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Vacuum‐assisted closure therapy combined with bi‐pectoral muscle flap for the treatment of deep sternal wound infections

Abstract

Deep sternal wound infection (DSWI) is a fatal complication after median sternotomy. This study was to assess the effect of vacuum‐assisted closure (VAC) combined with bi‐pectoral muscle advancement flap therapy on rehabilitation for the treatment of DSWI. Fifty‐two patients with DSWI underwent treatment of VAC and bi‐pectoral muscle flap. These patients were followed‐up 12 months postoperation. The patient characteristics, duration of VAC therapy, the mean hospital stay, and postoperative complications were retrospectively analysed. All patients underwent 1 to 3 VAC treatment sessions before closure. Fifty‐one of 52 DSWI patients were cured to discharge; the mean hospital stay was 26.5 days. The drainage tube continued to drain a large amount of bloody fluid in three patients after the wound was closed. Respiratory failure occurred in one patient with severe mediastinal and pulmonary infections and died eventually in hospital. One patient died of acute cerebral haemorrhage during the12‐month follow‐up. VAC therapy combined with bi‐pectoral muscle flap is a simple and effective treatment for DSWIs with short hospital stays and few complications. However, this is a retrospective case series presentation with no comparison group; further large‐scale controlled studies are needed.

Selective debridement of burn wounds using hydrosurgery system

Abstract

In recent years, hydrosurgery is a technology that has been applied more and more in debridement procedures. However, the selectivity of hydrosurgery to cutaneous necrotic tissues has not been proved. This study was designed to investigate the possible tissue selectivity of hydrosurgery in the debridement in burn wounds. Deep partial‐thickness burns were produced on the back of porcine, and 48 hours later, both burn wounds and normal skin were debrided using the hydrosurgery system. Then tissue samples were taken, and histological staining was performed and observed under microscope. Burn wound resection rates and the normal skin damaged rates were measured. Our result indicated that the burn wounds were significantly more sensitive than the normal skin when the water pressure produced by the hydrosurgery system was set between 3000 and 5000 psi (pounds per square inch), that is, the necrotic tissue portions were debrided more easily than the normal skin tissue. Based on these data, we suggest that 3000 to 5000 psi of water pressure in the hydrosurgery system has a skin tissue selectivity in burn wounds.

Prolonged stay in the emergency department is an independent risk factor for hospital‐acquired pressure ulcer

Abstract

It is not easy to ensure optimal prevention of hospital‐acquired pressure ulcer (HAPU) in crowded emergency departments (EDs). We hypothesised that a prolonged ED length of stay (LOS) is associated with an increased risk of HAPU. This is a single‐centre observational study. Prospectively collected HAPU surveillance data were analysed. Adult (aged 20 years) patients admitted through the ED from April 1, 2013 to December 31, 2016 were included. The primary outcome was the development of HAPU within a month. Covariates included demographics, comorbidities, conditions at triage, initial laboratory results, primary ED diagnosis, critical ED interventions, and ED dispositions. The association between ED LOS and HAPU was modelled using logistic and extended Cox regression. A total of 48 641 admissions were analysed. The crude odds ratio (OR) and hazard ratio (HR) for HAPU were increased to 1.44 (95% CI, 1.20‐1.72) and 1.21 (95% CI, 1.02‐1.45), respectively, in ED LOS 24 hours relative to ED LOS <6 hours. In multivariable logistic regression, ED LOS 12 and 24 hours were associated with higher risk of HAPU, with ORs of 1.30 (95% CI, 1.05‐1.60) and 1.80 (95% CI, 1.45‐2.23) relative to ED LOS <6 hours, respectively. The extended Cox regression showed that the risk lasted up to a week, with HRs of 1.42 (95% CI, 1.07‐1.88) and 1.92 (95% CI, 1.44‐2.57) relative to ED LOS <6 hours, respectively. In conclusion, Prolonged ED LOS is independently associated with HAPU. Shorter ED LOS should be pursued as a goal in a multifaceted solution for HAPU.

