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☐ ☆ ✇ BMJ Open

Psychological adjustment to death anxiety: a qualitative study of Chinese patients with advanced cancer

Por: Chen · F. · Ou · M. · Xia · W. · Xu · X. — Marzo 9th 2024 at 02:25
Objectives

Death anxiety (DA) refers to the negative emotions experienced when a person reflects on the inevitability of their own death, which is common among patients with cancer. It is crucial to understand the causes, coping styles and adjustment processes related to DA. The purpose of this qualitative study is to explore the adaptation process and outcome of patients with advanced cancer with DA and to provide evidence-based support for the development of targeted intervention measures to improve the mental health of such patients.

Design

This cross-sectional qualitative study sampled patients with advanced cancer (n=20). Grounded theory procedures were used to analyse transcripts and a theoretical model generated.

Setting

All interviewees in this study were from a tertiary oncology hospital in Hunan Province, China. The data analysis followed the constructive grounded theory method, involving constant comparison and memo writing.

Participants

A purposive and theoretical sampling approach was used to recruit 20 patients with advanced cancer with diverse characteristics.

Results

A total of 20 participants were included in the study. Four stages of DA in patients with advanced cancer were extracted from the interview data: (1) death reminder and prominence; (2) perception and association; (3) defence and control; (4) transformation and Acceptance.

Conclusions

This study highlights the psychological status and coping strategies of dynamic nature of patients with advanced cancer when confronted with negative emotions associated with death. It emphasises the importance of timely identification of DA in psychological nursing for patients with advanced cancer and the need for targeted psychological interventions based on their specific psychological processes.

Implications

Knowing interventions that aim to promote the integration of internal and external resources, enhance self-esteem and facilitate a calm and accepting attitude towards death could ultimately reduce the overall DA of patients with advanced cancer.

☐ ☆ ✇ BMJ Open

Survival outcomes following complete mediastinal lymphadenectomy or selective mediastinal lymphadenectomy in patients with stage I-IIIA non-small cell lung cancer: protocol for a systematic review and meta-analysis

Por: Xu · J. · Lai · J. · Huang · X. · Ren · Y. · Chen · Q. · Li · W. — Marzo 9th 2024 at 02:25
Introduction

Lung cancer remains the largest cause of cancer-related deaths worldwide. Surgical removal of non-small cell lung cancer (NSCLC) has the potential to achieve a cure, although there is ongoing debate regarding the significance of removing mediastinal nodes and the optimal extent of lymph node excision. The purpose of this research is to assess the survival outcomes in patients diagnosed with stage I–IIIA NSCLC who received either complete mediastinal lymphadenectomy (CML) or selective mediastinal lymphadenectomy (SML).

Methods and analysis

The protocol follows the guidelines recommended in Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols, and this meta-analysis will be conducted in accordance with the standard methodology recommended by the Cochrane Collaboration and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidance. We will conduct a comprehensive search for randomised controlled trials and non-randomised studies examining the effectiveness of CML compared with SML in patients with stage I–IIIA NSCLC. Two authors will perform a comprehensive search of the MEDLINE/PubMed, Embase, the Cochrane Library, CNKI, WanFang, Sinomed, VIP and Web of Science databases. There will be no restrictions on language or publication date, and the search will be conducted on 10 April 2024, with ongoing searches for new research. Reference lists will also be checked and pertinent journals will be hand searched. The primary outcomes include overall survival (OS) and disease-free survival (DFS), while the secondary outcomes consist of 1-year, 3-year and 5-year OS rates and 1-year, 3-year and 5-year DFS rates. Two independent reviewers will screen, extract data, assess quality and evaluate the potential for bias in the selected research, with a third acting as arbitrator. Subgroup analyses and sensitivity analyses are planned. The quality of the evidence will be evaluated using Grading of Recommendations Assessment, Development and Evaluation. Review Manager V.5.4 will be used for the analysis and synthesis process.

Ethics and dissemination

Ethical review and approval are not necessary for this study because it is based on a secondary analysis of the literature. The results will be submitted for reporting in a peer-reviewed publication.

Study registration

Open Science Framework (https://doi.org/10.17605/OSF.IO/PN7UQ).

☐ ☆ ✇ BMJ Open

Evaluation of the efficacy and safety of a precise thymalfasin-regulated PRaG regimen for advanced refractory solid tumours: protocol for the open-label, prospective, multicentre study (PRaG5.0 study)

Por: Kong · Y. · Chen · R. · Xu · M. · Zhang · J. · Chen · G. · Hong · Z. · Zhang · H. · Dai · X. · Ma · Y. · Zhao · X. · Peng · Y. · Zhang · C. · Xing · P. · Zhang · L. — Marzo 9th 2024 at 02:25
Introduction

The PRaG regimen, which consists of hypofractionated radiotherapy combined with a programmed cell death-1/programmed cell death ligand-1 (PD-1/PD-L1) inhibitor and granulocyte-macrophage colony stimulating factor (GM-CSF), has been demonstrated to have a survival benefit in patients with advanced solid tumours who have failed at least two lines of treatment. Nonetheless, lymphopenia poses an impediment to the enduring efficacy of PD-1/PD-L1 inhibitor therapy. Adequate lymphocyte reserves are essential for the efficacy of immunotherapy. Coupling the PRaG regimen with immunomodulatory agents that augment the number and functionality of lymphocytes may yield further survival benefits in this cohort of patients.

