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Efficacy of a povidone‐iodine foam dressing (Betafoam) on diabetic foot ulcer

Abstract

This study aimed to assess the efficacy of a new povidone‐iodine (PVP‐I) foam dressing (Betafoam) vs foam dressing (Medifoam) for the management of diabetic foot ulcers. This study was conducted between March 2016 and September 2017 at 10 sites in Korea. A total of 71 patients (aged ≥19 years) with type 1/2 diabetes and early‐phase diabetic foot ulcers (Wagener classification grade 1/2) were randomised to treatment with PVP‐I foam dressing or foam dressing for 8 weeks. Wound healing, wound infection, patient satisfaction, and adverse events (AEs) were assessed. The PVP‐I foam and foam dressing groups were comparable in the proportion of patients with complete wound healing within 8 weeks (44.4% vs 42.3%, P = .9191), mean (±SD) number of days to complete healing (31.00 ± 15.07 vs 33.27 ± 12.60 days; P = .6541), and infection rates (11.1% vs 11.4%; P = 1.0000). Median satisfaction score (scored from 0 to 10) at the final visit was also comparable between groups (10 vs 9, P = .2889). There was no significant difference in AE incidence (27.8% vs 17.1%, P = .2836), and none of the reported AEs had a causal relationship with the dressings. The results of this study suggest that PVP‐I foam dressing has wound‐healing efficacy comparable with foam dressing, with no notable safety concerns. This study was funded by Mundipharma Korea Ltd and registered at ClinicalTrials.gov (identifier NCT02732886).

Antimicrobial photodynamic therapy in skin wound healing: A systematic review of animal studies

Abstract

Bacterial infection is a common wound complication that can significantly delay healing. Classical local therapies for infected wounds are expensive and are frequently ineffective. One alternative therapy is photodynamic therapy (PDT). We conducted a systematic review to clarify whether PDT is useful for bacteria‐infected wounds in animal models. PubMed and Medline were searched for articles on PDT in infected skin wounds in animals. The language was limited to English. Nineteen articles met the inclusion criteria. The overall study methodological quality was moderate, with a low‐moderate risk of bias. The animal models were mice and rats. The wounds were excisional, burn, and abrasion wounds. Wound size ranged from 6 mm in diameter to 1.5 × 1.5 cm2. Most studies inoculated the wounds with Pseudomonas aeruginosa or methicillin‐resistant Staphylococcus aureus. Eleven and 17 studies showed that the PDT of infected wounds significantly decreased wound size and bacterial counts, respectively. Six, four, and two studies examined the effect of PDT on infected wound‐cytokine levels, wound‐healing time, and body weight, respectively. Most indicated that PDT had beneficial effects on these variables. PDT accelerated bacteria‐infected wound healing in animals by promoting wound closure and killing bacteria.

Ischemia and reperfusion injury in superficial inferior epigastric artery-based vascularized lymph node flaps

by David P. Perrault, Gene K. Lee, Antoun Bouz, Cynthia Sung, Roy Yu, Austin J. Pourmoussa, Sun Young Park, Gene H. Kim, Wan Jiao, Ketan M. Patel, Young-Kwon Hong, Alex K. Wong

Vascularized lymph node transfer (VLNT) is a promising treatment modality for lymphedema; however, how lymphatic tissue responds to ischemia has not been well defined. This study investigates the cellular changes that occur in lymph nodes in response to ischemia and reperfusion. Lymph node containing superficial epigastric artery-based groin flaps were isolated in Prox-1 EGFP rats which permits real time identification of lymphatic tissue by green fluorescence during flap dissection. Flaps were subjected to ischemia for either 1, 2, 4, or 8 hours, by temporarily occluding the vascular pedicle. Flaps were harvested after 0 hours, 24 hours, or 5 days of reperfusion. Using EGFP signal guidance, lymph nodes were isolated from the flaps and tissue morphology, cell apoptosis, and inflammatory cytokines were quantified and analyzed via histology, immunostaining, and rtPCR. There was a significant increase in collagen deposition and tissue fibrosis in lymph nodes after 4 and 8 hours of ischemia compared to 1 and 2 hours, as assessed by picrosirius red staining. Cell apoptosis significantly increased after 4 hours of ischemia in all harvest times. In tissue subject to 4 hours of ischemia, longer reperfusion periods were associated with increased rates of CD3+ and CD45+ cell apoptosis. rtPCR analysis demonstrated significantly increased expression of CXCL1/GRO-α with 2 hours of ischemia and increased PECAM-1 and TNF-α expression with 1 hour of ischemia. Significant cell death and changes in tissue morphology do not occur until after 4 hours of ischemia; however, analysis of inflammatory biomarkers suggests that ischemia reperfusion injury can occur with as little as 2 hours of ischemia.