Do emotional labour strategies influence emotional exhaustion and professional identity or vice versa? Evidence from new nurses 情绪劳动策略是否会对情绪枯竭和职业认同产生影响,反之亦然?源自新聘护士的证据

Abstract

Aims

The aim was to examine the reciprocal relationships of emotional labour strategies with emotional exhaustion and professional identity.

Design

This study adopted a four‐wave cross‐lagged panel design.

Methods

Survey data were collected in 2018 from a sample of 171 newly hired nurses from 58 hospitals in 11 provinces of China. Nurses’ emotional labour (i.e., deep acting and surface acting), emotional exhaustion and professional identity were repeatedly measured. Cross‐lagged panel analyses were conducted to examine the reciprocal relationships we hypothesized.

Results

We found that emotional exhaustion was positively related to surface acting (but not vice versa); deep acting was negatively related to emotional exhaustion (but not vice versa); professional identity was positively related to deep acting (but not vice versa).

Conclusion

Our findings suggest that deep acting and professional identity may decrease the level of emotional exhaustion, whereas emotionally exhausted nurses are more likely to employ surface acting strategies.

Impact

This research finding will have an impact on the nursing management. Healthcare managers may consider workshops or training and development programs that promote nurses’ professional identify to promote nurses’ use of deep acting and consequently reduce their level of emotional exhaustion, which has been associated with a variety of negative consequences, such as low quality of patient service, high medical accidents, and turnover rate.

目的

研究情绪劳动策略与情绪枯竭和职业认同的相互关系。

设计

本研究采用四波交叉滞后组设计。

方法

2018年,对我国11个省份58家医院的171名新聘护士进行问卷调查,收集数据。反复测量护士的情绪劳动(即深层伪装和表层伪装)、情绪枯竭和职业认同。采用交叉滞后组分析来检验我们先前假设的相互关系。

结果

我们发现,情绪枯竭与表层伪装呈显著正相关(反之不成立);深层伪装与情绪枯竭呈显著负相关(反之不成立);职业认同与深层伪装呈显著正相关(反之不成立)。

结论

我们的研究结果表明,深层伪装和职业认同可能会降低情绪枯竭的程度,而面临情绪枯竭的护士更有可能采用表层伪装策略。

影响

本项研究发现将对护理管理工作产生影响。医疗保健管理人员可能会考虑举办研讨会或开展培训和发展计划,以提高护士的职业认同感,从而促进护士采用深层伪装策略,降低他们的情绪枯竭程度。同时情绪枯竭还与各种负面影响有关,如患者服务质量低,医疗事故频发,人员流动率高。

The relationship of workplace violence and nurse outcomes: Gender difference study on a propensity score matched sample 工作场所暴力与护士结局的关系:倾向性评分匹配样本的性别差异研究

Abstract

Aims

To investigate workplace violence and nurse outcomes by comparing gender differences.

Design

A secondary analysis of cross‐sectional survey data.

Methods

Workplace violence was measured by four items from the International Hospital Outcome Study. Nurse outcomes were measured by tools including burnout, job satisfaction and intention to stay. We used propensity score matching to generate a sociodemographic balanced dataset of 108 male and 288 female nurses. A hypothetical relationship model was derived from the affective events theory. Comparative statistics and multi‐group structural equation modelling were conducted to analyze gender differences. Data were collected in China from December 2013 – August 2014.

Results

Male nurses reported more workplace violence from staff and less intention to stay than females. Besides finding the mediation of burnout sharing with female nurses consistent with the affective events theory, workplace violence was directly linked to less intention to stay in male nurses.

Conclusion

Male nurses experience more workplace violence by staff than female nurses. Besides responding emotionally to workplace violence like female nurses, male nurses also respond behaviourally.

Impact

What problem did the study address? Gender differences in workplace violence and its relationship to nurse outcomes. What were the main findings? Male nurses experienced more workplace violence than female nurses, linked directly to less intention to stay. Workplace violence linked to less job satisfaction and intention to stay in nurses was mediated by burnout. Where and on whom will the research have impact? Gender‐based prevention of and coping with workplace violence should be included in nursing training.

