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Acupuncture for retinitis pigmentosa: study protocol for a randomised, sham-controlled trial

Por: Huang · H. · Wang · J. · Li · H. · Lei · R. · Zou · W. · Huang · Q. · Gao · N. · Zheng · Y.
Introduction

Primary retinitis pigmentosa (RP) is a common hereditary retinal disease in ophthalmology that has a considerable impact on quality of life, but there are few effective therapeutic strategies. This trial aims to determine the efficacy and safety of acupuncture versus sham acupuncture (SA) for RP.

Methods and analysis

This is a study protocol for a randomised, participant-blind, sham-controlled trial. 64 eligible patients with RP will randomly be divided into acupuncture group and SA group. All groups will receive 48 sessions over 3 months. Participants will complete the trial by visiting the research centre in month 6/9 for a follow-up assessment. The primary outcome is visual field mean sensitivity and visual field mean deviation at month 3/6/9 compared with baseline. Secondary outcomes include the best-corrected visual acuity, central macular thickness, subfoveal choroidal thicknes, traditional Chinese medicine syndrome score and the scale of life quality for diseases with visual impairment at month 3/6/9 compared with baseline. Adverse events and safety indexes will be recorded throughout the study. SPSS V.25.0 statistical software was used for analysis, and measurement data were expressed as mean±SD.

Ethics and dissemination

Ethics approval was obtained from the Ethics Committee of the Chinese Clinical Trial Registry (approval no: ChiECRCT20200460). The results of this study will be published in a peer-reviewed journal, and trial participants will be informed via email and/or phone calls.

Trial registration number

ChiCTR2000041090.

Radiotherapy for head and neck tumours using an oral fixation and parameter acquisition device and TOMO technology: a randomised controlled study

Por: Zhang · X. · Wang · T. · Xiao · X. · Li · X. · Wang · C. Y. · Huang · B. · He · L. · Song · Y.
Introduction

Radiotherapy has become one of the main methods used for the treatment of malignant tumours of the head and neck. Spiral tomographic intensity-modulated radiotherapy has the many advantages of precision radiotherapy, which puts forward high requirements for postural reproducibility and accuracy. We will aim to ensure that the accurate positioning of the tumour will reduce the side effects of radiotherapy caused by positioning errors. We will design and implement this clinical trial using the patent of ‘a radiotherapy oral fixation and parameter acquisition device (patent number: ZL201921877986.5)’.

Methods and analysis

This will be a randomised, controlled, prospective study with 120 patients with head and neck tumours. Using the random number table method, a random number sequence will be generated, and the patients will be enrolled in the experimental group (oral fixation device) and the control group (conventional fixation) in a 2:1 ratio. The primary outcome will be the progression-free survival time after the treatment. Secondary outcomes will include the oral mucosal reaction and the quality of life. Follow-ups will be carried out according to the plan. This is V.1.0 of protocol on 1 April 2021. The recruitment process for this clinical trial commenced on 1 May 2021, and will end on 1 October 2022.

Ethics and dissemination

The trial received ethical approval from Medical Ethics Committee of Liaoning Provincial Cancer Hospital (number 20210131X). The final results will be presented at a scientific conference and published in a peer-reviewed journal in accordance with the journal’s guidelines.

Trial registration number

ChiCTR2100045096.

Sensor technology to monitor health, well-being and movement among healthcare personnel at workplace: a systematic scoping review protocol

Por: Välimäki · M. · Hipp · K. · Chen · J. · Huang · X. · Guo · J. · Wong · M. S.
Introduction

The well-being and health of healthcare personnel is becoming increasingly important in the delivery of high-quality healthcare. The recent developments in technology have provided new opportunities for the objective detection of a wide variety of real-world properties and movement. However, technologies that are used to monitor health, well-being and movement among healthcare personnel have not been fully synthesised. The overall aim of this scoping review is to examine what type of sensor technology is available to monitor the health, well-being and movement of healthcare personnel in healthcare settings. More specifically, we want to explore what types of sensor technology applications, for what purposes and how they have been used to monitor health, well-being and movement among healthcare personnel in different workplace settings.

