Conectar
This meta-analysis systematically evaluates the impact of negative-pressure wound therapy (NPWT) on surgical-site wound infection after vascular surgery. A comprehensive computerized search was conducted, from database inception to November 2023, in PubMed, Embase, Google Scholar, Cochrane Library, China National Knowledge Infrastructure, and Wanfang databases for randomized controlled trials (RCTs) on the application of NPWT in vascular surgery. Two researchers independently screened the literature, extracted data, and conducted quality assessments based on inclusion and exclusion criteria. Data analysis was performed using RevMan 5.4 software. A total of 11 RCTs involving 1597 vascular surgery patients were included. The analysis revealed that the application of NPWT in vascular surgery significantly reduced the incidence of wound infections (OR = 0.43, 95% CI: 0.32–0.58, p < 0.001) and complications (OR = 0.40, 95% CI: 0.27–0.58, p < 0.001). Additionally, NPWT was found to decrease the occurrence of both superficial wound infections (OR = 0.63, 95% CI: 0.36–1.12, p = 0.12) and deep wound infections (OR = 0.47, 95% CI: 0.19–1.16, p = 0.10), although these differences were not statistically significant. This study indicates that NPWT, compared with conventional treatment methods, has significant advantages in preventing postoperative wound infections and complications in vascular surgery patients and is therefore worthy of widespread clinical adoption.
This meta-analysis systematically evaluates the impact of the enhanced recovery after surgery (ERAS) concept on surgical site wound infections and postoperative complications in gastric cancer patients. A comprehensive computerized search was conducted in PubMed, Embase, Google Scholar, Cochrane Library, China National Knowledge Infrastructure and Wanfang databases for randomized controlled trials (RCTs), from database inception to November 2023, exploring the application of the ERAS concept in the perioperative period of gastric cancer surgery. Two researchers independently screened the literature, extracted data, and conducted quality assessments based on inclusion and exclusion criteria. Data analysis was performed using Stata 17.0 software. A total of 24 RCTs involving 2050 gastric cancer patients were included. The analysis revealed a significantly lower incidence of wound infections (OR = 0.23, 95% CI: 0.14–0.40, p < 0.001) and postoperative complications (OR = 0.20, 95% CI: 0.15–0.27, p < 0.001) in the ERAS group compared to the standard care group. This study demonstrates that the application of the ERAS concept during the perioperative period in gastric cancer surgery can effectively reduce the occurrence of wound infections and complications, thereby facilitating postoperative recovery.
by Wei Gao, Linlin Sun, Jinwei Gai, Yinan Cao, Shuqun Zhang
BackgroundThe triple negative breast cancer (TNBC) is the most malignant subtype of breast cancer with high aggressiveness. Although paclitaxel-based chemotherapy scenario present the mainstay in TNBC treatment, paclitaxel resistance is still a striking obstacle for cancer cure. So it is imperative to probe new therapeutic targets through illustrating the mechanisms underlying paclitaxel chemoresistance.
MethodsThe Single cell RNA sequencing (scRNA-seq) data of TNBC cells treated with paclitaxel at different points were downloaded from the Gene Expression Omnibus (GEO) database. The Seurat R package was used to filter and integrate the scRNA-seq expression matrix. Cells were further clustered by the FindClusters function, and the gene marker of each subset was defined by FindAllMarkers function. Then, the hallmark score of each cell was calculated by AUCell R package, the biological function of the highly expressed interest genes was analyzed by the DAVID database. Subsequently, we performed pseudotime analysis to explore the change patterns of drug resistance genes and SCENIC analysis to identify the key transcription factors (TFs). Finally, the inhibitors of which were also analyzed by the CTD database.
ResultsWe finally obtained 6 cell subsets from 2798 cells, which were marked as AKR1C3+, WNT7A+, FAM72B+, RERG+, IDO1+ and HEY1+HCC1143 cell subsets, among which the AKR1C3+, IDO1+ and HEY1+ cell subsets proportions increased with increasing treatment time, and then were regarded as paclitaxel resistance subsets. Hallmark score and pseudotime analysis showed that these paclitaxel resistance subsets were associated with the inflammatory response, virus and interferon response activation. In addition, the gene regulatory networks (GRNs) indicated that 3 key TFs (STAT1, CEBPB and IRF7) played vital role in promoting resistance development, and five common inhibitors targeted these TFs as potential combination therapies of paclitaxel were identified.