Objective

The aim of this study is to investigate the effectiveness and safety of a meticulously thymalfasin-controlled PRaG regimen in patients with advanced and chemotherapy-resistant solid tumours.

Methods and analysis

The study has a prospective, single-arm, open-label, multicentre design and aims to recruit up to 60 patients with histologically confirmed advanced solid tumours that have relapsed or metastasised. All eligible patients will receive a minimum of two cycles of the PRaG regimen comprising thymalfasin followed by maintenance treatment with a PD-1/PD-L1 inhibitor and thymalfasin for 1 year or until disease progression. Patients will be monitored according to the predetermined protocol for a year or until disease progression after initiation of radiotherapy.

Ethics and dissemination

The study protocol was approved by the Ethics Committee of the Second Affiliated Hospital of Soochow University, on 25 November 2022 (JD-LK-2022-151-01) and all other participating hospitals. Findings will be disseminated through national and international conferences. We also plan to publish our findings in high-impact peer-reviewed journal.

Trial registration number

NCT05790447.

☐ ☆ ✇ BMJ Open

Effect and safety of electroacupuncture on weight loss in obese patients with pre-diabetes: study protocol of a randomised controlled trial

Por: Li · X. · Lin · J. · Hu · C. · Liu · B. · Li · F. · Li · J. · Zeng · X. · Li · S. · Mi · Y. · Yin · X. · Xu · S. — Marzo 9th 2024 at 02:25
Introduction

Obesity has been identified as a significant risk factor for several chronic conditions, including diabetes, tumours and cardiovascular disease, and has been associated with increased mortality rates. Despite the well-established clinical practice of electroacupuncture (EA) as a potential treatment option for obesity, its efficacy remains questionable, primarily due to the paucity of empirical evidence supporting its therapeutic benefits.

Methods and analysis

The present study aims to investigate the efficacy and safety of EA for weight loss in obese individuals with pre-diabetes, using a randomised, placebo-controlled clinical trial design. A total of 256 eligible patients will be randomly assigned to one of two groups: EA (comprising EA treatment with health education) or superficial acupuncture (SA) (comprising SA treatment with health education). The intervention will be administered three times per week for the initial 12 weeks, two times per week for the subsequent 8 weeks and one time per week for the final 4 weeks, with a 24-week follow-up period. The primary outcome measure will be the percentage of patients who achieve a reduction of 10% or more in their body weight at week 24. Secondary outcome measures will include changes in body weight and body mass index, blood test results, data collected by the body composition analyser, size of adipose tissue scanned by MRI of the abdomen and the Impact of Weight on Quality of Life, the 21-item Three-Factor Eating Questionnaire-Revised and the Food Craving Questionnaire-Trait. The Treatment Emergent Symptom Scale will be employed to monitor every adverse reaction from baseline to follow-up.

Ethics and dissemination

This trial has received ethical clearance from the Ethics Committee of Shanghai Municipal Hospital of Traditional Chinese Medicine under the registration number 2021SHL-KY-74. All participants will provide their written informed consent prior to their enrolment. The findings of this investigation will be disseminated through peer-reviewed publications and scholarly conferences.

Trial registration number

NCT05237089.

☐ ☆ ✇ BMJ Open

Home-based mobile-guided exercise-based cardiac rehabilitation among patients undergoing transcatheter aortic valve replacement (REHAB-TAVR): protocol for a randomised clinical trial

Por: Shen · Z. · Mi · S. · Huang · C. · Zhou · D. · Pan · W. · Xu · X. · Lin · Y. · Zhang · Y. — Marzo 7th 2024 at 11:36
Introduction

Transcatheter aortic valve replacement (TAVR) is a standard treatment for aortic stenosis, particularly in older adults. Reduced exercise capacity and frailty significantly impact outcomes in TAVR patients, yet current management lacks strategies to address these issues. This study aims to assess the effectiveness of home-based mobile-guided exercise-based cardiac rehabilitation in TAVR patients, led by a multidisciplinary team with clear progression milestones.

