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Critical review of multimorbidity outcome measures suitable for low-income and middle-income country settings: perspectives from the Global Alliance for Chronic Diseases (GACD) researchers

Por: Hurst · J. R. · Agarwal · G. · van Boven · J. F. M. · Daivadanam · M. · Gould · G. S. · Wan-Chun Huang · E. · Maulik · P. K. · Miranda · J. J. · Owolabi · M. O. · Premji · S. S. · Soriano · J. B. · Vedanthan · R. · Yan · L. · Levitt · N. · on behalf of the GACD Multi-Morbidity Work
Objectives

There is growing recognition around the importance of multimorbidity in low-income and middle-income country (LMIC) settings, and specifically the need for pragmatic intervention studies to reduce the risk of developing multimorbidity, and of mitigating the complications and progression of multimorbidity in LMICs. One of many challenges in completing such research has been the selection of appropriate outcomes measures. A 2018 Delphi exercise to develop a core-outcome set for multimorbidity research did not specifically address the challenges of multimorbidity in LMICs where the global burden is greatest, patterns of disease often differ and health systems are frequently fragmented. We, therefore, aimed to summarise and critically review outcome measures suitable for studies investigating mitigation of multimorbidity in LMIC settings.

Setting

LMIC.

Participants

People with multimorbidity.

Outcome measures

Identification of all outcome measures.

Results

We present a critical review of outcome measures across eight domains: mortality, quality of life, function, health economics, healthcare access and utilisation, treatment burden, measures of ‘Healthy Living’ and self-efficacy and social functioning.

Conclusions

Studies in multimorbidity are necessarily diverse and thus different outcome measures will be appropriate for different study designs. Presenting the diversity of outcome measures across domains should provide a useful summary for researchers, encourage the use of multiple domains in multimorbidity research, and provoke debate and progress in the field.

The Organisational Context of Nursing Practice in Hospitals in China and its Relationship with Quality of Care, Patient and Nurse Outcomes: A Mixed Methods Review

ABSTRACT

Background

Achieving high quality care and retention of nurses are major concerns for nurse leaders in hospitals. The organisational context is theorised to influence the quality of care and patient and nurse outcomes. This review focuses on China where the healthcare system is different from most Western countries in terms of government healthcare expenditure, public health insurance, and healthcare delivery system.

Objectives

To explore the organisational context of nursing practice in hospitals in China and its relationship with quality of care, patient outcomes (patient adverse events, safety and satisfaction), and nurse outcomes (burnout, job satisfaction, and intention to leave).

Design

A mixed methods review.

Data Sources

The electronic databases PubMed, EMBase, CINAHL, PsycInfo, and China Academic Journals Database were used.

Methods

This review was conducted using the SALSA framework (Search, Appraisal, Synthesis and Analysis). Quality assessment was conducted using the Joanna Briggs Institute (JBI) critical appraisal checklists for cross‐sectional studies and qualitative research. A narrative synthesis was conducted and was supported by tabulation of study data. The PRISMA reporting guidelines were used for this review.

Results

23 articles met the inclusion criteria and were retrieved, analysed and synthesised. This review supports the link between organisational context, quality of care, patient and nurse outcomes in the Chinese healthcare system. Aspects of organisational context warrant attention including nurse staffing levels, the shortage of nurses, a lack of nurse participation in hospital affairs, and support for the professional development of nurses.

Conclusions

The findings suggest that tailored interventions are needed to improve the organisational context of nursing practice in Chinese hospitals, and in particular, to address the nurse workforce issues and organisational leadership and support. The unique policy context of the Chinese healthcare system should be considered when developing these interventions.

Clinical Relevance

Recognising the importance of the organisational context, it is imperative that nurse leaders make every effort to legislate for safe nurse staffing and to establish a caring culture to improve quality of care and nurse and patient outcomes.

Mediating effects of nursing organizational climate on the relationships between empathy and burnout among clinical nurses

Abstract

Aims and objectives

To investigate how nurses who worked in Guangdong province in China perceived empathy, nursing organization climate and burnout.

Design

A cross‐sectional quantitative research design was used. We carried out the research in accordance with the Strengthening the Reporting of Observational studies in Epidemiology checklist.

Methods

The study was carried out from August–October of 2018 using a structured electronic questionnaire. A total of 965 participants were selected with convenience sampling in Guangdong province.