目的

通过比较性别差异,探讨工作场所暴力与护士结局的关系。

设计

横向调查数据的二次分析。

方法

通过国际医院结局研究中的四个项目对工作场所暴力进行衡量研究。护士结局以工作倦怠、工作满意度和留任意愿为衡量指标。我们采用倾向性评分匹配,生成一个由108名男性护士和288名女性护士组成的社会人口平衡数据集。基于情绪事件理论提出了一个假设关系模型。通过利用好比较统计方法和多组结构方程建模来分析性别差异。数据于2013年12月至2014年8月在中国收集。

结果

相比于女护士,男护士更容易遭受工作场所暴力,留任意愿较低。除了通过与女护士分享工作倦怠的调解作用(与情绪事件理论一致)外,工作场所暴力与男护士的留任意愿降低直接相关。

结论

男护士比女护士更容易遭受工作场所暴力。除了像女护士一样对工作场所暴力做出情绪反应外,男护士还会做出行为上的反应。

影响

本项研究解决了哪些问题?工作场所暴力的性别差异及其与护士去留的关系。主要结果是什么?男护士比女护士更容易遭受工作场所暴力,这与其留任意愿较低直接相关。工作场所暴力与工作满意度和留任意愿降低相关,且通过工作倦怠调解。本项研究将适用于何处且对哪些人产生影响?护理培训应包括基于性别的工作场所暴力预防和应对措施。

Child‐rearing experiences and home environment concerns among Southeast Asian immigrant mothers in transnational marriage families in Taiwan 台湾跨国婚姻家庭中东南亚移民母亲的育儿经验与家庭环境问题

Abstract

Aims

To explore the child‐rearing experiences of immigrant mothers and their concerns about children's home environments in the contexts of transnational marriage families and non‐native culture.

Background

Immigrant mothers are often disadvantaged by a relative lack of information on and access to children's healthcare, but little research exists on the experiences of mothers in transnational marriage families as they attempt to provide a secure home environment while navigate an unfamiliar culture.

Design

A descriptive phenomenological research design based on intuition was employed to explore immigrant mothers’ unique lived reality through their subjective experiences and perceptions.

Methods

Semi‐structured interviews with 15 immigrant mothers from 15 transnational marriage families were conducted between May 2016–February 2017. Narratives were analyzed using the descriptive phenomenological method because it permits systematic discovery of the lived experiences from the perspective of the study's participants.

Results

Three major themes were identified: (a) striving to maintain a secure home for children; (b) suffering and struggling with difficulties; and (c) trying to overcome difficulties and build an adequate family environment. The essential, prevailing concept of immigrant mothers’ experience in child‐rearing was identified as ‘Where my child is, is home.’

Conclusion

Immigrant mothers bond emotionally and physically to their new land via their children. Their child‐raising experiences are interwoven with their roles in their new familial and cultural homes.

Impact

Immigrant brides often become mothers soon after marrying to continue their husbands’ family line. Understanding their unique child‐rearing experiences and challenges in providing a secure home in a non‐native culture will help nurses provide effective care. Study results will benefit paediatric/family nurses in any setting where care for transnational marriage families is provided, those families themselves, public policymakers and future researchers.

目的

探讨在跨国婚姻家庭和非本土文化背景下,移民母亲的育儿经验及其对儿童家庭环境的关注。

背景

移民母亲往往由于相对缺乏有关儿童医疗保健的信息和获取途径而处于不利地位,但关于跨国婚姻家庭中的母亲经历的研究很少,因为她们试图在陌生的文化中提供一个安全的家庭环境。

设计

采用基于直觉的描述性现象学研究设计,透过移民母亲的主观经验与看法,探讨其独特的生活实相。

方法

2016年5月至2017年2月,对来自15个跨国婚姻家庭的15名移民母亲进行半结构式访谈。叙述使用描述现象学方法进行分析,因为它允许从研究参与者的角度系统地发现生活经验。

