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A nomogram for predicting post‐operative wound complications after open reduction and internal fixation for calcaneal fractures

Abstract

The purpose of our study was to determine the risk factors for post-operative wound complications (PWCs) after open reduction and internal fixation (ORIF) for calcaneal fracture and establish a nomogram prediction model. We retrospectively analysed the clinical data of patients who suffered from calcaneal fractures and had been surgically treated for ORIF in our institution between January 2010 and January 2020. Perioperative information was obtained through the electronic medical record system, univariate and multivariate analyses were performed to determine the risk factors of PWCs, and a nomogram model was constructed to predict the risk of PWCs. The predictive performance and consistency of the model were evaluated by the Hosmer –Lemeshow (H-L) test and the calibration curve. In total, 444 patients were enrolled in our study. Multivariate analysis results showed that smoking, limb swelling, angle of incision, and CRP were independent risk factors for skin necrosis. The AUC value for skin necrosis risk was 0.982 (95%CI 0.97-0.99). The H-L test revealed that the normogram prediction model had good calibration ability (P = .957). Finally, we found a correlation between PWCs and smoking, limb swelling, angle of incision, and CRP after ORIF for calcaneal fracture patients. Our nomogram prediction model might be helpful for clinicians to identify high-risk patients, as interventions could be taken early to reduce the incidence of PWCs.

Effect of Chinese herbal topical medicine, acupuncture, and moxibustion on pressure ulcer wound healing: A meta‐analysis

Abstract

We performed a meta-analysis to evaluate the effect of Chinese herbal topical medicine, acupuncture, and moxibustion on pressure ulcer wound healing. A systematic literature search up to January 2022 was done and 13 studies included 1073 subjects with pressure ulcer wound at the start of the study; 593 of them were using traditional Chinese medicine treatments, and 480 were control for pressure ulcer wound. We calculated the odds ratio (OR) with 95% confidence intervals (CIs) to evaluate the effect of Chinese herbal topical medicine, acupuncture, and moxibustion on pressure ulcer wound healing by the dichotomous methods with a random or fixed-influence model. Traditional Chinese medicine treatments had significantly higher complete healing (OR, 5.94; 95% CI, 3.94–8.95, P < .001), and curative ratio post-treatment (OR, 4.79; 95% CI, 2.62–8.76, P < .001) compared with control for subjects with pressure ulcer wound. Traditional Chinese medicine treatments had a significantly higher complete healing and curative ratio post-treatment compared with control for subjects with pressure ulcer wounds. Further studies are needed to validate these findings.

Cold application for pain and anxiety reduction following chest tube removal: A systematic review and meta‐analysis

Abstract

Aim and Objectives

To conduct a systematic review and meta-analysis to evaluate the effects of cold application on pain and anxiety reduction after chest tube removal (CTR).

Background

The act of removing the chest tube often causes pain among cardiothoracic surgery patients.

Most guidelines regarding CTR do not mention pain management. The effects of cold application on reducing pain and anxiety after CTR are inconsistent.

Design

Systematic review and meta-analysis.

Methods

We searched six databases, including Embase, Ovid Medline, Cochrane Library, Scopus, the Index to Taiwan Periodical Literature System and Airiti Library, to identify relevant articles up to the end of February 2021. We limited the language to English and Chinese and the design to randomised controlled trials (RCTs). All studies were reviewed by two independent investigators. The Cochrane Collaboration's tool was used to assess the risk of bias, Review Manager 5.4 was used to conduct the meta-analysis. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology was used for assessing certainty of evidence (CoE).

Results

Ten RCTs with 683 participants were included in the meta-analysis. The use of cold application could effectively reduce pain and anxiety after CTR. The subgroup showed that a skin temperature drops to 13°C of cold application was significantly more effective for the immediate reduction in pain intensity after CTR compared with control group. The GRADE methodology demonstrated that CoE was very low level.

Conclusion

Cold application is a safe and easy-to-administer nonpharmacological method with immediate and persistent effects on pain and anxiety relief after CTR. Skin temperature drops to 13°C or lasts 20 min of cold application were more effective for immediate reduction of pain intensity following CTR.

Relevance to clinical practice

In addition to pharmacological strategy, cold application could be used as evidence for reducing pain intensity and anxiety level after CTR.

