Background: High-fidelity simulation (HFS) has been proposed as a novel, supplemental teaching-learning strategy to enhance students' confidence and competence in nursing practice. Aim: To describe available evidence about the effects of HFS on students' confidence and competence within nursing educational programmes. Methods: A review of studies published between 2000 and 2011 was undertaken using the following databases: CINAHL, Proquest, MEDLINE, Science Direct, OVID and Chinese Academic Journal. The concepts of confidence and competence as they related to HFS in nursing education were used for screening the literature. Quantitative studies were assessed for methodological quality. Findings: Eighteen English and six Chinese studies addressed confidence and competence as outcomes of simulation and were retrieved in this review. The results of meta-analysis indicated a mixed contribution of HFS to confidence and competency with a lack of high-quality random control trials and large sample sizes. Conclusions: Although qualitative studies presented positive results, there was still insufficient evidence for supporting the notion that students' confidence and competency are enhanced through HFS. More quantitative studies are needed to demonstrate effectiveness. There was a deficit of formal measurement tools available to evaluate HFS. Most research pays no attention to validation of measurements. The increased confidence and competence after simulation may not be realized until the student experiences a real situation like the one in the simulation. More research is needed to examine the transferability of the simulation experience into real situations.

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Norovirus (NoV) is a zoonotic virus that causes diarrhea in humans and animals. Outbreaks in nosocomial settings occur annually worldwide, endangering public health and causing serious social and economic burdens. The latter quarter of 2016 witnessed the emergence of the GII.P16-GII.2 recombinant norovirus throughout Asia. This genotype exhibits strong infectivity and replication characteristics, proposing its potential to initiate a pandemic. There is no vaccine against GII.P16-GII.2 recombinant norovirus, so it is necessary to design a preventive vaccine. In this study, GII.P16-GII.2 type norovirus virus-like particles (VLPs) were constructed using the baculovirus expression system and used to conduct immunizations in mice. After immunization of mice, mice were induced to produce memory T cells and specific antibodies, indicating that the VLPs induced specific cellular and humoral immune responses. Further experiments were then initiated to understand the underlying mechanisms involved in antigen presentation. Towards this, we established co-cultures between dendritic cells (DCs) or macrophages (Mø) and naïve CD4+T cells and simulated the antigen presentation process by incubation with VLPs. Thereafter, we detected changes in cell surface molecules, cytokines and related proteins. The results indicated that VLPs effectively promoted the phenotypic maturation of Mø but not DCs, as indicated by significant changes in the expression of MHC-II, costimulatory factors and related cytokines in Mø. Moreover, we found VLPs caused Mø to polarize to the M1 type and release inflammatory cytokines, thereby inducing naïve CD4+ T cells to perform Th1 immune responses. Therefore, this study reveals the mechanism of antigen presentation involving GII.P16-GII.2 recombinant norovirus VLPs, providing a theoretical basis for both understanding responses to norovirus infection as well as opportunities for vaccine development.