Background: Children with acute leukemia experience various distressing symptoms due to the disease and its treatment during chemotherapy. These symptoms cluster together and have negative impacts on patient outcomes. Objective: The aim of this study was to examine symptom clusters that children with acute leukemia undergoing chemotherapy are experiencing and the impact of these symptom clusters on their quality of life.Methods: A cross-sectional study design was used, and 184 Chinese children with acute leukemia who were undergoing chemotherapy were invited to participate in the study. Memorial Symptom Assessment Scale 10-18 and Pediatric Quality of Life Inventory General Core Module version 4.0 were applied. Exploratory factor analysis and multiple regression were used to identify symptom clusters and their influence on the quality of life. Results: Six symptom clusters were identified as gastrointestinal, emotional, neurological, skin mucosal, self-image disorder, and somatic cluster. The severity of each symptom cluster was negatively correlated with quality of life. Among them, gastrointestinal, emotional, and somatic clusters were significant predictors of quality of life. Conclusions: There are multiple symptom clusters in children with acute leukemia, which seriously affect children's quality of life. To relieve symptom burden and improve quality of life, nursing and medical staff should pay attention to the symptom management and control in a symptom cluster perspective. Implications for Practice: The results of this study will provide suggestions for the healthcare provider to plan for these symptoms and manage any concurrent symptoms for the successful promotion of children's quality of life.

acceptance and commitment therapy, childhood cancer, parents, psycho-oncology, psychological distress, quality of life Key points � Few experimental studies have tested Acceptance and Commitment Therapy (ACT) in parents of children with cancer � ACT is feasible considering the high rates of recruitment, adherence and retention � ACT is well accepted with high levels of satisfaction � ACT is effective in improving psychological flexibility and reducing guilt and worry � Future full-scale RCTs are warranted to confirm the results of this work This pilot RCT was conducted in the paediatric haematology and oncology inpatient department of the Children's Hospital of Soochow University in Jiangsu Province, China. It was registered with the

Aim Postoperative pain has adverse effects on children with urological problems, including sleep disturbances, incision dehiscence, bleeding and delayed recovery. Accurate parental assessment of children's behaviours and responses could help to manage postoperative pain. We aimed to implement evidence‐based practice for parental involvement in a urology ward, to increase parents' participation in children's postoperative pain management. Design The project was conducted in a paediatric urology ward using the framework and methods of the Fudan University Evidence‐Based Nursing Center's Evidence‐based Continuous Quality Improvement Model. Methods Fifteen audit criteria were used to represent best practice recommendations for parental involvement in postoperative pain management. A pre‐implementation audit was conducted with 211 randomly sampled children and parents. Obstacles, promoting factors and key strategies were analysed, and evidence‐based interventions implemented to improve compliance. A follow‐up audit using the same audit criteria was conducted with 202 children and parents to assess the effect of targeted strategies on compliance with best practice. The SQUIRE guidelines were followed. Results At the baseline audit, compliance with the evidence‐based criteria was 0%–71.5%; only five audit criteria achieved a compliance rate > 60%. After best practice implementation, the follow‐up audit showed compliance improvements for all criteria; compliance for three criteria improved to 100%. Patient or Public Contribution This best practice implementation project improved parents' participation in children's postoperative pain management. The findings demonstrate how audits can promote best practice in postoperative pain management for children. Additional studies will be conducted to address children's postoperative life quality based on best practice.

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