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The effects of intravenous lidocaine on wound pain and gastrointestinal function recovery after laparoscopic colorectal surgery

Abstract

To evaluate the efficacy of intravenous lidocaine in relieving postoperative pain and promoting rehabilitation in laparoscopic colorectal surgery, we conducted this meta‐analysis. The systematic search strategy was performed on PubMed, EMBASE, Chinese databases, and Cochrane Library before September 2019. As a result, 10 randomised clinical trials were included in this meta‐analysis (n = 527 patients). Intravenous lidocaine significantly reduced pain scores at 2, 4, 12, 24, and 48 hours on movement and 2, 4, and 12 hours on resting‐state and reduced opioid requirement in first 24 hours postoperatively (weighted mean difference [WMD] = −5.02 [−9.34, −0.70]; P = .02). It also decreased the first flatus time (WMD: −10.15 [−11.20, −9.10]; P < .00001), first defecation time (WMD: −10.27 [−17.62, −2.92]; P = .006), length of hospital stay (WMD: −1.05 [−1.89, −0.21]; P = .01), and reduced the incidence of postoperative nausea and vomiting (risk ratio: 0.53 [0.30, 0.93]; P = .03) when compared with control group. However, it had no effect on pain scores at 24 and 48 hours at rest, the normal dietary time, and the level of serum C‐reactive protein. In summary, perioperative intravenous lidocaine could alleviate acute pain, reduce postoperative analgesic requirements, and accelerate recovery of gastrointestinal function in patients undergoing laparoscopic colorectal surgery.

The association of telomere length and telomerase activity with adverse outcomes in older patients with non-ST-elevation acute coronary syndrome

by Danny Chan, Carmen Martin-Ruiz, Gabriele Saretzki, Dermot Neely, Weiliang Qiu, Vijay Kunadian

Background

Non-ST elevation acute coronary syndrome (NSTEACS) occurs more frequently in older patients with an increased occurrence of recurrent cardiac events following the index presentation. Telomeres are structures consisting of repeated DNA sequences as associated shelterin proteins at the ends of chromosomes. We aim to determine whether telomere length (TL) and telomerase activity (TA) predicted poor outcomes in older patients presenting with NSTEACS undergoing invasive care.

Method

Older patients undergoing invasive management for NSTEACS were recruited to the ICON-1 biomarker study (NCT01933581). Peripheral blood mononuclear cells (PBMC) were recovered on 153 patients. DNA was isolated and mean TL was measured by quantitative PCR expressed as relative T (telomere repeat copy number) to S (single copy gene number) ratio (T/S ratio), and a telomere repeat amplification assay was used to assess TA during index presentation with NSTEACS. Primary clinical outcomes consisted of death, myocardial infarction (MI), unplanned revascularisation, stroke and significant bleeding recorded at 1 year. TL and TA were divided into tertile groups for analysis. Cox proportional hazards regression was performed. Ordinal regression was performed to evaluate the relationship between TL and TA and traditional cardiovascular risk factors at baseline.

Results

298 patients were recruited in the ICON-1 study of which 153 had PBMC recovered. The mean age was 81.0 ± 4.0 years (64% male). Mean telomere length T/S ratio was 0.47 ± 0.25 and mean TA was 1.52 ± 0.61 units. The primary composite outcome occurred in 44 (28.8%) patients. There was no association between short TL or low TA and incidence of the primary composite outcome (Hazard Ratio [HR] 1.50, 95% Confidence Interval [CI] 0.68–3.34, p = 0.32 and HR 1.33, 95% CI 0.52–3.36, p = 0.51 respectively).

Conclusion

TL and TA are not found to be associated with the incidence of adverse outcomes in older patients presenting with NSTEACS undergoing invasive care.

Clinical trial registration

URL: https://www.clinicaltrials.gov Unique identifier: NCT01933581

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.

A randomized trial of a distraction‐type intervention to assist in managing dressing changes for children experienced burns

Abstract

Aim

To evaluate the impact of the specially designed medical dressing screen during wound dressing changes for children aged 1–3 who experienced a burn on their hand or foot.

Design

Randomized controlled trial.

Methods

The study was performed, between January 2019 ‐ April 2019, at a Burn Outpatient Ward. A total of 52 outpatient children who had suffered burns were included in the clinical trial. The burn area of these participants accounted for 1–5% of the total body surface area. The children were randomly divided into two equal‐sized groups, each receiving a different treatment. In the medical screen group (N = 26), a medical screen was used for children during the dressing changes. In the control group (N = 26), the children received only regular dressing changes. Pain level of the children during dressing change was the primary outcome, the satisfaction of children's parents and wound therapist were used as second outcomes. The Bonferroni method was used to perform pairwise comparisons of repeatedly measured data at different measurement times in two groups.

