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Surgical site infection following traumatic orthopaedic surgeries in geriatric patients: Incidence and prognostic risk factors

Abstract

Geriatric population is increasing rapidly worldwide, and fragility fracture and complication following orthopaedic surgery in elderly people have now become major challenges for surgeons. Further studies are required to identify potentially modifiable factors associated with surgical site infection (SSI) in geriatric patients. This retrospective, multicenter study was conducted at four level I hospitals in China. During the 31‐month study period, a total of 2341 patients (65 years or older) underwent orthopaedic surgery and complete data were recorded from September 2015 to April 2018. Demographics information, medications and additional comorbidities, surgery‐related variables, and laboratory indexes were extracted and analysed. Receiver‐operating characteristic analysis was performed to detect the optimum threshold of continuous variables. Independent risk factors of SSI were identified by univariate and multivariate analyses. Finally, 63 patients suffered from wound infection within the follow‐up period, indicating a 2.7% incidence rate of SSI. Statistical results showed that open injury (odds ratio [OR], 9.5; 95% confidence interval [CI], 5.4‐16.7), American Society of Anesthesiologists classified III‐IV score (OR, 2.2; 95% CI, 1.3‐3.8), surgical duration of >132 minutes (OR, 2.9; 95% CI, 1.1‐5.0), serum albumin (ALB) of <36.4 mg/L (OR, 2.0; 95% CI, 1.6‐3.4), and blood glucose (GLU) of >118 mg/dL (OR, 3.1; 95% CI, 1.1‐5.3) were independent risk factors of postoperative SSI. With the application of sensitive and modifiable variables such as surgical duration and the levels of ALB and GLU, more geriatric patients with sub‐high risk of postoperative SSI could be identified.

Thirty-day readmission after medical-surgical hospitalization for people who experience imprisonment in Ontario, Canada: A retrospective cohort study

by Fiona G. Kouyoumdjian, Ji Yun Lee, Aaron M. Orkin, Stephanie Y. Cheng, Kinwah Fung, Tim O’Shea, Gordon Guyatt

We aimed to compare 30-day readmission after medical-surgical hospitalization for people who experience imprisonment and matched people in the general population in Ontario, Canada. We used linked population-based correctional and health administrative data. Of people released from Ontario prisons in 2010, we identified those with at least one medical or surgical hospitalization between 2005 and 2015 while they were in prison or within 6 months after release. For those with multiple eligible hospitalizations, we randomly selected one hospitalization. We stratified people by whether they were in prison or recently released from prison at the time of hospital discharge. We matched each person with a person in the general population based on age, sex, hospitalization case mix group, and hospital discharge year. Our primary outcome was 30-day hospital readmission. We included 262 hospitalizations for people in prison and 1,268 hospitalizations for people recently released from prison. Readmission rates were 7.7% (95%CI 4.4–10.9) for people in prison and 6.9% (95%CI 5.5–8.3) for people recently released from prison. Compared with matched people in the general population, the unadjusted HR was 0.72 (95%CI 0.41–1.27) for people in prison and 0.78 (95%CI 0.60–1.02) for people recently released from prison. Adjusted for baseline morbidity and social status, hospitalization characteristics, and post-discharge health care use, the HR for 30-day readmission was 0.74 (95%CI 0.40–1.37) for people in prison and 0.48 (95%CI 0.36–0.63) for people recently released from prison. In conclusion, people recently released from prison had relatively low rates of readmission. Research is needed to elucidate reasons for lower readmission to ensure care quality and access.

Distraction using virtual reality for children during intravenous injections in an emergency department: A randomised trial

Abstract

Aim and objectives

To determine whether the virtual reality as a distracting intervention could reduce pain and fear in school‐age children receiving intravenous injections at an emergency department.

Background

An intravenous injection is the most common invasive procedure that paediatric patients encounter in emergency department. School‐age children seldom show their fear or discomfort during the procedure which may be ignored.

Design

A randomised controlled trial was conducted from December 2017–May 2018 and performed according to the CONSORT guidelines.

Methods

One hundred and thirty‐six children aged 7–12 years were randomly allocated to receive either a routine intravenous injection procedure or one with an immersive virtual reality experience. Children were asked to rate their pain and fear along with their caregivers and nurses on the Wong–Baker FACES Pain Rating Scale and Children's Fear Scale, respectively. The time required for successful intravenous insertion was also assessed in the emergency department. Clinical trial registration was done (ClinicalTrials.gov.: NCT04081935).

