Objectives:This study aimed to compare the effectiveness of the semi-virtual simulation and traditional simulation teaching models based on the Standards of Best Practice (SOBP) according to the International Nursing Association for Clinical Simulation and Learning (INACSL) in the Adult Nursing course. Methods:This study used a quasi-experimental design. A total of 94 third-year nursing students from a university in Beijing between November and December 2022 were recruited as participants. An innovative semi-virtual simulation teaching model was designed based on the SOBP established by the INACSL. In the Adult Nursing course, both the semi-virtual and traditional simulation teaching models were implemented. At the end of the simulation sessions, participants completed the Chinese version of the Simulation Effectiveness Tool-Modified (SET-M) to assess the effectiveness of the two teaching models. Results:All nursing students completed the simulation sessions. There was no difference (t = -0.93, P = 0.353) in the total scores between the semi-virtual simulation teaching model (50.87 ± 5.30) and the traditional simulation teaching model (50.37 ± 5.16). However, there was a statistically significant difference (t = -2.65, P = 0.010) in the prebriefing section (semi-virtual simulation: 5.60 ± 0.71; traditional simulation: 5.33 ± 0.78). In contrast, no statistically significant differences were found for the scenario and debriefing sections (P > 0.05). At the individual item level, statistical differences (P < 0.05) between the two models were identified for items 1 and 9, but not for the remaining items (P > 0.05). By analyzing the open-ended question, it was found that both simulation models were effective, and students' comments were similar. Conclusions:The study demonstrated equivalent effectiveness between the semi-virtual and traditional simulation teaching models. Semi-virtual simulation teaching model could offer a more flexible and feasible approach to simulation teaching.

Aim: This study aimed to evaluate the combination of virtual simulation and in -person simulation among undergraduate nursing students. Background: At present, in -person simulation is the main form of simulation in China. With the development of computer technology, computer -based virtual simulation is gradually applied in simulation and has shown unique advantages. However, simulation format that combines virtual simulation with in -person simulation is rare in China. Design: This was a mixed methods study, which applied a QUAN -> qual sequential explanatory approach. Methods: In the quantitative phase, a non -randomized controlled trial (NRCT) was employed among 93 junior nursing students from nursing school of a university in China. Students from parallel classes 1, 2 and 3 (45 students) were selected as experimental group, while students from parallel classes 4, 5 and 6 (48 students) were selected as control group. The control group completed the in -person simulation, while the experimental group was required to complete both virtual simulation and in -person simulation. The students' performance in inperson simulation was evaluated by the teachers according to a demonstrating checklist. After simulation, Students were invited to answer the Students' Satisfaction and Self-confidence in Learning Scale (SSS), Educational Practices in Simulation Scale (EPSS) and Clinical Learning Environment Comparison Survey (CLECS). A descriptive qualitative study was conducted in qualitative phase. Ten students were recruited by a purposive sampling method from the experimental group and were interviewed by the researcher. A semi -structured interview method was used to conduct in-depth interviews with them. Results: The mean score of the students' performance in the experimental group was higher than that in the control group (63.00 vs 57.67). There were no significant differences in learning satisfaction, self-confidence and simulated practice score (except cooperation dimension) between the two groups (P>0.05). For experimental group, the total CLECS score in in -person simulation was higher than that in virtual simulation, which was 84.98 +/- 12.50 and 72.58 +/- 13.04 respectively and the difference was statistically significant (t=5.270, p<0.001). Ten students were interviewed in the qualitative phase. Through the interview, we have learned that students believed that virtual simulation combined with in -person simulation is helpful to enhance their knowledge, improve their learning confidence and help them develop non -technical skills (i.e., decision -making and critical thinking). Conclusion: In -person simulation is the preferred form of simulation and virtual simulation is a beneficial supplement to in -person simulation. The combination of the two is suggested to be introduced into the simulation curriculum for undergraduate nursing students.