The factors associated with subjective cognitive decline and cognitive function among older adults 与老年人主观认知能力下降与认知功能相关的因素

Abstract

Aims

To explore the risk factors for subjective cognitive decline and cognitive function among older adults in South Korea.

Design

This study employed a descriptive cross‐sectional design.

Methods

A convenience sample of 182 patients was recruited from a senior welfare center in Seoul. The mean age of the participants was 78.4 years (SD 5.91). Among them, 64.3% were women. The data were collected by a trained research assistant using structured questionnaires from September 2016–February 2017. Demographic characteristics, comorbidities, depression, physical and cognitive activity levels, instrumental activities of daily living, subjective cognitive decline, and cognitive function were assessed. Student's t tests, chi‐square tests, and hierarchical multiple regression analyses were used for statistical analyses.

Results

The findings revealed that 37.4% of the participants were not cognitively intact. Depression, perceived health status, and cognitive function were significantly associated with subjective cognitive decline (F = 7.10, p < .001, adjusted R2 = 25.3). Age, educational level, perceived health status, and subjective cognitive decline were significantly related to cognitive function (F = 20.98, p < .001, adjusted R2 = 47.0). After controlling for these variables, cognitive activity was significantly and independently related to cognitive function.

Conclusion

The results suggest that for the maintenance of cognitive function, cognitive activity should be encouraged. In addition, older adults who complain of subjective cognitive decline and have risk factors such as depression need therapeutic interventions to prevent actual decrease of cognitive function.

Impact

The present findings advance prior knowledge by considering variables such as physical and cognitive activity levels to provide novel evidence that can be used to develop interventions for community‐dwelling older adults. Thus, to be effective, nursing interventions must seek to improve cognitive function through intellectual stimulation.

目的

探讨韩国老年人主观认知能力下降与认知功能的危险因素。

设计

本项研究采用描述性横向设计。

方法

采用方便抽样方法从首尔某家老年福利院随机抽取182例患者。参与者的平均年龄为78.4岁(SD 5.91)。其中64.3%为女性。数据由经过培训的助理研究员于2016年9月至2017年2月使用结构化问卷予以收集。并对人口学特征、合并症、抑郁、体力和认知活动水平、日常活动工具性活动、主观认知能力下降和认知功能进行评价。采用学生t检验、卡方检验和层次多元回归分析进行统计分析。

结果

研究结果显示,37.4%的参与者认知功能不完整。抑郁、感知健康状况和认知功能与主观认知能力下降显著相关(F = 7.10, p < .001,调整后R2 = 25.3)。年龄、文化程度、感知健康状况和主观认知能力下降与认知功能显著相关(F = 20.98, p < .001,调整后R2 = 47.0)。在控制这些变量后,认知活动与认知功能显著独立相关。

结论

结果表明,应鼓励认知活动,以维持认知功能。此外,需对主观认知能力下降且有抑郁症状等危险因素的老年人进行治疗干预,以防止认知功能出现实际下降。

影响

本研究结果通过考虑体力活动和认知活动水平等变量来推进先验知识,以提供新的证据,从而用于为居住在社区的老年人制定干预措施。因此,护理干预措施必须设法通过智力刺激来改善认知功能,才能取得有效的效果。

Social provision partially mediates the complex associations among posttraumatic stress, obsessive‐compulsive and depressive symptoms in traumatized patients 社会保障部分调解创伤后应激、强迫症和抑郁症状之间的复杂关联

Abstract

Aim

To identify the associations among posttraumatic stress, depressive and obsessive‐compulsive symptoms (OCS) in outpatients with psychological trauma and to examine the mediating effect of social provision.

Background

Psychologically traumatized patients simultaneously experience depressive and OCS. Social provision may mediate multiple symptoms differently compared with social support.

Design

Cross‐sectional and correlational study.

