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Non-pharmacological interventions have been used in the rehabilitation of stroke survivors, but their effects on stroke survivors' quality of life (QoL) are unknown.
This review aimed to summarize the existing evidence regarding non-pharmacological interventions for QoL in stroke survivors and to evaluate the effectiveness of different types of interventions.
We systematically searched databases including PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Chinese BioMedical Literature Database, China Science and Technology Journal Database, and Wanfang data from the earliest available records to March 2023. Randomized controlled trials which explored the effects of non-pharmacological interventions on QoL in stroke patients were included. The meta-analysis was conducted to evaluate the effectiveness of different interventions on QoL. The Review Manager 5.3 was used to conduct the meta-analysis and the revised Cochrane risk-of-bias tool was used to assess the methodological quality of trials.
A total of 93,245 records were identified, and 34 articles were reviewed and summarized, of which 20 articles were included in the meta-analysis. The summary of the findings of the included studies revealed fitness training, constraint-induced movement therapy (CIMT), physical exercise, music therapy (MT), and art-based interventions may have positive effects on QoL. The fitness training improved total QoL, especially in physical domains including physical functioning (mean difference [MD] = 10.90; 95% CI [7.20, 14.59]), role physical (MD = 10.63; 95% CI [6.71, 14.55]), and global health (MD = 8.76; 95% CI [5.14, 12.38]). The CIMT had a slight effect on general QoL (standardized mean difference [SMD] = 0.48, 95% CI [0.16, 0.80]), whereas significantly improved strength (MD = 8.84; 95% CI [1.31, 16.38]), activities of daily living/instrumental activities of daily living (ADL/IADL; MD = 10.42; 95% CI [2.98, 17.87]), and mobility (MD = 8.02; 95% CI [1.21, 14.83]). MT had a positive effect on the mental health domain (SMD = 0.54; 95% CI [0.14, 0.94]).
Our findings suggest that fitness training and CIMT have a significant effect on improving physical QoL, while MT has a positive effect on improving psychological QoL. Future studies may use comprehensive and multicomponent interventions to simultaneously improve the patients' physical, psychological, and social QoL.
We conducted this study to investigate the effect of evidence-based care on surgical site wound infection after caesarean section. A computerised search of PubMed, Embase, Google Scholar, Cochrane Library, China National Knowledge Infrastructure and Wanfang databases for randomised controlled trials (RCTs) on the use of evidence-based care in caesarean section delivery was applied from the database inception to November 2023. Two researchers independently screened the literature, extracted data and performed quality assessment based on inclusion and exclusion criteria. Stata 17.0 software was applied for data analysis. Twenty-one RCTs involving 3269 caesarean sections were finally included. The analysis revealed the implementation of evidence-based nursing interventions was effective in reducing the incidence of post-caesarean section wound infections (OR = 0.29, 95% CI: 0.21–0.39, p < 0.001) and complications (OR = 0.29, 95% CI: 0.23–0.38, p < 0.001) compared with conventional care. This study shows that the application of evidence-based nursing in postoperative caesarean section care can effectively reduce the incidence of postoperative wound infection and complications and improve the quality of life, which is worthy of clinical nursing application and promotion.
This meta-analysis systematically evaluates the impact of the enhanced recovery after surgery (ERAS) concept on surgical site wound infections and postoperative complications in gastric cancer patients. A comprehensive computerized search was conducted in PubMed, Embase, Google Scholar, Cochrane Library, China National Knowledge Infrastructure and Wanfang databases for randomized controlled trials (RCTs), from database inception to November 2023, exploring the application of the ERAS concept in the perioperative period of gastric cancer surgery. Two researchers independently screened the literature, extracted data, and conducted quality assessments based on inclusion and exclusion criteria. Data analysis was performed using Stata 17.0 software. A total of 24 RCTs involving 2050 gastric cancer patients were included. The analysis revealed a significantly lower incidence of wound infections (OR = 0.23, 95% CI: 0.14–0.40, p < 0.001) and postoperative complications (OR = 0.20, 95% CI: 0.15–0.27, p < 0.001) in the ERAS group compared to the standard care group. This study demonstrates that the application of the ERAS concept during the perioperative period in gastric cancer surgery can effectively reduce the occurrence of wound infections and complications, thereby facilitating postoperative recovery.