Aim: This study aimed to scrutinize the extent of engagement in the implementation of scenario-based simulation training within hospital settings and the status of occupational burnout and psychological capital among nursing instructors. Methods: This research spanned from August 2022 to June 2023. A total of 172 nursing instructors from 67 hospitals participated in an electronic survey, which included knowledge, attitudes, and practices questionnaires related to scenario-based simulation training, the Maslach burnout inventory-general survey for assessing occupational burnout, and the 24-item Psychological Capital Questionnaire. Results: The findings revealed that the average scores for knowledge and attitude in scenario-based simulation training among the 172 nursing instructors were (54.85 +/- 13.26) and (76.55 +/- 28.82), respectively. Out of these, 105 instructors (61.0%) have engaged in scenario-based simulation training, with an average practice score of (64.0 +/- 25.4). Psychological capital emerged as a significant influencing factor on the attitudes and practices of nursing instructors in scenario-based simulation training ( p = .046, p = .004, respectively). Positive correlations were observed between knowledge, attitude, and practice, while a positive association was noted between occupational burnout and psychological capital.

OBJECTIVES:To investigate the body composition and dietary intake in the patients with head and neck cancer (HNC) during radiotherapy (RT), and explore the relationship between them.METHODS:This was a prospective, longitudinal observational study. Adult patients with HNC undergoing RT between March 2017 and August 2018 were recruited. Patients' body compositions were evaluated by bioelectrical impedance analysis, and dietary intake was recorded by 24-hour dietary recall at three time points, including baseline (T1), mid-treatment (T2) and post-treatment (T3). Patients were divided into low, middle and high energy intake groups based on the average daily energy intake (DEI). Changes in body weight (BW), fat mass (FM), fat-free mass (FFM) and skeletal muscle mass (SMM) among these three groups were compared.RESULTS:From T1 to T3, the median loss of patients' BW, FM, FFM and SMM was 4.60, 1.90, 2.60 and 1.50 kg, respectively. The loss of BW was more dramatic from T2 to T3 than that from T1 to T2. BW loss was mainly contributed by SMM loss from T1 to T2 and by FM loss from T2 to T3. Meanwhile, patients' dietary intake reduced during treatment. High DEI group had a significantly attenuated loss of patients' BW, FFM, SMM and FM compared with the low DEI group.CONCLUSION:Patients' BW, FM, FFM and SMM all significantly reduced, especially from T2 to T3, with decreased DEI during RT, which stresses the importance of nutrition intervention during the whole course of RT.

Abstract Objective Radiation mucositis, especially pharyngeal mucositis, severely affects the oral intake of patients of head and neck cancer (HNC) during radiotherapy. Whether the nutritional status affects the severity of pharyngeal mucositis is currently unknown. This study investigated the incidence of malnutrition and radiation pharyngeal mucositis in patients with HNC during radiotherapy and analyzed the impact of the nutritional status on radiation pharyngeal mucositis. Methods Consecutive patients with HNC receiving radiotherapy were recruited for this longitudinal observational study. Data were collected at baseline (T1), midtreatment (T2), and at the end of treatment (T3). The Common Terminology Criteria for Adverse Events version 4.0 and the Global Leadership Initiative on Malnutrition criteria were used to assess pharyngeal mucositis and the nutritional status, respectively. Results There were 348 HNC patients who completed all assessments. The pharyngeal mucositis of patients with HNC was aggravated during radiotherapy (χ2 = 553.521, P < 0.001). At T3, 56.0% of patients had moderate or severe pharyngeal mucositis. The proportion of patients with malnutrition increased significantly during treatment (21.3% at T1 vs 46.8% at T2 vs 76.1% at T3, χ2 = 209.768, P < 0.001). Both a multivariable analysis of generalized estimating equations and a logistic regression analysis showed that pharyngeal mucositis was associated with malnutrition. Conclusions Malnutrition was common in patients with HNC during radiotherapy, and it was closely related to pharyngeal mucositis. Joint interventions targeting nutrition and symptom management should be considered for patients with HNC.

Objective:To explore undergraduate nursing students′ learning outcomes in actual and simulated learning environment and to compare them.Methods:A convenient sample of 193 undergraduate nursing students from 4 universities in Beijing completed clinical learning environment comparison survey (CLECS). Wilcoxon signed rank test was used to compare the differences.Results:The total CLECS score in actual learning environment (80.5±15.3) was higher than that in the simulated learning environment (76.6±14.1), and the difference was statistically significant ( Z=-3.03, P=0.002). The scores of the four dimensions including communication, holistic, critical thinking, and teaching-learning dyad in actual learning environment were higher than those in the simulated learning environment, with the scores being (9.1±2.0) vs. (7.5±2.3), (11.4±3.2) vs. (10.3±3.4), (6.2±1.5) vs. (5.5±1.6), and (15.5±3.4) vs. (15.1±3.1), respectively, and the differences were all statistically significant ( P<0.05). The score of the self-efficacy dimension in the actual learning environment (10.9±2.5) was lower than that in the simulated learning environment (11.4±2.6), and the difference was statistically significant ( Z=-2.64, P=0.008). Conclusions:It is recommended that nursing faculty establish clinical teaching guidelines that combine actual clinical practice with simulated clinical practice to achieve optimal results.