Methods and analysis

This scoping review protocol will follow Arksey and O’Malley’s methodology, complemented by the approach of the Joanna Briggs Institute to scoping reviews and guidance for conducting systematic scoping reviews. Peer-reviewed literature will be identified using a search strategy developed by a librarian, and a wide range of electronic datasets of medical, computer and information systems disciplines will be used. Eligibility of the articles will be determined using a two-stage screening process consisting of (1) a title and abstract scan, and (2) a full-text review. Extracted data will be thematically analysed and validated by an expert of sensor technology and a group of nurses as stakeholders. Descriptive statistics will be calculated when necessary.

Ethics and dissemination

The results obtained from the review will inform what technology has been used, how it has been used in healthcare settings and what types of technology might still be needed for future innovations. Findings of the scoping review will be published in a peer-reviewed journal.

Registration

This review was submitted in Open Science Framework on 12 December 2020.

Trajectories of resilience and related factors in primary caregivers of patients with advanced head and neck cancer: A longitudinal cohort study

Abstract

Purpose

Primary caregivers (PC) of patients with advanced head and neck cancer (HNC) report stress during caregiving time post-treatment. We sought to identify the trajectories of resilience from initial completion of treatment to 1-year post-treatment in PC of patients with advanced HNC and to determine the factors associated with trajectories of resilience.

Design

In this prospective cohort study with convenience sampling, patient–PC dyads were recruited from a medical center in northern Taiwan between August 2015 and July 2020.

Methods

We recruited 120 patient–PC dyads and followed up at treatment completion and 1, 6, and 12 months post-treatment. Generalized estimating equation analysis was performed to identified factors related to resilience.

Findings

PCs’ overall resilience increased from initial completion of treatment to peak at 1-year post-treatment. Patient factors associated with greater overall resilience included older age, higher performance status, and shorter time since cancer diagnosis; PC factors included reporting more social support, better physical health, and better mental health.

Conclusions

PC mental health was the most important factor in the resilience trajectory of patients with advanced HNC cancer.

Clinical relevance

Quantifying the relevant factors of trajectories of resilience will help to identify vulnerable PCs and guide survivorship care in the early stages of the post-treatment period.

Effects of Vitality Acupunch exercise on functional fitness and activities of daily living among probable sarcopenic older adults in residential facilities

Abstract

Purpose

To test the effects of a Vitality Acupunch exercise program on the functional fitness and the ability to perform the activities of daily living (ADL) among older adults with probable sarcopenia in residential facilities.

Design

This was a cluster-randomized controlled trial. A total of 12 long-term care facilities randomly assigned to the intervention and control groups with 1:1 allocation ratio. Among them, 114 older adults with probable sarcopenia participated at baseline and were allocated to either the intervention or control group according to the facility where they resided in. Of these, 103 older adults completed the study.

Methods

The intervention group (n = 52) underwent the Vitality Acupunch exercise program three times a week, each lasting 40 min, for 6 months while the control group (n = 51) performed its routine daily activities.

Findings

The functional fitness and ADL of the intervention group significantly improved at each time point (all p < 0.001), while the control group showed a significant decreasing trend. Except the lower limb muscular endurance, the functional fitness and ADL of the intervention group significantly improved compared to the control group at T1, and the improvements were still significant at T2.

Conclusions

Functional fitness and the ability to perform ADL in older adults with probable sarcopenia were significantly improved after receiving the Vitality Acupunch exercises.

Clinical relevance

An exercise that integrates the meridian theory and exercise concepts effectively improves functional fitness in probable sarcopenic older adults.

Clinical trial registration

Clinicaltrials.gov (NCT04504786). The trial was first posted on August 7, 2020. This part of the data was collected from August 2020 to March 2021.

Comparison of physical and psychosocial function post‐treatment among oral cancer patients with low‐to‐moderate and high nicotine dependence

Abstract

Purpose

After suddenly stopping smoking after an initial oral cancer (OC) diagnosis, patients may restart smoking and nicotine dependence. This study sought to identify factors associated with high nicotine dependence in OC patients who restarted smoking post-treatment.

Design

A cross-sectional study.

Methods

A group of 220 OC patients who restarted smoking post-treatment were recruited from the outpatient radiation department of a single cancer center in northern Taiwan. Demographic and clinical characteristics were recorded, and patients were assessed for nicotine and smoking dependence, physical activity and function, socio-emotional function, social support, and depression.