ConclusionIn this study, we identified 3 paclitaxel resistance relevant IFs and their inhibitors, which offers essential molecular basis for paclitaxel resistance and beneficial guidance for the combination of paclitaxel in clinical TNBC therapy.
Multiple myeloma (MM) is a malignant plasma cell disorder. The most widely accepted staging system for MM is the revised International Staging System based on cytogenetic and clinical biomarkers. The circulating clonal plasma cells (CPCs) were reported to have potential prognostic impact on MM. Among various diagnostic approaches, multiparametric flow cytometry (FCM) offers heightened sensitivity, minimal invasiveness and reproducibility. We conducted a meta-analysis to evaluate the prognostic value of quantifying CPCs via FCM in newly diagnosed symptomatic MM (NDMM) patients.
Systematic review and meta-analysis.
PubMed, Web of Science, Embase and references of included studies.
We included observational studies that evaluated the prognostic value of CPCs detected by FCM in NDMM.
Data were screened and extracted independently by two investigators. The pooled results originated from random effects models. The primary endpoint was overall survival (OS). The secondary endpoint was progression-free survival (PFS). To evaluate the prognostic value of CPCs in NDMM, HRs and their 95% CI for both OS and PFS were derived using COX multivariable models. These values were then used to compute the pooled estimated effect.
Our meta-analysis encompassed a total of 2704 NDMM patients from 11 studies up to 27 August 2022. The pooled HR for OS and PFS in CPC-positive (CPCs+) group and CPC-negative group were 1.95 (95% CI 1.24 to 3.07) and 2.07 (95% CI 1.79 to 2.39), respectively. The autologous stem cell transplantation (ASCT) failed to eliminate the adverse impact on OS and PFS. The heterogeneity may stem from the use of novel agents or traditional chemotherapy as initial treatment.
This meta-analysis indicates CPCs+ had an adverse impact on the prognosis of NDMM patients in the total population, and the adverse impact could not be eliminated by ASCT.
CRD42021272381.
Non-communicable diseases (NCDs) are rising in low-income and middle-income countries, including Malawi. To inform policy-makers and planners on the preparedness of the Malawian healthcare system to respond to NCDs, we estimated NCD service readiness in publicly financed healthcare facilities in Malawi.
We analysed data from 564 facilities surveyed in the 2019 Harmonised Health Facility Assessment, including 512 primary healthcare (PHC) and 52 secondary and tertiary care (STC) facilities. To characterise service readiness, applying the law of minimum, we estimated the percentage of facilities with functional equipment and unexpired medicines required to provide NCD services. Further, we estimated permanently unavailable items to identify service readiness bottlenecks.
Fewer than 40% of PHC facilities were ready to deliver services for each of the 14 NCDs analysed. Insulin and beclomethasone inhalers had the lowest stock levels at PHC facilities (6% and 8%, respectively). Only 17% of rural and community hospitals (RCHs) have liver and kidney diagnostics. STC facilities had varying service readiness, ranging from 27% for managing acute diabetes complications to 94% for chronic type 2 diabetes management. Only 38% of STC facilities were ready to manage chronic heart failure. Oral pain medicines were widely available at all levels of health facilities; however, only 22% of RCHs and 29% of STCs had injectable morphine or pethidine. Beclomethasone was never available at 74% of PHC and 29% of STC facilities.
Publicly financed facilities in Malawi are generally unprepared to provide NCD services, especially at the PHC level. Targeted investments in PHC can substantially improve service readiness for chronic NCD conditions in local communities and enable STC to respond to acute NCD complications and more complex NCD cases.
To investigate factors that differentiate elderly adults in rural China who accept free vision screening and cataract surgery from those who could benefit from vision care but refuse it when offered.
We conducted a population-based, cross-sectional study between October and December 2016. Logistic regression models were used to examine the predictors of accepting free vision screening and cataract surgery.
Rural communities in Handan, China.