BACKGROUND:Evidence supporting predictive effects of pretreatment nutritional risk and nutritional status on nutrition impact symptom (NIS) clusters during radiotherapy in patients with head and neck cancer (HNC) is insufficient. METHODS:At baseline (T1 ), we collected severity and interference of NIS (Head and Neck Patient Symptom Checklist), nutritional risk, and nutritional status. During (T2 ) and at the end of radiotherapy (T3 ), we re-evaluated NIS. Symptom clusters were identified by exploratory factor analysis using mean scores of NIS severity at T2 and T3 . Predictive effects were explored by generalized estimating equations. RESULTS:Five hundred thirty-seven patients were recruited and 334 of them completed. Four clusters were identified; the oropharyngeal symptom cluster was the most severe and had the greatest interference with diet. Patients with pretreatment nutritional risk or malnutrition experienced more severe oropharyngeal symptom cluster. CONCLUSIONS:Pretreatment nutritional risk or malnutrition could predict the oropharyngeal symptom cluster in patients with HNC undergoing radiotherapy.

Body composition may influence the prognosis of head and neck cancer (HNC) patients. To find out the most crucial factors in this relationship, we explored the association between body composition and survival.

Aim: This study aimed to investigate the knowledge, attitude and practice towards simulation among CNTs in China and analyze the influencing factors. Background: In China, simulation is now increasingly used by Clinical Nursing Teachers (CNTs) who are mainly responsible for nurses' continuing education, novice nurses training and nursing students practice in clinical settings. Over the past 20 years, enrolment scale of nursing education was expanded greatly, and the number of registered nurses increased from 1.22 to 4.10 million in China. To contribute to nurses' or nursing students' professional development and successful transition to competent practitioners, CNTs are now being challenged to use simulation to develop more learner-centered educational programs, which could better facilitate learner engagement. As faculty preparation is a prerequisite for conducting quality simulation, it is critical that CNTs have the requisite knowledge and skills to use simulation to its full potential. However, data on CNTs' knowledge, attitude and practice towards simulation is limited. Design: A cross-sectional study. Methods: A total of 342 CNTs from six tertiary affiliated teaching hospitals of a medical university in Beijing, China, participated in the study. Electronic questionnaire of Nurse Educators' Knowledge, Attitude and Practice towards Simulation (NEKAPS) was delivered to CNTs. Analysis of variance, t-test were used to analyze data. Results: The mean score of knowledge and attitude for all participants was 60.01 +/- 13.42 and 81.40 +/- 19.99, respectively. The mean practice score was 70.65 +/- 22.05 for 162 participants (47.4 %) who had conducted simulation in their hospitals. Participants with higher educational level (F=3.476, p = 0.032) and nursing career length <= 15 years (t = 2.676, p = 0.008) had higher knowledge scores. However, there were no significant differences among different groups for attitudes. Participants with age <= 35 years old (t = 3.355, p = 0.001), nursing teaching length <= 10 years (t = 2.073, p = 0.041) and advanced beginner nurses (t = 3.212, p = 0.002) presented higher practice scores. Conclusions: CNTs had a low level of knowledge on simulation. Their attitudes towards simulation were positive, whereas their practices were still lacking. It is highlighted an urgent need for standardized training of CNTs to improve their knowledge and practice towards simulation, so that they can optimize the simulation programs they provide for nurses or nursing students.