Results

Pain and fear scores were significantly lower in the virtual reality group, as were the children's ratings as perceived by their caregivers and nurses. The children's ratings of pain and fear were positively correlated with the caregivers’ ratings and the nurses' ratings as well. The time required for successful intravenous insertion was significantly lower in the virtual reality group.

Conclusion

Visual reality intervention can effectively reduce the pain and fear during intravenous procedure in school‐age children in emergency department.

Relevance to clinical practice

The results of this study indicate the feasible clinical value of virtual reality interventions during the administration of intravenous injections in school‐age children in emergency departments.

Has the Reporting Quality of Systematic Review Abstracts in Nursing Improved Since the Release of PRISMA for Abstracts? A Survey of High‐Profile Nursing Journals

Abstract

Background

The PRISMA for Abstracts (PRISMA‐A) was developed to guide authors to present a structured abstract. However, the adherence of abstracts to these guidelines in some areas was of concern.

Aims

To determine whether the publication of PRISMA‐A resulted in an improvement in the abstracts reported with nursing systematic reviews (SRs).

Methods

This was a cross‐sectional study. We searched PubMed for randomized controlled trials–based SRs published in top‐tier nursing journals. A PRISMA‐A checklist was used to assess abstracts in the SR included. Total score on checklists, comparison of total scores between two periods, and effect factors were analyzed.

Results

Overall, abstract reporting compliance with PRISMA‐A has not improved significantly with the time span. Of the 81 SRs, 74.1% were structured. About half reported eligibility criteria, information sources, and description of the effect as recommended. Registration status was reported only in 4.9%. The reporting quality was significantly higher for journals with higher impact factors (p < .001).

Linking Evidence to Action

Although not inclusive of all SRs in the nursing field, our sample reflects the general trend that there was no significant improvement in the compliance of SR abstracts reported in nursing with the release of PRISMA‐A. There is room for improvement, as most items have not been fully reported.

Safe sexual behaviors intention among female youth: The construction on extended theory of planned behavior

Abstract

Aim

To examine female youth's intentions for safe sex with the relationship partners based on the extended theory of planned behaviour (TPB) model and explore the direct and indirect impact of parent–child communication about sex, peer interaction related to sexual issues, and exposure to sexually explicit materials on female youth's safe sexual behaviour intentions.

Design

A non‐experimental, cross‐sectional research design.

Methods

A convenience sampling was employed for data collection and 731 female youth aged 15–24 years old were recruited in 2013–2014. An anonymous, self‐report structured questionnaire was used as a research instrument to collect participants' basic information and measure the internal and additional variables in the extended TPB model.

Results

The extended TPB model explained 42–45% of the total variance. Perceived behavioural control (PBC) and subjective norms had a positive effect on female youth's intentions for contraceptive use, condom use, and dual use with relationship partner; PBC was found to have the greatest influence. Among the additional variables in the extended TPB model, more parent–child communication about sex was found to lead to more positive dual use intentions. More peer interaction related to sexual issues was found to lead to less dual use intentions.

Conclusions

To improve female youth's sexual health, the priorities are to reinforce their PBC and subjective norms and enhance parent–child communication about sex. Future efforts should strengthen sex education in families and schools and shape a social environment that facilitates safe sex.

Impact

The extended TPB model can successfully predict female youth's safe sexual behaviour intentions. Empowering female youth to establish a sense of subjectivity and awareness of being a mature individual with physical autonomy, is importance for their sexual health.

A randomized trial of a distraction‐type intervention to assist in managing dressing changes for children experienced burns

Abstract

Aim

To evaluate the impact of the specially designed medical dressing screen during wound dressing changes for children aged 1–3 who experienced a burn on their hand or foot.

Design

Randomized controlled trial.

Methods

The study was performed, between January 2019 ‐ April 2019, at a Burn Outpatient Ward. A total of 52 outpatient children who had suffered burns were included in the clinical trial. The burn area of these participants accounted for 1–5% of the total body surface area. The children were randomly divided into two equal‐sized groups, each receiving a different treatment. In the medical screen group (N = 26), a medical screen was used for children during the dressing changes. In the control group (N = 26), the children received only regular dressing changes. Pain level of the children during dressing change was the primary outcome, the satisfaction of children's parents and wound therapist were used as second outcomes. The Bonferroni method was used to perform pairwise comparisons of repeatedly measured data at different measurement times in two groups.

Results

The results showed that the medical screen group had better outcomes with respect to pain management during dressing changes; in addition, the satisfaction score of the wound therapist and children's parents presented also better outcomes compared with the control group.

Conclusion

This study demonstrated application of the medical screen for burns can relieve the pain of 1 ‐ 3‐year old children experienced a burn during dressing changes. In addition, the application of the medical screen also increased the satisfaction of the child's parents and wound therapist.