Results

A total of 786 valid questionnaires were collected in this study. The average burnout score of participants was 38.19 (SD 13.32) and 67.4% of them rated their burnout as more than 30 points, while 5.7% were higher than 60 points. The multi‐variable linear regression model explained 9.4% of the variance in burnout related to sociodemographic variables (p < 0.001). Empathy was significantly and positively associated with nursing organizational climate and emotional exhaustion while negatively associated with reduced personal accomplishment. In addition, nursing organizational climate mediated the relationship between empathy and reduced personal accomplishment.

Conclusion

Our findings suggest that both empathy and nursing organizational climate are protective factors that prevent burnout in this population. Managers can alleviate nurses’ burnout through developing empathy and improving the organizational climate.

Impact

This study demonstrates that empathy is not the cause of burnout; rather, it can prevent nurses from experiencing burnout. Nursing organizational climate is another protective factor that has a mediating effect on empathy and burnout. Improving empathy and nursing organizational climate could help reduce nurse burnout.

Impact of smoking on the income level of Chinese urban residents: a two-wave follow-up of the China Family Panel Study

Por: Wei · H. · Zhong · Z. · Yang · L. · Yao · T. · Huang · S. · Mao · Z.
Objectives

This study attempts to analyse the impact of smoking on the income level of Chinese urban residents to provide a reference for creating informed regulations on cigarette smoking.

Design

A population-based cohort study.

Method

Two waves of panel data in 2014 and 2016 from the China Family Panel Study were used. A total of 8025 urban adults were identified. The Hausman–Taylor model was used to analyse the theoretical relationship between smoking and income.

Results

The percentage of current smokers decreased from 27.39% (2014) to 26.24% (2016), while the percentage of former smokers rose from 9.78% to 11.78%. The results from the Hausman–Taylor model showed that current smokers and former smokers are associated with statistically significant decrease in the income of urban residents of 37.70% and 44.00%, respectively, compared with that of non-smokers. After eliminating the impact of smoking on income, the poverty rate among urban residents decreased from 15.33% to 13.63%.

Conclusions

Smoking can significantly reduce the income of Chinese urban residents, resulting in immense negative impacts on Chinese society. Therefore, the government should raise the tax rate on tobacco, include smoking cessation treatment in medical insurance coverage, promote publicity campaigns on the awareness of tobacco hazards and encourage smokers to quit smoking early.

Interventions promoting physical activity among adults and children in the six Gulf Cooperation Council countries: protocol for a systematic review

Por: Pearson · F. · Huangfu · P. · Abu-Hijleh · F. M. · Awad · S. F. · Abu-Raddad · L. J. · Critchley · J. A.
Introduction

Prevalence of overweight, obesity and diabetes are high and rising across the Gulf Cooperation Council (GCC) countries (Oman, Bahrain, Kuwait, Qatar, Saudi Arabia and the United Arab Emirates). In parallel, physical activity (PA) levels are low relative to international standards. PA aids weight control and reduces risk of non-communicable diseases including diabetes and cardiovascular disease. It is likely interventions developed elsewhere will not translate to GCC countries due to unique environmental, social and cultural factors. This protocol is for a systematic review assessing the efficacy of interventions promoting PA within GCC countries among generally healthy adults and children. The primary outcome of interest is change in objectively measured or self-reported PA levels, the secondary outcomes of interest are changes in anthropometry or chronic disease risk factors (eg, blood pressure). Interventions will be compared with no intervention or those of differing PA intensity or duration. The relationships between PA change and the following will be assessed: intervention intensity or duration, season in which intervention occurs, sex, age, nationality and sustainability over time.

Methods and analysis

A systematic search strategy will identify indexed publications on the efficacy of interventions promoting PA. Randomised controlled trials and quasi-experimental studies recruiting predominantly healthy children and adults will be included. Studies of exercise rehabilitation will be excluded. Medline, Embase, Cinahl, Cochrane Library, SportDiscus, Web of Science, Index Medicus for the Eastern Mediterranean Region and Qscience will be searched. Clinical trial registries including the International Clinical Trials Registry Platform, the Iranian Registry of Clinical Trials and ClinicalTrials.gov will be searched for ongoing and unpublished studies. Searches will be ran from database inception until 1 May 2020 and be supplemented by checking references of key articles. Two reviewers will independently screen identified citations then full texts using prespecified inclusion and exclusion criteria. Piloted data extraction forms will be used in duplicate. Inconsistencies in screening or data extraction will be resolved by a third investigator or study author contact. Risk of bias will be independently assessed by two reviewers using validated tools. A narrative summary of findings will be produced supplemented with meta-analyses and exploration of heterogeneity as appropriate.

Ethics and Dissemination

The review aims to strengthen the findings of the primary studies it incorporates and explore the impact of setting. It will synthesise existing published aggregate patient data. If publications or data with ethical concerns are identified, they will be excluded from the review. Results of the systematic review will be published in full and authors will engage directly with research audiences and key stakeholders to share findings.