Purpose: This study aims to develop and validate machine learning (ML) models for cancer-associated deep vein thrombosis (DVT), and compare the performance of these models with the Khorana Score (KS).Methods: We randomly extracted data of 2100 cancer patients between January 1st, 2017 and October 31st, 2019 and 1035 patients with Doppler ultrasonography were enrolled to develop and validate ML models. Both uni-variable analysis and the Lasso regression were applied to select the important predictors. Model training and hyper-parameter tuning were implemented on 70% (725/1035) of the data using a ten-fold cross-validation method. The remaining 30% (310/1035) data was used to compare the performance with seven indicators, the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, accuracy, balanced accuracy, the Brier Score, and the calibration curve, among all five ML models, linear discriminant analysis (LDA), logistic regression (LR), classification tree (CT), random forest (RF), and support vector machine (SVM), and the KS.Results: The percentage of cancer-associated DVT in this study was 22.3% (231/1035). The top five important predictors were D-Dimer, age, Charlson Comorbidity Index (CCI), length of stay (LOS), and previously VTE history according to RF. LDA (AUC of 0.773) and LR(AUC of 0.772) out-performed KS(AUC of 0.642), but CT(AUC of 0.639), RF(AUC of 0.660), and SVM(AUC of 0.665) did not surpass it. The combination with D-Dimer showed improved performance of all models. A nomogram and a web calculator https://webcalculatorofcancerassociateddvt.shinyapps.io/dynnomapp/ were used to visualize the best recommended LR model.Conclusion: This study developed and validated cancer-associated DVT predictive models using five ML algorithms and visualized the best recommended model by a nomogram and a web calculator. The nomogram and web calculator developed in this study may be able to assist doctors and nurses to evaluate the individualized cancer-associated DVT risk and make decision making. However, other prospective cohort studies are suggested to be conducted to externally validate the recommended model.

Studies regarding malnutrition in patients with nasopharyngeal carcinoma (NPC) using the Global Leadership Initiative in Malnutrition (GLIM) criteria are still limited. Our study aimed to investigate the prevalence of malnutrition using the GLIM criteria in NPC patients receiving radiotherapy and explore the relationship between pre-radiotherapy (pre-RT) malnutrition and survival. A total of 113 NPC patients were enrolled for nutritional assessment using the GLIM criteria at different radiotherapeutic time points, and related toxicities were graded. Regarding the results, 19 patients (16.8%) were malnourished before radiotherapy and 103 patients (91.2%) were malnourished at the end of radiotherapy. Among the phenotypic GLIM criteria, low fat-free muscle index (FFMI) before radiotherapy was associated with mucositis and radiodermatitis (p < 0.05). Importantly, patients with malnutrition before radiotherapy had significantly poorer 2-year progression free survival (PFS) than the patients being well-nourished (62.1% vs. 88.9%, p = 0.015). From the multivariate Cox regression model, being-well nourished before radiotherapy was the protective factor for PFS (HR: 0.27; 95%CI: 0.089-0.85; p = 0.023) and male was the risk factor for PFS (HR: 7.25; 95%CI: 1.548-34.00; p = 0.012). In conclusion, malnutrition according to the GLIM criteria is common in NPC patients undergoing radiotherapy, and pre-RT malnutrition is correlated with survival. Supplemental data for this article is available online at .

Objective Patients with head and neck cancer (HNC) receiving radiotherapy (RT) are at high risk of weight loss (WL) due to a variety of nutrition impact symptoms (NIS). This study aimed to describe the NIS through the Head and Neck patient Symptom Checklist and body weight over time and further explore the impact of NIS on WL in patients with HNC undergoing RT. Methods This was a prospective, longitudinal observational study. NIS and body weight of 117 participants were assessed at baseline, mid-treatment and post-treatment of RT. Generalised estimation equations (GEE) were used to conduct repeated measures analysis of NIS interference score and body weight at each time point and estimate the impact of NIS interference score on WL. Results All participants experienced a substantial increase in the mean number of NIS during RT, with each patient having eight to nine NIS at mid-treatment and post-treatment. Marked increases were noted in almost each NIS score during RT. Compared with their baseline body weight, 97 (82.9%) and 111 (94.9%) participants experienced WL at mid-treatment and post-treatment, with the mean WL of 2.55 +/- 1.70 kg and 5.31 +/- 3.18 kg, respectively. NIS of dry mouth (beta=-0.681, p=0.002, 95% CI -1.116 to -0.247), difficulty swallowing (beta=-0.410, p=0.001, 95% CI -0.651 to -0.169) and taste change (beta=-0.447, p=0.000, 95% CI -0.670 to -0.225) impacted WL significantly in GEE multivariate model. Conclusions Patients with HNC experience a variety of NIS which have significant impact on WL during RT. Assessment of NIS, especially dry mouth, difficulty swallowing and taste change, should be given more considerable attention in the supportive care of patients with HNC.

