patients. Implications for the profession: Our findings can be used to develop patient‐centred respiratory rehabilitation interventions by nurses and clinicians for post‐COVID‐19 patients. Reporting Method: PRISMA guideline was followed. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

(1) Background: Patients who are critically ill or undergo major surgery are admitted to intensive care units (ICUs). Prolonged immobilization is the most likely cause of pressure injuries (PrIs) in the ICU. Previous studies of Western populations found that effective protocols could reduce the incidence of PrIs, and the efficacy of systemic targeted intervention protocols in preventing PrIs in the Chinese population needs to be surveyed. (2) Methods: We reviewed cases of PrIs in the ICUs of Taipei Veterans General Hospital from 2014 to 2019. The ICU nurses at the hospital began to implement targeted interventions in January 2017. The incidence density of PrIs was calculated by dividing the number of PrIs by person days of hospitalizations in the pre-bundle (2014–2016) and post-bundle (2017–2019) stages. Poisson regression was performed to compare the trend of incidence densities. (3) Results: The incidence density of PrIs was 9.37/1000 person days during the pre-bundle stage and 1.85/1000 person days during the post-bundle stage (p < 0.001). The relative risk (RR) was 0.197 (95% confidence interval: 0.149–0.26). The incidence densities of iatrogenic PrIs and non-iatrogenic PrIs decreased as the RRs decreased. (4) Conclusions: Targeted interventions could significantly reduce the incidence of PrIs. Healthcare providers must follow the bundle care protocol for PrI prevention to improve the quality of healthcare and promote patient health. [ABSTRACT FROM AUTHOR]

Millions of people worldwide are mourning the loss of loved ones due to the COVID‐19 epidemic, which may adversely impact their mental health. This meta‐analysis aimed to investigate pandemic grief symptoms and disorders for developing policy, practice, and research priorities. The databases of Cochrane, Embase, Ovid‐MEDLINE, WHO COVID‐19, NCBI SARS‐CoV‐2, Scopus, Web of Science, CINAHL, and Science Direct were comprehensively searched until July 31, 2022. The Joanna Briggs Institute's and Hoy's criteria were used to evaluate the studies. A pooled prevalence was presented in a forest plot figure with a corresponding 95% confidence interval (CI) and prediction interval. Between‐study heterogeneity was measured using the I2 and Q statistics. Variations in the prevalence estimates in different subgroups were examined by moderator meta‐analysis. The search identified 3677 citations, of which 15 studies involving 9289 participants were included in the meta‐analysis. The pooled prevalence rate of grief symptoms was 45.1% (95%CI: 32.6%–57.5%), and grief disorder was 46.4% (95%CI: 37.4%–55.5%). Grief symptoms were significantly higher in <6 months (45.8%; 95%CI: 26.3%–65.3%) compared to the period of more than 6 months. Unfortunately, moderator analyses for grief disorders could not be performed due to limited studies. The prevalence of grief problems during the pandemic was substantially higher than in non‐pandemic conditions; therefore, it is crucial to strengthen bereavement support to reduce psychological distress. The results provide a foundation for nurses and healthcare workers to anticipate a heightened need for support and provision of bereavement care in the post‐pandemic era. [ABSTRACT FROM AUTHOR]