Adults aged 50 years or older, with presenting visual acuity ≤6/18 in the better seeing eye, suspected by examining ophthalmologist to be due to cataract.
Among 613 persons with cataract identified on a population basis, 596 (97.2%) completed the household survey (mean (SD) age, 71.5 (10.0) years; 79.8% female). A total of 214 persons (35.9%) refused participation, while 382 (64.1%) took part in the vision screening. A total of 193 (50.5%) participants were found eligible for surgery, while 189 (49.5%) were not. Among 99 randomly selected participants who were offered immediate free surgery, surgery was accepted by 77 participants (77.8%) and refused by 22 (22.2%). In the multivariate model, being engaged in income-generating activities (p
Our results suggest that refusal of basic eye examinations may be at least as important a determinant of low surgical rates in rural China as lack of acceptance of surgery itself.
This meta-analysis investigates the effect of dexmedetomidine on postoperative wound healing in neurosurgical patients. A thorough literature search resulted in the selection of seven studies from an initial pool of 1546 records. The analysis focused on wound healing outcomes, evaluated by the Redness, Oedema, Ecchymosis, Discharge, Approximation (REEDA) scale and the Manchester Scar Scale (MSS). Results indicated significant improvements in the dexmedetomidine group: the REEDA scale scores at day seven post-surgery showed a Standardized Mean Difference group (SMD = −16.18, 95% CI: [−22.30, −10.06], p < 0.01), and the MSS scores at 3 months post-operation demonstrated an (SMD = −8.95, 95% CI: [−14.27, −3.62], p < 0.01). These findings suggest that dexmedetomidine may enhance wound healing and reduce scar formation in neurosurgical patients. Bias assessment indicated a low risk of bias across the studies.
by M. Rifqi Rokhman, Bustanul Arifin, Benedetta Broggi, Anne-Fleur Verhaar, Zulkarnain Zulkarnain, Satibi Satibi, Dyah Aryani Perwitasari, Cornelis Boersma, Qi Cao, Maarten J. Postma, Jurjen van der Schans
BackgroundThis study investigated the association between elevated risk of developing diabetes and impaired health-related quality of life (HRQoL) in the Indonesian population.
MethodsA cross-sectional study was conducted on 1,336 Indonesians from the general population who had no previous diagnosis of diabetes. Utility score to represent HRQoL was measured using the EuroQol 5-dimension, while the risk for developing diabetes was determined using the Finnish Diabetes Risk Score (FINDRISC) instrument. All participants underwent a blood glucose test after fasting for 8 hours. The association between FINDRISC score and HRQoL adjusted for covariates was analysed using multivariate Tobit regression models. Minimal clinically important differences were used to facilitate interpretation of minimal changes in utility score that could be observed.
ResultsThe median (interquartile range) of the overall FINDRISC score was 6 (7), while the mean (95% confidence intervals) of the EQ-5D utility score was 0.93 (0.93–0.94). Once adjusted for clinical parameters and socio-demographic characteristics, participants with a higher FINDRISC score showed a significantly lower HRQoL. No significant association was detected between fasting blood glucose level categories and HRQoL. A difference of 4–5 points in the FINDRISC score was considered to reflect meaningful change in HRQoL in clinical practice.
ConclusionAn elevated risk of developing diabetes is associated with a lower HRQoL. Therefore, attention should be paid not only to patients who have already been diagnosed with diabetes, but also to members of the general population who demonstrate an elevated risk of developing diabetes. This approach will assist in preventing the onset of diabetes and any further deterioration of HRQoL in this segment of the Indonesian population.