Methods and analysis

The study involves 90 patients aged 60–89 in a single centre who will be randomised to a 3-month novel multidomain exercise intervention or routine care. Outcome assessors will be blinded towards group allocation. The primary outcome is the 6-min walk distance at month 3. The secondary outcomes include the 6-min walk distance at month 6, physical function measured by total Short Physical Performance Battery score and exercise adherence measured by the Exercise Adherence Rating Scale at months 3 and 6. Additional outcome measures, including rehospitalisations, death, handgrip strength, frailty (Fried Criteria and Essential Toolset), cognitive function (Mini-Mental State Examination), quality of life (EuroQol 5-Dimension 5-Level), nutritional status (Mini-Nutritional Assessment), anxiety (General Anxiety Disorder-7), depression (Geriatric Depression Scale), sleep (Pittsburgh Sleep Quality Index), functional capacity (Duke Activity Status Index), clinical indices (body mass index, symptoms, signs, left ventricular ejection fraction (LVEF), N-Terminal Pro-Brain Natriuretic Peptide, etc) and social support (Lubben Social Network Scale-6), along with comprehensive cost analysis, enhance the study’s significance. The study’s findings hold crucial implications for crafting an effective exercise-focused cardiac rehabilitation strategy for TAVR patients. Community implementation not only deepens understanding but also fosters the potential integration of exercise-based cardiac rehabilitation into self-care, promising enhanced patient adherence and overall cardiovascular health management.

Ethics and dissemination

Ethical approval was obtained from the Zhongshan Hospital, Fudan University Ethics Committee (B2022-062R). Results will be disseminated to local stakeholders and the research community through publications and conferences.

Trial registration number

NCT05989594

☐ ☆ ✇ BMJ Open

Effectiveness of Yijinjing exercise in the treatment of early-stage knee osteoarthritis: a randomized controlled trial protocol

Por: Guo · G. · Wang · Y. · Xu · X. · Lu · K. · Zhu · X. · Gu · Y. · Yang · G. · Yao · F. · Fang · M. — Marzo 7th 2024 at 10:14
Introduction

Knee osteoarthritis (KOA) is still a challenging degenerative joint disease with high morbidity and disease burden. Early-stage KOA, the focus of this study, could present a Window of Opportunity to arrest the disease process and reduce the disease burden. Yijinjing exercise is an important part of physical and psychological therapies in Traditional Chinese Exercise and may be an effective treatment. However, there is no clinical efficacy assessment of Yijinjing exercise for patients with early-stage KOA. Therefore, we designed a randomised controlled trial to evaluate the effectiveness of Yijinjing exercise on patients with early-stage KOA.

Methods and analysis

This is a parallel-design, two-arm, analyst assessor-blinded, randomised controlled trial. In total, 60 patients with early-stage KOA will be recruited and randomly assigned to the Yijinjing exercise group (n=30) and health education group (n=30) at a ratio of 1:1, receiving 12 weeks of Yijinjing exercise or health education accordingly. The primary outcome will be measured with the Western Ontario and McMaster Universities Osteoarthritis Index, and the secondary outcomes will include the Visual Analogue Scale, Short-Form 36 Item Health Survey Questionnaire, Beck Depression Inventory, Perceived Stress Scale, Berg Balance Scale, and Gait Analysis for a comprehensive assessment. Outcome measures are collected at baseline, at 12 week ending intervention and at the 12 week, 24 week and 48 week ending follow-up. The primay time point will be 12 weeks postintervention. Adverse events will be recorded for safety assessment.

Ethics and dissemination

This study has been approved by the ethical application of the Shanghai Municipal Hospital of Traditional Chinese Medicine Ethics Committee (2021SHL-KY-78).

Trial registration number

ChiCTR2200065178

☐ ☆ ✇ BMJ Open

Combined MRI-TRUS fusion targeted and systematic biopsy versus systematic biopsy alone for the detection of prostate cancer: protocol for a prospective single-centre trial

Por: Liu · W. · Kadier · A. · Shen · D. · He · Y. · Dong · S. · Zhu · K. · Xu · G. · Zhao · B. · Mao · S. · Guo · C. · Yao · X. · Wei · Q. · Han · D. · Yang · B. — Marzo 2nd 2024 at 04:33
Introduction

The classic way of diagnosing prostate cancer (PCa) is by conducting the 12-core systematic biopsy (SB). However, it has a low detection rate for clinically significant PCa (csPCa) and can lead to the detection of clinically insignificant PCa (cisPCa). Although MRI-transrectal ultrasound (MRI-TRUS) fusion targeted biopsy (TB) can effectively improve the detection rate of csPCa, it may still miss some cases. Therefore, we propose using a combination of TB and SB methods to enhance the detection rate of csPCa while minimising the detection rate of cisPCa.

