Background: During the Coronavirus Disease 2019 (COVID-19) pandemic, frontline nurses face enormous mental health challenges. Epidemiological data on the mental health statuses of frontline nurses are still limited. The aim of this study was to examine mental health (burnout, anxiety, depression, and fear) and their associated factors among frontline nurses who were caring for COVID-19 patients in Wuhan, China. Methods: A large-scale cross-sectional, descriptive, correlational study design was used. A total of 2,014 eligible frontline nurses from two hospitals in Wuhan, China, participated in the study. Besides sociodemographic and background data, a set of valid and reliable instruments were used to measure outcomes of burnout, anxiety, depression, fear, skin lesion, self-efficacy, resilience, and social support via the online survey in February 2020. Findings: On average, the participants had a moderate level of burnout and a high level of fear. About half of the nurses reported moderate and high work burnout, as shown in emotional exhaustion (n = 1,218, 60.5%), depersonalization (n = 853, 42.3%), and personal accomplishment (n = 1,219, 60.6%). The findings showed that 288 (14.3%), 217 (10.7%), and 1,837 (91.2%) nurses reported moderate and high levels of anxiety, depression, and fear, respectively. The majority of the nurses (n = 1,910, 94.8%) had one or more skin lesions, and 1,950 (96.8%) nurses expressed their frontline work willingness. Mental health outcomes were statistically positively correlated with skin lesion and negatively correlated with self-efficacy, resilience, social support, and frontline work willingness. Interpretation: The frontline nurses experienced a variety of mental health challenges, especially burnout and fear, which warrant attention and support from policymakers. Future interventions at the national and organisational levels are needed to improve mental health during this pandemic by preventing and managing skin lesions, building self-efficacy and resilience, providing sufficient social support, and ensuring frontline work willingness.

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Aims: To synthesize the effectiveness of web-based psychosocial interventions on self-efficacy, anxiety, depression, quality of life (QoL), non-specific psychological and cancer-specific distress among patients with colorectal cancer (CRC). Design: A systematic review and meta-analysis. Data sources: Six databases (PubMed, PsycINFO, Embase, Scopus, CINAHL and CNKI) were searched from inception to December 2021. Review methods: Experimental/quasi-experimental studies involving patients with CRC for the improvement of aforementioned outcomes were included. Two reviewers screened and extracted the data, and assessed studies' methodological quality using risk of bias tools. Meta-analyses and narrative syntheses were performed. Results: Nineteen studies consisting of 1386 participants were identified. Cognitivebehavioural therapy delivered online was the most common trialled web-based psychosocial intervention. Meta-analyses revealed no positive effect for self-efficacy (standardized mean difference 0.93, 95% CI: 0.52 to 1.35, p < .01) and minimal benefit for QoL (mean difference [MD] 2.83, 95% CI: −0.31 to 5.98, p = .08) but significant positive effects for anxiety (MD −2.23, 95% CI: −3.31 to −1.14, p < .01) and depression (MD −2.84, 95% CI: −4.09 to −1.59, p < .01) among CRC survivors in the intervention group as compared with the control group. Narrative synthesis suggested possible benefits in reducing distress. Conclusion: Web-based psychosocial interventions are promising alternatives to conventional delivery methods in reducing patients' anxiety, depression and distress. However, evidence on self-efficacy and QoL remains inconsistent. More adequately powered, well-designed trials with targeted and theory-based interventions are required to ascertain findings. Impact: By highlighting the potential of web-based psychosocial interventions in reducing anxiety and depression among CRC survivors, this review has put forth beneficial information supporting the use and acceptance of web-based care delivery in light of COVID-19 restrictions and nationwide lockdowns. Meanwhile, the paucity of empirical support reflects the necessity of more extensive research to test and improve other health outcomes.