Registration NO: 1,900,020,953.

Impact

Compared with conventional dressing methods, the medical screen can be used as a novel way to decrease the negative experience of burn patients ages 1–3 who require dressing changes.

Systematic review of negative pressure wound therapy for head and neck wounds with fistulas: Outcomes and complications

Abstract

Fistula formation in head and neck wounds is considered one of the most challenging complications that a head and neck reconstructive surgeon may encounter. The current mainstay of treatment is aggressive surgical debridement followed by vascularised soft tissue coverage. Negative pressure wound therapy (NPWT) has been successfully used for the closure of complicated wounds for decades. This study analysed the outcomes and complications of NPWT in the management of head and neck wounds with fistulas. A systematic search of studies published between January 1966 and September 2019 was conducted using the PubMed, MEDLINE, EMBASE, and SCOPUS databases and using the following key words: “negative pressure wound therapy,” “head and neck,” and “fistula.” We included human studies with abstract and full text available. Analysed endpoints were rate of fistula closure, follow‐up duration, and complications if present. Nine retrospective case series (Level IV evidence) that collectively included 122 head and neck wounds with orocutaneous fistulas, pharyngocutaneous fistulas, and salivary contamination were examined. The number of patients included in each study ranged from 5 to 64. The mode of NPWT varied among the included studies, with most adopting a continuous pressure of −125 mm Hg. Mean durations of NPWT ranged from 3.7 to 23 days, and the reported fistula closure rate ranged from 78% to 100%. To achieve complete wound healing, six studies used additional procedures after stopping NPWT, including conventional wound dressings and vascularised tissue transfer. Information regarding follow up was provided in only three of the nine studies, where patients were followed for 5, 10, and 18 months. No serious adverse events were reported. NPWT for head and neck wounds with fistulas may be considered a safe treatment method that yields beneficial outcomes with a low risk of complications. The current data originated mainly from studies with low levels of evidence characterised by heterogeneity. Therefore, definitive recommendations based on these data cannot be offered. Additional high‐quality trials are warranted to corroborate the findings of this systematic review.

Multicentre randomised double-blind placebo controlled trial of combination vancomycin and cefazolin surgical antibiotic prophylaxis: the Australian surgical antibiotic prophylaxis (ASAP) trial

Por: Peel · T. · Astbury · S. · Cheng · A. C. · Paterson · D. · Buising · K. · Spelman · T. · Tran-Duy · A. · de Steiger · R. S. · on behalf of the ASAP Trial Group · Peel · Choong · Cheng · Paterson · Buising · Dowsey · Crawford · Steiger · Spelman · Clarke · Tran-Duy · Ben Howden · Mol
Introduction

Resistant Gram-positive organisms, such as methicillin-resistant staphylococci, account for a significant proportion of infections following joint replacement surgery. Current surgical antimicrobial prophylaxis guidelines recommend the use of first-generation or second-generation cephalosporin antibiotics, such as cefazolin. Cefazolin, however, does not prevent infections due to these resistant organisms; therefore, new prevention strategies need to be examined. One proposed strategy is to combine a glycopeptide antibiotic with cefazolin for prophylaxis. The clinical benefit and cost-effectiveness of this combination therapy compared with usual therapy, however, have not been established.

Methods and analysis

This randomised, double-blind, parallel, superiority, placebo-controlled, phase 4 trial will compare the incidence of all surgical site infections (SSIs) including superficial, deep and organ/space (prosthetic joint) infections, safety and cost-effectiveness of surgical prophylaxis with cefazolin plus vancomycin to that with cefazolin plus placebo. The study will be performed in patients undergoing joint replacement surgery. In the microbiological sub-studies, we will examine the incidence of SSIs in participants with preoperative staphylococci colonisation (Sub-Study 1) and incidence of VRE acquisition (Sub-Study 2). The trial will recruit 4450 participants over a 4-year period across 13 orthopaedic centres in Australia. The primary outcome is the incidence of SSI at 90 days post index surgery. Secondary outcomes include the incidence of SSI according to joint and microorganism and other healthcare associated infections. Safety endpoints include the incidence of acute kidney injury, hypersensitivity reactions and all-cause mortality. The primary and secondary analysis will be a modified intention-to-treat analysis consisting of all randomised participants who undergo eligible surgery. We will also perform a per-protocol analysis.

Ethics and dissemination

The study protocol was reviewed and approved by The Alfred Hospital Human Research Ethics Committee (HREC/18/Alfred/102) on 9 July 2018. Study findings will be disseminated in the printed media, and learnt forums.