Results

The results showed that the medical screen group had better outcomes with respect to pain management during dressing changes; in addition, the satisfaction score of the wound therapist and children's parents presented also better outcomes compared with the control group.

Conclusion

This study demonstrated application of the medical screen for burns can relieve the pain of 1 ‐ 3‐year old children experienced a burn during dressing changes. In addition, the application of the medical screen also increased the satisfaction of the child's parents and wound therapist.

Registration NO: 1,900,020,953.

Impact

Compared with conventional dressing methods, the medical screen can be used as a novel way to decrease the negative experience of burn patients ages 1–3 who require dressing changes.

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.

Neonatal outcomes and its association among gestational diabetes mellitus with and without depression, anxiety and stress symptoms in Malaysia: A cross-sectional study

Prevalence of depression, anxiety and stress symptoms in gestational diabetes mellitus ranges from 10.2% to 39.9% based on previous studies in Malaysia. Presence of depression, anxiety or stress in pregnancy may increase the risk of neonatal morbidity and mortality. The aim of this study was to determine the prevalence of neonatal outcomes and its association among mothers with gestational diabetes mellitus with and without the presence of depression, anxiety and stress symptoms in Malaysia.

The role of Th1/Th2 cell chemokine expression in hypertrophic scar

Abstract

The aim of this study was to study the role of Th1/Th2 cell‐associated chemokines in the formation of hypertrophic scars in rabbit ears. Twenty‐six New Zealand white rabbits were used to establish the hypertrophic scar model of rabbit ear and the normal scar model of rabbit's back. Two rabbits were sacrificed on days 0 and 21, 28, 35, 42, 49, 56, and 63 after operation. The specimens were stained with haematoxylin‐eosin (HE). Scar elevation index (SEI) was used to detect the expression of 10 chemokines related to Th1/Th2 cells in both scar formation expressions. Real‐time polymerase chain reaction (PCR) results showed that two chemokines (CXCL10, CXCL12) were highly expressed during the formation of normal scar, and there was almost no expression during the formation of hypertrophic scar (*P < 0.05). The chemokines (CCL2, CCL3, CCL4, CCL5, CCL7, CCL13, CX3CL1) were almost non‐expressed in the formation of normal scars but were expressed for a long time in the formation of hypertrophic scars. The four chemokines, CCL2, CCL4, CCL5, and CX3CL1, maintained a long‐term high expression level during the formation of hypertrophic scars (P < 0.01). There were also three chemokines (CCL14, CCL19, CCL21) that were almost undetectable in normal scarring, but there was transiently low‐level expression (P < 0.05) only during the peak proliferative phase in proliferative scarring. Th1/Th2 cell‐associated chemokines are different in the type, quantity and expression, and maintenance time of rabbit ear hypertrophic scars.

Resilience among stroke survivors: A cohort study of the first 6 months 中风幸存者的恢复能力:前6个月的定群研究

Abstract

Aims

To explore (a) resilience among patients over the first 6 months following a first ischaemic stroke; (b) factors associated with resilience at hospitalization, 1, 3, and 6 months postdischarge; (c) baseline predictors of resilience at 6 months postdischarge.

Design

a cohort study.

Methods

From February 2017–January 2018, 217 patients presenting at two hospitals with a first ischaemic stroke were recruited. Their resilience, medical coping styles, general self‐efficacy, functional independency, socio‐demographic, and clinical data were assessed while they were still in hospital (baseline) and at 1, 3, and 6 months after discharge.

Results

Resilience among stroke patients decreased significantly 1 month after hospital discharge and remained stable. Predictors of resilience were as follows: self‐efficacy and resignation at baseline; number of children, functional independency, general self‐efficacy, and resignation at 1 month; and religion, resignation, self‐efficacy, confrontation at 3 months and 6 months. The baseline factors that predicted resilience at 6 months were income level, religion, stroke severity at discharge, self‐efficacy, and resignation.

Conclusion

Stroke survivors experienced a significant decrease in resilience from hospitalization until 1‐month postdischarge. Factors contributing to resilience after a stroke varied across time. Self‐efficacy and coping styles were particularly important and contributed to long‐term resilience.