Cost-effective analysis of mechanical thrombectomy alone in the treatment of acute ischaemic stroke: a Markov modelling study

Por: Han · M. · Qin · Y. · Tong · X. · Ji · L. · Zhao · S. · Liu · L. · Chen · J. · Liu · A.
Objective

Recently, a randomised controlled trial (DIRECT-MT) demonstrated that mechanical thrombectomy (MT) was non-inferior to MT with intravenous alteplase as to the functional outcomes. This study aims to investigate whether MT alone is cost-effective compared with MT with alteplase in China.

Methods

A Markov decision analytic model was built from the Chinese healthcare perspective using a lifetime horizon. Probabilities, costs and outcomes data were obtained from the DIRECT-MT trial and other most recent/comprehensive literature. Base case calculation was conducted to compare the costs and effectiveness between MT alone and MT with alteplase. One-way and probabilistic sensitivity analyses were performed to evaluate the robustness of the results.

Results

MT alone had a lower cost and higher effectiveness compared with MT with alteplase. The probabilistic sensitivity analysis demonstrated that, over a lifetime horizon, MT alone had a 99.5% probability of being cost-effective under the willingness-to-pay threshold of 1x gross domestic product per capita in China based on data obtained from the DIRECT-MT trial. These results remained robust under one-way sensitivity analysis.

Conclusions

MT alone was cost-effective compared with MT with alteplase in China. However, cautions are needed to extend this conclusion to regions outside of China.

Low cost multifunctional 3D printed image quality and dose verification phantom for an image-guided radiotherapy system

by Jian-Kuen Wu, Min-Chin Yu, Shih-Han Chen, Shu-Hsien Liao, Yu-Jen Wang

Purpose

Image-guided radiation therapy (IGRT) is used to precisely deliver radiation to a tumour to reduce the possible damage to the surrounding normal tissues. Clinics use various quality assurance (QA) equipment to ensure that the performance of the IGRT system meets the international standards set for the system. The objective of this study was to develop a low-cost and multipurpose module for evaluating image quality and dose.

Methods

A multipurpose phantom was designed to meet the clinical requirements of high accuracy, easy setup, and calibration. The outer shell of the phantom was fabricated using acrylic. Three dimensional (3D) printing technology was used to fabricate inner slabs with the characteristics of high spatial resolution, low-contrast detectability, a 3D grid, and liquid-filled uniformity. All materials were compatible with magnetic resonance (MR). Computed tomography (CT) simulator and linear accelerator (LINAC) modules were developed and validated.

Results

The uniformity slab filled with water is ideal for the assessment of Hounsfield units, whereas that filled with wax is suitable for consistency checks. The high-spatial-resolution slab enables measurements with a resolution up to 5 lp/cm. The low-contrast detectability slab contains rods of 5 different sizes that can be clearly visualised. These components meet the American College of Radiology (ACR) standards for QA of CT simulators and LINACs.

Conclusions

The multifunctional phantom module meets the ACR recommended QA guidelines and is suitable for both LINACs and CT-sim. Further measurements in an MR simulator and an MR linear accelerator (MR-LINAC) will be arranged in the future.

Assessing the cost-effectiveness of precision medicine: protocol for a systematic review and meta-analysis

Por: Chen · W. · Anothaisintawee · T. · Butani · D. · Wang · Y. · Zemlyanska · Y. · Wong · C. B. N. · Virabhak · S. · Hrishikesh · M. A. · Teerawattananon · Y.
Introduction

Precision medicine (PM) involves gene testing to identify disease risk, enable early diagnosis or guide therapeutic choice, and targeted gene therapy. We aim to perform a systematic review and meta-analysis to quantify the cost-effectiveness profile of PM stratified by intervention type, identify sources of heterogeneity in the value-for-money of PM.

Methods and analysis

We will perform a systematic search in Embase, MEDLINE, EconLit and CRD databases for studies published in English language or with translation in English between 1 January 2011 and 8 July 2021 on the topic of cost-effectiveness analysis of PM interventions. The focus will be on studies that reported health and economic outcomes. Study quality will be assessed using the Biases in Economic Studies checklist. The incremental net benefit of PM screening, diagnostic, treatment-targeting and therapeutic interventions over conventional strategies will be respectively pooled across studies using a random-effect model if heterogeneity is present, otherwise a fixed-effect model. Subgroup analyses will be performed based on disease area, WHO region and World Bank country-income level. Additionally, we will identify the potential sources of heterogeneity with random-effect meta-regressions. Finally, biases will be detected using jackknife sensitivity analysis, funnel plot assessment and Egger’s tests.