PROSPERO registration number

131817.

Effect of subsidies on healthful consumption: a protocol for a systematic review update

Por: Pearson · F. · Huangfu · P. · Abu-Hijleh · F. M. · Awad · S. F. · Abu-Raddad · L. J. · Critchley · J. A.
Introduction

The prevalence of diet-related non-communicable diseases (NCDs) are rapidly increasing in most parts of the world. In order to ameliorate the related public health burden, evidence-informed policies to improve diet need to be implemented. Financial subsidies that promote healthful consumption patterns have the potential to reduce NCD risk and may also reduce inequality if targeted at those of low socio-economic position. This protocol is for an updated systematic review of such evidence.

Methods and analysis

A systematic search strategy will be used to identify publications on fiscal intervention studies indexed in Embase, CINAHL, Web of Science, EconLit and PubMed in between January 2013 to February 2019. Two reviewers will independently sift identified citations using prespecified inclusion and exclusion criteria to inform full-text review. The outcomes of interest are: consumption patterns (% change in targeted items and in overall dietary patterns), purchasing patterns (% change) or body mass index. Pretested data capture forms will be used for double data extraction. Any inconsistencies in citation sifting or data extraction will be resolved by a third investigator and study authors will be contacted if needed. Systematic searches will be supplemented by reference checking of key articles. Study quality will be assessed and a narrative summary of findings will be produced. Meta-analyses and exploration of heterogeneity will be completed if appropriate.

Ethics and dissemination

The review aims to strengthen findings of the primary studies it incorporates. It will synthesise existing published aggregated patient data and only present further aggregate data. Given this, no concerns are held relating to confidentiality and informed consent due to re-use of patient data.

If publications or data with ethical concerns are identified, they will be excluded from the review.

Results of the systematic review will be published in full and authors will engage directly with research audiences and key stakeholders to share findings.

PROSPERO registration number

CRD42019125013

Is the Yale Global Tic Severity Scale a valid tool for parent-reported assessment in the paediatric population? A prospective observational study in Taiwan

Por: Ho · C.-S. · Huang · J.-Y. · Yang · C.-H. · Lin · Y.-J. · Huang · M.-Y. · Su · Y.-C.
Objective

The Yale Global Tic Severity Scale (YGTSS) is the most commonly used clinician-rated evaluation tool for Tourette syndrome (TS), with established reliability and validity. This study aims to determine whether the YGTSS is a valid parent-reported assessment in the TS population.

Design

A prospective cohort study.

Setting

A major medical centre in Taiwan.

Methods

A total of 594 patients were enrolled. A revised traditional Chinese version of the YGTSS was made available to parents via Google docs. Parents were encouraged to complete the YGTSS the day before each outpatient clinic visit. At each visit, a paediatric neurology fellow also administered the YGTSS assessment. We investigated whether differences in scores between physicians and parents changed as the number of parent evaluations increased. The results of the physician assessments were also taken as the expert standard for evaluating the sensitivity and specificity of the parent-reported assessments was conducted for the same visit.

Results

The differences in the YGTSS scores between participants and physicians were small. The mean difference in the total assessment score was 4.15 points. As the number of times the parent evaluation was performed increased, the difference between the parent and physician scores decreased. Discrimination of moderate-to-severe attacks was good using the parent-assessed YGTSS (area under the receiver operating characteristic curve, 0.858; 95% CI 0.839 to 0.876). The sensitivity for detecting a moderate-to-severe attack by YGTSS parent assessment was 79.7% (95% CI 76.6 to 82.8), and the specificity was 91.8% (95% CI 89.9 to 93.7).

Conclusion

The parent-reported YGTSS is a promising tool for TS assessment, demonstrating good discriminative ability for disease severity, with user precision increasing with experience.

State-level variation in opioid prescribing after knee arthroscopy among the opioid-naïve in the USA: 2015-2019

Por: Ukert · B. · Huang · Y. · Sennett · B. · Delgado · K.
Objective

It has been established that most patients prescribed opioids after minor surgery have tablets left over, better understanding the variation in opioid prescribing and variation in dosage of the prescription could guide efforts to reduce prescribing. This study describes the state-level variation in opioid prescribing after a knee arthroscopy among opioid-naïve patients.

Design

Retrospective cohort study.

Setting

Commercial insurance claims data.

Participants

98 623 individual across the USA with commercial insurance who were opioid-naïve and had a knee arthroscopy between 2015 and 2019.