结果

确定了三大主题:(a)努力为儿童维持一个安全的家;(b)在困难中受苦挣扎;和(c)努力克服困难,建立一个适当的家庭环境。移民母亲育儿经验的基本的、流行的概念被确定为“我的孩子在哪里,哪里就是家”。

结论

移民母亲通过她们的孩子在情感和身体上与新国家联系在一起。她们的育儿经历与她们在新的家庭和文化家园中的角色交织在一起。

影响

移民新娘往往在结婚后不久就成为母亲,延续丈夫家族的香火。了解她们独特的育儿经验和在非本土文化中提供安全家园的挑战,将有助于护士提供有效的护理。研究结果将有益于为跨国婚姻家庭提供护理的任何环境中的儿科/家庭护士,这些家庭本身,公共政策制定者和未来的研究人员。

Perspectives of residents and staff regarding food choice in residential aged care: A qualitative study

Abstract

Aims and objectives

To explore the experiences of food choice and meal service in residential aged care facilities and its impact on autonomy, self‐determination and quality of life from the perspectives of both residents and staff.

Background

Globally, residential aged care is a principal provider of care for older people who can no longer live independently at home. Within this setting, lack of food choice has been identified as a significant factor impacting on residents' self‐determination, sense of autonomy and quality of life.

Design

This study used an exploratory descriptive qualitative approach guided by self‐determination theory.

Method

A total of 14 participants (seven residents and seven staff members) from two Australian residential aged care facilities were recruited through purposive and snowball sampling with assistance from one independent contact nurse at each facility. In‐depth, semi‐structured interviews were conducted, digitally recorded and transcribed. The COREQ checklist was used in this qualitative study.

Results

Three main themes were identified from the interview data provided by residents and staff, which were as follows: (a) catering for the masses; (b) organisational barriers to providing choice; and (c) food impacts well‐being.

Conclusions

This study explored the experiences of food choice and service in residential aged care facilities, from the perspectives of both residents and staff. Results of interviews highlighted the importance of providing adequate food choice which has become an enduring issue that requires more attention and commitment to make a positive change for residents living in residential aged care facilities.

Relevance to clinical practice

Nurses and other staff working in residential aged care facilities need to be aware of the importance of providing adequate food choice, including for residents who require modified diets. As advocates for residents, nursing staff must address the persistent lack of food choice. However, this will require a radical change in organisational culture and strong leadership.

The self‐assessment of clinical competence and the need for further training: A cross‐sectional survey of advanced practice nursing students

Abstract

Aims and objectives

(a) To describe and analyse advanced practice nursing students' self‐assessment of their clinical competence and need for further training and (b) to analyse the possible predictive variables in their self‐assessment.

Background

The self‐assessment of clinical competence in nursing education is important for identifying professional development and educational needs to improve patient care.

Design

A cross‐sectional survey following STROBE guidelines was used.

Methods

Ninety‐nine students from three universities/university colleges in Norway participated in the study, and data were collected using a revised version of the Professional Nurse Self‐Assessment Scale II. Descriptive, correlation and regression analyses were performed.

Results

The students gave the highest self‐assessment ratings for their clinical competence in taking full responsibility and for their need for further training in medication effects and interactions. Although the students gave themselves low ratings for the use of electronic devices, they assessed their need for further training in this area as average. Clinical work experience as a registered nurse and previous higher education level were not significant predictors of clinical competence nor the need for further training.

Conclusion

The findings indicate that self‐assessment is appropriate for students in advanced practice nursing programmes. This study implies that programmes in advanced practice nursing need to familiarise students with the possibilities of information technology. It questions the entry requirement that stipulates that prospective students must have several years of clinical work experience as registered nurses before entering advanced practice nursing programmes. These programmes need to communicate that competencies other than direct clinical practice are also needed for students' future roles.

Relevance to clinical practice

The study contributes to the exploration of how students self‐assess own clinical competence and need for further training in advanced practice nursing programmes. Further research should evaluate the development of clinical competence.