目的 了解高等院校护理教师对开展情景模拟教学的知信行情况,并分析其影响因素.方法 2020年3月,通过方便取样,采用自行编制的高等院校护理教师对情景模拟教学的知信行调查问卷对国内38所高等院校的201名护理教师进行电子问卷调查.结果 201名护理教师的情景模拟教学知识和态度总分分别为(60.85±12.78)分和(74.61±10.82)分,146名(72.6％)教师已经开展情景模拟教学,其情景模拟教学行为总分为(65.36±17.56)分.学历是护理教师情景模拟教学知识总分的影响因素,学校类型是护理教师情景模拟教学态度及行为总分的影响因素.结论 护理教师对开展情景模拟教学的知识水平较低,态度较积极,但行为存在不足.建议加强对护理教师情景模拟教学知识的规范化培训,同时不能忽略信念的培养,从而提高情景模拟教学的质量.

Although preoperative physical exercise has been demonstrated to be associated with clinical improvements among abdominal cancer patients, there remains heterogeneity in exercise strategies and uncertainty of what the optimal strategies should be. This scoping review aimed to review and summarize the existing knowledge about preoperative exercise strategies for abdominal cancer patients. The Joanna Briggs Institute (JBI) framework for conducting scoping reviews was adopted to investigate preoperative physical exercise strategies for patients undergoing major abdominal cancer surgery. A total of 1563 studies were identified and 24 were included in this review. Most of the study populations were colorectal cancer (n = 14). The most common type of exercise was a combination of aerobic and resistance exercises (n = 19). The most common form of aerobic exercise was walking (n = 13) or cycling (n = 12). Most resistance exercises were targeting at major muscle groups (n = 12). Most of the studies were performed at moderate intensity (n = 14) with frequency of 2 ~ 3 times/week (n = 14). The time of a training session was 30 ~ 60 min in half studies (n = 12). The intervention duration for most studies was less than 4 weeks (n = 11). Exercise locations included home (n = 10), facility (n = 7), and a combination of home and facility (n = 5). Phone calls were utilized by nearly half of the home-based exercise studies to supervise the exercise adherence (n = 7). This review provides a comprehensive summary of preoperative physical exercise strategies. It has the potential to inform clinical practice and future studies.

PURPOSE:Early detection and intervention of lymphedema is essential for improving the quality of life of breast cancer survivors. Previous studies have shown that patients have symptoms such as arm tightness and arm heaviness before experiencing obvious limb swelling. Thus, this study aimed to develop a symptom-warning model for the early detection of breast cancer-related lymphedema. METHODS:A cross-sectional study was conducted at a tertiary hospital in Beijing between April 2017 and December 2018. A total of 24 lymphedema-associated symptoms were identified as candidate predictors. Circumferential measurements were used to diagnose lymphedema. The data were randomly split into training and validation sets with a 7:3 ratio to derive and evaluate six machine learning models. Both the discrimination and calibration of each model were assessed on the validation set. RESULTS:A total of 533 patients were included in the study. The logistic regression model showed the best performance for early detection of lymphedema, with AUC = 0.889 (0.840-0.938), sensitivity = 0.771, specificity = 0.883, accuracy = 0.825, and Brier scores = 0.141. Calibration was also acceptable. It has been deployed as an open-access web application, allowing users to estimate the probability of lymphedema individually in real time. The application can be found at https://apredictiontoolforlymphedema.shinyapps.io/dynnomapp/. CONCLUSION:The symptom-warning model developed by logistic regression performed well in the early detection of lymphedema. Integrating this model into an open-access web application is beneficial to patients and healthcare providers to monitor lymphedema status in real-time.