Methods and analysis

This study is a prospective, single-centre investigation that aims to assess and compare the detection rate of csPCa using MRI-TRUS fusion TB combined with SB versus TRUS 12-core SB alone. Biopsy-naïve men with suspected PCa will be subjected to multiparametric MRI. Patients with Prostate Imaging Reporting and Data System (V.2.1) score ≥3 will be enrolled in the TB-SB combination group. The sample size is established as 660 participants, considering a 10% drop-out rate. The primary outcome is the detection rate of csPCa in men without prior biopsy using MRI-TRUS fusion TB combined with the standard TRUS-guided 12-core SB method. CsPCa will be defined as International Society of Urological Pathology Grade ≥2.

Ethics and dissemination

This study has been approved by the Ethics Committee at the Shanghai Tenth People’s Hospital, an affiliated hospital of Tongji University School of Medicine. The research results will be published in a peer-reviewed international journal.

Trial registration number

ChiCTR2000036089.

☐ ☆ ✇ International Wound Journal

Effects of negative pressure wound therapy on wound infection and healing in patients with open fracture wounds: A meta‐analysis

Por: Ning‐Lu Xu · Wei Mi — Febrero 8th 2024 at 06:59

Abstract

A meta-analysis was conducted to comprehensively evaluate the impact of negative pressure wound therapy (NPWT) on wound infection and healing in patients with open fracture wounds. Computer searches were performed in EMBASE, Google Scholar, Cochrane Library, PubMed, Wanfang and China National Knowledge Infrastructure databases for randomized controlled trials (RCTs) on the application of NPWT in open fracture wounds, with the search period covering the databases inception to September 2023. Two researchers independently screened the literature, extracted data and conducted quality assessments. Stata 17.0 software was employed for data analysis. Overall, 17 RCTs involving 1814 patients with open fracture wounds were included. The analysis revealed that compared with other treatment methods, NPWT significantly shortened the wound healing time (standardized mean difference [SMD] = −2.86, 95% confidence intervals [CI]: −3.51 to −2.20, p < 0.001) and fracture healing time (SMD = −3.14, 95% CI: −4.49 to −1.79, p < 0.001) in patients with open fracture wounds. It also significantly reduced the incidence of wound infection (odds ratio [OR] = 0.36, 95% CI: 0.23–0.56, p < 0.001) and complications (OR = 0.29, 95% CI: 0.20–0.40, p < 0.001). This study indicates that in the treatment of open fracture wounds, NPWT, compared with conventional treatment methods, can accelerate the healing of wounds and fractures, effectively control infections and reduce the occurrence of complications, demonstrating high safety.

☐ ☆ ✇ International Wound Journal

Evaluation of diabetic foot care knowledge, determinants of self‐care practices and the efficacy of health education

Por: Xiaomei Xu · Sensen Zheng · Zhenhao Cao · Housen Jiang · Lin Shi · Zhenjie Wang · Hui Xu — Febrero 8th 2024 at 06:15

Abstract

To evaluate the risk factors connected with diabetic foot care and investigate the impact of health education on promoting proper diabetic foot care practices. An explanatory and mixed-method study was performed. We administered a structured pretest questionnaire to patients diagnosed with Type 2 diabetes who frequented our health examination center and community health clinics. The survey encompassed patient demographics, basic knowledge concerning diabetic foot care, and self-care practices pertaining to diabetic foot care. Concurrent assessments and scoring were carried out. Following the survey, patients underwent health education sessions focusing on foot self-care behaviours. Their progress was reevaluated after 2 weeks to gauge its effectiveness. We identified educational attainment, diabetes duration, regular follow-up, and blood sugar control as critical factors influencing knowledge about foot care and self-care practices related to it. Pearson correlation analysis demonstrated a positive relationship between scores for diabetic foot care knowledge and scores for self-care behaviours (r = 0.32, p < 0.001). Health education led to a significant improvement in the self-care behaviours of diabetic patients. A variety of factors affect the occurrence of diabetic foot complications and the self-care behaviours associated with diabetic foot care. Health education proves to be an effective means of enhancing diabetic foot care behaviours.

☐ ☆ ✇ BMJ Open

Impact of intraosseous regional administration of tranexamic acid in total knee arthroplasty on perioperative blood loss: a protocol for a randomised controlled trial

Por: Wei · Z. · Yu · M. · Xu · Y. · Weng · X. · Feng · B. — Febrero 13th 2024 at 01:46
Introduction

Total knee arthroplasty (TKA) is a common surgical intervention to treat joint diseases. However, TKA is associated with significant blood loss. Tranexamic acid (TXA) has been used to reduce perioperative bleeding and postoperative blood transfusion. This study aims to explore the effectiveness and safety of intraosseous regional administration (IORA) of TXA in TKA and compare differences in perioperative blood loss between IORA of TXA, intravenous infusion of TXA, and combined IORA and intravenous infusion of TXA.