Exposure

Patients who filled an opioid prescription within 3 days of a knee arthroscopy.

Outcome measures

Opioid prescriptions were measured as a pharmacy claim for filling an opioid within 3 days of a knee arthroscopy. We measured the patient and state-level opioid prescribing rate, tablet count, morphine milligram equivalent dose per prescription and risk-adjusted predicted opioid quantity.

Results

Overall, 72% of patients filled an opioid prescription with a median tablet count of 40 and median morphine milligram equivalent of 250. Patients with an invasive procedure (27.9% vs 22.4%; p

Conclusion

Wide variation in the likelihood of receiving a prescription, depending on state of residence, was observed. The dosages prescribed were high and have been associated with transition to long-term use. These findings suggest that there is substantial opportunity for the development of guidelines to reduce variability in opioid prescribing for this common ambulatory procedure.

Value of lung ultrasound for the diagnosis of COVID-19 pneumonia: a protocol for a systematic review and meta-analysis

Por: Yang · Y. · Zhang · D. · Zhou · C. · Huang · H. · Wang · R.
Introduction

In the recent COVID-19 pandemic, cases have exceeded over one million, with the number of confirmed cases increasing by 50 000–60 000 per day. The virus has killed nearly 50 000 people all over the world in only 3 months. These reforms bring major challenges to the public health and healthcare system. The pulmonary pathological features during the initial phase of COVID-19 are alveolar oedema, pneumocyte hyperplasia, gravitational consolidations and interstitial thickening. The ability of lung ultrasound (LUS) and its evolving applications in the diagnosis of COVID-19 pneumonia are widespread. This study aims to evaluate the surveillance value of LUS in the diagnosis of COVID-19 pneumonia.

Methods and analysis

We will perform a systematic search and meta-analysis on the use of LUS to diagnose and confirm COVID-19 pneumonia. We will search Ovid Medline, Ovid Embase, Web of Science, Cochrane Library, Scopus, Google Scholar, China Biology Medicine disc and WHO Global Health Library for studies on diagnostic accuracy from December 2019 to April 2021. Data collection and screening will be individually accomplished by two reviewers. The assessment of risk of bias for each outcome will be conducted using the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies 2) tool. Data will be synthesised and heterogeneity will be evaluated. Meta-analysis will be conducted when strong homogeneous data are accessible. Grading of Recommendations Assessment, Development and Evaluation(GRADE) will be used to assess quality of evidence.

Ethics and dissemination

Approval of ethics committee is not needed for this review. While results will be disseminated electronically, effective dissemination will be done through presentations and peer-reviewed publication.

PROSPERO registration number

CRD42020177803; pre-results.

Breast feeding after caesarean delivery on maternal request: protocol of a systematic review and meta-analysis

Por: Mu · W. · Huang · Y. H. · Chaumont · A. · Letourneau · I. · El-Chaar · D. · Xia · T. · Wu Wen · S.
Introduction

Caesarean delivery under maternal request (CDMR) is a major factor contributing to the rising global rates of caesarean section (CS) procedure. The choice of CDMR without medical indications could provide a sense of assured safety by avoiding the experiences and complications of vaginal birth, and the risks related to an emergency CS. However, it might adversely influence women’s breast feeding patterns and produce a long-lasting impact on maternal and neonatal health. This study aims to systematically review the current evidence relating to the effects of intentions of performing CDMR on breast feeding.

Methods and analysis

A comprehensive literature search will be performed in three English-language electronic databases, major clinical study registries and other sources for original studies reporting the breast feeding outcomes after a planned CDMR or vaginal delivery. The three databases Medline, Embase and the Cochrane Central Register of Controlled Trials will be searched via Ovid from inception to February 2020. Randomised controlled trials (RCTs), pseudo-RCTs, cohort studies and case–control studies on this topic will be included. Participants in the experimental or case group should meet the Robson criteria of classes 2B or 4B and have experienced planned CS undertaken for no maternal or foetal indication, whereas participants in the control group have undergone scheduled vaginal delivery. All kinds of breast feeding outcomes will be included. Meta-analyses will be attempted to provide an estimate of the pooled effect and will be stratified by different study designs. A qualitative description will be provided if quantitative synthesis proves to be fruitless.

Ethics and dissemination

This study is a secondary literature review that does not need ethical approval. No primary data will be collected from the participants. Findings of this study will be presented at scientific conferences and be published in scientific journals.

PROSPERO registration number

CRD42020160303.