Methods

Data were collected between August 2016–May 2017. Psychiatric outpatients (= 151) completed a structured questionnaire consisting of the Korean versions of the Social Provision Scale, Beck Depression Inventory‐II, Maudsley Obsessional‐Compulsive Inventory and Impact of Event Scale–Revised. Structural equation modelling was used to examine the recursive association among the three symptoms and the mediation of social provision.

Results

There was a recursive association between posttraumatic stress symptoms (PTSS) and depressive symptoms, which were simultaneously associated with OCS with a one‐way direction. OCS and social provision partially mediated these identified associations among three symptoms.

Conclusions

Our findings provide insight into the complex associations of multiple symptoms experienced by traumatized outpatients and the partial mediation of social provision. Psychiatric and mental health professionals may enhance social functioning and interpersonal interactions based on social provision components used for helping traumatized patients with obsessive‐compulsive and depressive symptoms.

Impact

There was a recursive association between PTSS and depressive symptoms that were simultaneously associated with OCS with a one‐way direction. Social provision functions as a partial mediator when working with OCS. Mental health nurses can develop social provision interventions for depressive symptoms for traumatized outpatients with OCS.

目的

确定心理创伤门诊患者创伤后应激、抑郁、强迫症状之间的关系,研究社会保障的调解作用。

背景

心理创伤患者同时遭受抑郁和强迫症状。社会保障可能以不同于社会支持的方式对多种症状进行调解。

设计

横向及相关性研究。

方法

于2016年8月至2017年5月期间收集数据。精神科门诊患者(N = 151)完成结构化问卷,包括韩国版的社会保障量表、贝克抑郁量表第2版、莫兹利强迫调查表和事件冲击量表(修订版)。采用结构方程建模来检验三种症状之间的递归关系以及社会保障的调解作用。

结果

创伤后应激症状(PTSS)与抑郁症状之间存在递归关联,且与强迫症状呈单向相关。强迫症状和社会保障可部分调解这三种症状之间的已确定的关联联系。

结论

本项研究发现有助于深入了解创伤后门诊患者所经历的多种症状之间的复杂联系,以及社会保障的部分调解作用。精神和心理健康专业人士可根据用于帮助患有强迫症和抑郁症状的创伤患者的社会保障成分,加强社会功能和人际交往。

影响

创伤后应激症状与抑郁症状之间存在递归关联,同时与强迫症状存在单向关联。同强迫症状关联时,社会保障可发挥部分调整作用。心理健康护士可以为患有强迫症状的创伤后门诊患者制定针对抑郁症状的社会干预措施。

The psychological processes voiced by nursing students when caring for suicidal patients during their psychiatric clinical practicum: A qualitative study

Abstract

Aims and objectives

This study was designed to explore the psychological processes experienced by nursing students caring for suicidal patients during their first psychiatric clinical practicum.

Background

Nursing students expressed fear when caring for patients who presented with suicidal behaviours. Yet, there is a lack of research exploring nursing students' feelings and thoughts when caring for suicidal patients.

Design

A grounded theory study.

Methods

A theoretical sample of 22 undergraduate nursing students who had cared for suicidal patients for at least 5 days during their psychiatric clinical practicum. Data were collected from 2016–2017, in three universities in Taiwan, using a semi‐structured interview and constant comparative analysis. COREQ reporting guidelines were utilised.

Results

Four categories emerged depicting the psychological processes and revealing that the student nurses navigated four phases when caring for patients exhibiting suicidal behaviours. The phases were as follows: (a) apprehension and fear: involving students being frightened about patients attempting suicide; (b) frustration and powerlessness: concerning students finding it challenging to focus on changing patients' suicidal ideations; (c) support and catharsis: covering the students having to ask for psychological support from other people and explore their painful emotions; (d) confidence and empathy: meaning that the students incorporated enhanced confidence and cultivated advanced empathy, leading to the integration of competent care competencies towards suicidal patients.

Conclusions

Findings could help nursing teachers to understand students' psychological processes when caring for suicidal patients. Teachers could provide appropriate support to help reduce students' negative thoughts and feelings and increase their care competencies when nursing suicidal patients during their psychiatric clinical practicum.

Relevance to clinical practice

Clinical nurse teachers could support and facilitate students to develop their competencies and confidence as they negotiate the four phases and, actually, complete their internship goals on their clinical practicums.

Factors Associated with Spiritual Care Competencies in Taiwan's Clinical Nurses: A Descriptive Correlational Study

Abstract

Aims and objectives

To determine factors associated with nurses' spiritual care competencies.