Methods and analysis

This randomised controlled trial will enrol 105 patients with osteoarthritis who meet the inclusion criteria for unilateral TKA. Patients were randomly divided into three groups using the random number table method. Group A received 1.0 g of TXA via IORA, group B received 1.0 g of TXA via intravenous infusion 15 min prior to the tourniquet release, and group C received both IORA of 1.0 g of TXA and intravenous infusion of 1.0 g of TXA. The primary outcome measure is perioperative total blood loss. Secondary outcomes include bleeding events, venous thromboembolism events, inflammation reactions, other complications and knee function assessments.

Ethics and dissemination

This study has been approved by the Ethics Committee of Peking Union Medical College Hospital and registered in the Chinese Clinical Trial Registry. Informed consent will be obtained from all the patients before enrolment. The trial will be conducted in accordance with the principles of the Declaration of Helsinki and the International Conference on Harmonization Good Clinical Practice guidelines. The results of this study will be disseminated through peer-reviewed publications, conference presentations and social media platforms. The findings will provide valuable insights into the use of IORA of TXA in TKA and may lead to the development of new strategies for perioperative blood management in joint replacement surgery.

Trial registration number

The Ethics Committee of Peking Union Medical College Hospital (approval number: K2371); Chinese Clinical Trial Registry (trial registration number: ChiCTR2200066293).

☐ ☆ ✇ Worldviews on Evidence-Based Nursing

Facilitators and barriers to implementation of telemedicine in nursing homes: A qualitative systematic review and meta‐aggregation

Por: Min Chua · Xue Kee Lau · Jeanette Ignacio — Febrero 10th 2024 at 15:22

Abstract

Background

Telemedicine is an effective way to provide nursing home residents ease of access to consultations with healthcare professionals. It is safe, effective, and time- and cost-efficient, and can be used when there are movement restrictions, such as during the COVID-19 pandemic. This literature focuses only on healthcare professionals' experiences and perspectives on the use of telemedicine in long-term care facilities.

Objectives

This review concentrated on telemedicine programs that did not involve remote monitoring. It aimed to comprehensively appraise existing literature examining the facilitators and barriers in implementing telemedicine services in nursing homes.

Methods

A systematic qualitative review was conducted with content analysis. Database searching was conducted in PubMed, Embase, Cochrane, Scopus, and CINAHL. Hand searching for gray literature and reference lists of included papers was also performed. Qualitative studies or mixed-method studies with a qualitative analysis addressing implementation of telemedicine in any long-term care facilities were included. The Critical Appraisal Skills Programme qualitative checklist was used to assess the quality of the included studies. The data were extracted and cross-checked between two reviewers. A third reviewer was consulted for any disagreements. Meta-aggregation was used to synthesize the results.

Results

Eighty-one findings were extracted, which informed 16 categories and 13 synthesized findings. The synthesized findings were related to the innovation domain, infrastructure, work processes, individuals, and implementation processes.

Linking Evidence to Action

This review highlighted factors that affect the successful implementation of a telemedicine service in nursing homes. These findings provide evidence to support the future utilization of this service in the nursing home setting. Further research should explore the best approach to address these barriers and facilitators.

☐ ☆ ✇ BMJ Open

Reporting and influencing factors of patient-reported outcomes in acupuncture randomised controlled trials: a cross-sectional study protocol

Por: Duan · Y. · Zhao · P. · Liu · S. · Deng · Y. · Xu · Z. · Xiong · L. · Chen · Z. · Zhu · W. · Wu · S. · Yu · L. — Febrero 8th 2024 at 03:36
Introduction

Patient-reported outcomes (PROs) are health reports that come directly from the patients themselves and represented the experience and insights of the patient’s perspective on the impact of the intervention. PROs were increasingly emphasised in acupuncture randomised controlled trials (RCTs). However, the reporting quality of PROs in acupuncture RCTs has not been investigated to date. Therefore, we constructed this study to reveal the basic characteristics and reporting quality of PROs in acupuncture RCTs, and explore the relationship between concealment, blinding and RROs. We hope our findings can provide guidance for the reporting standards and future development of PROs in acupuncture RCTs in reverse.

Methods and analysis

RCTs using acupuncture treatment as the intervention and PROs as primary outcomes or secondary outcomes will be systematically searched through seven databases MEDLINE, EMBASE, CENTRAL, CBM, CNKI, Wanfang and VIP between 1 January 2012 and 15 October 2022. The basic characteristics, concealment, blinding design and the characteristics of PROs in included RCTs will be summarised. The reporting quality of PROs will be assessed based on the CONSORT PRO extension. Logistic analysis will be performed to identify the association between concealment, blinding and RROs.

Ethics and dissemination

Ethical approval is not required for this study. This protocol has been registered in Open Science Framework (OSF) Registries. The findings of this study will be submitted to a peer-reviewed academic journal.

