Objective To evaluate the impact of immersive virtual reality（IVR）-based cognitive training on the cognitive function,activity of daily living（ADL） and negative emotion for people with subjective cognitive decline （SCD）,mild cognitive impairment（MCI） or Alzheimer’s disease（AD）. Methods 11 electronic databases,such as PubMed,Embase,CINAHL etc.,and clinical trials registry platforms were searched for related articles published in English and Chinese from inception until April 27th,2021. We retrieved randomized controlled trials or quasi-experience studies focused on IVR-based cognitive training in adults with SCD,MCI or AD. Literature search,study selection,data extraction and methodological quality evaluation were conducted by 2 researchers independently. Meta-analysis was performed by RevMan 5.4. Results 8 studies involving 406 patients were included. Meta-analysis indicated that IVR-based cognitive training significantly enhanced the overall cognition[SMD=0.37,95%CI（0.15,0.60）,P=0.001],short-term memory[SMD=0.62,95%CI（0.19,1.04）,P=0.005] and ADL [SMD=0.84,95%CI（0.57,1.11）,P<0.001] in people with MCI or AD. However,after IVR-based cognitive training,effects on executive function[SMD=-0.24,95%CI（-0.56,0.08）,P=0.140] and long-term memory[SMD=0.00,95%CI（-0.42,0.41）,P=0.990] were not statistically significant in people with MCI or AD,and effects on negative emotion was unclear. Moreover,there was a paucity of intervention studies on IVR-based cognitive training for SCD. Conclusion This meta-analysis suggests that IVR-based cognitive training can provide positive influences on cognitive function and ADL in people with MCI or AD. Due to limited quantity and different interventions of the included studies,more studies with larger sample sizes are required to verify the above conclusions. Moreover,more studies are needed to explore the effects of IVR-based cognitive training for people with SCD.

Objective To compare the cost-effectiveness of PICCs and PORTs from catheter insertion to removal,and to provide economic evidence to choose the more cost-effective central venous access devices（CVADs） for medium- to long-term use. Methods 444 patients who received medium- to long-term chemotherapy by PICCs in a tertiary hospital in Shanghai from January 2016 to October 2019 and 477 patients with PORTs in this hospital from January 2013 to October 2019 were included by convenience sampling method. Data was collected from a retrospective cohort study. A cost-effectiveness analysis was conducted from the hospital perspective to compare the total costs,effectiveness index,cost-effectiveness ratio and incremental cost-effectiveness ratio（ICER） of PICCs and PORTs in total dwelling time,3-6 month,6-9 month and 9-12 month dwelling time of subgroups respectively. Results For the total dwelling time,3-6 month,6-9 month and 9-12 month dwelling time,the average total cost per day or the average total cost were all significantly lower in PICCs than those in PORTs（P<0.001）. The effectiveness indexes were all slightly lower in PICCs than those in PORTs. The cost-effectiveness ratios were all lower in PICCs than those in PORTs. The ICERs were 543.50,234 411.00,120 092.25 and 109 164.00 respectively. Conclusion When catheter dwelling time was less than 12 months,PICCs were more cost-effective than PORTs. Therefore,PICCs should be recommended as the more cost-effective CVADs for medium- to long-term use from economic evaluation perspective. Furthermore,the ICER can be applied for decision-making. If the ICER was below the willingness-to-pay value,PICCs and PORTs were all acceptable cost-effective options;otherwise,PICCs were more cost-effective.

Objective To develop a blood glucose management protection motivation questionnaire for patients with gestational diabetes mellitus（GDM） and to test its reliability and validity. Methods Based on Protection Motivation Theory and according to the "Clinical Nursing Practice Guideline for Gestational Diabetes Mellitus",the primary questionnaire was formulated through literature review,patient semi-structured interviews and expert consultations. 7 experts and 408 patients with GDM were selected to test the reliability and validity. Results The protection motivation questionnaire contains 35 items in 7 dimensions. The content validity index of the questionnaire was 0.976. Cronbach’s α coefficients of the questionnaire was 0.901 and split-half reliability of the questionnaire was 0.965;Cronbach’s α coefficients of 7 dimensions ranged from 0.850 to 0.953 and split-half reliability of 7 dimensions ranged from 0.905 to 0.961. Exploratory factor analysis identified 7 principal factors,which accumulatively explained 75.32% of total variance. Confirmatory factor analysis indicated good model fit. Conclusion Blood glucose management protection motivation questionnaire has good reliability and validity,which can be used to evaluate GDM pregnant women’s blood glucose management protection motivation,and to analyze and predict their blood glucose management behavior.

Objective To establish an evaluation index system and an effectiveness index for PICC and PORT. Methods The Delphi method was adopted to identify the indicators and their weight coefficients in the evaluation index system for evaluating PICC and PORT through two rounds of expert consultation. Then the effectiveness index for evaluating the effect of PICC and PORT was established based on the synthetical index method. Results The responses rates of two rounds of Delphi consultation were all 100%. The experts’ authoritative coefficient was 0.87. The coordination coefficients of the two rounds of Delphi consultation were 0.283 and 0.306（both of them P<0.001）. The evaluation index system for evaluating the effect of PICC and PORT was established,including 3 primary indicators,9 secondary indicators,and 13 tertiary indicators. Then the effectiveness index for evaluating the effect of PICC and PORT was established based on exponential formula and synthetical index formula. Conclusion The established evaluation index system and the effectiveness index for evaluating the effect of PICC and PORT are scientific,reliable and feasible,providing a quantitative method for decision makers and administrators to make holistic comparison of the effect of PICC and PORT.