Does theory of planned behaviour play a role in predicting uptake of colorectal cancer screening? A cross-sectional study in Hong Kong

Por: Huang · J. · Wang · J. · Pang · T. W.-Y. · Chan · M. K.-Y. · Leung · S. · Chen · X. · Leung · C. · Zheng · Z.-J. · Wong · M. C.-S.
Objective

Colorectal cancer (CRC) ranked second in terms of cancer mortality worldwide. It is associated with a substantial global disease burden. We aimed to examine whether the theory of planned behaviour (TPB) could predict the uptake of faecal immunochemical test to inform novel strategies for enhancing CRC screening participation in population-based programmes.

Design

Cross-sectional study.

Settings

A Hong Kong-based and territory-wide telephone survey was conducted during the study period from October 2017 to November 2018.

Participants

4800 asymptomatic individuals aged 61–70 years who can communicate in Cantonese were recruited during the survey period. Those who had a history of CRC, chronic bowel inflammation, two or more first-degree relatives with CRC, and received colonoscopy in the past 10 years or faecal occult blood test in the past 5 years were excluded.

Outcome measures

The association between CRC screening uptake and the factors pertinent to TPB was analysed by univariable and multivariable regression models and the mediating effect of intention. We adjusted for age, gender, educational level, marital and working status, as well as household income.

Results

Multivariable regression analysis showed that high perceived behavioural control (adjusted OR (AOR)=12.35, 95% CI 8.21 to 18.60, p

Conclusions

The variables pertinent to TPB could successfully predict CRC screening uptake. Promotion of CRC screening based on interventions that increase perceived behavioural control and behavioural intention could potentially enhance screening uptake. Further studies are needed to establish the cause and effect relationship among these variables and screening uptake, as well as to evaluate the cost-effectiveness of such interventions.

Effectiveness of a couple‐based psychosocial intervention on patients with prostate cancer and their partners: A quasi‐experimental study

Abstract

Aims

To understand the effectiveness of a couple‐based psychosocial information package (PIP) and multimedia psychosocial intervention (MPI) on patients with prostate cancer and their partners.

Design

A random assignment and quasi‐experimental design were used.

Methods

From August 2015–March 2018, 103 newly diagnosed patients with prostate cancer and their partners were divided into a control group (CG) (N = 50), PIP group (N = 25) and MPI group (N = 28). The CG received usual care, the PIP group received information manuals and telephone counselling for 6‐week and the MPI group received multimedia films and manuals and professional support for 6 weeks. The three groups were posttested 6, 10, 18 and 24 weeks after the pre‐test. The outcome measurements included disease appraisals, emotion status, relationship satisfaction, health‐related quality of life (HRQOL) and satisfaction with MPI.

Results/Findings

Partners in the MPI and PIP groups experienced significant improvements in positive and negative affect or mental HRQOL as compared with the CG. The effectiveness of MPI and PIP on negative affect, mental HRQOL, however, were not statistically significant in patients with prostate cancer. Nevertheless, patients were satisfied with the MPI.

Conclusion

Nurses can provide different types of interventions for partners, depending on personal preferences and available resources.

IMPACT

There is a lack of studies that focus on the effectiveness of couple‐based psychosocial intervention on both the patients with prostate cancer and their partners in Asia. Partners in the multimedia psychosocial intervention group and psychosocial information package group experienced improvements in positive affect, negative affect or health‐related quality of life as compared with the control group. Patients in both intervention groups experienced similar negative affect and health‐related quality of life as compared with the control group. The couple‐based psychosocial interventions can be provided by nurses based on partners’ preferences and available resources.

EGFR testing and erlotinib use in non-small cell lung cancer patients in Kentucky

by Kara L. Larson, Bin Huang, Quan Chen, Thomas Tucker, Marissa Schuh, Susanne M. Arnold, Jill M. Kolesar

This study determined the frequency and factors associated with EGFR testing rates and erlotinib treatment as well as associated survival outcomes in patients with non small cell lung cancer in Kentucky. Data from the Kentucky Cancer Registry (KCR) linked with health claims from Medicaid, Medicare and private insurance groups were evaluated. EGFR testing and erlotinib prescribing were identified using ICD-9 procedure codes and national drug codes in claims, respectively. Logistic regression analysis was performed to determine factors associated with EGFR testing and erlotinib prescribing. Cox-regression analysis was performed to determine factors associated with survival. EGFR mutation testing rates rose from 0.1% to 10.6% over the evaluated period while erlotinib use ranged from 3.4% to 5.4%. Factors associated with no EGFR testing were older age, male gender, enrollment in Medicaid or Medicare, smoking, and geographic region. Factors associated with not receiving erlotinib included older age, male gender, enrollment in Medicare or Medicaid, and living in moderate to high poverty. Survival analysis demonstrated EGFR testing or erlotinib use was associated with a higher likelihood of survival. EGFR testing and erlotinib prescribing were slow to be implemented in our predominantly rural state. While population-level factors likely contributed, patient factors, including geographic location (areas with high poverty rates and rural regions) and insurance type, were associated with lack of use, highlighting rural disparities in the implementation of cancer precision medicine.