Ethics and dissemination

For this type of study ethics approval or formal consent is not required. The results will be disseminated at various presentations and feedback sessions, in conference abstracts and manuscripts that will be submitted to peer-reviewed journals.

PROSPERO registration number

CRD42021272956.

Psychometrics and measurement invariance: Health Literacy Scale for Vietnamese and Indonesian married immigrants

Abstract

Aims

To examine the psychometrics and measurement invariance of the Short-Form Health Literacy 12-item questionnaire (HL-SF12) among Vietnamese and Indonesian married immigrants.

Design

A cross-sectional survey design.

Methods

In total, 1171 Vietnamese and Indonesian married immigrants were enrolled between September 2019 and December 2019. An exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to verify the structural validity of the suggested factor structure. The multiple-group CFA (MGCFA) used a series of hierarchical nested-in models as a measurement invariance test which confirmed the adequacy of the model fit at each stage.

Results/Findings

The Kaiser–Meyer–Olkin coefficient was 0.898, and the Bartlett test of sphericity was statistically significant (χ 2[66] = 1965.97, p < 0.01). According to a scree plot and Kaiser's criterion for eigenvalues of >1, the EFA explained 61.6% of the total variance and confirmed three theoretically supported factors of health care, disease prevention and health promotion. The 12 items showed factor loadings of >0.4 and four items were in each subscale. The CFA showed adequate structural validity, including a relative chi-squared/degrees of freedom (X 2 /df) of 2.01, a comparative fit index (CFI) of 0.98 and a root mean square error of approximation (RMSEA) of 0.04 (95% confidence interval [0.03, 0.05]) in married immigrants. For the measurement invariance, a change in the goodness-of-fit measures did not exceed 0.02 for the RMSEA or 0.01 for the CFI. The results indicated Cronbach's α values of 0.87 for the HL-SF12 scale in Vietnamese and Indonesian combined samples (n = 1171). A t-test showed that the HL-SF12 and its three subscales were unable to significantly differentiate between Vietnamese and Indonesian groups (all p > 0.05).

Conclusions

The HL-SF12 scale showed acceptable theoretically supported structural validity, equivalent measurement invariance and reliable internal consistency among Vietnamese and Indonesian married immigrants. Measurements of immigrants' HL using the HL-SF12 could be integrated into future immigrant health policies.

Impact

As the first study of the measurement invariance of the HL-SF12 instrument among immigrants. Related factors of immigrants' HL can be further explored to increase immigrants' health and empowerment.

Predicting neurodevelopmental risk in children born to mothers living with HIV in Kenya: protocol for a prospective cohort study (Tabiri Study)

Por: Oyungu · E. · El Kebbi · O. · Vreeman · R. · Nyandiko · W. · Monahan · P. O. · Tu · W. · Khaitan · A. · Desta · Z. · Slogrove · A. L. · Humphrey · J. M. · Were · E. · Patel · R. C. · Carlucci · J. G. · Wools-Kaloustian · K. · McHenry · M. S.
Introduction

For the growing number of children with in utero and postpartum exposure to HIV and/or antiretrovirals, it is unclear which exposures or risk factors play a significant role in predicting worse neurodevelopmental outcomes. This protocol describes a prospective longitudinal cohort study of infants born to mothers living with HIV and those born to mothers without HIV. We will determine which risk factors are most predictive of child neurodevelopment at 24 months. We aim to create a risk assessment tool to help predict which children are at risk for worse neurodevelopment outcomes.

Methods and analysis

This study leverages an existing Kenyan cohort to prospectively enrol 500 children born to mothers living with HIV and 500 to those without HIV (n=1000 total) and follow them from birth to age 24 months. The following factors will be measured every 6 months: infectious morbidity and biological/sociodemographic/psychosocial risk factors. We will compare these factors between the two groups. We will then measure and compare neurodevelopment within children in both groups at 24 months of age using the Child Behaviour Checklist and the Bayley Scales of Infant and Toddler Development, third edition. Finally, we will use generalised linear mixed modelling to quantify associations with neurodevelopment and create a risk assessment tool for children ≤24 months.