Trial registration number

ACTRN12618000642280

A school-based, multi-faceted health promotion programme to prevent obesity among children: protocol of a cluster-randomised controlled trial (the DECIDE-Children study)

Por: Liu · Z. · Wu · Y. · Niu · W.-Y. · Feng · X. · Lin · Y. · Gao · A. · Zhang · F. · Fang · H. · GAO · P. · Li · H.-J. · Wang · H. · the study team for the DECIDE-children study · Wang · Liu · Lin · Feng · Li · Zhou · Li · Jin · Li · Cheng · Di Wang · Song · Zhou · Xu · Song · Gao · Chen · Shang
Introduction

Obesity is a public health concern that is becoming increasingly more serious worldwide. Effective and sustainable childhood obesity prevention strategies may help to reduce the prevalence of obesity and may have an impact on lifelong health. However, few such strategies have been rigorously evaluated for Chinese children in different regions of China.

Methods and analysis

The Diet, ExerCIse and CarDiovascular hEalth-Children is a cluster-randomised controlled trial that aims to assess the effectiveness and sustainability of a school-based, multi-faceted intervention to prevent obesity among Grade 4 primary school students (8–10 years old) in China. Twenty-four schools (approximately 1200 students) from above average, average and below average developed regions in China will be randomised to an intervention (12 schools) or usual practice (12 schools) group. The intervention will last for one school year (9 months) and consists of activities towards students, parents and school environment. A smartphone application will be used to assist in providing information on, monitoring and providing feedback on the behaviours and body weight of the students. Data will be collected at baseline, 4 months, 9 months and 21 months. The primary outcome will be the difference between groups in the change in students’ body mass index at 9 months after the baseline investigation. The secondary outcomes will include the differences between groups in the changes in anthropometric measures, diet, physical activity levels and other measures at the follow-up visits. A variety of process evaluation methods will be used to evaluate the implementation process of the complex intervention.

Ethics and dissemination

This study was approved by the Peking University Institution Review Board (IRB00001052-18021). The results will be disseminated through publication in peer-reviewed journals, presentations at conferences and in lay summaries provided to school staff and participants.

Trial registration number

NCT03665857.

A systematic review and meta‐analysis: Vinegar consumption on glycaemic control in adults with type 2 diabetes mellitus 系统评估与荟萃分析:食醋对2型糖尿病成人患者血糖控制的影响

Abstract

Aim

To systematically review the effectiveness of vinegar consumption in improving glycaemic control in adults with type 2 diabetes mellitus.

Design

A systematic review and meta‐analysis.

Review sources

The CINAHL, Excerpta Medica database (EMBASE), Medline, PubMed, Scopus and Cochrane databases were searched in April 2019. Interventional studies published in the English language, from inception to 15 April 2019, were included.

Review methods

Two investigators independently assessed the quality of the studies, discussed their findings to reach consensus and complied with the standards of the Cochrane Handbook for Systematic Reviews of Interventions. Random‐effects meta‐analysis was conducted in Review Manager 5.3.5 to assess the effect size. A series of subgroup and sensitivity analyses were conducted to explore the causes of heterogeneity. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.

Results

A total of six relevant studies, including 317 patients with type 2 diabetes mellitus, were selected from 356 studies identified through electronic searches and reference lists. The meta‐analysis showed significantly better fasting blood glucose and haemoglobin A1c (HbA1c) level. In secondary analyses, there was a remarkable reduction in total cholesterol and low‐density lipoprotein postintervention.

Conclusion

Vinegar content varied across the studies, and the sample sizes in the included studies were relatively small. Therefore, caution should be exercised when trying to extrapolate the results to a larger population.

Impact

Existing reviews are limited to narrative synthesis, lacking critical appraisal, heterogenous outcomes, nor any report of fasting blood glucose and HbA1c. This meta‐analysis review extends the evidence on the beneficial effects of vinegar on glycaemic control as measured by HbA1c and fasting blood glucose. Clinicians could incorporate vinegar consumption as part of their dietary advice for patients with diabetes.