Results

Among patients who restarted smoking after treatment for OC, 75.9% reported low-to-moderate dependence on smoking, while 24.1% reported high nicotine dependence. Factors associated with high nicotine dependence included higher incidence of smoking per day, greater dependence on smoking, less physical activity per week, and poorer social–emotional function. Those highly dependent on nicotine were younger, unmarried, had less education, and had begun smoking earlier than those with low-to-moderate nicotine dependence.

Conclusions

The amount of smoking per day, greater smoking behavioral dependence, less physical activity per week, and worse social–emotional function affected high nicotine dependence.

Clinical relevance

Smoking cessation training and counseling for OC patients may help them better control their use of tobacco after treatment.

Nurses’ experiences of emergency department triage during the COVID‐19 pandemic in Indonesia

Abstract

Purpose

To explore the experiences of nurses working in emergency departments in selecting and triaging patients during the COVID-19 pandemic.

Design

Descriptive phenomenology was applied in this study.

Methods

Data were collected from nurses working at hospitals in Indonesia using snowball sampling and telephone interviews. A total of 10 emergency nurses participated, and Colaizzi's method of data analysis was applied.

Findings

Six themes and 10 subthemes emerged. The main themes were “extreme challenges in triage,” “feeling of responsibility under uncontrolled spread and infection,” “physical and psychological exhaustion,” “discovering strategies under difficult circumstances,” “looking for positive reinforcement,” and “optimism in togetherness.” Nurses had to deal with the challenge of COVID-19 in the ED triage, interestingly so, the nurses they have shown the development of professional responsibility. Nurses are also experienced in finding patient selection and triage strategies and the sense of optimism that may influence strategy and practice during the COVID-19 pandemic.

Conclusions

This findings identify nurses’ experiences in dealing with the extreme challenges of emergency department triage as well as their associated strategies and optimism.

Clinical relevance

Providing support to emergency nurses, improving emergency department triage, and community empowerment are suggested as strategies to improve nursing care during the COVID-19 pandemic.

Efficacy and safety of non‐pharmacological interventions for labour pain management: A systematic review and Bayesian network meta‐analysis

Abstract

Aims and objectives

To compare and rank the efficacy and safety of non-pharmacological interventions in the management of labour pain.

Background

Recently, various non-pharmacological interventions have been applied to manage labour pain and have shown positive effects. However, evidence identifying which type of non-pharmacological intervention is more efficient and safer is limited.

Design

Systematic review and Bayesian network meta-analysis based on PRISMA-NMA.

Methods

Seven databases were searched from database inception–March 2020. Two reviewers independently performed study selection, quality appraisal and data extraction. Conventional meta-analysis was conducted using either fixed-effects model or random-effects model according to statistical heterogeneity. The Bayesian network meta-analysis was conducted using the consistency model.

Results

43 studies involving nine non-pharmacological interventions were included. The Bayesian network meta-analysis showed that acupressure (SMD = −2.00, 95% CrI −3.09 to −0.94), aromatherapy (SMD = −2.01, 95% CrI −3.70 to −0.35) and massage therapy (SMD = −1.26, 95% CrI −2.26 to −0.30) had significant positive effects on alleviating labour pain, with aromatherapy being the most effective. The results also revealed that yoga (SMD = −130.85, 95% CrI −212.01 to −59.32) and acupressure (SMD = −10.14, 95% CrI −20.24 to −0.41) were the most effective interventions for shortening the first stage and the second stage of labour, respectively. There were no significant differences between non-pharmacological interventions and usual care or placebo control on the use of pharmacological methods and neonatal 5-min Apgar score.

Conclusions

The evidence in this network meta-analysis illustrates that non-pharmacological interventions are effective and safe for labour pain management in low-risk pregnant women. In the future, well-designed studies are needed to validate the conclusion of this network meta-analysis.

Relevance to clinical practice

The results support the use of non-pharmacological interventions, especially aromatherapy and acupressure, to relieve labour pain in low-risk pregnant women. Non-pharmacological interventions for labour pain management are recommended to apply according to maternal women's preference and values.

Decision aids for breast cancer screening in women approximately 50 years of age: A systematic review and meta‐analysis of randomised controlled trials

Abstract

Aims and Objectives

Review the content, quality and effect of breast cancer screening decision aids (BCS-DAs) in women approximately 50 years of age to provide a basis for the development of DAs.

Background

Breast cancer screening (BCS) decisions are complex and should vary depending on a woman's risk of breast cancer and her values and preferences. Decision aids (DAs) can help support women and medical staff in shared decision-making (SDM) when solving BCS problems.