Background

Holistic nursing care includes biopsychosocial and spiritual care. However, nurses are limited by a lack of knowledge, time constraints and apprehension of assessing spiritual issues, which leaves them unable to assess and meet patients' spiritual needs. Thus, when patients experience spiritual distress, clinical nurses lose the opportunity to support spiritual growth and self‐actualization. In Taiwan, spiritual care, religion, and culture are unique compared to those in other countries. Overall, factors associated with Taiwanese nurses' spiritual care competencies lack comprehensive exploration.

Methods

This study adopted a descriptive correlational design using cross‐sectional survey (see Supplementary File 1). Cluster sampling was used to select clinical nurses from fourteen units of a medical center and a regional hospital. Data were collected from January to June 2018 with a 97.03% response rate. Clinical nurses completed a background questionnaire, spiritual care practice questionnaire, spirituality and spiritual care related scales. Data were analyzed using descriptive and linear regression. This report followed the STROBE checklist.

Results

Spiritual care competence ranged from 44‐123 (mean 84.67±12.88; range 27‐135) . The majority of clinical nurses rated their spiritual care competence as moderate (64‐98). The significant factors associated with nurses' spiritual care competence were education, religion, interest in spiritual care, having role models, past life events, barriers to providing spiritual care of the spiritual care practice score, and spiritual attitude and involvement score. The overall model was significant (p<.001) and accounted for 55.0% of variance (adjusted R 2=.488).

Conclusions

Most clinical nurses have moderate spiritual care competence. Objective factors identified affect clinical nurses' spiritual care competencies.

Relevance to clinical practice

To improve nurses' spiritual care competencies, objective factors that affect clinical nurses' spiritual care competencies must be emphasized. Multiple strategies for enhancing nurses' own spiritual well‐being can be provided via employee health promotion projects and activities, and promoting nurses' spirituality and spiritual care competencies can be explored in clinical settings through bedside teaching, situational simulation, objective structured clinical examinations, and self‐reflection.

Systematic review and meta‐analyses of randomized control trials of the effectiveness of psychosocial interventions for homeless adults

Abstract

Aims

To evaluate the effect of psychosocial interventions for homeless adults on their psychosocial outcomes.

Design

A systematic review and meta‐analyses were performed for critical appraisal and synthesis of the included studies.

Data sources

A systematic search of studies published before 10 September 2018 was performed using PubMed, Cochrane Library, EMBASE, PsycINFO, and CINAHL.

Review methods

The review included randomized controlled trials conducting psychosocial interventions and assessing psychosocial outcomes for homeless adults. After systematically describing study and intervention characteristics, we conducted meta‐analyses by the type of outcome and subgroup meta‐analyses by the type of intervention and outcome. Fourteen studies were included in this review and 11 were included in the meta‐analyses.

Results

A significant effect of psychosocial interventions in reducing anxiety and enhancing mental health status among homeless adults was noted.

Conclusion

The meta‐analyses showed that psychosocial interventions may reduce anxiety and enhance the mental health status of homeless people. Specifically, we suggest that relaxation response training may be effective in improving anxiety and mental health status and cognitive behavioural therapy may reduce anxiety.

Impact

Although psychosocial interventions for homeless persons have been implemented for a decade, their impact for psychosocial outcomes among homeless adults has not been evaluated. This review suggest that psychosocial interventions may improve anxiety and mental health status among homeless adults. The findings of the present study may provide directions for developing psychosocial interventions to help vulnerable homeless adults in managing psychological outcomes.

Evaluation of titanium mesh cranioplasty and polyetheretherketone cranioplasty: protocol for a multicentre, assessor-blinded, randomised controlled trial

Por: Yang · J. · Sun · T. · Yuan · Y. · Li · X. · Yu · H. · Guan · J.
Introduction

Cranioplasty is a common surgery in neurosurgery department. However, restoring the integrity of skull brings many challenges to surgeons, and the selection of ideal implant materials is throughout the history of cranioplasty. Although titanium mesh was still preferred by many neurosurgeons in cranial reconstruction, the new polyetheretherketone (PEEK) material, for example, is gaining popularity for craniofacial reconstruction today. There remain limited data that compare the outcome of PEEK cranioplasty and titanium mesh cranioplasty. It is necessary to conduct a study to compare outcome of different materials for cranioplasty.