by Xiaoxian Pei, Ling Zhang, Dan Liu, Yajuan Wu, Xiaowei Li, Ying Cao, Xiangdong Du
Traumatic brain injury (TBI) occurs worldwide and is associated with high mortality and disability rate. Apoptosis induced by TBI is one of the important causes of secondary injury after TBI. Notoginsenoside R1 (NGR1) is the main phytoestrogen extracted from Panax notoginseng. Many studies have shown that NGR1 has potent neuroprotective, anti-inflammatory, and anti-apoptotic properties and is effective in ischemia-reperfusion injury. Therefore, we investigated the potential neuroprotective effects of NGR1 after TBI and explored its molecular mechanism of action. A rat model of TBI was established using the controlled cortical impact (CCI) method. The expression levels of Bcl-2, Bax, caspase 3, and ERK1/2-related molecules in the downstream pathway were also detected by western blotting. The expression levels of pro-inflammatory cytokines were detected by real-time quantitative PCR. Nissl staining was used to clarify the morphological changes around the injury foci in rats after TBI. Fluoro-Jade B (FJB) and terminal deoxynucleotidyl transferase (TdT) dUTP Nick-End Labeling (TUNEL) fluorescence staining were used to detect the apoptosis of neural cells in each group of rats. The results showed that NGR1 administration reduced neurological deficits after TBI, as well as brain edema and brain tissue apoptosis. It also significantly inhibited the expression of pro-inflammatory cytokines. Furthermore, NGR1 decreased the expression levels of extracellular signal-regulated kinase (ERK) and p-RSK1, which are phosphorylated after trauma. This study suggests that NGR1 can improve neuronal apoptosis in brain injury by inhibiting the ERK signaling pathway. NGR1 is a potential novel neuroprotective agent for the treatment of secondary brain injury after TBI.Frailty has been currently considered as a multidimensional concept, including physical, cognitive and social frailty. Frailty has also been associated with a range of adverse events, which might increase the risks of disability, falls, fractures, delirium and death. Increasing evidence has shown that multicomponent exercise training can improve physical and cognitive function, delay or reverse frailty. However, there is still a lack of exercise intervention programmes for the frail older adults in China. This trial aims to investigate the effects of the muscle-building and antifrailty exercise combined with Baduanjin on the physical function of frail older adults, as well as the effectiveness and safety of the intervention.
This study is a prospective randomised controlled trial. A total of 192 patients, aged 70 years or older, who are diagnosed as prefrailty or frailty based on the Fried criteria will be included. Prior written and informed consent will be obtained from every subject. These subjects will be randomly assigned to the exercise intervention group (n=96) and the control group (n=96). The exercise intervention group will undergo different exercise programmes for different levels of physical function. They will perform the muscle-building and antifrailty exercise three times per week for 30–60 min for 24 weeks. The control group will implement health education on frailty and maintain the old lifestyle without any intervention.
The primary outcomes include the change in frailty and functional capacity, assessed according to the Fried Scale and the Short Physical Performance Battery. Secondary outcomes include the changes in body composition, Activities of daily living, Mini-Mental State Examination, The Geriatric Depression Scale-15 and the haematological indicators.
The study has been approved by the Medical Ethics Committee of the PLA General Hospital (approval no.: S2022-600-02).
ChiCTR2300070535.
This study aimed to assess the prevalence and related factors of myopia among school-aged children after COVID-19 pandemic.
Cross-sectional study.
Pudong New Area, Shanghai.
1722 children aged 7–9 randomly selected from 8 primary schools were screened from 1 February 2023 to 30 April 2023.
Children’s height, weight and eye parameters were examined. Myopia was defined as a cycloplegic spherical equivalent ≤–0.50 dioptres in either eye. A vision-related behaviour questionnaire was applied to investigate the associations between myopia and its risk factors.
Of the 1722 individuals enrolled, 25.6% (456) had myopia. After adjusting other characteristics, the following factors were associated with an increased rate of myopia: age (9 years vs 7 years, adjusted OR (AOR) 1.84, 95% CI 1.18 to 2.85, p=0.007), parental myopia status (both myopia vs none, AOR 5.66, 95% CI 3.71 to 8.63, p
The prevalence of myopia is of concern among young school-aged children after COVID-19. Correcting eye use behaviour and improving sleep habits may reduce myopia. Also, gender differences should be considered in prevention strategies for children’s myopia.
To compare anaesthesia-related outcomes between patients monitored by newly recruited nurse anaesthetists and those monitored by newly recruited anaesthesiologists.
This was a retrospective study.
We conducted a retrospective study that collected demographic information on newly recruited nurse anaesthetists and anaesthesiologists between 2017 and 2022 and recorded information on patients within 6 months of monitoring. Postoperative pain, emergency agitation, nausea, and vomiting were designated anaesthesia-related outcomes. Propensity score matching was used to adjust for covariates. The study adhered to the STROBE guidelines.