Design

Systematic review and meta-analysis.

Methods

Four databases were searched starting at the time of establishment of the database to March 2021. The PRISMA checklist was followed. The meta-analysis was carried out using Review Manager 5.3 software. The quality of the studies was assessed using the risk of bias tool recommended by the Cochrane Handbook. The quality of the DAs was assessed using the International Standards for Decision Aid (IPDASi v4.0).

Results

The search strategy obtained 2024 references. After abstraction and full text screening, a total of seven studies were included. This article systematically reviews the content, quality and effectiveness of DAs in seven RCTs in helping women to make BCS decisions. The DAs were mostly in paper or online form and displayed disease screening information, analysed the benefits and harms of options and clarified the value to patients. Among all the DAs, only one met the minimum quality standards of IPDASi v4.0. Comprehensive analysis shows that DAs can significantly improve knowledge and increase the proportion of women who make informed choices, but they have no effect on screening attitude, intention, decision conflict or regret.

Conclusions

In the future, nurses should be encouraged to develop DAs in accordance with strict standards and to make them applicable to young women of different backgrounds.

Relevance to clinical practice

The result may be provide a basis for the development of DAs to promote women's informed screening choices.

Characteristics, interventions and outcomes of patients with valvular heart disease hospitalised in China: a cross-sectional study

Por: Huang · X. · Dhruva · S. S. · Yuan · X. · Bai · X. · Lu · Y. · Yan · X. · Liu · J. · Li · W. · Hu · D. · Ji · R. · Gao · M. · Miao · F. · Li · J. · Ge · J. · Krumholz · H. M. · Li · J.
Objectives

Little is known about contemporary characteristics and management of valvular heart disease (VHD) in China. This study aimed to examine the clinical characteristics, aetiology and type of VHD, interventions and in-hospital outcomes of patients with VHD hospitalised in China.

Methods

We used a two-stage random sampling design to create a nationally representative sample of patients with VHD hospitalised in 2015 in China and included adult patients with mild, moderate or severe VHD. We abstracted data from medical records, including echocardiogram reports, on patient characteristics, aetiology, type and severity of VHD, interventions and in-hospital outcomes. We weighted our findings to estimate nationally representative hospitalisations. We performed multivariable logistic regression analysis to identify factors associated with valve intervention.

Results

In 2015, 38 841 patients with VHD were hospitalised in 188 randomly sampled hospitals, representing 662 384 inpatients with VHD in China. We sampled 9363 patients, mean age 68.7 years (95% CI 42.2 to 95.2) and 46.8% (95% CI 45.8% to 47.8%) male, with an echocardiogram. Degenerative origin was the predominant aetiology overall (33.3%, 95% CI 32.3% to 34.3%), while rheumatic origin was the most frequent aetiology among patients with VHD as the primary diagnosis (37.4%, 95% CI 35.9% to 38.8%). Rheumatic origin was also the most common aetiology among patients with moderate or severe VHD (27.3%, 95% CI 25.6% to 29.0% and 33.6%, 95% CI 31.9% to 35.2%, respectively). The most common VHD was mitral regurgitation (79.1%, 95% CI 78.2% to 79.9%), followed by tricuspid regurgitation (77.4%, 95% CI 76.5% to 78.2%). Among patients with a primary diagnosis of severe VHD who were admitted to facilities capable of valve intervention, 35.6% (95% CI 33.1% to 38.1%) underwent valve intervention during the hospitalisation. The likelihood of intervention decreased significantly among patients with higher operative risk.

Conclusions

Among patients with VHD hospitalised in China, the predominant aetiology was degenerative in origin; among patients with moderate or severe VHD, rheumatic origin was the most common aetiology. Targeted strategies and policies should be promoted to address degenerative VHD. Patients with severe VHD may be undertreated, particularly those with high operative risk.

Establishing best practices in cancer online support groups: protocol for a realist review

Por: Bender · J. L. · Babinski · S. · Wong · G. · Tricco · A. C. · Englesakis · M. · Cyr · A. B. · Potts · H. · Perski · O. · Esplen · M. J. · Young · C. · Wassersug · R. · Forster · V. · Papadakos · J. · Soobiah · C. · Fox · C. · Gothard-Huang · A. · Witteman · H.
Introduction

Considerable observational evidence suggests that cancer online support groups reduce feelings of isolation, depression and anxiety, enhance coping and self-management, and lead to better informed patients. Other studies indicate that cancer online support groups can increase distress. Yet no studies theorise the complex, context-dependent mechanisms by which cancer online support groups generate their—sometimes contrasting—outcomes.