Quitting trajectories of Chinese women smokers following telephone smoking cessation counselling: A longitudinal study

Abstract

Aims and Objectives

This study mapped the quitting patterns (trajectories) of Hong Kong Chinese women smokers who had received counselling via a quitline service and examined factors correlated with different trajectories.

Background

Quitting smoking is always a gradual and progressive process. However, most existing studies on smoking cessation have adopted a cross‐sectional approach to conduct evaluation. Little is known about the quitting trajectories of smokers, particularly those who are women after receiving smoking cessation counselling.

Methods

We used a retrospective longitudinal design and analysed 474 women smokers who had called the quitline. Quitting trajectories were mapped using latent growth modelling. Multinomial logistic regression was performed to identify factors associated with class membership. A STROBE checklist was completed.

Results

We identified three trajectory groups: ‘quitters’ who quit smoking at 6 months and abstained from cigarettes up to 6 years; ‘reducers’ who cut down cigarette consumption ≥50% at 3 years and maintained reduced levels up to 6 years; and ‘increasers’ who increased smoking ≥20% at 3 years and continued smoking up to 6 years. Participants who perceived more difficulties in quitting were more likely to be increasers. Those with higher daily cigarette consumption at baseline were more likely to be reducers.

Conclusions

We clarified three trajectory groups of women smokers. The results indicate that existing cessation services need to be improved, especially for women smokers who do not quit after receiving telephone counselling.

Relevance to clinical practice

Existing cessation services need to be improved, especially for women smokers who do not quit after receiving telephone counselling. For those who reduce smoking but fail to quit, quit plans should be developed that provide step‐by‐step guidance in achieving abstinence through smoking reduction. Instant messages may complement telephone counselling to deliver cessation support for those who increase their cigarette consumption.

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

Abstract

Background

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

Aims

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

Methods

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

Results

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

Linking Evidence to Action

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

Effectiveness of a Modified Comprehensive Behavioral Intervention for Tics for Children and Adolescents with Tourette’s Syndrome: A Randomized Controlled Trial

Abstract

Aim

To evaluate the effectiveness of a modified 4‐session Comprehensive Behavioral Intervention for Tics program for decreasing tics in children and adolescents with Tourette's syndrome.

Background

Comprehensive Behavioral Intervention for Tics program has been shown to decrease tic severity. However, the lack of behavior therapists in countries such as in Taiwan, may preclude application of the standard 8‐session, 10‐week program.

Design

Randomized controlled study.

Methods

Participants aged 6–18 years diagnosed with Tourette's syndrome or chronic tic disorder were recruited from February 2015 through September 2016. Participants in the control and intervention groups (N = 23 each) received the routine care (daily pyridoxine [50 mg] and psychoeducation). The intervention group received additional four behavioral intervention sessions over a 3‐month period that included psychoeducation, habit‐reversal training, relaxation training and education on tic relapse prevention. The outcome measures, Yale Global Tic Severity Scale scores, were assessed at before and after the completion of program for both groups and again at 3 months follow‐up for the intervention group. The effect of the intervention on severity scores was assessed using a generalized estimated equation.

Results

Comparison of scores before and after intervention showed that the intervention significantly decreased the severity of total motor tics (B = −3.28, p < .01) and total tics (B = −5.86, p < .01) as compared with control treatment. YGTSS scores for the intervention group were lower at 3 months follow‐up as compared with before treatment or immediately after treatment completion (total tics, p < .001).

Conclusion

The modified 4‐session Comprehensive Behavioral Intervention for Tics program was more effective than routine care for decreasing tic severity in our cohort of 6–18‐year‐olds. This improvement was maintained 3 months after intervention.

Impact

Health care providers, including nurses, in countries currently not adopting Comprehensive Behavioral Intervention for Tics program should be made aware of the positive effects of this modified intervention for Tourette's syndrome.