Methods/design

In this multicentre, assessor-blinded, randomised controlled study, we will randomise 140 patients in a 1:1 ratio to PEEK cranioplasty versus titanium cranioplasty. Eligible patients are adults who were diagnosed with cranial defect (due to severe traumatic brain injury, ischaemic stroke, haemorrhagic stroke, infiltrative tumour and so on), the defect size is over 25 cm2, and they need to agree to participate in this trial. Instead of standard examinations, the enrolled patients receive neurological, motor, cognitive function and cerebral hemodynamics examinations as well as cosmetic evaluation. The procedures are repeated 3, 6 months after cranioplasty. The primary outcome, defined as infection or implant exposure after surgery, is the implant failure rate within 6 months. Secondary outcomes include postoperative complication rates, neurological outcomes, motor function, cerebral hemodynamics, cosmetic outcome and the total cost over a 6-month period.

Ethics and dissemination

This trial protocol has been approved by Biomedical Research Ethics Committee of West China Hospital of Sichuan University. All patients will be fully informed the implant materials, potential complications after surgery, responsibilities during the trial, and they will sign the informed consent before joining in this trial. If the patient’s cognitive function is impaired, the patient’s next of kin would be carefully informed. The results will be disseminated through academic conferences, student theses and will be published in a peer-reviewed journal.

Trail registration number

ChiCTR1900024625; Pre-results.

Retinoic acid-stimulated ERK1/2 pathway regulates meiotic initiation in cultured fetal germ cells

by Sung-Min Kim, Toshifumi Yokoyama, Dylan Ng, Ferhat Ulu, Yukiko Yamazaki

In murine fetal germ cells, retinoic acid (RA) is an extrinsic cue for meiotic initiation that stimulates transcriptional activation of the Stimulated by retinoic acid gene 8 (Stra8), which is required for entry of germ cells into meiotic prophase I. Canonically, the biological activities of RA are mediated by nuclear RA receptors. Recent studies in somatic cells found that RA noncanonically stimulates intracellular signal transduction pathways to regulate multiple cellular processes. In this study, using a germ cell culture system, we investigated (1) whether RA treatment activates any mitogen-activated protein kinase (MAPK) pathways in fetal germ cells at the time of sex differentiation, and (2) if this is the case, whether the corresponding RA-stimulated signaling pathway regulates Stra8 expression in fetal germ cells and their entry into meiosis. When XX germ cells at embryonic day (E) 12.5 were cultured with RA, the extracellular-signal-regulated kinase (ERK) 1/2 pathway was predominantly activated. MEK1/2 inhibitor (U0126) treatment suppressed the mRNA expressions of RA-induced Stra8 and meiotic marker genes (Rec8, Spo11, Dmc1, and Sycp3) in both XX and XY fetal germ cells. Furthermore, U0126 treatment dramatically reduced STRA8 protein levels and numbers of meiotic cells among cultured XX and XY fetal germ cells even in the presence of RA. Taken together, our results suggest the novel concept that the RA functions by stimulating the ERK1/2 pathway and that this activity is critical for Stra8 expression and meiotic progression in fetal germ cells.

Incidence, characteristics, and mortality of infective endocarditis in France in 2011

by S. Sunder, L. Grammatico-Guillon, A. Lemaignen, M. Lacasse, C. Gaborit, D. Boutoille, P. Tattevin, E. Denes, T. Guimard, M. Dupont, L. Fauchier, L. Bernard

Objectives

We assessed the determinants of mortality in infective endocarditis (IE), using the national hospital discharge databases (HDD) in 2011.

Methods

IE stays were extracted from the national HDD, with a definition based on IE-related diagnosis codes. This definition has been assessed according to Duke criteria by checking a sample of medical charts of IE giving a predictive positive value of 86.1% (95% confidence interval (CI): 82.7% - 89.5%). The impact of heart valve surgery on survival has been studied if performed during the initial stay, and over the year of follow-up. Risk factors of in-hospital mortality were identified using logistic regression model for the initial stay and Cox Time-dependent model for the 1-year mortality.