Methods and analysis

Guided by an integrated knowledge translation approach and the strategy for patient-oriented research, we will conduct a realist review of cancer online support groups in partnership with stakeholders. We will follow Pawson’s five steps and existing quality standards to develop a program theory that explains how cancer online support groups work, for whom and in what circumstances. The specific research questions will be: what positive and negative outcomes have been reported on cancer online support groups? What are the mechanisms that are associated with these outcomes, in which contexts and for whom? Through a rigorous review of relevant scientific and grey literature, as well as ongoing dialogue with stakeholders, a program theory will be developed to explain who benefits from cancer online support groups and who does not, what benefits they derive (or do not), and the factors that affect these outcomes.

Ethics and dissemination

The use of secondary data for this review precludes the need for ethical approval. Dissemination will be informed by the knowledge-to-action framework and will consist of tailored knowledge products that are conceived of collaboratively with stakeholders. These will include peer-reviewed publications on how cancer online support groups can be optimised and best practice recommendations to maximise the benefits experienced by people with cancer. These traditional scientific outputs, along with their respective evidence summaries, will be amplified through strategic social media events hosted and promoted by knowledge users.

PROSPERO registration number

CRD42021250046.

Effect of Pudilan Keyanning antibacterial mouthwash on dental plaque and gingival inflammation in patients during periodontal maintenance phase: study protocol for double-blind, randomised clinical trial

Por: Liu · J. · Huang · Y. · Lou · X. · Liu · B. · Liu · W. · An · N. · Wu · R. · Ouyang · X.
Introduction

Plaque control plays a critical role in the prevention and treatment of periodontitis. Antibacterial mouthwash is one of the most important tools for plaque control. Pudilan, including extracts of Scutellaria baicalensis root, Taraxacum mongolicum, Bunge corydalis herb and Isatis indigotica, was reported playing the role of anti-inflammatory and anti-bacterial. However, its effect on dental plaque and periodontal inflammation remains unknown. We aimed to assess the efficacy of Pudilan Keyanning antibacterial mouthwash which contains the active essence of Pudilan and 0.03%–0.06% cetylpyridinium chloride, as well as Pudilan active essence for plaque control and gingival anti-inflammation in patients during periodontal maintenance phase.

Methods and analysis

In this double-blind, randomised, placebo-controlled clinical trial, a total of 120 participants during periodontal maintenance phase will be enrolled. After supragingival scaling, they will be randomly assigned into three groups in a 1:1:1 ratio: the Pudilan Keyanning antibacterial mouthwash group, a chlorhexidine acetate mouthwash (0.12%) group or a placebo group with mouthwash containing the same components as the Pudilan Keyanning mouthwash except for Pudilan active ingredients. They will rinse with mouthwash, respectively, two times per day for 6 weeks. Clinical parameters (such as plaque index, bleeding index) and the level of volatile sulfide in the breath will be measured and analysed. The subgingival plaque will be collected and analysed microbiologically. Questionnaire feedback will be analysed.

Ethics and dissemination

The study protocol (V.4) was reviewed and approved by the Medical Ethical Committee of Peking University School and Hospital of Stomatology (Ethics Approval No. PKUSSIRB-201950153b). All participants signed a written consent form.

Trial registration number

ChiCTR2000041253.

Critical reappraisal of neoadjuvant concurrent chemoradiotherapy for treatment of locally advanced colon cancer

by Yen-Cheng Chen, Hsiang-Lin Tsai, Ching-Chun Li, Ching-Wen Huang, Tsung-Kun Chang, Wei-Chih Su, Po-Jung Chen, Tzu-Chieh Yin, Chun-Ming Huang, Jaw-Yuan Wang

Background

Locally advanced colon cancer (LACC) is associated with surgical challenges during R0 resection, increased postoperative complications, and unfavorable treatment outcomes. Neoadjuvant concurrent chemoradiotherapy followed by surgical resection is an effective treatment strategy that can increase the complete surgical resection rate and improve the patient survival rate. This study investigated the efficacy and toxicity of concurrent chemoradiotherapy in patients with LACC as well as the prognosis and long-term clinical outcomes of these patients.