Impact of metoprolol standard dosing pathway in Chinese patients with acute coronary syndrome: protocol for a multicentre prospective study

Por: Li · D. · Dong · W. · Liu · Y. · Wang · J. · Mu · Y. · Zhou · H. · Wang · J. · Zhou · S. · Chen · Y.
Introduction

Metoprolol is the most frequently used β-receptor blockers; however, the prescribed dose in China is far less than the recommended doses in the guidelines. Based on the Chinese and International guidelines and the Chinese clinical practice, we are conducting this study (NCT03413410) to test the feasibility and tolerability of the metoprolol optimal dosing pathway by observing the percentage of patients achieving target dose in Chinese acute coronary syndrome (ACS) patients during hospitalisation.

Methods and analysis

A total of about 1000 patients aged ≥18 years, hospitalised for ACS will be enrolled from ~15 hospital sites in China between February 2018 and April 2019. The percentage of patients achieving the target metoprolol dosage at discharge is the primary endpoint. The secondary endpoints included the following: mean heart rate (HR) and blood pressure (BP) of the patients who have achieved target dose at discharge and during the follow-up period, percentage of patients experiencing bradycardia (HR

Ethics and dissemination

The study protocol has been approved by the Ethics committee of the Chinese PLA General Hospital (number: S2017-112-01). Study findings will be disseminated through presentations at national and international conferences and submitted for publications in peer-reviewed journals.

Trial registration number

ClinicalTrials.gov registry (NCT03413410).

Cohort profile: the Australian Longitudinal Study of Adults with Autism (ALSAA)

Por: Arnold · S. · Foley · K.-R. · Hwang · Y. I. · Richdale · A. L. · Uljarevic · M. · Lawson · L. P. · Cai · R. Y. · Falkmer · T. · Falkmer · M. · Lennox · N. G. · Urbanowicz · A. · Trollor · J.
Purpose

There is a significant knowledge gap regarding the lives of adults on the autism spectrum. Some literature suggests significant health and mental health inequalities for autistic adults, yet there is a lack of comprehensive longitudinal studies exploring risk factors. Further, most research does not include the perspective of autistic adults in its conduct or design. Here, we describe the baseline characteristics and inclusive research approach of a nationwide longitudinal study.

Participants

The Autism Cooperative Research Centre for Living with Autism’s Australian Longitudinal Study of Adults with Autism (ALSAA) is a questionnaire-based longitudinal study of autistic adults (25+ years old) with follow-up at 2-year intervals. Autistic advisors were involved in each stage of research apart from data analysis. Three questionnaires were developed: self-report, informant report (ie, proxy report) and carers (ie, carer experiences and characteristics).

Findings to date

An inclusive research protocol was developed and agreed with autistic advisors. Baseline data were collected from 295 autistic adults (M=41.8 years, SD=12.0) including 42 informant responses, 146 comparison participants and 102 carers. The majority of autistic participants (90%) had been diagnosed in adulthood (M=35.3 years, SD=15.1). When compared with controls, autistic adults scored higher on self-report measures of current depression and anxiety. Participant comments informed ongoing data gathering. Participants commented on questionnaire length, difficulty with literal interpretation of forced response items and expressed gratitude for research in this area.

Future plans

A large comprehensive dataset relating to autistic adults and their carers has been gathered, creating a good platform for longitudinal follow-up repeat surveys and collaborative research. Several outputs are in development, with focus on health service barriers and usage, caregivers, impact of diagnosis in adulthood, further scale validations, longitudinal analyses of loneliness, suicidal ideation, mental illness risk factors and other areas. Baseline data confirm poorer mental health of autistic adults. The ALSAA demonstrates a working approach to inclusive research.

Reporting specifications regarding epilepsy practice guidelines based on the RIGHT reporting checklist: an analysis

Por: Wang · Z. · Zhang · Y. · Guo · W. · Hu · X. M. · Gao · X. · Lu · L.
Objective

Clinical guidelines are designed to optimise patient care and provide efficient approaches for therapy. Epilepsy is a chronic brain disorder that continues to experience a considerable treatment gap due to non-standard recommendations. We assessed the reporting quality of clinical practice guidelines on epilepsy over the past 5 years to generate a reporting specification for this study.