The study's statistical analysis included 4483 patients monitored by 22 newly recruited nurse anaesthetists and 4959 patients monitored by 23 newly recruited anaesthesiologists. Compared with patients monitored by newly trained anaesthesiologists, the patients monitored by nurse anaesthetists were younger (42.07 ± 20.00 vs. 47.39 ± 18.45 years, p < 0.001) and had a lower body mass index (23.56 ± 4.46 vs. 24.19 ± 4.25, p < 0.001). Patients monitored by anaesthesiologists had a greater proportion of women (61.62% vs. 59.25%, p < 0.001), a high proportion of ASA III and ASA IV (17.1% vs. 8.88%, p < 0.001), and a longer mean surgery duration (78.65 ± 59.01 vs. 70.70 ± 60.65 min, p < 0.001). After propensity score matching was used to adjust for covariates, no statistically significant differences were found in the prevalence of postoperative pain, emergency agitation, or postoperative nausea and vomiting between the two groups (p < 0.05).
Nurse anaesthetists monitoring alone during anaesthesia maintenance is feasible and safe. The two groups had no significant differences in the incidence of postoperative pain, emergency agitation, or postoperative nausea and vomiting.
The shortage of anaesthesiologists leads to heavy work burden and high incidence of occupational burnout among anaesthesiologists. The study found that it was safe for nurse anaesthetists to perform anaesthetic monitoring alone in the operating room under the supervision of the attending anaesthesiologist and did reduce the burden of anaesthesiologists’ work. The results of the current study contribute to the expansion of occupational categories for nurse anaesthetists in countries where anaesthesiologists are in short supply. It provides new ideas for hospital administrators and policy-makers to formulate medical and nursing service policies.
To explore nurse-midwives' perceptions of safety culture in maternity hospitals.
A descriptive phenomenological study was conducted using focus groups and reported following the Consolidated Criteria for Reporting Qualitative Research.
Data were obtained through two online focus group sessions in June 2022 with 13 nurse-midwives from two maternity hospitals in the central region of Portugal. The first focus group comprised 6 nurse-midwives, and the second comprised 7 nurse-midwives. Qualitative data were analysed using content analysis.
Two main themes emerged from the data: (i) barriers to promoting a safety culture; (ii) safety culture promotion strategies. The first theme is supported by four categories: ineffective communication, unproductive management, instability in teams and the problem of errors in care delivery. The second theme is supported by two categories: managers' commitment to safety and the promotion of effective communication.
The study results show that the safety culture in maternity hospitals is compromised by ineffective communication, team instability, insufficient allocation of nurse-midwives, a prevailing punitive culture and underreporting of adverse events. These highlight the need for managers to commit to providing better working conditions, encourage training with the development of a fairer safety culture and encourage reporting and learning from mistakes. There is also a need to invest in team leaders who allow better conflict management and optimization of communication skills is essential.
Disseminating these results will provide relevance to the safety culture problem, allowing greater awareness of nurse-midwives and managers about vulnerable areas, and lead to the implementation of effective changes for safe maternal and neonatal care.
There was no patient or public contribution as the study only concerned service providers, that is, nurse-midwives themselves.
Diabetic foot ulcer often leads to amputation, and both nutritional status and immune function have been associated with this process. We aimed to investigate the risk factors of diabetic ulcer-related amputation including the Controlling Nutritional Status score and neutrophil-to-lymphocyte ratio biomarker. We evaluated data from hospital in patients with diabetic foot ulcer, performing univariate and multivariate analyses to screen for high-risk factors and Kaplan–Meier analysis to correlate high-risk factors with amputation-free survival. Overall, 389 patients underwent 247 amputations over the follow-up period. After correction to relevant variables, we identified five independent risk factors for diabetic ulcer-related amputation: ulcer severity, ulcer site, peripheral arterial disease, neutrophil-to-lymphocyte ratio and nutritional status. Amputation-free survival was lower for the moderate-to-severe versus mild cases, for the plantar forefoot versus hindfoot location, for the concomitant peripheral artery disease versus without and in the high versus low neutrophil-to-lymphocyte ratio (all p < 0.01). The results showed that ulcer severity (p < 0.01), ulcer site (p < 0.01), peripheral artery disease (p < 0.01), neutrophil-to-lymphocyte ratio (p < 0.01) and Controlling Nutritional Status score (p < 0.05) were independent risk factors for amputation in diabetic foot ulcer patients and have predictive values for diabetic foot ulcer progression to amputation.