目的

针对食醋在改善2型糖尿病成人患者血糖控制方面的有效性展开系统性评估。

设计

系统评估与荟萃分析

评估数据来源

2019年4月通过CINAHL、医学文摘数据库(EMBASE)、Medline、PubMed、Scopus和Cochrane数据库进行搜索。从数据库建立之初到2019年4月15日以英语发表的干预性研究文献应包括在内。

评估方法

两名研究人员各自针对研究质量进行评估,讨论研究结果达成一致,同时遵守《Cochrane干预措施系统评估操作手册》的标准。在系统评估管理软件(Review Manager 5.3.5)中进行随机效应荟萃分析,以评估影响程度。还进行了一系列子组和敏感性分析,以便探讨出现异质性的原因。采用推荐分级、评估、制定与评价(GRADE)方法对证据质量进行评估。

结果

从356项通过电子检索和参考文献确定的研究中,共选出6项相关研究,其中包括317例2型糖尿病患者。荟萃分析结果显示,空腹状态下血糖和血红蛋白A1c(HbA1c)水平明显改善。在二次分析中,总胆固醇和低密度脂蛋白在干预后显著减少。

结论

不同研究中的食醋含量各不相同,且纳入研究的样本量相对较小。因此,在试图将结果外推到较大人群时需谨慎。

影响

现有评估工作仅限于采用叙述性综合法,缺乏关键性评价和异质性结果,并且尚无任何有关空腹状态下血糖和HbA1c情况的报告。本项荟萃分析评估拓展了醋对血糖控制(通过测量HbA1c和空腹状态下血糖得出)的有益作用的证据。因此,临床医师可将食醋囊括在糖尿病患者饮食建议之中。

Using healthcare failure mode and effect analysis as a method of vaginal birth after caesarean section management

Abstract

Aims and objectives

This research was conducted to explore the effectiveness of employing the healthcare failure mode and effect analysis method in the management of trial of labour after caesarean, with the aims of increasing vaginal birth after caesarean section rate and reducing potential risks that might cause severe complications.

Background

Previously high caesarean section rate in China and the “two children” policy leads to the situation where multiparas are faced with the choice of another caesarean or trial of labour after caesarean. Despite evidences showing the benefits of vaginal birth after caesarean, obstetricians and midwives in China tend to be conservative due to limited experience and insufficient clinical routines. Thus, its management needs further optimisation in order to make the practice safe and sound.

Design

A prospective quality improvement programme using the healthcare failure mode and effect analysis.

Methods

With the structured methodology of healthcare failure mode and effect analysis, we determined core processes of antepartum and intrapartum management, conducted risk priority numbers and devised remedial protocols for failure modes with high risks. The programme was then implemented as a clinical routine under the agreement of the institutional review board and vaginal birth after caesarean success rates were compared before and after the quality improvement programme, both descriptively and statistically. Standards for Quality Improvement Reporting Excellence 2.0 checklist was chosen on reporting the study process.

Results

Seventy failure modes in seven core processes were identified in the management process, with 14 redressed for actions. The 1‐year follow‐up trial of labour after caesarean and vaginal birth after caesarean rate was increased compared with the previous 3 years, with a vaginal birth after caesarean rate of 86.36%, whereas the incidence of uterine rupture was not compromised.

Conclusions

The application of healthcare failure mode and effect analysis can not only promote trial of labour after caesarean and vaginal birth after caesarean rate, but also maintaining a low risk of uterine rupture.

Relevance to clinical practice

This modified vaginal birth after caesarean management protocol has been shown effective in increasing its successful rate, which can be continued for further comparison of severe complications to the previous practice.

Investigating the effect of age on platelet ultrastructure using transmission electron microscopy

Abstract

In the present study, the age‐ and sex‐related differences in platelet ultrastructure were investigated using transmission electron microscopy (TEM). A total of 15 healthy volunteers were grouped according to age, with 5 people in each of the following groups: young group (25‐45 years), middle‐aged group (46‐65 years), and old‐aged group (> 65 years). In the TEM micrographs, the internal components, specifically the α‐granules, dense granules, and lysosomal granules, of 20 platelets were counted for each group. Two‐way analysis of variance of age and sex variance was used to compare the results. The ultrastructure of the platelets in the old‐aged group was observed to be quite different from those of the young and middle‐aged groups. Specifically, with ageing, the platelet membrane becomes more irregular in shape and non‐smooth, and multiple platelet membrane ruptures are observed. Furthermore, the pseudopodia and protuberances become more numerous and slender, and the number of α‐granules is significantly reduced. These morphological changes indicate that ageing may affect the function of platelets, which in turn affects the efficacy of platelet concentrates. Thus, the effects of age should be considered when using platelet concentrates prepared from elderly autologous blood.

The perioperative administration of dexamethasone and infection (PADDI) trial protocol: rationale and design of a pragmatic multicentre non-inferiority study

Por: Corcoran · T. B. · Myles · P. S. · Forbes · A. B. · O'Loughlin · E. · Leslie · K. · Story · D. · Short · T. G. · Chan · M. T. · Coutts · P. · Sidhu · J. · Cheng · A. C. · Bach · L. A. · Ho · K. M. · on behalf of the Australian and New Zealand College of Anaesthetists Clinical Tri
Introduction

The intraoperative administration of dexamethasone for prophylaxis against postoperative nausea and vomiting is a common and recommended practice. The safety of the administration of this immunosuppressive agent at a time of significant immunological disruption has not been rigorously evaluated in terms of infective complications.