Setting

Seven databases were searched in May 2018 focusing on the period from 2013 to 2018. These included Medline, EMBASE, PubMed, Cumulative Index to Nursing and Allied Health Literature, China National Knowledge Infrastructure, Wanfang and Chinese Science and Technology Journal Database (VIP). Reporting quality of epilepsy guidelines was assessed by two independent authors using the Reporting Items for practice Guidelines in HealThcare (RIGHT) approach. Spearman’s correlation was used to assess inter-rater reliability.

Participants

Participants with epilepsy or seizure, not limited by age, gender, course of disease or cause of epilepsy, were included.

Interventions

There were no limitations with regard to intervention.

Primary and secondary outcome measures

The outcome was the ability of the RIGHT tool to measure reporting quality.

Results

Twelve relevant guidelines were included in this study. The reporting quality was not high in any of the included guidelines. The highest reporting quality included a ‘yes’ proportion of 77.1%, whereas the worst included a corresponding proportion of 37.1%. Overall evaluation results showed that 16.7% of the included guidelines were of high quality, 75% were of medium quality and 8.3% were of low quality. The correlation between the two estimators was credible (>0.7).

Conclusions

Appraisal of these guidelines using the RIGHT tool revealed that the quality of reporting varied among guidelines. Items that exhibited low quality in most included guidelines were healthcare questions, rationale/explanation for recommendations, quality assurance, funding source(s) and role(s) of the funder, and limitations of the guideline. Thus, these aspects should receive greater attention in future guideline reporting.

Occurrence and multilocus genotyping of <i>Giardia duodenalis</i> from post-weaned dairy calves in Sichuan province, China

by Jiaming Dan, Xueping Zhang, Zhihua Ren, Liqin Wang, Suizhong Cao, Liuhong Shen, Junliang Deng, Zhicai Zuo, Shumin Yu, Ya Wang, Xiaoping Ma, Haifeng Liu, Ziyao Zhou, Yanchun Hu, Hualin Fu, Changliang He, Yi Geng, Xiaobin Gu, Guangneng Peng, Zhijun Zhong

Giardia duodenalis is a zoonotic parasitic protist and poses a threat to human and animal health. This study investigated the occurrence of G. duodenalis infection in post-weaned calves from Sichuan province, China. Faecal samples were collected from a total of 306 post-weaned calves (3–12 months old) from 10 farms, including 4 intensive feeding farms and 6 free-ranging farms. The overall infection rate of G. duodenalis was 41.2% (126/306) based on the PCR results at any of the three genetic loci: beta-giardin (bg), triose-phosphate isomerase (tpi) and glutamate dehydrogenase (gdh) genes. Giardia duodenalis assemblages E (n = 115, 91.3%), A (n = 3, 2.4%), and A mixed with E (n = 8, 6.3%) were identified among the 126 positive specimens. Multilocus sequence typing of G. duodenalis revealed 34 assemblage E multilocus genotypes (MLGs), 1 assemblage A MLG and 7 mixed assemblage (A and E) MLGs. The eBURST data showed a high degree of genetic diversity within assemblage E MLGs. The phylogenetic tree revealed that MLG E3 was the primary MLG subtype in Sichuan province and also the most widely distributed in China.

Effects on renal outcome of concomitant acute pyelonephritis, acute kidney injury and obstruction duration in obstructive uropathy by urolithiasis: a retrospective cohort study

Por: Lee · E. H. · Kim · S.-H. · Shin · J.-h. · Park · S. B. · Chi · B. H. · Hwang · J. H.
Objective

Obstruction release from urolithiasis can be delayed with a lack of suggested time for preventing the deterioration of renal function. The objective of this study was to investigate the effect of obstruction duration, concomitant acute kidney injury (AKI) or acute pyelonephritis (APN) during the obstruction on the prognosis of renal function.

Design

Retrospective cohort study.

Setting and participants

1607 patients from a urolithiasis-related obstructive uropathy cohort, between January 2005 and December 2015.

Outcome measures

Estimated glomerular filtration rate (eGFR) decrease ≥30% and/or end-stage renal disease (ESRD), and eGFR decrease ≥50% and/or ESRD, according to obstruction duration, AKI and APN accompanied by obstructive uropathy.