Results

The analysis included 6,235 patients. The annual incidence of definite IEs was 63 cases/million residents. Staphylococci and Streptococci were the most common bacteria (44% and 45%, respectively). A valvular surgery was performed in 20% of cases, but substantial variations existed between hospitals. The in-hospital mortality was 21% (ranging 12% to 27% according to the region of patients), associated with age>70, chronic liver disease, renal failure, S. aureus, P. aeruginosa or candida infection and strokes whereas valvular surgery, a native valve IE or intraveinous drug use (right heart IE) were significantly protective for an initial death. The same factors were associated with the one-year mortality, except for valvular surgery which was associated with a 1.4-fold higher risk of death during the year post IE.

Conclusion

We reported a high IE incidence rate. Valvular surgery was considerably less frequent in this study than in the previous published data (near 50%) whereas mortality was similar. Surgery was associated with higher survival if undergone within the initial stay. There were significant regional differences in frequency of surgery but it did not impact mortality.

Cohort profile: the Biology, Affect, Stress, Imaging and Cognition (BASIC) study on perinatal depression in a population-based Swedish cohort

Por: Axfors · C. · Bränn · E. · Henriksson · H. E. · Hellgren · C. · Kunovac Kallak · T. · Fransson · E. · Lager · S. · Iliadis · S. I. · Sylven · S. · Papadopoulos · F. C. · Ekselius · L. · Sundström-Poromaa · I. · Skalkidou · A.
Purpose

With the population-based, prospective Biology, Affect, Stress, Imaging and Cognition (BASIC) cohort, we aim to investigate the biopsychosocial aetiological processes involved in perinatal depression (PND) and to pinpoint its predictors in order to improve early detection.

Participants

From September 2009 to November 2018, the BASIC study at Uppsala University Hospital, Sweden, has enrolled 5492 women, in 6478 pregnancies, of which 46.3% first-time pregnancies and with an average age of 31.5 years. After inclusion around gestational week 16–18, participants are followed-up with data collection points around gestational week 32, at childbirth, as well as three times postpartum: after 6 weeks, 6 months and 1 year. At the last follow-up, 70.8% still remain in the cohort.

Findings to date

In addition to internet-based surveys with self-report instruments, participants contribute with biological samples, for example, blood samples (maternal and from umbilical cord), biopsies (umbilical cord and placenta) and microbiota samples. A nested case–control subsample also takes part in cognitive and emotional tests, heart rate variability tests and bioimpedance tests. Subprojects have identified various correlates of PND of psychological and obstetric origin in addition to factors of the hypothalamic–pituitary–adrenal axis and immune system.

Future plans

In parallel with the completion of data collection (final follow-up November 2019), BASIC study data are currently analysed in multiple subprojects. Since 2012, we are conducting an ongoing follow-up study on the participants and their children up to 6 years of age (U-BIRTH). Researchers interested in collaboration may contact Professor Alkistis Skalkidou (corresponding author) with their request to be considered by the BASIC study steering committee.

effect of physical activity on independent living ability among community-dwelling elderly in urban areas of Liaoning Province in China: a population-based study

Por: Wang · B. · Wu · Y. · Zhang · T. · Han · J. · Yu · L. · Sun · W.
Objective

Independent living ability is crucial for the elderly; however, its assessment performed in China employs various scales and lacks risk factors, especially behavioural and social-psychological factors, which could be improved through health education. This study aimed to assess the independent living ability of community-dwelling elderly in urban areas of China and to identify the association with behavioral and social-psychological factors.

Design

A population-based study using random cluster sampling method was performed in two core cities in Liaoning Province during March–November 2012.

Study population

3686 individuals who were >=65 years old, had no dementia and cognitive impairment, had lived in the sampled communities for >=5 years and could take part in the study were enrolled.

Main outcome measures

Interviews were conducted to collect information of independent living ability, indicated by the instrumental activity of daily living (IADL), behavioural factors, social-psychological factors and confounders (demographic characteristics and health status). The Mini-Mental State Examination was used to screen for cognitive impairment.

Results

The independence rate was 46.3% in men and 41.1% in women. Structural equation modelling analysis showed that physical activity, drawn from taking a walk and doing exercise, had the strongest association with the IADL in both men (–0.34, SE 0.10) and women (–0.33, SE 0.11). Falling in the last year and worrying about falling were also significantly associated with IADL. The effects of regular drinking, feeling lonely and participating in entertainment were significant in men.

Conclusion

The independent living ability of the elderly in urban areas in Liaoning Province in China was at a low level. Physical activity was one of the important roles in both men and women; whereas the role of social-psychological factors only existed in men. Gender-specific healthcare and education to avoid sedentary life should be advocated for the elderly to maintain/improve their independent living ability.