Methods/analysis

This is a pragmatic, multicentre, randomised, controlled, non-inferiority trial. A total of 8880 patients undergoing elective major surgery will be enrolled. Participants will be randomly allocated to receive either dexamethasone 8 mg or placebo intravenously following the induction of anaesthesia in a 1:1 ratio, stratified by centre and diabetes status. Patient enrolment into the trial is ongoing. The primary outcome is surgical site infection at 30 days following surgery, defined according to the Centre for Disease Control criteria.

Ethics/dissemination

The PADDI trial has been approved by the ethics committees of over 45 participating sites in Australia, New Zealand, Hong Kong, South Africa and the Netherlands. The trial has been endorsed by the Australia and New Zealand College of Anaesthetists Clinical Trials Network and the Australian Society for Infectious Diseases Clinical Research Network. Participant recruitment began in March 2016 and is expected to be complete in mid-2019. Publication of the results of the PADDI trial is anticipated to occur in early 2020.

Trial registration number

ACTRN12614001226695.

Sociodemographic, clinical and pharmacological profiles of medication misuse and dependence in hospitalised older patients in Norway: a prospective cross-sectional study

Por: Cheng · S. · Siddiqui · T. G. · Gossop · M. · Kristoffersen · E. S. · Lundqvist · C.
Objectives

Timely recognition of medication misuse and dependence is crucial to avoid both adverse drug events and increasing health expenditure. Yet the detection of these disorders in older people remains challenging due to the paucity of evidence on characteristics of patients at risk. This study investigates sociodemographic, pharmacological and clinical characteristics and factors associated with prolonged medication use, misuse and dependence in hospitalised older patients, focusing on three commonly prescribed central nervous system depressants (CNSDs): opioid analgesics, benzodiazepines and z-hypnotics.

Design

A prospective, cross-sectional study complying with the Strengthening the Reporting of Observational Studies in Epidemiology guidelines.

Setting

Somatic departments of the Akershus University Hospital, Norway.

Participants

246 patients aged 65–90 were included.

Outcome measures

Prolonged use was defined as using CNSDs for ≥4 weeks. Misuse and dependence were assessed with the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition criteria for substance abuse and dependence. We used descriptive statistics to report patients’ characteristics and logistic regression to demonstrate factors associated with prolonged use, and misuse or dependence.

Results

Forty per cent of participants reported using CNSDs for ≥4 weeks. The odds of prolonged use were higher for patients aged 75–84 (OR=2.32, 95% CI 1.16 to 4.65) and ≥85 (OR=3.33, 95% CI 1.25 to 8.87) vs

Conclusion

CNSD overuse is prevalent among hospitalised older patients, despite clear guidelines and recommendations. Our findings underline a need for stronger focus on responsible prescribing, timely detection and prevention of this issue, with special attention towards older patients, those with enhanced pain, polypharmacy and/or concurrent use of several CNSDs.

Trial registration number

NCT03162081.

Effects of foliar application of amino acid liquid fertilizers, with or without <i>Bacillus amyloliquefaciens</i> SQR9, on cowpea yield and leaf microbiota

by Dongsheng Wang, Xuhui Deng, Bei Wang, Na Zhang, Chengzhi Zhu, Zixuan Jiao, Rong Li, Qirong Shen

Leaf surface fertilization with liquid fertilizer produced from amino acids constitutes a potentially important source of nitrogen and is important for plant production. However, few reports have focused on the plant growth promotion by novel liquid fertilizers created by new amino acid resources, let alone the influence on leaf microbiota. In this study, the effects of liquid fertilizer, created by amino acids hydrolyzed from animal hairs with or without the PGPR strain Bacillus amyloliquefaciens SQR9, on crop yield and leaf microbiota were investigated. The results showed that leaves sprayed with amino acid liquid fertilizer (AA) and liquid biological fertilizer (AA9) persistently increased cowpea yields compared to the control amended with chemical fertilizer (CF). Fertilization with amino acid fertilizer showed no significant difference in microbial composition compared with the CF treatment; however, the introduction of functional microbes altered the microbial composition. Pearson correlation analysis, VPA analysis and SEM models all revealed that the amino acids liquid fertilizer application, but not the functional strain or the altered microbiota, performed as the direct driver attributing to yield enhancement. We conclude that leaf fertilization with a novel amino acid liquid fertilizer can greatly enhance the crop yield and that the addition of beneficial microbes may perform the role in further altering the composition of leaf microbiota.