Impact

Understanding resilience among stroke survivors is needed to inform the development of interventions to enhance the psychological recovery of survivors. The levels of resilience among stroke survivors were low compared with those in the normal older population. Nurses should provide greater psychological support during hospitalization to stroke survivors and especially to those with lower income, higher stroke severity at discharge, no religion, lower self‐efficacy, or who use resignation as a coping strategy as those survivors may have lower resilience 6 months later. Future studies are needed to test interventions designed to change or modify stroke survivors' coping styles and promote self‐efficacy, thereby enhancing higher resilience.

目的

探讨(a)首发缺血性中风后患者前6个月的恢复能力;(b)出院后1、3和6个月再次住院时影响恢复能力相关因素;(c)出院后6个月恢复能力的基线预测指标。

设计

定群研究。

方法

从2017年2月至2018年1月,在两家医院共招募了217名首发缺血性中风患者。并对他们在住院期间(基线)和出院后1、3和6个月的恢复能力、医疗应对方式、一般自我效能感、功能独立性、社会人口学和临床数据进行评估。

结果

中风患者出院后1个月恢复能力明显下降,并保持稳定。恢复能力的预测指标如下:基线时的自我效能感和辞职打算;1个月时的子女陪护人数、功能独立性、一般自我效能感和子女人数;3个月和6个月时的宗教信仰、辞职打算、自我效能感和对抗。预测6个月时的恢复能力的基线因素包括收入水平、宗教信仰、出院时中风严重程度、自我效能感和辞职打算。

结论

从住院到出院后1个月,中风幸存者的恢复能力明显下降。影响中风后恢复能力的因素随时间而变化。自我效能感和应对方式尤其重要,对长期恢复能力有一定影响。

影响

有必要了解中风幸存者的恢复能力,以便制定干预措施,提高幸存者的心理康复能力。与正常老年人相比,中风幸存者的恢复能力水平较低。护士应在中风幸存者住院期间为其提供更大的心理支持,尤其是那些收入较低、出院时中风严重程度较高、无宗教信仰、自我效能感较低的患者,或是那些将辞职作为应对策略的患者,因为此类幸存者在6个月后的恢复能力可能较低。

未来需要进行进一步的研究,以对旨在改变中风幸存者应对方式并提高自我效能感的干预措施进行检验,从而提高恢复能力。

Clinical prediction score for superficial surgical site infections: Real‐life data from a retrospective single‐centre analysis of 812 hepatectomies

Abstract

Superficial surgical site infections (SSIs) are one of the most common postoperative complications of hepatectomy for liver cancer. The objective of this study is to clarify the risk factors and determine a clinical prediction score for SSIs after partial hepatectomy for malignant tumour. A total of 812 consecutive patients were enrolled who underwent partial hepatectomy for liver malignant tumour from January 2017 to December 2017. Univariate and multivariate analyses were conducted to identify the risk factors for SSIs. Clinical prediction score was then constructed using coefficients of identified significant predictors. Risk stratification was then carried out by receiver operating characteristic curve analysis. Of all the 812 patients, SSIs were observed in 31 (3.82%) patients. A multivariate analysis identified four predictors as independent risk factors for SSIs, which were splenomegaly, perioperative blood transfusion, intensive care unit (ICU) admission, and low postoperative serum albumin concentration (<35 g/L). Clinical prediction score ranged from 0 to 4.6 with its discrimination concordance (C) statistic of 0.70 (95% confidence interval [CI] 0.59, 0.81). Risk stratification classified these patients into low, moderate, and high risk in SSIs. This risk score system may credibly stratify the risk of SSIs with relatively high sensitivity and specificity. Splenomegaly, history of blood transfusion, ICU admission, and postoperative serum albumin concentration less than 35 g/L could be used to predict SSIs with acceptable discrimination. This clinical risk score system may be useful in prediction of SSIs after hepatectomy for malignant tumours.

Prevalence and characteristics of polycystic ovary syndrome in Brazilian women: protocol for a nation-wide case-control study

Por: Spritzer · P. M. · Marchesan · L. B. · Santos · B. R. · Cureau · F. V. · Oppermann · K. · Reis · R. M. d. · Ferriani · R. A. · Weiss · R. · Meirelles · R. · Candido · A. L. · Reis · F. M. · Brazilian PCOS Network · Rocha · Baracat · Maciel · Soares · Filho · Gemelli · Soares Junior
Introduction

Brazil is a large country, with a population of mixed ethnic background and broad variation in dietary and physical activity traits across its five main regions. Because data on Brazilian women with polycystic ovary syndrome (PCOS) are still scarce, a nation-wide collaborative study was designed to determine the prevalence of metabolic and reproductive abnormalities and the presence of anxiety and depression in Brazilian women with PCOS. In addition, the study aims at describing how these characteristics are distributed across PCOS phenotypes and at detecting associations with regional demographic and lifestyle aspects, genetic variants, and epigenetic markers.