Materials

From January 2012 to July 2020, we retrospectively reviewed the real-world data of 75 patients with LACC who received neoadjuvant concurrent chemoradiotherapy. The chemotherapy regimen consisted of folinic acid, 5-fluorouracil, and oxaliplatin (FOLFOX). The following data were obtained from medical records: patients’ characteristics, pathologic results, toxicity, and long-term oncologic outcome.

Results

Of the 75 patients, 13 (17.3%) had pathologic complete responses. Hematologic adverse effects were the most common (grade 1 anemia: 80.0% and leukopenia: 82.7%). Conversely, grade 2 or 3 adverse effects were relatively uncommon (P = 0.019). The estimated 5-year overall and disease-free survival rates were 68.6% and 50.6%, and the medians of overall and disease-free survival periods were 72.3 and 58.7 months, respectively. Moreover, patients with pathologic complete responses had improved overall survival (P = 0.039) and an improved local recurrence control rate (P = 0.042) but an unfavorable distant metastasis control rate (P = 0.666) in the long-term follow-up.

Conclusion

The long-term oncologic outcome of patients with LACC following concurrent chemoradiotherapy is acceptable, and the adverse effects seem to be tolerable. Pathologic N downstaging was an independent prognostic factor for patients’ overall survival. However, a large prospective, randomized control study is required to confirm the current results.

Effect of exercise on bone mineral density among patients with osteoporosis and osteopenia: A systematic review and network meta‐analysis

Abstract

Aims and objectives

To systematically review and compare the efficacy of different exercise interventions on bone mineral density (BMD, g/cm2) in patients with osteoporosis and osteopenia.

Background

It is vitally important to prevent and treat bone loss in patients with osteoporosis and osteopenia. Exercise can effectively increase bone density and slow down bone loss in middle-aged and older people. However, it is still unclear which type of exercise intervention is the most effective on bone mineral density.

Design

Systematic review and network meta-analysis (NMA) according to PRISMA.

Methods

Randomised controlled trials of different exercise treatments for osteopenia and primary osteoporosis were included. A Frequentist network meta-analysis was conducted to appraise the efficacy of different types of exercise. The outcome was bone mineral density of different parts of the body.

Results

Ninety-seven studies were included. The network meta-analysis showed that combined exercise, resistance exercise, aerobic exercise and mind-body exercise had a significant effect in improving the bone density of lumbar spine. The surface under the cumulative ranking area (SUCRA) values for mind-body exercise was 0.99 and ranked first. For BMD of the femoral neck, all kinds of exercise interventions increased the bone density significantly compared with no exercise and the optimal type was mind-body exercise (SUCRA = 0.99). In terms of the total hip bone mineral density, aerobic exercise and resistance exercise could improve hip bone density, with the resistance exercise (SUCRA = 0.95) ranking as first.

Conclusions

This NMA demonstrated the mind–body exercise might be the optimal exercise type to increase the BMD of the lumbar spine and femoral neck and resistance exercise is the most promising type for total hip BMD.

Factors associated with the time to return negative RT-PCR from COVID-19 in paediatric patients: a retrospective cohort study

Por: Shao · J. · Xu · H. · Liu · Z. · Ying · X. · Xu · H. · Wang · X. · Lu · J. · Huang · Y. · Wang · G. · He · Y. · Chen · J. · Ma · S. · Zou · S. · Cui · Y. · Chen · R. · Lu · J. · Li · X. · Li · Z. · Huang · G. · Wang · W.
Objective

This study aimed to describe the epidemiological and clinical features and potential factors related to the time to return negative reverse transcriptase (RT)-PCR in discharged paediatric patients with COVID-19.

Design

Retrospective cohort study.

Setting

Unscheduled admissions to 12 tertiary hospitals in China.

Participants

Two hundred and thirty-three clinical charts of paediatric patients with confirmed diagnosis of COVID-19 admitted from 1 January 2020 to 17 April 2020.

Primary and secondary outcome measures

Primary outcome measures: factors associated with the time to return negative RT-PCR from COVID-19 in paediatric patients. Secondary outcome measures: epidemiological and clinical features and laboratory results in paediatric patients.