Exploring the role of hospitals and office-based physicians in timely provision of statins following acute myocardial infarction: a secondary analysis of a nationwide cohort using cross-classified multilevel models

Por: Schang · L. · Koller · D. · Franke · S. · Sundmacher · L.
Objectives

To examine the role of hospitals and office-based physicians in empirical networks that deliver care to the same population with regard to the timely provision of appropriate care after hospital discharge.

Design

Secondary data analysis of a nationwide cohort using cross-classified multilevel models.

Setting

Transition from hospital to ambulatory care.

Participants

All patients discharged for acute myocardial infarction (AMI) from Germany’s largest statutory health insurance fund group in 2011.

Main outcome measure

Patients’ odds of receiving a statin prescription within 30 days after hospital discharge.

Results

We found significant variation in 30-day statin prescribing between hospitals (median OR (MOR) 1.40; 95% credible interval (CrI) 1.36 to 1.45), hospital-physician pairs caring for the same patients (MOR 1.32; 95% CrI 1.26 to 1.38) and to a lesser extent between physicians (MOR 1.14; 95% CrI 1.11 to 1.19). About 67% of the variance between hospital-physician pairs and about 45% of the variance between hospitals was explained by hospital characteristics including a rural location, teaching status and the number of beds, the number of patients shared between a hospital and an office-based physician as well as 16 patient characteristics, including multimorbidity and dementia. We found no impact of physician characteristics.

Conclusions

Timely prescription of appropriate secondary prevention pharmacotherapy after AMI is subject to considerable practice variation which is not consistent with clinical guidelines. Hospitals contribute more to the observed variation than physicians, and most of the variation lies at the patient level. To ensure care continuity for patients, it is important to strengthen hospital capacity for discharge management and coordination between hospitals and office-based physicians.

Academic versus non-academic neurosurgeons in China: a national cross-sectional study on workload, burnout and engagement

Por: Yu · J. · Gao · J. · Chen · J. · Sun · Y.
Objectives

Chinese neurosurgery has made great progress during the past decades; yet, little is known about the working status of neurosurgeons. This study aimed to evaluate the difference between academic and non-academic neurosurgeons, focusing on their professional burnout, job satisfaction and work engagement.

Design

Cross-sectional nationwide survey.

Study setting

The survey was conducted in China between 2017 and 2018.

Participants

A total number of 823 academic neurosurgeons and 379 non-academic neurosurgeons participated in this study.

Outcome measures

Professional burnout, job satisfaction and work engagement were assessed using the Maslach Burnout Inventory, the Job Descriptive Index and the Utrecht Work Engagement Scale, respectively.

Results

The majority of respondents were male (92.93%), less than 45 years old (85.27%) and married (79.53%). Chinese neurosurgeons worked 63.91±11.04 hours per week, and approximately 45% experienced burnout. Compared with non-academic respondents, academic neurosurgeons had longer working hours (p

Conclusion

Chinese neurosurgeons are under significant stress particularly for the non-academic neurosurgeons. Offering better opportunities for training, promotion, higher income and safer working environments could be solutions to relieve burnout and improve career satisfaction and engagement.

Trial registration number

ChiCTR1800014762. This article is not linked to a clinical trial.

Validation of the distress thermometer for caregivers of children and adolescents with schizophrenia 儿童和青少年精神分裂症患者的护理者痛苦温度计的验证

Abstract

Aim

To develop and psychometrically test the distress thermometer for caregivers (DT‐C) and document the distress level in primary caregivers of children and adolescents diagnosed with schizophrenia.

Design

A validation diagnostic accuracy study and descriptive cross‐sectional survey.

Methods

DT‐C was adopted based on Harverman's distress thermometer for parents. The cut‐off score was detected by using receiver operating characteristic analysis with the Depression Anxiety Stress Scale‐21 as a reference standard in a sample of 324 caregivers of children and adolescents diagnosed with schizophrenia in China collected between Jan 2017 and Feb 2018.