☐ ☆ ✇ BMJ Open

Quantitative assessments of retinal macular structure among rural-dwelling older adults in China: a population-based, cross-sectional, optical coherence tomography study

Por: Zhang · Q. · Zhang · C. · Wang · Y. · Cong · L. · Liu · K. · Xu · Z. · Jiang · C. · Zhou · W. · Zhang · C. · Dong · Y. · Feng · J. · Qiu · C. · Du · Y. — Febrero 6th 2024 at 17:23
Objectives

To quantitatively assess and compare retinal macular structures of rural-dwelling older adults in China using two different optical coherence tomography (OCT) scanners and to examine their associations with demographic, lifestyle, clinical and ocular factors.

Design, setting and participants

This population-based, cross-sectional study included 971 participants (age ≥60 years) derived from the Multimodal Interventions to Delay Dementia and Disability in Rural China study. We collected data on demographics, lifestyle factors, clinical conditions (eg, cardiovascular disease (CVD)) and ocular factors (eg, visual acuity and spherical equivalent). We used two models of spectral-domain OCT to measure macular parameters in nine Early Treatment Diabetic Retinopathy Study subfields. Data were analysed using the multiple general linear models.

Results

Spectralis OCT demonstrated higher macular thickness but a lower macular volume than Primus 200 OCT (p

Conclusions

Macular thickness and volume assessed by Spectralis and Primus 200 OCT scanners differ. Older age and female sex are associated with lower macular thickness and volume. Macular parameters are associated with education, CVD and spherical equivalent.

Trial registeration number

MIND-China study (ChiCTR1800017758).

☐ ☆ ✇ BMJ Open

Balloon dilation for the treatment of male urethral strictures: a systematic review and meta-analysis

Por: Li · X. · Xu · C. · Ji · X. · Zhu · Z. · Cai · T. · Guo · Z. · Lin · J. — Febrero 6th 2024 at 17:23
Objective

The use of minimally invasive endoluminal treatment for urethral strictures has been a subject for debate for several decades. The aim of this study was to review and discuss the safety, efficacy and factors influencing the clinical application of balloon dilation for the treatment of male urethral strictures.

Design

Systematic review and meta-analysis.

Data sources

Embase, Medline, Web of Science, Cochrane Library and Scopus were searched for publications published before 17 July 2022.

Study selection

Two independent researchers screened and assessed the results, and all clinical studies on balloon dilation for the treatment of urethral strictures in men were included.

Data extraction and synthesis

The success rate, rate of adverse events, International Prostate Symptom Scores, maximum uroflow (Qmax) and postvoid residual urine volume were the main outcomes. Stata V.14.0 was used for statistical analysis.

Results

Fifteen studies with 715 patients were ultimately included in this systematic review. The pooled results of eight studies showed that the reported success rate of simple balloon dilation for male urethral strictures was 67.07% (95% confidence interval [CI]: 55.92% to 77.36%). The maximum urinary flow rate at 3 months (risk ratio [RR]= 2.6510, 95% CI: 1.0681 to 4.2338, p

Conclusion

Balloon dilation may be an intermediate step before urethroplasty and is a promising alternative therapy to simple dilation and DVIU. The balloon is a promising drug delivery tool, and paclitaxel drug-coated balloon dilation is effective in reducing retreatment rates in patients with recurrent anterior urethral strictures. The aetiology, location, length, previous treatment of urethral stricture may be associated with the efficacy of balloon dilation.

PROSPERO registration number

CRD42022334403.

☐ ☆ ✇ BMJ Open

Priming transcranial direct current stimulation for improving hemiparetic upper limb in patients with subacute stroke: study protocol for a randomised controlled trial

Por: Zhu · F. · Xu · X. · Jin · M. · Chen · J. · Feng · X. · Wang · J. · Yu · D. · Wang · R. · Lian · Y. · Huai · B. · Lou · X. · Shi · X. · He · T. · Lu · J. · Zhang · J. J. · Bai · Z. — Febrero 3rd 2024 at 05:51
Introduction

Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique that modulates brain states by applying a weak electrical current to the brain cortex. Several studies have shown that anodal stimulation of the ipsilesional primary motor cortex (M1) may promote motor recovery of the affected upper limb in patients with stroke; however, a high-level clinical recommendation cannot be drawn in view of inconsistent findings. A priming brain stimulation protocol has been proposed to induce stable modulatory effects, in which an inhibitory stimulation is applied prior to excitatory stimulation to a brain area. Our recent work showed that priming theta burst magnetic stimulation demonstrated superior effects in improving upper limb motor function and neurophysiological outcomes. However, it remains unknown whether pairing a session of cathodal tDCS with a session of anodal tDCS will also capitalise on its therapeutic effects.

Methods and analysis

This will be a two-arm double-blind randomised controlled trial involving 134 patients 1–6 months after stroke onset. Eligible participants will be randomly allocated to receive 10 sessions of priming tDCS+robotic training, or 10 sessions of non-priming tDCS+robotic training for 2 weeks. The primary outcome is the Fugl-Meyer Assessment-upper extremity, and the secondary outcomes are the Wolf Motor Function Test and Modified Barthel Index. The motor-evoked potentials, regional oxyhaemoglobin level and resting-state functional connectivity between the bilateral M1 will be acquired and analysed to investigate the effects of priming tDCS on neuroplasticity.