Ethics and dissemination

The study is approved by the Moi University’s Institutional Research and Ethics Committee (IREC/2021/55; Approval #0003892), Kenya’s National Commission for Science, Technology and Innovation (NACOSTI, Reference #700244) and Indiana University’s Institutional Review Board (IRB Protocol #110990). This study carries minimal risk to the children and their mothers, and all mothers will provide written consent for participation in the study. Results will be disseminated to maternal child health clinics within Uasin Gishu County, Kenya and via papers submitted to peer-reviewed journals and presentation at international conferences.

Laparoscopic versus open pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: study protocol for a multicentre randomised controlled trial

Por: Pan · S. · Qin · T. · Yin · T. · Yu · X. · Li · J. · Liu · J. · Zhao · W. · Chen · X. · Li · D. · Liu · J. · Li · J. · Liu · Y. · Zhu · F. · Wang · M. · Zhang · H. · Qin · R. · Minimally Invasive Treatment Group in the Pancreatic Disease Branch of Chinas International Exchange and Prom
Introduction

Pancreatic cancer is one of the deadliest cancers and pancreaticoduodenectomy (PD) is recommended as the optimal operation for resectable pancreatic head cancer. Minimally invasive surgery, which initially emerged as hybrid-laparoscopy and recently developed into total laparoscopy surgery, has been widely used for various abdominal surgeries. However, controversy persists regarding whether laparoscopic PD (LPD) is inferior to open PD (OPD) for resectable pancreatic ductal adenocarcinoma (PDAC) treatment. Further studies, especially randomised clinical trials, are warranted to compare these two surgical techniques.

Methods and analysis

The TJDBPS07 study is designed as a prospective, randomised controlled, parallel-group, open-label, multicentre noninferiority study. All participating pancreatic surgical centres comprise specialists who have performed no less than 104 LPDs and OPDs, respectively. A total of 200 strictly selected PD candidates diagnosed with PDAC will be randomised to receive LPD or OPD. The primary outcome is the 5-year overall survival rate, whereas the secondary outcomes include overall survival, disease-free survival, 90-day mortality, complication rate, comprehensive complication index, length of stay and intraoperative indicators. We hypothesise that LPD is not inferior to OPD for the treatment of resectable PDAC. The enrolment schedule is estimated to be 2 years and follow-up for each patient will be 5 years.

Ethics and dissemination

This study received approval from the Tongji Hospital Ethics Committee of Tongji Medical College, Huazhong University of Science and Technology, and monitor from an independent third-party organisation. Results of this trial will be presented in international meetings and published in a peer-reviewed journal.

Trial registration number

NCT03785743.

Gut microbial dysbiosis in rheumatoid arthritis: a systematic review protocol of case-control studies

Por: Wang · D.-W. · Pang · X.-T. · Zhang · H. · Gao · H.-X. · Leng · Y.-F. · Chen · F.-Q. · Zhang · R. · Feng · Y. · Sun · Z.-L.
Introduction

Rheumatoid arthritis (RA) has a huge societal impact due to the high prevalence, irreversible joint damage and systemic complications. Gut microbiota plays an important role in the pathogenesis and progression of RA by regulating the host immune system. Restoring intestinal homeostasis by altering the microbiota could be an attractive strategy for the prevention and treatment of RA. However, the signature features of microbial dysbiosis in RA are still controversial. Therefore, we aim to elucidate the characteristic change in the diversity and composition of gut microbiota in RA.

Methods and analysis

We will systematically search through PubMed, EMBASE, Web of Science and Cochrane Library, as well as dissertations and conference proceedings. The reference lists of all included studies will be also reviewed to retrieve additional relevant studies. The case-control studies that reported either the relative abundance of bacteria at the phylum or genus level or at least one of the alpha-diversity, beta-diversity indexes in both RA and healthy controls will be included. Eligible studies will be screened independently by two reviewers according to the inclusion criteria. The Newcastle-Ottawa Quality Assessment Scale will be used to assess the quality of the included studies. Data extraction, qualitative and quantitative analysis will be performed within the gut microbial dysbiosis in RA. The expected outcomes will be the identification of the specific changes in composition and diversity of the gut microbiota in patients with RA. The quality of evidence will be assessed by the Grading of Recommendations Assessment, Development and Evaluation framework.

Ethics and dissemination

Ethical approval is unnecessary as this review does not address the data and privacy of patients. The results will be published in a peer-reviewed scientific journal and conference presentations.

PROSPERO registration number

CRD42021225229.