Results

One‐item DT of DT‐C indicated a good retest reliability (r = 0.86) and one‐item DT and the Problem List (PL) indicated good convergent validity (r = 0.67–0.88). Overall and individual PL domains showed good internal consistency (KR 20 values ranged from 0.70–0.90). Setting seven as the cut‐off score, the values of sensitivity (0.72–0.81), specificity (0.86–0.90), Youden's index (0.61–0.70), positive predictive value (0.67–0.74), and negative predictive value (0.84–0.92) were most satisfactory and area under curve values showed significantly excellent discrimination (0.88–0.90). The average DT score for the 324 participants was 6.34 (SD 2.49), with 46.9% of the participants above the cut‐off. Caregivers above the cut‐off score faced significant multiple problems in practical, family/social, cognitive, emotional, and parenting domains.

Conclusion

The DT‐C, with six domains containing 35 items in Problem List and with the cut‐off score at seven, can be a rapid screening tool to measure distress in these caregivers. The level of distress in caregivers was relatively high. Psychoeducation on specific needs and a solid mutual support network are recommended for mitigating caregivers’ distress.

Impact

This study adapted a reliable DT‐C to measure distress of caregivers, which has the potential to be introduced to caregivers of other types of child and adolescent mental disorders in research, assessments and care planning for health professionals.

目的

开发和护理者的痛苦温度计(DT‐C),从心理测量学上进行测试,并记录被诊断为精神分裂症的儿童和青少年的主要护理者的痛苦程度。

设计

验证诊断准确性研究和描述性横断面调查。

方法

采用的痛苦温度计是在Harverman的父母痛苦温度计的基础上设计的。采用焦虑抑郁压力量表‐21进行接受者操作特征分析,检测出临界值,作为中国2017年1月至2018年2月之间诊断出儿童精神分裂症儿童和青少年324名护理者的参照标准。

结果

痛苦温度计中的一项DT表示良好的重测信度(r =0.86),一项DT和问题表(PL)表示良好的收敛效度(r =0.67‐0.88)。整体和个别问题表域显示出良好的内部一致性(KR 20值范围为0.70‐0.90)。以7为临界值时,敏感性(0.72‐0.81)、特异性(0.86‐0.90)、尤登指数(0.61‐0.70)、阳性预测值(0.67‐0.74)和阴性预测值(0.84‐0.92)最为满意,曲线下面积值显示出显著的优异区分性(0.88‐0.90)。324名参与者的平均DT得分为6.34(SD为2.49),46.9%的参与者高于临界值。高于临界值的护理者在工作、家庭/社会、认知、情感和养育方面面临着重大的多重问题。

结论

痛苦温度计有6个领域,包含问题列表中的35个项目,临界值为7,可以作为一个快速筛查工具来测量这些护理者的痛苦程度。护理者的痛苦程度相对较高。建议针对特定需要进行心理教育,并建立稳固的互助网络,以减轻护理者的痛苦。

影响

本研究采用了可靠的痛苦温度计来测量护理者的痛苦程度,有可能被引入到其他类型儿童和青少年精神障碍的护理者的研究、评估和保健专业人员的护理计划中。

Clusters of competence: Relationship between self‐reported professional competence and achievement on a national examination among graduating nursing students

Abstract

Aims

To identify clusters based on graduating nursing students’ self‐reported professional competence and their achievement on a national examination. Furthermore, to describe and compare the identified clusters regarding sample characteristics, students’ perceptions of overall quality of the nursing programme, and students’ general self‐efficacy (GSE).

Design

A cross‐sectional study combining survey data and results from a national examination.

Methods

Data were collected at two universities and one university college in Sweden in January 2017, including 179 students in the final term of the nursing programme. The study was based on the Nurse Professional Competence Scale, the GSE scale, and results from the National Clinical Final Examination. A two‐step cluster analysis was used to identify competence profiles, followed by comparative analyses between clusters.

Results

Three clusters were identified illustrating students’ different competence profiles. Students in Clusters 1 and 2 passed the examination, but differed in their self‐assessments of competence, rating themselves under and above the overall median value, respectively. Students in Cluster 3 failed the examination but rated themselves at the overall median level or higher.

Conclusion

The study illustrates how nursing students’ self‐assessed competence might differ from competency assessed by examination, which is challenging for nursing education. Self‐evaluation is a key learning outcome and is, in the long run, essential to patient safety.

Impact

The study has identified clusters of students where some overestimate and others underestimate their competence. Students who assessed their competence low but passed the exam assessed their GSE lower than other students. The findings illuminate the need for student‐centred strategies in nursing education, including elements of self‐assessment in relation to examination to make the students more aware of their clinical competence.

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