The meta-analysis aims to evaluate and compare the sternal wound infections following internal mammary artery grafts for a coronary bypass. Examinations comparing bilateral internal mammary artery to single internal mammary artery for coronary artery bypass grafting were among the meta-analyses from various languages that met the inclusion criteria. Using dichotomous random- or fixed-effect models, the results of these investigations were examined, and the Odd Ratio (OR) with 95% confidence intervals (CIs) was computed. A total of 31 examinations from 2001 to 2023 were recruited for the current analysis including 181 503 personals with coronary artery bypass grafting. Bilateral internal mammary artery had significantly higher sternal wound infection (OR, 1.51; 95% CI, 1.37–1.68, p < 0.001), superficial sternal wound infection (OR, 1.72; 95% CI, 1.16–2.56, p = 0.007), deep sternal wound infection (OR, 1.62; 95% CI, 1.41–1.86, p < 0.001), sternal wound infection in diabetics (OR, 1.48; 95% CI, 1.16–1.90, p = 0.002), sternal wound infection in elderly (OR, 1.38; 95% CI, 1.22–1.57, p < 0.001), sternal wound infection in pedicled preparation (OR, 1.70; 95% CI, 1.30–2.23, p < 0.001) and sternal wound infection in skeletonized preparation (OR, 1.40; 95% CI, 1.09–1.81, p = 0.009) compared to single internal mammary artery in personals with coronary artery bypass grafting. Bilateral internal mammary artery grafting is linked to a higher risk of impaired wound healing, particularly in diabetic individuals, elderly, pedicled preparation, and skeletonized preparation. Nevertheless, caution should be exercised while interacting with its values since examinations were performed by different surgeons with different skills on different types of personals.
by Xinmeng Yao, Jinmei Li, Jialu He, Qinzhun Zhang, Yi Yu, Yinan He, Jinghua Wu, Weihong Tang, Chengyin Ye
BackgroundPulmonary rehabilitation (PR) has been recognized to be an effective therapy for chronic obstructive pulmonary disease (COPD). However, in China, the application of PR interventions is still less promoted. Therefore, this cross-sectional study aimed to understand COPD patients’ intention to receive PR, capture the potential personal, social and environmental barriers preventing their willingness of receiving PR, and eventually identify demanding PR services with the highest priority from patients’ point of view.
MethodsIn total 237 COPD patients were recruited from 8 health care facilities in Zhejiang, China. A self-designed questionnaire was applied to investigate patients’ intention to participate in PR and potentially associated factors, including personal dimension such as personal awareness, demographic factors, COPD status and health-related literacy/behaviors, as well as social policies and perceived environmental barriers. The demand questionnaire of PR interventions based on the Kano model was further adopted.
ResultsAmong the 237 COPD patients, 75.1% of COPD patients were willing to participate in PR interventions, while only 62.9% of the investigated patients had heard of PR interventions. Over 90% of patients believed that the cost of PR services and the ratio of medical insurance reimbursement were potential obstacles hindering them from accepting PR services. The multiple linear regression analysis indicated that the PR skills of medical staff, knowledge promotion and public education levels of PR in the community, patients’ transportation concerns and degree of support from family and friends were significantly associated with willingness of participation in PR interventions. By using the Kano model, the top 9 most-requisite PR services (i.e., one-dimensional qualities) were identified from patients’ point of view, which are mainly diet guidance, education interventions, psychological interventions and lower limb exercise interventions. Subgroup analysis also revealed that patients’ demographics, such as breathlessness level, age, education and income levels, could influence their choice of priorities for PR services, especially services related to exercise interventions, respiratory muscle training, oxygen therapy and expectoration.
ConclusionsThis study suggested that PR-related knowledge education among patients and their family, as well as providing basic package of PR services with the most-requisite PR items to COPD patients, were considerable approaches to promote PR attendance in the future.