Assessment of mental health trajectories before and after myocardial infarction, atrial fibrillation or stroke: analysis of a cohort study in Tromso, Norway (Tromso Study, 1994-2016)

Por: Lorem · G. F. · Opdal · I. M. · Wilsgaard · T. · Schirmer · H. · Lochen · M.-L. · Olsen · I. P. · Steigen · T. · Rognmo · K.
Objectives

The increased survival rate of cardiovascular disease (CVD) implies a higher proportion of individuals who live with CVD. Using data from the Tromsø Study, we aimed to investigate mental health symptom trajectories before and after myocardial infarction, atrial fibrillation or stroke in a general population and to explore factors that contribute to the association.

Design

Cohort study.

Setting

Sample drawn from inhabitants of the municipality of Tromsø, Norway, who participated in the Tromsø Study (1994–2016).

Participants

A total of 18 719 participants (52.3% women) were included, and of these 2098 (32.9% women) were diagnosed with myocardial infarction, 1896 (41.9% women) with atrial fibrillation and 1263 (42.9% women) with stroke.

Primary outcome measures

Mental health symptoms were assessed using the Hopkins Symptom Checklist-10 and the Conor Mental Health Index.

Results

The participants who were diagnosed with either myocardial infarction or stroke had a significant monotonous increase in mental health symptoms before myocardial infarction (p=0.029) and stroke (p=0.029) that intensified at the time of diagnosis. After the event, the study found a higher prevalence of mental health symptoms with a decline in symptom levels over time for myocardial infarction (p

Conclusion

The study indicates that mental health problems among individuals with myocardial infarction, atrial fibrillation and stroke may have started to develop several years before the cardiovascular event and suggests that successful CVD rehabilitation may need to consider previous life factors. Future research is recommended to examine whether health promotion measures in a general population also create mental health resilience after a CVD event.

Associations between fibrinogen levels and the risk of cardiovascular disease and all-cause death: a cohort study from the Chin-Shan community in Taiwan

Por: Hsieh · C.-T. · Chien · K.-L. · Hsu · H.-C. · Lin · H.-J. · Su · T.-C. · Chen · M.-F. · Lee · Y.-T.
Objectives

Although several studies have investigated the association between fibrinogen level and the risk of cardiovascular disease (CVD), few studies have been conducted in Asia.

Setting

We conducted a community-based prospective cohort study in the Chin-Shan community, Taiwan.

Participants

A total of 2222 participants (54.6±11.9 years, 53.4% women, and 22.4 years of follow-up) who underwent plasma fibrinogen measurements and were without CVD at baseline were recruited, among which 735 participants with available C reactive protein (CRP) were included in the joint analysis of the association of fibrinogen and CRP levels with the risk of CVD.

Primary and secondary outcome measures

Fibrinogen and CRP levels were measured by clotting and high-sensitivity immunoturbidimetric assays, respectively. The study outcomes were CVD events and all-cause death. Our definition of CVD included both coronary artery disease (CAD) and stroke cases. Cox proportional hazards regression models were used to estimate the HRs and 95% CIs.

Results

Compared with the lowest quartile, participants with higher fibrinogen levels tended to have a higher risk of CAD (adjusted HR for the highest quartile=1.48 (95% CI 0.90 to 2.44); test for trend p=0.037) regardless of CRP level (adjusted HR=2.12 (95% CI 1.24 to 3.63) and 2.17 (95% CI 1.06 to 4.44) for high fibrinogen/low CRP and high fibrinogen/high CRP, respectively). The association was not observed for stroke (adjusted HR for the highest quartile=0.99 (95% CI 0.62 to 1.60); test for trend p=0.99) and was only observed for all-cause death among participants =0.004).

Conclusions

Fibrinogen may be a potential risk factor for CAD but not for stroke. Further studies are necessary to clarify the differences in the role of fibrinogen levels on the risk of CVD between Asian and Western countries.

Prevalence of metabolic syndrome among the adult population in western China and the association with socioeconomic and individual factors: four cross-sectional studies

Por: Xu · X. · Zeng · J. · Yang · W. · Dong · T. · Zhang · X. · Cheng · S. · Zhou · X. · Zhou · M. · Niu · L. · Yi · G. · Li · Y. · Zhang · L. · Deng · Y. · Wu · X.
Objectives

This study explored the prevalence of and individual influencing factors for metabolic syndrome (MS) as well as associated socioeconomic factors and regional aggregation.