With the outbreak and pandemic of coronavirus disease-2019 (COVID-19), a huge number of people died of it. Apart from lung injuries, multiple organs have been confirmed to be impaired. In COVID-19 time, primary wound healing processes always prolong, however, its possible underlying mechanisms are still unclear. Therefore, to overcome this clinical problem, clarifying its underlying mechanisms clearly is necessary and urgently needed. In this review, we summarized that COVID-19 can prolong primary wound healing by inducing excessive inflammation and oxidative stress, disturbing immune system and haematological system, as well as influencing the functions and viability of epidermal stem cells (ESCs). Otherwise, we summarized that the strict control measures of blocking up COVID-19 pandemic can also have side effects on primary wound healing process.
This study aims to compare perceived family functioning between Chinese patients who had an acute ischaemic stroke (AIS) and family caregivers, and explore the association between family functioning and patients’ depressive symptoms.
This is a cross-sectional study design.
Stroke centres of two tertiary hospitals in Nanjing, China.
One hundred and sixty-nine dyads of patients who had an AIS and family caregivers.
Family functioning of patients who had an AIS and their primary family caregivers was assessed by the Family Assessment Device (FAD, Chinese version). Depressive symptoms of patients who had an AIS was assessed by the Centre for Epidemiological Studies Depression Scale. We test the agreement and differences in family functioning. Multivariate linear regression models were used to test the association of differences of family functioning within dyads with patients’ depressive symptoms.
AIS families demonstrated unhealthy family functioning. A total of 115 patients (76.9%) and 124 caregivers (73.4%) had a score of 2 or higher in FAD-general functioning (GF), indicating unhealthy family functioning. The intraclass correlation coefficient of FAD subdomain between patients who had an AIS and caregivers ranged from 0.15 to 0.55, which indicating the agreement of family functioning within dyads was poor to moderate. There was a significant difference between the FAD-GF scores of the patients and those of their caregivers (Z=–2.631, p=0.009), with caregivers reporting poorer general family functioning. Poor family functioning and greater difference of perceived family functioning within dyads were related to higher level of patients’ depressive symptoms (β=5.163, p
These findings indicate that healthcare professionals should assess family functioning in both patients who had a stroke and caregivers. Improvement of family function and decreasing discrepancies within dyads may be helpful for relieving patients’ depressive symptoms.
by Jimmy Zhang, Anh H. Nguyen, Daniel Jilani, Ramses Seferino Trigo Torres, Lauren Schmiess-Heine, Tai Le, Xing Xia, Hung Cao
Chronic methamphetamine use, a widespread drug epidemic, has been associated with cardiac morphological and electrical remodeling, leading to the development of numerous cardiovascular diseases. While methamphetamine has been documented to induce arrhythmia, most results originate from clinical trials from users who experienced different durations of methamphetamine abuse, providing no documentation on the use of methamphetamine in standardized settings. Additionally, the underlying molecular mechanism on how methamphetamine affects the cardiovascular system remains elusive. A relationship was sought between cardiotoxicity and arrhythmia with associated methamphetamine abuse in zebrafish to identify and to understand the adverse cardiac symptoms associated with methamphetamine. Zebrafish were first treated with methamphetamine 3 times a week over a 2-week duration. Immediately after treatment, zebrafish underwent electrocardiogram (ECG) measurement using an in-house developed acquisition system for electrophysiological analysis. Subsequent analyses of cAMP expression and Ca2+ regulation in zebrafish cardiomyocytes were conducted. cAMP is vital to development of myocardial fibrosis and arrhythmia, prominent symptoms in the development of cardiovascular diseases. Ca2+ dysregulation is also a factor in inducing arrhythmias. During the first week of treatment, zebrafish that were administered with methamphetamine displayed a decrease in heart rate, which persisted throughout the second week and remained significantly lower than the heart rate of untreated fish. Results also indicate an increased heart rate variability during the early stage of treatment followed by a decrease in the late stage for methamphetamine-treated fish over the duration of the experiment, suggesting a biphasic response to methamphetamine exposure. Methamphetamine-treated fish also exhibited reduced QTc intervals throughout the experiment. Results from the cAMP and Ca2+ assays demonstrate that cAMP was upregulated and Ca2+ was dysregulated in response to methamphetamine treatment. Collagenic assays indicated significant fibrotic response to methamphetamine treatment. These results provide potential insight into the role of methamphetamine in the development of fibrosis and arrhythmia due to downstream effectors of cAMP.Vicarious trauma can significantly affect the physical and mental health of nurses, as well as their ability to provide quality of care. However, the concept of vicarious trauma has received limited attention and remains controversial in the nursing context.