Factors Associated With Resilience Among Primary Caregivers of Patients With Advanced Cancer Within the First 6 Months Post‐Treatment in Taiwan: A Cross‐Sectional Study

Abstract

Purpose

To identify factors associated with resilience in primary caregivers of patients with advanced oral cavity cancer within the first 6 months post‐treatment.

Design

A cross‐sectional study.

Methods

We recruited patient–primary caregiver dyads from the outpatient radiation department of a medical center in Northern Taiwan. Patients were assessed using a set of structured questionnaires to measure performance status and demographic and clinical characteristics. Primary caregivers were measured in their social support, resilience, and care characteristics.

Results

Of the 148 dyads surveyed, 33.8% of primary caregivers reported moderately low to moderate resilience, and 61.5% reported low resilience. Greater resilience of primary caregivers was associated with the primary caregiver factors of younger age, lower educational level, and more affectionate social support; and greater resilience was associated with the patient factors of better performance status and older age. These factors explained 40.4% of the variance in resilience.

Conclusions

Patients’ performance status and primary caregivers’ affectionate social support strongly influence overall resilience and each domain of resilience.

Clinical Relevance

Providing primary caregivers with sufficient social resources and a support group can help them cope with the demands of caregiving for loved ones with oral cavity cancer.

Injection Molded Autoclavable, Scalable, Conformable (iMASC) system for aerosol-based protection: a prospective single-arm feasibility study

Por: Byrne · J. D. · Wentworth · A. J. · Chai · P. R. · Huang · H.-W. · Babaee · S. · Li · C. · Becker · S. L. · Tov · C. · Min · S. · Traverso · G.
Objective

To develop and test a new reusable, sterilisable N95 filtering facepiece respirator (FFR)-comparable face mask, known as the Injection Molded Autoclavable, Scalable, Conformable (iMASC) system, given the dire need for personal protective equipment within healthcare settings during the COVID-19 pandemic.

Design

Single-arm feasibility study.

Setting

Emergency department and outpatient oncology clinic.

Participants

Healthcare workers who have previously undergone N95 fit testing.

Interventions

Fit testing of new iMASC system.

Primary and secondary outcome measures

Primary outcome is success of fit testing using an Occupational Safety and Health Administration (OSHA)-approved testing method, and secondary outcomes are user experience with fit, breathability and filter replacement.

Results

Twenty-four subjects were recruited to undergo fit testing, and the average age of subjects was 41 years (range of 21–65 years) with an average body mass index of 26.5 kg/m2. The breakdown of participants by profession was 46% nurses (n=11), 21% attending physicians (n=5), 21% resident physicians (n=5) and 12% technicians (n=3). Of these participants, four did not perform the fit testing due to the inability to detect saccharin solution on premask placement sensitivity test, lack of time and inability to place mask over hair. All participants (n=20) who performed the fit test were successfully fitted for the iMASC system using an OSHA-approved testing method. User experience with the iMASC system, as evaluated using a Likert scale with a score of 1 indicating excellent and a score of 5 indicating very poor, demonstrated an average fit score of 1.75, breathability of 1.6, and ease of replacing the filter on the mask was scored on average as 2.05.

Conclusions

The iMASC system was shown to successfully fit multiple different face sizes and shapes using an OSHA-approved testing method. These data support further certification testing needed for use in the healthcare setting.

High INtensity Interval Training In pATiEnts with intermittent claudication (INITIATE): protocol for a multicentre, proof-of-concept, prospective interventional study

Por: Pymer · S. · Harwood · A. · Ibeggazene · S. · McGregor · G. · Huang · C. · Twiddy · M. · Nicholls · A. R. · Ingle · L. · Carroll · S. · Long · J. · Rooms · M. · Chetter · I. C. · On behalf of INITIATE investigator group
Introduction

The first-line recommended treatment for patients with intermittent claudication (IC) is a supervised exercise programme (SEP), which includes a minimum of 2-hours of exercise per week over a 12-week period. However, provision, uptake and adherence rates for these SEP programmes are poor, with time constraints cited as a common participant barrier. High-intensity interval training (HIIT) is more time-efficient and therefore has the potential to overcome this barrier. However, evidence is lacking for the role of HIIT in those with IC. This proof-of-concept study aims to consider the safety, feasibility, tolerability and acceptability of a HIIT programme for patients with IC.