Design

Four cross-sectional surveys were analysed for trends in MS and associations with socioeconomic and individual factors through multilevel logistic regression analyses. The risk associated with nutrient intake was also assessed through a dietary survey in 2015.

Setting

From 2010 to 2018, 8–15 counties/districts of West China were included.

Participants

A total of 28 274 adults were included in the prevalence analysis. A total of 23 708 adults were used to analyse the related factors.

Results

The overall prevalence of MS ranged from 21.4% to 27.8% over the 8 years, remaining basically stable within the 95% CI. Our study found that the urbanisation rate and hospital beds per 1000 people were positively associated with MS, and the number of doctors in healthcare institutions per 1000 persons was negatively associated with MS. The ORs for females, people with college education and higher and unmarried or single people were 1.49, 0.67 and 0.51, respectively (p

Conclusion

The high burden of MS, unreasonable proportions of energy and micronutrient intake and low percentage of high levels of physical activity were the major challenges to public health in western China. Improving the human resources component of medical services, such as the number of doctors, increasing the availability of public sports facilities and E-health tools and improving individual dietary quality and education might help prevent MS.

Association of self-reported snoring and hyperuricaemia: a large cross-sectional study in Chongqing, China

Por: Chen · T. · Ding · X. · Tang · W. · Chen · L. · Mao · D. · Song · L. · Lian · X.
Objective

To examine the relationship between self-reported snoring and hyperuricaemia in a large-scale population in Chongqing, China.

Setting

Face-to-face electronic questionnaire survey, physical examination and biological sample testing were conducted in 13 districts of Chongqing. Chongqing is a municipality in southwest China.

Participants

In this study, 23 308 Han ethnicity permanent residents aged 30–79 years were recruited. Individuals missing data were excluded, 22 389 subjects were included in final analysis.

Primary and secondary outcome measures

Serum uric acid (UA) was measured using an oxidase method. Hyperuricaemia was defined as serum UA >420 µmol/L in men and >360 µmol/L in women. Information about self-reported snoring was obtained by questionnaire survey. All participants were divided into ‘no snoring’ ‘snoring occasionally’ and ‘snoring frequently’. Multivariable logistic regression analysis was performed to assess the relationship between self-reported snoring and hyperuricaemia.

Results

The prevalence of hyperuricaemia was 14.43%, and snorers were more likely to have hyperuricaemia than non-snorer in different age and gender groups. For the total population, those who snore occasionally or frequently were more likely to be hyperuricaemia (OR 1.19, 95% CI 1.07 to 1.31; OR 1.33, 95% CI 1.19 to 1.47) compared with no snoring people. Stratification by age, gender and body mass index (BMI), we found that the positive association between snoring frequently and hyperuricaemia was insisted in different age, gender and high BMI groups, and the strength of association varied with different age, gender and BMI category.

Conclusion

Snoring frequency was positively associated with higher risk of hyperuricaemia. Snoring frequently may be a signal for hyperuricaemia, especially for women, those over 59 years of age, or those who are overweight or obese.

Transdermal buprenorphine improves overall quality of life and symptom severity in cancer patients with pain

Abstract

Aim and Objectives

This study explored the effect of transdermal buprenorphine on quality of life and six symptoms in cancer patients with pain.

Background

Transdermal opioids offer advantages over traditional routes of administration. The impact of transdermal buprenorphine on quality of life for patients with cancer in Asian populations is unknown.

Design

This study employed a single-arm observational repeated measures design. Cancer patients with pain were evaluated prior to treatment (baseline). Over a 4-week treatment period, quality of life and symptoms were assessed at 2 and 4 weeks. This study adhered to the recommendations of STROBE guidelines.

Methods

This multi-site study was conducted in six hospitals located across northern, middle and southern Taiwan. Adult cancer patients whose pain was previously stable with opioid analgesics and, based on clinical judgement, were able to convert to transdermal buprenorphine treatment were invited to participate. Quality of life was measured with the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30 (QLQ-C30).

Results

Generalised estimating equations showed participants who completed at least one follow-up measurement (N = 80) over 4-weeks had a significant improvement in overall quality of life. Functional status only improved for social functioning. However, symptom severity decreased significantly for nausea/vomiting, pain, insomnia and constipation.

Conclusions

The study provides initial evidence supporting transdermal buprenorphine for providing beneficial effects of improving quality of life and reducing severity of symptoms in Asian patients with cancer.