Ethics and dissemination

The study has been approved by the Research Ethics Committee of the Shanghai Yangzhi Rehabilitation Center (reference number: Yangzhi2023-022) and will be conducted in accordance with the Declaration of Helsinki of 1964, as revised in 2013.

Trial registration number

ChiCTR2300074681.

☐ ☆ ✇ International Wound Journal

Best practices for managing malodorous and infected wounds in advanced cervical cancer

Abstract

This cross-sectional study was conducted to examine the most effective strategies for managing malodorous and infected wounds in patients who have been diagnosed with advanced cervical cancer. The research was conducted in Liupanshui, China. The study specifically examined demographic profiles, wound characteristics and effectiveness of wound management approaches. The study incorporated the heterogeneous sample of 289 participants who fulfilled the inclusion criteria. Data collection was conducted via structured questionnaires and medical record evaluations. Descriptive statistics and statistical analyses, such as regression analysis, were utilized to evaluate demographic attributes, wound profiles and effects of different approaches to wound management. The findings unveiled the heterogeneous demographic composition of patients, encompassing differences in socioeconomic standing, educational attainment and age. A wide range of wound characteristics were observed, as 65.7% of lesions during the acute phase with diameter between 2 and 5 centimetres, while 41.5% of lesions had this range. The most prevalent types of infections were those caused by fungi (48.4%), followed by bacterial infections lacking resistance (38.1%). A moderate degree of odour intensity was prevalent, affecting 45.0% of the cases. With maximal odour reduction of 80%, a mean healing time of 25 days and patient satisfaction rating of 4.5 out of 5, Negative Pressure Wound Therapy demonstrated itself to be the most efficacious treatment method. Additional approaches, such as photodynamic therapy and topical antibiotic therapy, demonstrated significant effectiveness, as evidenced by odour reductions of 70% and 75%, respectively, and patient satisfaction ratings of 4.3 and 4.2. Thus, the study determined challenges associated with management of malodorous and infected lesions among patients with advanced cervical cancer. The results underscored the significance of individualized care approaches, drew attention to efficacious wound management techniques and identified critical determinants that impacted patient recuperation. The findings of this study hold potential for advancing palliative care for individuals diagnosed with advanced cervical cancer.

☐ ☆ ✇ International Wound Journal

Effect of transconjunctival sutureless vitrectomy versus 20‐G vitrectomy on surgical wound closure in patients: A meta‐analysis

Por: Yan Huang · Jun Sun · Jimin Wang · Xuedong Zhang · Zhongpei Chen — Febrero 2nd 2024 at 00:44

Abstract

A meta-analysis was conducted to evaluate the impact of transconjunctival sutureless vitrectomy (TSV) over 20 G vitrectomy on wound healing, as well as the requirements for closing the wound in order to treat vitreoretinal diseases. Among the 500 cases who had been treated with vitrectomy to September 2023, 250 were treated by transconjunctiva without vitrectomy and 250 were treated with 20 G vitrectomy. The odds ratio (OR) and mean difference (MD) of 95% confidence interval (CI) were computed to evaluate the influence of wound opening and closing on vitrectomy diseases. The evaluation of vitreoretinal diseases was performed with either a random-or fixed-effect model, which involved TSV compared to 20 G vitrectomy. Compared to 20 G vitrectomy, the opening time of the wound in TSV was less (MD, −2.03; 95% CI, −2.87, −1.19; p < 0.0001); Compared to 20 G vitrectomy, the closing time of the wound was less (MD, −4.84; 95% CI, −6.38, −3.03; p < 0.0001); Nevertheless, there were no statistically significant differences in the incidence of vitreous haemorrhage after TSV surgery compared with 20 G vitrectomy (OR, 0.74; 95% CI, 0.25, 2.18; p = 0.59). TSV vitrectomy can shorten the duration of the operation and speed up the healing of the wound. It is suggested that additional studies be carried out with a larger sample size in order to verify this conclusion.