Background Elective colorectal cancer (CRC) surgeries offer enhanced surgical outcomes but demand high self-efficacy in prehabilitation and competency in self-care and disease management postsurgery. Conventional strategies to meet perioperative needs have not been pragmatic, and there remains a pressing need for novel technologies that could improve health outcomes. Objective The aim of this paper was to describe the development of a smartphone-based interactive CRC self-management enhancement psychosocial program (iCanManage) in order to improve health outcomes among patients who undergo elective CRC surgeries and their family caregivers. Methods A multidisciplinary international team comprising physicians, specialist nurses, a psychologist, software engineers, academic researchers, cancer survivors, patient ambassadors, and ostomy care medical equipment suppliers was formed to facilitate the development of this patient-centric digital solution. The process occurred in several stages: (1) review of current practice through clinic visits and on-site observations; (2) review of literature and findings from preliminary studies; (3) content development grounded in an underpinning theory; (4) integration of support services; and (5) optimizing user experience through improving interface aesthetics and customization. In our study, 5 participants with CRC performed preliminary assessments on the quality of the developed solution using the 20-item user version of the Mobile App Rating Scale (uMARS), which had good psychometric properties. Results Based on the collected uMARS data, the smartphone app was rated highly for functionality, aesthetics, information quality, and perceived impact, and moderately for engagement and subjective quality. Several limiting factors such as poor agility in the adoption of digital technology and low eHealth literacy were identified despite efforts to promote engagement and ensure ease of use of the mobile app. To overcome such barriers, additional app-training sessions, an instruction manual, and regular telephone calls will be incorporated into the iCanManage program during the trial period. Conclusions This form of multidisciplinary collaboration is advantageous as it can potentially streamline existing care paths and allow the delivery of more holistic care to the CRC population during the perioperative period. Should the program be found to be effective and sustainable, hospitals adopting this digital solution may achieve better resource allocation and reduce overall health care costs in the long run. Trial Registration ClinicalTrials.gov NCT04159363; https://clinicaltrials.gov/ct2/show/NCT04159363

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BackgroundRheumatoid arthritis is a chronic, progressive and debilitative inflammatory autoimmune disease that exerts negative impact on patients' physical and psychosocial wellbeing.1 This leads to an overall reduction of their quality of life.2 A review of the literature shows that no any study has examined the predictors of health-related quality of life (HRQoL) among a wide range of relevant and interrelated factors.ObjectivesTo explore the HRQoL and its predictors among patients with RA in Singapore.MethodsThis was a cross-sectional, descriptive, correlational study. A convenience sample of 108 outpatients aged 21 and above, diagnosed with RA for more than six months was recruited from a tertiary public hospital in Singapore from October 2013 to February 2014. Outcomes were measured by valid and reliable instruments of the European Quality of Life-5 dimensions, Morisky Medication Adherence Scale-8 items, Medical Outcomes Study Social Support Survey, Impact of Rheumatic Diseases on General health and Lifestyle pain-subscale, Numerical Rating Scale, Health Assessment Questionnaire-Disability Index and the Hospital Anxiety and Depression Scale. Descriptive statistics, independent t-tests, analysis of variance, Pearson Product-Moment correlation coefficient and multiple linear regression were used to analyse the data using the IBM SPSS version 21.0 for Windows (IBM Corp., Armonk, NY).ResultsParticipants had moderate HRQoL. Statistically significant difference of HRQoL was found between living status subgroups. HRQoL was positively correlated with medication adherence and overall social support. HRQoL was negatively correlated with pain, functional disability, anxiety and depression. Pain, functional disability and depression were main predictors of HRQoL among patients with RA.ConclusionsThis study highlights the impact of pain, functional disability and depression on HRQoL of patients with RA. Healthcare professionals should pay more attention to improving patients' psychological wellbeing, in addition to manage their physical symptoms, such as pain and functional ability. This study implied a need for future interventions to enhance the HRQoL of patients with rheumatoid arthritis by considering the main predictors of HRQoL.ReferencesMorris, A., Yelin, E. H., Wong, B., & Katz, P. P. (2008). Patterns of psychosocial risk and long-term outcomes in rheumatoid arthritis. Psychology, Health & Medicine, 13(5), 529-544. doi: 10.1080/13548500801927113.Sangha, O. (2000). Epidemiology of rheumatic disease. Rheumatology (Oxford), 39(Suppl. 2), 3-12.AcknowledgementsWe appreciate the support from all participants.Disclosure of InterestNone declared

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