Relevance to clinical practice

The findings of this study can inform the clinical practice that the use of transdermal buprenorphine in cancer patients with pain may also reduce the severity of other symptoms and improve overall quality of life.

Trial registration details

This study was registered in ClinicalTrials.gov. Identifier: NCT04315831.

The TARGET Nurses' health cohort study protocol: Towards a revolution in getting nurses' health ticked

Abstract

Aim

To evaluate the health status of nurses in China and explore the impact of work-related stress, work environment and lifestyle factors on their health outcomes.

Design

The Chinese Nurses' Health Study is a multicentred, prospective cohort study.

Methods

We plan to recruit approximately 80,000 registered nurses aged between 18 and 65 years. Eligible nurses will be introduced to complete a series of web-based questionnaires after obtaining their informed consent. Follow-up questionnaires will be completed at 2-year interval to continuously track subsequent exposures. Health-related indicators will be obtained through self-reporting by nurses and the provincial and national registry platforms such as National Central Cancer Registry. The funding was approved in July 2020 and Research Ethics Committee approval was granted in February 2021.

Discussion

The study is the first multicentred prospective cohort study that aims to assess the impact of work-related stress, work environment and lifestyle factors on the health of Chinese nurses. The results of the Chinese Nurses' Health Cohort Study will potentially draw a picture of the current situation of general health and well-being among nurses in China and their health risks. This will be critical in recommending locally tailored strategic preventive measures and policies to reduce health and well-being threats for nurses and potentially general public, thereby promoting the quality of healthcare in China and globally.

Impact

This study will help to understand the health status and working environment characteristics of Chinese nurses, and provide valuable epidemiological evidence for improving working environment and promoting well-being. The results of this study are potentially of great significance for formulating targeted nursing strategies to promote the nurses' health, nursing quality and patient safety in China and even around the world.

Clinical Trial Registration Number and name of trial register

ChiCTR.org (ID:ChiCTR2100043202), The Nurses' Health Cohort Study of Shandong.

Adverse effects of non‐intubated airway suctioning: a clinical data‐based study

Abstract

Aims and objectives

The purpose of this study was to investigate the adverse effects of non-intubated suctioning.

Background

Airway hygiene aims to maintain a patent airway to ensure adequate ventilation. Nasopharyngeal, oropharyngeal or nasotracheal suctioning may be used in patients who require airway suctioning but do not have an artificial airway. However, no studies till date provide insight into the adverse effects of non-intubated airway suctioning.

Design

A clinical data-based retrospective design.

Method

Using institutional and clinical databases of three university hospitals in 2008–2016, we conducted a study with a propensity score matching method of 3,326 hospitalised patients who had undergone suction therapy with or without a tracheotomy. Conditional logistic regression analyses were performed to investigate the link between suctioning and the probabilities of adverse effects. STROBE checklist was used to report the current study.

Results

Patients who required nasopharyngeal, oropharyngeal or nasotracheal suctioning had a higher risk of gastrointestinal ulcers than tracheotomised patients (adjusted OR 1.99; 95% CI, 1.24–3.20). Patients who received non-intubated suction had a higher risk of developing pneumonia (adjusted OR 1.59; 95% CI, 1.26–2.00), and the risk of aspiration pneumonia was three times higher than tracheotomised patients (adjusted OR 3.04; 95% CI, 1.40–6.60).

Conclusions

Non-intubated patients who require suctioning for airway clearing are more susceptible to gastrointestinal ulcers, pneumonia and aspiration pneumonia. The findings would facilitate in alerting healthcare professionals to this group of patients. However, more clinical research is needed to elucidate the mechanisms of adverse effects in non-intubated patients who require suctioning.

Relevance to Clinical Practice

The adverse effects of suctioning can easily be overlooked in debilitated patients with no intubation. Professionals must be aware of the discomfort and risks that patients may experience.

Food frequency questionnaire for dietary assessment among adults at a risk of coronary heart disease: A mixed‐methods study

Abstract

Aims and objectives

To develop and psychometrically test a food frequency questionnaire for adults at risk of coronary heart disease (Cardio-FFQ).

Background

Comprehensive dietary assessment is critical for the prevention of cardiovascular disease, but appropriate instruments to perform this work are lacking.

Design

A sequential mixed-methods study followed the COREQ and STROBE guidelines.