Results

The median age of patients in our cohort was 7.50 (IQR: 2.92–12.17) years, and 133 (57.1%) patients were male. 42 (18.0%) patients were evaluated as asymptomatic, while 162 (69.5%) and 25 (10.7%) patients were classified as mild or moderate, respectively. In Cox regression analysis, longer time to negative RT-PCR was associated with the presence of confirmed infection in family members (HR (95% CI): 0.56 (0.41 to 0.79)). Paediatric patients with emesis symptom had a longer time to return negative (HR (95% CI): 0.33 (0.14 to 0.78)). During hospitalisation, the use of traditional Chinese medicine (TCM) and antiviral drugs at the same time is less conducive to return negative than antiviral drugs alone (HR (95% CI): 0.85 (0.64 to 1.13)).

Conclusions

The mode of transmission might be a critical factor determining the disease severity of COVID-19. Patients with emesis symptom, complications or confirmed infection in family members may have longer healing time than others. However, there were no significant favourable effects from TCM when the patients have received antiviral treatment.

Effect of tissue adhesives in repairing perineal trauma during childbirth: A systematic review and meta‐analysis

Abstract

Aims and objectives

To investigate the effect of tissue adhesives on perineal wound healing and pain relief in women with perineal trauma during childbirth.

Background

Due to the high incidence and severe consequences of perineal trauma during childbirth, tissue adhesives are recommended as an alternative to conventional sutures to repair perineal trauma. Although many original studies have explored the effect of tissue adhesives on perineal wound healing and pain relief in women with perineal trauma during childbirth, these studies have differed in participants, interventions and outcomes. Therefore, the effect of tissue adhesives on wound healing and pain relief in perineal trauma during childbirth is inconclusive.

Design

A systematic review and meta-analysis based on PRISMA 2020.

Methods

A systematic and comprehensive literature search was conducted. Eight electronic databases, three clinical trial registers, and grey literature were searched from inception to 28th April 2021 and reference lists were also retrieved. Randomised controlled trials (RCTs) involving women with first- or second-degree perineal lacerations or women who underwent episiotomy were included. The intervention was the use of tissue adhesives alone or in combination with sutures. For the outcome indicators of perineal wound healing and pain relief, subgroup analyses based on the extent of perineal trauma and measurement time points were conducted, respectively.

Results

A total of 14 RCTs involving 2264 participants were included in this research. The results indicated that for first-degree lacerations, the incidence of wound complications was significantly higher in the tissue adhesives group. In contrast, for episiotomy, the effect of the combination of tissue adhesives and sutures was comparable to that of sutures exclusively. The pooled results revealed that tissue adhesives exerted a positive effect on relieving immediate and short-term perineal pain, but no significant difference was found in the effect of long-term pain relief. Moreover, this review also supported the effect of tissue adhesives in shortening intraoperative repair time and improving clinician-maternal satisfaction.

Conclusions

The existing evidence illustrates that tissue adhesives effectively promote perineal wound healing and relieve immediate and short-term pain. However, for first-degree lacerations, the increased occurrence of wound complications must be prudently considered when applying tissue adhesives alone, whereas, for episiotomy, the combination of tissue adhesives and sutures may be a promising repair alternative. Future studies are encouraged to adopt long-term effect, adverse effect, and cost-effect analysis as important outcome indicators to comprehensively validate the applicability and generalisability of tissue adhesives.

Relevance to clinical practice

For first-degree perineal lacerations, we do not recommend using tissue adhesives alone to repair the wound, given the increased wound complications. While for episiotomy, the combination of tissue adhesives and sutures may be a promising alternative to the use of sutures exclusively. Additionally, the adverse effect and long-term effect of using tissue adhesives alone to repair perineal trauma should be further clarified.

Prevalence of strabismus among preschool children in eastern China and comparison at a 5-year interval: a population-based cross-sectional study

Por: Wang · Y. · Zhao · A. · Zhang · X. · Huang · D. · Zhu · H. · Sun · Q. · Yu · J. · Chen · J. · Zhao · X. · Li · R. · Han · S. · Dong · W. · Ma · F. · Chen · X. · Liu · H.
Objective

To update data on strabismus and evaluate the changes in prevalence and patterns among preschoolers in eastern China over a period of 5 years.

Design

Nanjing Eye Study, a longitudinal population-based study.

Setting

Recruitment and testing in kindergartens in Yuhuatai District, Nanjing.

Participants

2300 eligible children.