Results

When the prognosis was divided by obstruction duration quartile, the longer the obstruction duration the higher the probability of eGFR reduction >50% (p=0.02). In patients with concomitant APN or severe AKI during hospitalisation with obstructive uropathy, an eGFR decrease of >30% and >50% occurred more frequently, compared with others (p7 days for multivariate analysis, we found that concomitant APN (HR 3.495, 95% CI 1.942 to 6.289, p7 days (HR 1.854, 95% CI 1.095 to 3.140, p=0.001) were independently associated with an eGFR decrease >50%. Tree analysis also showed that AKI grade 3, APN and an obstruction duration >7 days were the most important factors affecting renal outcome.

Conclusions

In patients with urolithiasis-related obstructive uropathy, concomitant APN was strongly associated with deterioration of renal function after obstruction release. The elapsed time to release the obstruction also affected renal function.

Association between syphilis seroprevalence and age among blood donors in Southern China: an observational study from 2014 to 2017

Por: Wu · X. · Guan · Y. · Ye · J. · Fu · H. · Zhang · C. · Lan · L. · Wu · F. · Tang · F. · Wang · F. · Cai · Y. · Yu · W. · Feng · T.
Objective

This study investigated the association between syphilis seroprevalence and age among blood donors, and described the distribution of serological titres among syphilis-infected donors, aiming to confirm the syphilis epidemic characteristics and to promote effective interventions for older adults.

Methods

Data were obtained from the Shenzhen Programme for Syphilis Prevention and Control in 2014–2017. Blood samples were screened using the ELISAs, and confirmed using the Treponema pallidum particle agglutination assay (TPPA) and toluidine red unheated serum test (TRUST).

Results

Among 394 792 blood donors, 733 tested TPPA and TRUST positive (active infection), and 728 tested only TPPA positive (historical infection). The overall prevalence of syphilis seropositivity was 370.1 per 100 000 (95% CI 351.1 to 389.0 per 100 000); the prevalence of active infection was 185.7 per 100 000 (95% CI 172.2 to 199.1 per 100 000). People aged ≥45 years displayed a prevalence of 621.8 per 100 000 in syphilis seropositivity and 280.5 per 100 000 in active infection, which were 3.8 times and 2.4 times higher than that for people aged 2 trend=311.9, p trend2 trend=72.1, p trendtrend

Conclusions

The findings confirm the high prevalence of syphilis among older adults, and suggest the need to increase awareness among healthcare providers and deliver more targeted prevention interventions for older adults to promote early testing.

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

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

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

Methods and analysis

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

Ethics and dissemination

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

Trial registration number

NCT03665857.

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

Abstract

Aim

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

Design

A systematic review and meta‐analysis.

Review sources

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

Review methods

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

Results

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

Conclusion

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

Impact

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

目的

针对食醋在改善2型糖尿病成人患者血糖控制方面的有效性展开系统性评估。

设计

系统评估与荟萃分析

评估数据来源

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

评估方法

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

结果

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

结论

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

影响

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

Pyoderma gangrenosum at multiple sites in a post‐colostomy ulcerative colitis patient with chronic hepatitis B virus: A case report

Abstract

Pyoderma gangrenosum is an uncommon ulcerative cutaneous lesion manifesting as rapidly progressing single or multiple skin ulcers. Permanent stoma in inflammatory bowel disease patients remains an independent risk of pyoderma gangrenosum. In the current report, we describe a case of pyoderma gangrenosum in a post‐colostomy ulcerative colitis patient with chronic hepatitis B. Pyoderma gangrenosum began seemingly as peristomal dermatitis that rapidly developed into painful ulcerations with subsequent appearance of sterile pustules and ulcerations in the left lower leg. The patient significantly improved after active management with prednisolone, antiviral therapy with entecavir, and wound dressings. Our case suggests that physicians and surgeons should have a high index of suspicion of pyoderma gangrenosum in post‐colostomy ulcerative colitis patients who develop peristomal dermatitis.

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