Relationship between gay app use and HIV testing among men who have sex with men in Shenzhen, China: a serial cross-sectional study

Por: Wei · L. · Chen · L. · Zhang · H. · Yang · Z. · Liu · S. · Tan · W. · Xie · W. · Liu · L. · Zhao · J. · Cheng · J.
Objectives

To investigate the relationship between gay app use and HIV testing among men who have sex with men (MSM).

Design

Serial cross-sectional study.

Setting

A newly well-developed city in China.

Participants

4935 MSM were recruited through offline sampling methods from 2015 to 2017.

Primary and secondary outcomes

The primary outcome is the difference in HIV testing between app and non-app users.

Results

2872 (58.2%) and 2159 (43.7%) participated MSM had been tested for HIV within lifetime and the past year, respectively. Compared with non-app-using MSM, app-using MSM had a significantly higher prevalence of HIV testing within lifetime (adjusted OR (AOR): 1.48, 95% CI 1.27 to 1.72) and the past year (AOR: 1.36, 95% CI 1.18 to 1.57). App-using MSM were more likely to take an HIV test at the Centers for Disease Control and Prevention (AOR: 1.48, 95% CI 1.24 to 1.76) and community-based organisations (AOR: 1.71, 95% CI 1.44 to 2.03), but less often at gay venues (AOR: 0.49, 95% CI 0.37 to 0.63). Meanwhile, app-using MSM were more likely to take self-testing (AOR: 1.61, 95% CI 1.21 to 2.14). Predictors of HIV testing in the past year were: having an education level of college or higher (AOR: 1.29, 95% CI 1.01 to 1.65), being self-identified as a homosexual (AOR: 1.23, 95% CI 1.02 to 1.46), being recruited through clinic-based sampling (AOR: 1.30, 95% CI 1.06 to 1.60), using gay app (AOR: 1.49, 95% CI 1.21 to 1.83), engaging in group sex (AOR: 1.64, 95% CI 1.23 to 2.19), having received HIV-related service (AOR: 5.49, 95% CI 4.57 to 6.60), having a high level of HIV-related knowledge (AOR: 1.33, 95% CI 1.10 to 1.61) and high-risk perception (AOR: 2.95, 95% CI 1.40 to 6.23).

Conclusions

Gay app use was significantly associated with increased HIV testing among MSM hard to reach by traditional outreach. Therefore, it is imperative to expand HIV testing among non-app-using MSM. Continued efforts, innovative strategies and increased resource are highly needed to realise the first ‘90’ target.

Pathways of healthcare and antibiotics use following reported gastrointestinal illness: a cross-sectional study in rural Anhui, China

Por: Shen · X. R. · Xie · M. · Chai · J. · Feng · R. · Cheng · J. · Liu · R. · Kadetz · P. · Wang · D.
Objective

To document the factors, and their pathways, that influence healthcare and antibiotics use following reported gastrointestinal illnesses in Anhui province, China.

Study design

This study uses cross-sectional design, descriptive statistical analysis, pathway mapping and multivariate logistic regression modelling.

Setting

Households in 12 villages in Anhui province, China.

Participants

A total of 3659 residents who: (1) held a registered rural residence and were actually living in the sampled villages when this study was conducted; (2) were aged 18 years and older and (3) were willing to participate and able to answer the survey questions.

Outcome measures

Planned and measured variables included the occurrence of gastrointestinal illness, professional care seeking and antibiotic use due to the illness and factors influencing these measures.

Results

Of the 3659 informants, 29.0% reported gastrointestinal illness episodes in the past year. Of these episodes, 50.2% led to professional care seeking and 65.4% of antibiotic use. Multivariate logistic modelling identifies that: (1) reported gastrointestinal illnesses were more frequent in north compared with middle (OR 0.569, 95% CI 0.472 to 0.686) and south (OR 0.588, 95% CI 0.492 to 0.702) Anhui, and were positively associated with age (B=0.123, p

Conclusions

Reported gastrointestinal illnesses are quite prevalent in the sample population and a large proportion of these have resulted in professional care and antibiotics use. The factors associated with the reported illnesses and pathways of healthcare and antibiotic use, as identified in this study, should inform future research and intervention efforts.