Methods and analysis

This multicentre, single-group, prospective, interventional feasibility study will recruit 40 patients with IC, who will complete 6 weeks of HIIT, 3 times a week. HIIT will involve a supervised programme of 10x1 min high-intensity cycling intervals at 85%–90% peak power output (PPO), interspaced with 10x1 min low intensity intervals at 20%–25% PPO. PPO will be determined from a baseline cardiopulmonary exercise test (CPET) and it is intended that patients will achieve ≥85% of maximum heart rate from CPET, by the end of the second HIIT interval. Primary outcome measures are safety (occurrence of adverse events directly related to the study), programme feasibility (including participant eligibility, recruitment and completion rates) and HIIT tolerability (ability to achieve and maintain the required intensity). Secondary outcomes include patient acceptability, walking distance, CPET cardiorespiratory fitness measures and quality of life outcomes.

Ethics and dissemination

Ethical approval was obtained via a local National Health Service research ethics committee (Bradford Leeds – 18/YH/0112) and recruitment began in August 2019 and will be completed in October 2020. Results will be published in peer-reviewed journals and presented at international conferences and are expected to inform a future pilot randomised controlled trial of HIIT versus usual-care SEPs.

Trial registration number

NCT04042311; Pre-results.

On-line parameter identification of the lumped arterial system model: A simulation study

by Feng Huang, Shunv Ying

A lumped model of the arterial system has been used in constructing a hybrid mock loop due to its real-time response. However, the parameters of the model are always from a general case and not adapted to a specific patient. In this study, we focused on on-line parameter identification of the lumped model of the arterial system that could be used for a specific patient. A five-element lumped arterial model is adopted in this study, in which the five parameters are to be determined. The aortic flow rate and the venous pressure are chosen as the inputs of the model, and aortic pressure as the output. An iterative optimization based on the established state space equations of the five-element model is used to seek the best parameter values by minimizing the difference between the model prediction and the previously obtained aortic pressure. The method is validated using simulated data from a complete numerical cardiovascular model. Results show that the method can track the dynamic variation of the parameters very well. Finally, a sensitivity analysis of the model parameters is conducted to interpret the effect of parameter changes. The good performance of the identification demonstrates the potential application of this method to customize a hybrid mock loop for a specific patient or clinically monitor the arterial vessel characteristics in real time.

Effects of flexible sacrum positions during the second stage of labour on maternal and neonatal outcomes: A systematic review and meta‐analysis

Abstract

Aims and objectives

To assess the effects of flexible sacrum positions on mode of delivery, duration of the second stage of labour, perineal trauma, postpartum haemorrhage, maternal pain, abnormal foetal heart rate patterns and Apgar scores based on published literature.

Background

Maternal positions served as a nonmedical intervention may facilitate optimal maternal and neonatal outcomes during labour. Flexible sacrum positions are conducive to expanding pelvic outlet. Whether flexible sacrum positions have positive effects on maternal and neonatal well‐being is a controversial issue under heated discussion.

Design

We performed a systematic review and meta‐analysis based on PRISMA guidelines.

Methods

Randomised controlled trials (RCTs) comparing any flexible sacrum position with non‐flexible sacrum position in the second stage of labour were included. PubMed, EMBASE, Cochrane Library, CINAHL, CNKI (China National Knowledge Infrastructure), SinoMed and Wanfang databases were searched from inception to 11 March 2019 for published RCTs. Risk of bias was assessed by the Cochrane criteria, and random‐effects meta‐analyses were conducted by RevMan 5.3.

Results

Sixteen studies (3,397 women) published in English were included. Flexible sacrum positions in the second stage of labour could reduce the incidence of operative delivery, instrumental vaginal delivery, caesarean section, episiotomy, severe perineal trauma, severe pain and shorten the duration of active pushing phase in the second stage of labour. However, flexible sacrum positions may increase the incidence of mild perineal trauma. There was no significant difference in the duration of the second stage of labour, maternal satisfaction and other outcomes.

Conclusions

Flexible sacrum positions are superior in promoting maternal well‐being during childbirth. However, several results require careful interpretation. More rigorous original studies are needed to further explore their effects.

Relevance to clinical practice

The results support the use of flexible sacrum positions. Flexible sacrum positions are recommended to apply flexibly or tailor to individual woman's labour progress.

Decision‐making among the substitute decision makers in intensive care units: An investigation of decision control preferences and decisional conflicts 重症监护室中替代决策者的决策:对决策控制偏好和决策冲突的调查

Abstract

Aims

To explore decision control preferences and decisional conflicts and to analyse their association among the surrogate decision makers in the intensive care unit.