☐ ☆ ✇ International Wound Journal

Global burden and trends of disability‐adjusted life years and mortality for decubitus ulcer: A systematic analysis

Por: Hongfan Ding · Zhenghao Yu · Hongwu Yao · Xiao Xu · Yunxi Liu · Minliang Chen — Febrero 1st 2024 at 12:24

Abstract

The management of chronic wounds has presented a significant dilemma, which is evident not only in clinical treatment but also in the substantial burden it places on medical resources. The global COVID-19 pandemic in 2020 is likely to further exacerbate this trend. Therefore, it is imperative to delve deeper into the impact of chronic wound on disease burden across different regions and populations. In this study, we focused on decubitus ulcers (DU) as representative chronic wounds and utilized data from the Global Burden of Disease (GBD) 2019 database (http://ghdx.healthdata.org/gbd-results-tool) pertaining to age, gender, region, year and socio-demographic index (SDI) group. Disability-adjusted life years (DALYs) and mortality were utilized as indicators to assess the burden of DU. The analysis and visualization were performed using R software (version 4.2.3). A decrease in the global ASRs of DALYs and mortality for DU was observed across most regions between 1990 and 2019. The reduction in burden was particularly significant in regions characterized by a high SDI, while regions with a high-middle SDI experienced an increase. The burden of DU increased with age for both males and females, with males generally experiencing a higher burden compared to females. Strengthening population-based data on the prevalence of DU and implementing dynamic monitoring at the public health level will enable policymakers to develop evidence-based strategies for efficient allocation of healthcare resources.

☐ ☆ ✇ International Wound Journal

Studying the effects of stress, mental health and psychological well‐being on wound healing rates after oesophageal varices ligation in liver cirrhosis patients

Por: Hui Xi Yu · Ling Xue Fu · Yi Ying Wang · Sheng Li Zheng — Febrero 1st 2024 at 12:10

Abstract

It is of utmost importance to comprehend the impact that psychological factors have on physical rehabilitation, specifically in regards to wound healing following ligation of oesophageal varices in patients with liver cirrhosis. The present study investigated the correlation between wound recovery rates and psychological well-being, stress and mental health. From January 2022 to September 2023, 148 patients from were evaluated as part of this cross-sectional observational study. The psychological well-being of participants was evaluated utilizing the Hospital Anxiety and Depression Scale (HADS), Perceived Stress Scale (PSS) and Psychological General Well-Being Index (PGWBI). The rates of wound recovery were assessed following ligation. The mean duration for wound recovery was 28.37 ± 9.65 days. The mean wounds healing time of patients who obtained higher PSS scores (18.55) was marginally longer. On the contrary, there was a moderate reduction in healing time associated with higher HADS scores (mean 14.10). On average (68.88), PGWBI scores indicated a negligible effect on wound healing. The variance in healing durations between Child-Pugh classifications A, B and C (mean values of 28.65, 26.90 and 29.57 days respectively) suggested that the severity of liver disease has an impact. As a result of ligation of oesophageal varices, the study demonstrated that psychological factors and wound recovery in patients with liver cirrhosis are intricately intertwined. There seems to be the substantial and intricate relationship between stress, mental health and wound recovery. The results of this study supported the notion that psychological evaluation and support should be incorporated into the management of patients with liver cirrhosis.

☐ ☆ ✇ Journal of Advanced Nursing

Suicide death, suicidal ideation and suicide attempt in patients with diabetes: A systematic review and meta‐analysis

Por: Zhan‐Hong Fan · Jie Xu · Meng‐Wei Ge · Jie‐Wei Huang · Hai‐Tao Ni · Wang‐Qin Shen · Hong‐Lin Chen — Enero 31st 2024 at 13:10

Abstract

Aims

Diabetes has been indicated to be a risk factor for suicide. We aim to estimate the prevalence of suicide in patients with diabetes.

Design

A meta-analysis using PRISMA methodology was adopted to examine the incidence of suicide in diabetic patients.

Data Sources

From inception to October 2022, three online databases (PubMed, China National Knowledge Infrastructure and Web of Science) were used to search studies.

Review Methods

We used random-effects model to analysis. And our primary outcome was the incidence of suicide death per 100 person-years, and other outcomes were prevalence of suicidal ideation and suicide attempt. To explore the sources of heterogeneity in our study, we performed subgroup and meta-regression analyses.

Results

The suicide death rate in diabetic patients was 0.027 per 100 person-years, with a higher rate for Type 1 Diabetes Mellitus compared to Type 2 Diabetes Mellitus. The prevalence of suicidal ideation in diabetes patients was 0.175, with a higher prevalence in Type 1 Diabetes Mellitus compared to Type 2 Diabetes Mellitus. The prevalence of suicide attempts in diabetes patients was 0.033, indicating a higher rate for Type 2 Diabetes Mellitus compared to Type 1 Diabetes Mellitus.

Conclusions

The results indicate a high rate of suicide among people with diabetes, and this study identifies populations and regions at high risk for suicide. Our review emphasizes interventions in mental health and the improvement of suicide prevention programmes.

Impact

The study investigated suicide death, suicidal ideation and suicide attempt in diabetic individuals. Suicide rates are elevated among diabetic patients, and various patient groups face distinct suicide risks. It is important to prioritize the mental well-being of diabetic individuals and enhance interventions, including personalized approaches, to inform public health efforts aimed at preventing and addressing suicide among diabetic patients.

Patient or Public Contribution

No patient or public involvement.

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