The purpose of this study was to clarify and define the concept of vicarious trauma as it pertains to the nursing context.
The Schwartz and Kim's three-stage hybrid concept analysis method was used to define the concept. In the theoretical phase, PubMed, CINAHL, OVID, Medline, Embase, Web of Science, Scopus, ProQuest, PsycINFO, CNKI database, VIP database and Wanfang database were used using keywords “nurs*”and “vicarious trauma*”, resulting in a total of 25 papers. In the fieldwork phase, we conducted participatory observations in three hospitals and semi-structured in-depth interviews with 18 clinical nurses from seven cities. In the analysis phase, the results of the previous two phases were integrated to develop a comprehensive concept of vicarious trauma in nursing.
Based on the results of the theoretical and field phases, we propose the concept of vicarious trauma in nursing as follows: vicarious trauma is a psychological trauma impacting nurses' cognitive schema which they may experience in clinical settings or on social media, resulting from deeply empathize with the physical or emotional trauma of patients, family, or colleagues, such as patients' physical injuries or death, family's grieving feelings and colleagues' received threats and attacks. Positively, vicarious trauma can transform into vicarious post-trauma growth through repositioning and connection, nourishing nurses and promoting their personal and professional development.
The concept of vicarious trauma in nursing is multidimensional and holistic. This study clarifies the concept of vicarious trauma in nursing using the hybrid concept analysis, providing a framework for future research and practice on vicarious trauma in the nursing field.
Nurses contributed to the conduct of the study by participating in the data collection via interviews.
by Xiaobin Yuan, Ruizhi Xue, Xiaoming Cao
IntroductionPerineal extramammary paget’s disease (EMPD) is characterized with high recurrence rate. Although numerous therapeutic measures for this disease have been reported so far, it is unknown whether there is significant difference in their recurrence-preventing efficiency. This study aims to compare the recurrence outcomes of reported perineal EMPD treatments.
MethodsWe searched public databases of for published studies concerning perineal EMPD treatments. After screening by inclusion and exclusion criteria, we extracted the data relevant to recurrence rate, and conducted network meta-analysis (NMA) by using Bayesian random-effects approach.
ResultsOur analysis included 29 previous studies (involving both male and female patients) and 11 treatment designs which are wide local excision (WLE), local excision (LE), Mohs micrographic surgery (MMS), radiotherapy (RT), radical vulvectomy (RV), photodynamic therapy (PDT), lasers (LS), imiquimod, and WLE+RT, WLE+PDT, WLE+LS. Comparing with WLE, the MMS showed significant advantage in reducing recurrence [OR: 0.18 (0.03–0.87)], while none of the rest treatments has statistically significant results. After removing outlier studies, MMS still has the significant advantages [OR: 0.35 (0.11–0.82)], and LE turned to be the treatment with worst performance [OR: 13 (2.50–110)]. Covariance analysis of follow-up length, gender differences, and lesion locations indicated only short follow-up time could affect the recurrence statistics, which tend to conceal the real differences. Funnel plot demonstrated there is no significant small study effect.
ConclusionMMS has the best performance on reducing perineal EMPD recurrence, while LE exhibits the worst capability in such regard. Recurrence-preventing abilities of other treatments have no significant difference between each other.
FreshRSS 