Background Nutritional status of nasopharyngeal carcinoma (NPC) patients lying at a high risk of nutrition defect to a great extent determines the post-treatment outcomes, which deserves thorough observation. However, limited ever-conducted studies regarding the NPC patients’ malnutrition by effective methods like the Global Leadership Initiative in Malnutrition (GLIM) criteria heavily obstructed this prospect. Our study aimed to investigate the incidence of malnutrition in NPC cancer patients using GLIM criteria and explore the relationships between malnutrition and adverse effects, survival status.Methods A retrospective chart review of 113 patients with NPC from December 2016 to October 2019. The nutritional status of NPC undergoing radiotherapy (RT) was determined by GLIM criteria at three-time points: pre-RT, in the middle of RT, and at the end of RT. The adverse effects were graded according to the Radiation Therapy Oncology Group (RTOG) scoring criteria. Kaplan–Meier method was used to compare survival outcomes, and the differences were evaluated using the log-rank test.ResultsNineteen cases (16.8%) were malnutrition before radiotherapy; overall stage ( p =0.017) and induction chemotherapy( p =0.002) contributed to pre-radiotherapy malnourishment, and the nutritional status worsened with radiotherapy. Of the phenotypic GLIM criteria, low fat free mass index (FFMI) before radiotherapy was associated with mucositis and radiodermatitis ( p <0.05). With a median follow-up of 28.3 months, the Kaplan-Meier curve indicated that malnutritional patients had significantly poorer Progress Free survival (PFS); 2-year PFS was 88.9% in the well-nourishment group vs. 62.1% in the malnutrition group ( p =0.015). In multivariate analysis, nutritional status and gender were independent prognostic factors of poorer PFS (HR 3.387, 95%CI 1.299-8.834, p =0.013 and HR 5.698, 95%CI 1.290-25.168, p =0.022).Conclusion Malnutrition is common in NPC patients, and it increases significantly during radiotherapy. Malnutrition, according to GLIM criteria, is correlated with survival. Our study could justify the effectiveness and usability of GLIM for NPC patients undergoing RT. Appropriate nutritional guidance or nutritional support should be taken to improve the NPC patients’ nutritional status during radiotherapy.

Abstract Background Nutritional status of nasopharyngeal carcinoma (NPC) patients lying at a high risk of nutrition defect to a great extent determines the post-treatment outcomes, which deserves thorough observation. However, limited ever-conducted studies regarding the NPC patients’ malnutrition by effective methods like the Global Leadership Initiative in Malnutrition (GLIM) criteria heavily obstructed this prospect. Our study aimed to investigate the incidence of malnutrition in NPC cancer patients using GLIM criteria and explore the relationships between malnutrition and adverse effects, survival status.Methods A retrospective chart review of 113 patients with NPC from December 2016 to October 2019. The nutritional status of NPC undergoing radiotherapy (RT) was determined by GLIM criteria at three-time points: pre-RT, in the middle of RT, and at the end of RT. The adverse effects were graded according to the Radiation Therapy Oncology Group (RTOG) scoring criteria. Kaplan–Meier method was used to compare survival outcomes, and the differences were evaluated using the log-rank test.ResultsNineteen cases (16.8%) were malnutrition before radiotherapy; overall stage (p=0.017) and induction chemotherapy(p=0.002) contributed to pre-radiotherapy malnourishment, and the nutritional status worsened with radiotherapy. Of the phenotypic GLIM criteria, low fat free mass index (FFMI) before radiotherapy was associated with mucositis and radiodermatitis (p<0.05). With a median follow-up of 28.3 months, the Kaplan-Meier curve indicated that malnutritional patients had significantly poorer Progress Free survival (PFS); 2-year PFS was 88.9% in the well-nourishment group vs. 62.1% in the malnutrition group (p=0.015). In multivariate analysis, nutritional status and gender were independent prognostic factors of poorer PFS (HR 3.387, 95%CI 1.299-8.834, p=0.013 and HR 5.698, 95%CI 1.290-25.168, p=0.022).Conclusion Malnutrition is common in NPC patients, and it increases significantly during radiotherapy. Malnutrition, according to GLIM criteria, is correlated with survival. Our study could justify the effectiveness and usability of GLIM for NPC patients undergoing RT. Appropriate nutritional guidance or nutritional support should be taken to improve the NPC patients’ nutritional status during radiotherapy.