Design

The study carried out a cross‐sectional survey among the surrogates.

Methods

The participants were 115 surrogate decision makers of critical patients, from August to September 2019. A Chi‐squared test and logistic regression were used to assess decision control preferences and decisional conflicts, and Spearman's rank correlation coefficient was employed to examine their association.

Results

Of the 115 surrogate decision makers, 51.3% preferred a collaborative role, and 63.48% were somewhat unsure about making decisions. Logistic regression analysis identified decision control preferences was associated with surrogates’ age, education level, and personality traits, while decisional conflicts was associated with surrogates’ age, education level, character, medical expense burden, and Acute Physiology and Chronic Health Evaluation‐II score. Cohen's kappa statistics showed a bad concordance of decision‐making expectations and actuality, with kappa values of 0.158 (p < .05). Wherein surrogates who experienced discordance between their preferred and actual roles, have relatively higher decisional conflicts.

Conclusion

This study identified individual differences of surrogate decision makers in decision control preferences and decisional conflicts. These results imply that incorporation of the individual decision preferences and communication styles into care plans is an important first step to develop high quality decision support.

Impact

This research is a contribution to the limited study on decision control preferences and decisional conflicts among surrogate decision makers of critically ill patients. Moreover based on the investigation of understanding the status and related factors of decision preferences and decisional conflicts set the stage for developing effective decision support interventions.

目的

旨在探讨决策控制偏好和决策冲突,并分析决策控制偏好和决策冲突在重症监护室替代决策者中的关联性。

设计

该研究对替代者进行了横断面调查。

方法

参与者为2019年8月至9月期间115名危重患者的替代决策者。采用卡方检验和逻辑回归来评估决策控制偏好和决策冲突,并采用斯皮尔曼等级相关系数考察其关联性。

结果

在这115名替代决策者中,51.3%的人更倾向于合作角色,而63.48%的人则对决策不太确定。逻辑回归分析发现,决策控制偏好与替代决策者的年龄、教育水平、性格特征相关,而决策冲突与替代决策者的年龄、教育水平、性格、医疗费用负担、急性生理和慢性健康评价‐II评分相关。Cohen的kappa统计量显示,决策期望与实际值不太一致,kappa值为0.158(p < .05)。其中经历过偏好角色和实际角色不协调的替代决策者,其决策冲突相对更高。

结论

该研究确定了替代决策者在决策控制偏好和决策冲突方面的个体差异。这些结果意味着,将个人决策偏好和沟通方式纳入护理计划是制定高质量决策支持措施的重要的第一步。

影响

该研究对危重患者替代决策者决策控制偏好和决策冲突的有限研究作出了一定贡献。此外,基于对决策偏好和决策冲突的现状及相关因素的调查了解,为制定有效的决策支持干预措施奠定了基础。

Factors influencing postpartum blood glucose screening among women with prior gestational diabetes mellitus in a rural community

Abstract

Aims

The aims of the present study were: a) to investigate the current state of postpartum glucose screening in rural China; and b) to explore the factors influencing postpartum blood glucose screening among women with prior GDM based on Andersen's behavioural model of health service use.

Design

A multisite, cross‐sectional study design, conducted from November 2017 to January 2018.

Methods

A total of 465 women with prior GDM were included from two county‐level hospitals in rural China. The potential influencing factors for postpartum blood glucose screening based on Andersen's behavioural model, including predisposing, enabling, and need factors, were collected by self‐reported questionnaires. Chi‐square tests and logistic regression were used to explore the influence of these factors on whether screening of blood glucose level after delivery occurred.

Results

The mean age of the women was 31.92 years old (SD 5.16) and the mean time after delivery was 16.73 months (SD 15.07). The postpartum glucose screening proportion was 32.7%. Women who did not have a full‐time job (p = .011) (predisposing factor), had not received any treatment for GDM (p = .002), and were not informed about screening plans for diabetes by health professionals (p < .001) (enabling factor) were less likely to engage in postpartum glucose screening. The need factor, high actual risk of developing type 2 diabetes mellitus (T2DM), was not associated with postpartum blood glucose screening (p > .05).

Conclusions

In rural China, most women with prior GDM were not screened for T2DM after delivery. The women with prior GDM who did not have a full‐time job or had not received any prior treatment for GDM should be the target population for health education on postpartum glucose screening.

Impact

There is a need for data on postpartum blood glucose testing rates among rural women. Future interventions aimed at increasing postpartum blood glucose screening are needed.

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