Methods

This study was conducted between April 2016 and November 2017. It started with dietary history interviews (Phase 1) to identify candidate food items of the Cardio-FFQ, which validity and reliability were assessed (Phase 2) through expert consultation and four seasonal measurements, including test and retest with a 2-week gap every season. Physical activity and blood glucose and lipids were assessed seasonally, while another FFQ was administered during the fourth measurement. Content analysis was used to analyse verbatim interview transcripts, while descriptive and inferential analyses were used to simplify the Cardio-FFQ and examine its psychometric properties.

Results

Phase I involved 34 participants during their first onset of acute coronary syndrome and generated 176 candidate food items (consumed by at least three participants) under 12 food categories. These food items were simplified to form the 133-item Cardio-FFQ after discarding items with trivial contributions to food commonalities or between-person variance. Further analysis showed that the simplified questionnaire had satisfactory content validity, concurrent validity, convergent validity, predictive validity, known-group validity and test–retest reliability.

Conclusion

The 133-item Cardio-FFQ is a valid and reliable tool for a comprehensive dietary assessment appropriate for adults at risk of coronary heart disease.

Relevance to clinical practice

Nurses may use the Cardio-FFQ to conduct a dietary assessment to better support people to commit to healthy diets, aiming to reduce the risk of coronary heart disease.

Effects of tai chi and qigong on rehabilitation after COVID-19: a protocol for systematic review and meta-analysis

Por: Zhang · Z. · Ren · J. G. · Guo · J. L. · An · L. · Li · S. · Zhang · Z. C. · Chen · Y. · Liu · H. · Lei · X.
Introduction

COVID-19 is a public health emergency of international concern, which is characterised by rapid and widespread transmission, high mortality and complications. Several studies have shown the benefits of tai chi and qigong for recovery after COVID-19; however, no meta-analysis has been reported. Therefore, the purpose of this study is to evaluate the efficacy and safety of tai chi and/or qigong on rehabilitation after COVID-19 through a systematic review and meta-analysis to provide a reference and basis for clinical application.

Methods and analysis

This study will use the Cochrane Library, PubMed, Web of Science, Embase, China Knowledge Network, China Biomedical Literature Database, Chinese Scientific Journal Database and Wanfang Database. The time period is from the inception of the database to November 2021, with no language restrictions. Searches will be conducted using the subject terms "Taichi","Qigong" and "COVID-19" plus free-text words. Articles will be screened and collected by two reviewers independently. Included studies will be assessed for quality using the Cochrane Risk of Bias Assessment Tool. Statistical analyses will be performed using the Revman V.5.3 software. The primary outcomes include 1-second forced expiratory volume and 1-second forced vital capacity, oxygen saturation, total white cell count and quality of life score. Secondary outcomes include time to remission of major symptoms, incidence of adverse events, clinical cure rate and mortality. Subgroup and sensitivity analyses will also be used to explore and interpret the heterogeneity. This protocol is written based on the guideline of the Preferred Reporting Items for Systematic Reviews and Meta-analyses Protocol.

Ethics and dissemination

Ethical approval and consent are unnecessary because no primary data will be collected. The results will be disseminated through peer-reviewed publications.

PROSPERO registration number

CRD42021288962.

Autophagy characteristics and establishment of autophagy prognostic models in lung adenocarcinoma and lung squamous cell carcinoma

by Zhubei Chen, Hui Xiong, Hao Shen, Qingsheng You

Background

Non-small cell lung cancer (NSCLC), which makes up the majority of lung cancers, remains one of the deadliest malignancies in the world. It has a poor prognosis due to its late detection and lack of response to chemoradiaiton. Therefore, it is urgent to find a new prognostic marker.

Methods

We evaluated biological function and immune cell infiltration in lung adenocarcinoma (LUAD) and lung squamous cell carcinoma (LUSC) patients from TCGA and GEO databases between different clusters based on autophagy related hub genes. Autophagy scores were used to assess the degree of autophagy in each individual by using component analysis.

Results

Three different clusters were obtained. Gene set variation analysis, single-sample gene set enrichment analysis and survive analysis showed differences among these three clusters. We demonstrated that the autophagy score of each patient could predict tumor stage and prognosis. Patients with a high autophagy score had a better prognosis, higher immune infiltration, and were more sensitive to immunotherapy and conventional chemotherapy.

Conclusion

It was uncovered that autophagy played an irreplaceable role in NSCLC. Quantified autophagy scores for each NSCLC patient would help guide effective treatment strategies.

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