Main outcome measures

Comprehensive ocular examinations were conducted in 1986 children aged 48–

Results

The overall prevalence rate of strabismus in NES was 5.56% (95% CI 4.54% to 6.57%), which was not significantly different from that in NPVP (4.99%, 95% CI 4.13% to 5.84%, p=0.40). The prevalence of subtypes of strabismus underwent significant changes, with significant increase in intermittent exotropia (IXT) in NES (2.78% vs 4.69%, p=0.001) and significant decrease in constant exotropia (1.17% vs 0.15%, p

Conclusion

The prevalence of strabismus appeared stable in children aged 48–

Efficacy of left ventricular unloading strategies during venoarterial extracorporeal membrane oxygenation in patients with cardiogenic shock: a protocol for a systematic review and Bayesian network meta-analysis

Por: Zhang · P. · Wei · S. · Zhai · K. · Huang · J. · Cheng · X. · Tao · Z. · Gao · B. · Liu · D. · Li · Y.
Introduction

Venoarterial extracorporeal membrane oxygenation (VA-ECMO) has been widely used for patients with refractory cardiogenic shock. A common side effect of this technic is the resultant increase in left ventricular (LV) afterload which could potentially aggravate myocardial ischaemia, delay ventricular recovery and increase the risk of pulmonary congestion. Several LV unloading strategies have been proposed and implemented to mitigate these complications. However, it is still indistinct that which one is the best choice for clinical application. This Bayesian network meta-analysis (NMA) aims to compare the efficacy of different LV unloading strategies during VA-ECMO.

Methods and analysis

PubMed, Embase, the Cochrane Library and the International Clinical Trials Registry Platform will be explored from their inception to 31 December 2020. Random controlled trials and cohort studies that compared different LV unloading strategies during VA-ECMO will be included in this study. The primary outcome will be in-hospital mortality. The secondary outcomes will include neurological complications, haemolysis, bleeding, limb ischaemia, renal failure, gastrointestinal complications, sepsis, duration of mechanical ventilation, length of intensive care unit and hospital stays. Pairwise and NMA will respectively be conducted using Stata (V.16, StataCorp) and Aggregate Data Drug Information System (V.1.16.5), and the cumulative probability will be used to rank the included LV unloading strategies. The risk of bias will be conducted using the Cochrane Collaboration’s tool or Newcastle-Ottawa Quality Assessment Scale according to their study design. Subgroup analysis, sensitivity analysis and publication bias assessment will be performed. The Grading of Recommendations Assessment, Development and Evaluation will be conducted to explore the quality of evidence.

Ethics and dissemination

Either ethics approval or patient consent is not necessary, because this study will be based on literature. The results will be disseminated through peer-reviewed publications and conference presentations.

PROSPERO registration number

CRD42020165093.

Cross-sectional comparisons of sodium content in processed meat and fish products among five countries: potential for feasible targets and reformulation

Por: Song · Y. · Li · Y. · Guo · C. · Wang · Y. · Huang · L. · Tan · M. · He · F. J. · Harris · T. · MacGregor · G. A. · Ding · J. · Dong · L. · Liu · Y. · Wang · H. · Zhang · P. · Ma · Y.
Introduction

Reducing sodium intake has been identified as a highly cost-effective strategy to prevent and control high blood pressure and reduce cardiovascular mortality. This study aims to compare the sodium content in processed meat and fish products among five countries, which will contribute to the evidence-base for feasible strategies of sodium reduction in such products.

Methods

Sodium content on product labels of 26 500 prepackaged products, 19 601 meat and 6899 fish, was collected in supermarkets from five countries using the FoodSwitch mobile application from 2012 to 2018. To be specific, it was 1898 products in China, 885 in the UK, 5673 in Australia, 946 in South Africa and 17 098 in the USA. Cross-sectional comparisons of sodium levels and proportions meeting 2017 UK sodium reduction targets were conducted using Kruskal-Wallis H and the 2 test, respectively across the five countries.

Results

The results showed that processed meat and fish products combined in China had the highest sodium level (median 1050 mg/100 g, IQR: 774–1473), followed by the USA, South Africa, Australia, with the lowest levels found in UK (432 mg/100 g, IQR: 236–786) (p

Conclusion

Processed meat and fish products differ greatly in sodium content across different countries and across different food subcategories. This indicates great potential for food producers to reformulate the products in sodium content, as well as for consumers to select less salted food.

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