Objective:To observe the changes of nutrition impact symptoms (NIS) and fat-free mass and analyze the relationship between them in patients with head and neck cancer (HNC) during radiotherapy.Methods:A convenient sampling method was adopted to select HNC patients who received radiotherapy in the outpatient clinic of department of radiotherapy for head and neck cancer in a cancer hospital in Beijing from March 2017 to January 2020. The nutrition impact symptoms (NIS) were assessed by a nutrition impact symptoms checklist and the fat free mass was assessed by bioelectrical impedance analysis at three time points: before radiotherapy (T1), during radiotherapy (T2) and at the end of radiotherapy (T3). The Generalized Estimating Equations (GEE) was used to analyze the relationship between them.Results:A total of 542 HNC patients were included in the analysis. During radiotherapy, the patients' NIS number and score presented an increasing trend, reaching the highest level and peaked at the end of radiotherapy. The change of fat-free mass showed a decreasing trend and reached the minimum at the end of radiotherapy. Patients with higher NIS scores had more percentage loss of fat-free mass.Conclusions:During radiotherapy, patients with HNC showed an increase in NIS score and lost fat-free mass. Patients with higher NIS score lost more percentage of fat-free mass, which suggested that clinical medical staff should pay attention to NIS management and take comprehensive intervention measures in time to reduce the loss of fat-free mass.

Objective: The aim of the study was to evaluate the effectiveness of palliative care simulations with standardized patients in improving the knowledge, skill performance, and critical thinking of newly hired oncology nurses. Methods: By convenience sampling, 59 newly hired oncology nurses in 2019 were enrolled as control group and 50 in 2020 as simulation group at a grade-A tertiary cancer hospital. Simulation group accepted theory (3 sessions) and simulation teaching includes three representative scenarios (6 sessions) in palliative care: pain management, special scenario communication, and turn over. Control group accepted traditional theory and skill teaching (9 sessions). Then both groups underwent four weeks clinical practice. The knowledge score was assessed by knowledge questionnaires, skill performance by standardized clinical evaluations, and critical thinking by the California Critical Thinking Disposition Inventory in both groups before and after intervention. The satisfaction of two groups was assessed by the learning satisfaction scale. Analysis of variance was conducted among the two groups by SPSS20.0. A difference was considered significant when P < 0.05. Results: After intervention, the simulation group was significantly greater in knowledge of pain management (t = -7.560, P < 0.001), and knowledge of special scenario communication (Z = 5.031, P < 0.001), as well as the skill score of turnover (Z = 2.808, P = 0.005) than the control group. The critical-thinking score was also significantly greater in the simulation group (Z = 6.229, P < 0.001). The simulation group had higher satisfaction (Z = 5.144, P < 0.001). Conclusions: Palliative care simulation with standardized patients can improve newly hired oncology nurses' knowledge, skill performance, and critical thinking and satisfaction of teaching. It would be an effective strategy to train newly hired oncology nurses.

Purpose: Our study aims to investigate dietary intake characteristics and their association with skeletal muscle mass in head and neck cancer patients treated with radiotherapy. Methods: From March 2017 to August 2018, patients with head and neck cancer who received radiotherapy at our affiliated hospital were enrolled. Dietary intake was assessed through 24-hr dietary recall and skeletal muscle mass was evaluated by bioelectrical impedance analysis at three-time points. Appendicular skeletal muscle mass was adjusted for height squared defined sarcopenia and correlated with dietary intake by generalized estimating equations (GEE). Results: This study sample comprised 287 patients [median age: 54 years; 187 (65.2%) men]. Median dietary intake at post-treatment was 14.95 kcal/kg/day energy and 0.63 g/kg/day protein. Skeletal muscle mass decreased significantly in all patients. The prevalence of sarcopenia increased from 24.4% before treatment to 46.7% at the end of treatment. Exploratory univariate GEE analysis revealed that radiotherapy time-point, malegender, age >= 60 and decreased dietary energy intake significantly impacted on muscle loss represented by the appendicular skeletal muscle index. After controlling covariates, dietary energy intake was only positively associated with muscle loss in women (P = 0.013, 95% CI = 0.003-0.027) but not in men (P = 0.788, 95% CI = - 0.007-0.009). Conclusion: While the loss in skeletal muscle is more prevalent in men receiving radiotherapy, the effects of dietary energy intake were only associated with women. A prospective randomized clinical trial is required to identify the appropriate amount of dietary energy supplement by gender in cancer patients treated with radiotherapy.