Efficacy of dexmedetomidine as an adjuvant to local wound infiltration anaesthesia in abdominal surgery: A meta‐analysis of randomised controlled trials

Abstract

To assess the efficacy and safety of dexmedetomidine (DEX) as an adjuvant to local wound infiltration anaesthesia in abdominal surgery, we conducted this meta‐analysis. First, the systematic search strategy was performed on PubMed, Embase, and Cochrane Library and five randomised controlled trials (RCTs) involving 294 patients were included. Then, the outcome data were extracted from the studies and their effect sizes were calculated using Review Manager 5. As a result, the addition of DEX significantly reduced visual analogy scores at 6 hours after surgery (mean difference = −0.53[−0.82, −0.25], P < .001), 12 hours after surgery (mean difference = −0.39 [−0.73, −0.05]; P = .03), and 24 hours after surgery (mean difference = −0.20 [−0.29, −0.11], P < .001) and reduced total analgesic consumption within 24 hours after surgery (mean difference = −4.92 [−9.00, −0.84]; P = .02) compared with placebo groups. However, there was no difference in the incidence of postoperative nausea and vomiting (risk ratio = 0.68 [0.41, 1.14]; P = .14). In summary, DEX as a local anaesthetic adjuvant added for local wound infiltration anaesthesia in abdominal surgery could reduce visual analogy scores and postoperative analgesic consumption without changing incidence of postoperative nausea and vomiting.

Patients' experiences of coping with multiple chronic conditions: A qualitative descriptive study

Abstract

Objective

To explore the experiences of how Chinese adults cope with multiple chronic conditions in everyday life.

Background

Having multiple chronic conditions is stressful, requiring people to make physical and mental adaptations. There is little evidence exploring how people cope with multiple chronic conditions, especially in an Asian context.

Design

A qualitative descriptive design was employed. The Consolidated criteria for reporting qualitative research (COREQ) was used to report this study.

Methods

This study was conducted in a tertiary referral and teaching hospital in Bengbu, Anhui, China, between August and October 2018. A purposive sample of 14 people with multiple chronic conditions, aged between 32 and 75 years, completed a demographic questionnaire and semi‐structured face‐to‐face interviews. The interviews were digitally recorded and transcribed verbatim. Qualitative content analysis guided data analysis.

Results

Four distinctive themes comprising subthemes were developed from participants' narratives pertaining to coping with multiple chronic conditions: (a) appraising multiple chronic conditions, (b) addressing multiple chronic conditions management, (c) maintaining psychological well‐being and (d) fulfilling a social role. Illustrative quotations were cited to support each theme.

Conclusions

This study underscores that people cope with multiple chronic conditions in everyday life by using a compendium of coping strategies. As one of the influencing factors, culture dominates the ways of coping at different levels among people with multiple chronic conditions. These findings expand the current literature on coping based on an Asian perspective and inform further cross‐culture research on this topic.

Relevance to clinical practice

Healthcare professionals should understand peoples' experiences of coping with multiple chronic conditions to provide more holistic and dynamic health care to address their actual needs. Healthcare professionals should be acquainted with how culture impacts individuals' coping and develops culture‐tailored supportive programmes such as family‐based interventions, to promote the health of people with multiple chronic conditions.

Psychological distress and its association with job satisfaction among nurses in a teaching hospital

Abstract

Aim and objectives

To determine the prevalence of psychological distress and its association with job satisfaction among nurses in a teaching hospital in Malaysia.

Background

Nurses constitute the majority of health care workers, and, compared with other professions, nursing profession is highly stressful and, hence, a cause of anxiety and depression. This may affect nurses' job satisfaction.

Method

Using self‐administered questionnaires, Depression Anxiety and Stress Scale (DASS‐21) and Job Satisfaction Scale for Nurses (JSS), a cross‐sectional study of 932 nurses from the inpatient departments of a teaching hospital was conducted in December 2017. Descriptive analyses and multiple logistic regressions were used for the analysis. The STROBE guideline was used in this study.

Results

The overall prevalence of psychological distress was 41%. The prevalence of stress, anxiety and depression were 14.4%, 39.3% and 18.8%, respectively. It was found that single and widowed nurses had a higher level of stress, anxiety and depression compared with married nurses. In addition, nurses in the age of 26–30 years had a higher level of depression than nurses in other age groups. Also, nurses who worked in the paediatric departments had a higher level of depression compared with nurses in other departments. The majority of the nurses were satisfied with their job at 92.0%. Those nurses who were not satisfied were found to be significantly associated with a high level of stress and depression.

Conclusion

This study revealed that the level of stress, anxiety and depression is high. Stress and depression were found to be associated with nurses' low job satisfaction.

Relevance to clinical practice

Stress and depression can affect nurses' job satisfaction, it is important for nursing managers to institute strategies to address this issue.

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