This study aimed to explore the association between metabolic-associated fatty liver disease (MAFLD) and ulcer recurrence risk in patients with diabetic foot ulcers (DFUs) through an ambispective longitudinal cohort. From December 2013 to December 2022, a total of 482 inpatients with DFUs (PEDIS grade 3 and above with a severe infection) were eligible for inclusion in this study. This was an ambispective longitudinal cohort study. All participants were followed up every 6 months for 9 years with a median of 36 months. According to whether having MAFLD or not, all subjects were placed into two groups: non-MAFLD (n = 351) and MAFLD (n = 131). The association between MAFLD and ulcer recurrence in patients with DFUs was then evaluated through multivariate Cox regression analysis, stratified analyses and Kaplan–Meier survival analysis. Throughout the follow-up period, out of 482 subjects with DFUs, 68 had ulcer recurrence (14.1%). Three Cox regression models were established for data analyses. In the model I (unadjusted), MAFLD was significantly associated with the ulcer recurrence rate in patients with DFUs (HR = 1.79; 95% CI = 1.097–2.92; p = 0.02). Model II (adjusted model I with gender and age) (HR = 1.781; 95% CI = 1.09–2.912; p = 0.021) and model III (adjusted model II with CVD, duration of diabetes and Cr.) (HR = 1.743; 95% CI = 1.065–2.855; p = 0.027) also showed that MAFLD was significantly related to the ulcer recurrence risk in patients with DFUs, respectively. Stratified analysis indicated that subjects aged ≥60 had a greater risk of ulcer recurrence in MAFLD than in non-MAFLD (HR = 2.31; 95% CI = 1.268–4.206; p = 0.006). Kaplan–Meier survival curve analysis showed that ulcer recurrence rate had a significant association with MAFLD (log-rank, p = 0.018). This study indicated a close association between ulcer recurrence risk and MAFLD in patients with DFUs, especially in the elderly (aged ≥60). Therefore, special attention should be paid to the elderly with both DFUs and MAFLD because they have a higher ulcer recurrence rate than other general populations in routine clinical practice.
A meta-analysis was conducted to comprehensively assess the effect of continuous nursing on wound infection and quality of life in patients with cancer-related stomas, providing an evidence-based rationale for the care of these patients. A computerised search of PubMed, Web of Science, Ovid, EMBASE, the Cochrane Library, China National Knowledge Infrastructure, and Wanfang Data for randomised controlled trials (RCTs) on the effect of continuous nursing on wound infection and quality of life in patients with cancer-related stoma was conducted from the time the database was created to March 2023. The retrieved literature was screened, data were extracted, and the quality of the literature was evaluated according to the inclusion and exclusion criteria. Meta-analysis was performed using RevMan 5.4 software. Seventeen RCTs involving 1437 patients were included. Of the 1437 patients, 728 were in the continuous nursing group and 709 were in the control group. The results showed that continuous nursing significantly reduced the rate of wound infection in patients with cancer-related stomas (odds ratio [OR]: 0.30, 95% confidence interval [CI]: 0.16–0.53, p < 0.001) and improved their quality of life (standardised mean difference: 1.90. 95% CI: 1.32–2.47, p < 0.001). Available evidence suggests that continuous nursing for patients with cancer-related stomas can significantly reduce wound infections and improve their quality of life.
This study aimed to systematically evaluate the effects of enhanced recovery after surgery (ERAS) on surgical site infections, postoperative complications, and length of hospital stay in patients undergoing colorectal surgery. A comprehensive search was conducted of PubMed, Web of Science, Ovid, EMBASE, The Cochrane Library, China National Knowledge Infrastructure (CNKI), and Wanfang Data from database inception to April 2023 to identify relevant studies on the application of ERAS in colorectal surgery. Studies were screened, and data were extracted based on predetermined inclusion and exclusion criteria. Meta-analysis was performed using RevMan 5.4 software. A total of 22 studies, including 3702 patients (ERAS group: 1906; control group: 1796), were included in the final analysis. ERAS significantly reduced the incidence of surgical site infection (odds ratio [OR]: 0.49, 95% confidence interval [CI]: 0.34–0.69, p < 0.001), postoperative complications (OR: 0.33, 95% CI: 0.27–0.41, p < 0.001), and length of hospital stay (standardised mean difference: −1.22 days, 95% CI: −1.66 to −0.77 days, p < 0.001). These findings suggest that ERAS reduces the incidence of surgical site infections and postoperative complications and shortens the length of hospital stay in patients undergoing colorectal surgery. Therefore, ERAS should be promoted and applied in clinical practice.
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