Methods and analysis

The Brazilian PCOS study is being conducted in the outpatient clinics of eight university hospitals within the public healthcare network (Unified Health System) across the country. Additional centres will be included following completion of the research ethics approval process. The sample includes women with PCOS according to Rotterdam criteria at inclusion in the study and a control group of healthy women matched by age, socioeconomic status and geographical region. Data will be collected in each centre and incorporated into a unified cloud database. Clinical, demographic, socioeconomic, psychological, metabolic, epigenetic and genotypic variables will be evaluated. The data resulting from this study will be useful to guide specific public strategies for primary and secondary prevention of metabolic and reproductive comorbidities in the PCOS population of Brazil.

Ethics and dissemination

The study protocol was approved by each local Research Ethics Committee. Written informed consent will be obtained from each participant. During data collection, analysis and publication, care will be taken to ensure confidentiality of participant information. Study results will be published in peer-reviewed journals and disseminated at international conferences. This research protocol was registered with the Research Ethics Committee of HCPA, through Plataforma Brasil.

Trial registration number

CAAE 18082413.9.1001.5327

Study protocol: becoming and being a mother living with HIV - a multicentre longitudinal mixed methods study among pregnant women living with HIV, non-pregnant women living with HIV and pregnant women not living with HIV in a high-income setting (the 2B M

Por: Moseholm · E. · Fetters · M. D. · Aho · I. · Mellgren · A. · Johansen · I. S. · Storgaard · M. · Pedersen · G. · Katzenstein · T. L. · Weis · N.
Introduction

The success of combination antiretroviral therapy has decreased the risk of perinatal HIV transmission and normalised pregnancy in women living with HIV (WLWH). Despite these advances, WLWH still face complex medical and psychosocial issues during pregnancy and postpartum, and there is a gap of knowledge on the experiences of becoming and being a mother living with HIV in today’s context. The overall aim of this study is to investigate psychosocial outcomes and experiences of WLWH in Scandinavia during pregnancy and early motherhood.

Methods and analysis

This is a multicentre longitudinal convergent mixed methods study consisting of a quantitative survey study, a qualitative interview study and a mixed methods analysis. The survey study aims to examine psychosocial outcomes of WLWH across the pregnancy – postpartum trajectory. Participants are pregnant WLWH living in Scandinavia. Two control groups of HIV-negative pregnant women and non-pregnant WLWH are also included. Data is collected in the third trimester, 3 and 6 months postpartum using standardised questionnaires. Statistical analysis will assess changes over time and identify predictors of adverse outcomes. The interview study seeks to understand experiences of pregnancy and becoming a mother while living with HIV. Pregnant WLWH who are enrolled in the survey study will be asked to participate in individual interviews in the third trimester and 6 months postpartum. Data will be analysed using narrative analysis. The survey and interview results will be merged in a mixed methods analysis to assess confirmation, expansion or discordance between the data sets.

Ethics and dissemination

Approval from the Danish Data Protection Agency (VD-2018–253), and the Finnish and Swedish Ethics Committees have been obtained (HUS/1330/2019 and Dnr: 2019–04451, respectively). Study results will be disseminated to patient organisations, through publications in peer-reviewed journals and at scientific conferences.

Evaluation of the role of transhepatic flow in postoperative outcomes following major hepatectomy (THEFLOW): study protocol for a single-centre, non-interventional cohort study

Por: Golriz · M. · Lemekhova · A. · Khajeh · E. · Ghamarnejad · O. · Al-Saeedi · M. · Strobel · O. · Thilo · H. · Müller-Stich · B. · Schneider · M. · Berchtold · C. · Tinoush · P. · Mayer · P. · Chang · D.-H. · Weiss · K. H. · Hoffmann · K. · Mehrabi · A.
Introduction

Liver resection is the only curative treatment for primary and secondary hepatic tumours. Improvements in perioperative preparation of patients and new surgical developments have made complex liver resections possible. However, small for size and flow syndrome (SFSF) is still a challenging issue, rendering patients inoperable and causing postoperative morbidity and mortality. Although the role of transhepatic flow in the postoperative outcome has been shown in small partial liver transplantation and experimental studies of SFSF, this has never been studied in the clinical setting following liver resection. The aim of this study is to systematically evaluate transhepatic flow changes following major liver resection and its correlation with postoperative outcomes.

Methods and analysis

The TransHEpatic FLOW (THEFLOW) study is a single-centre, non-interventional cohort study, and aims to enrol 50 patients undergoing major hepatectomy (defined as hemihepatectomy or extended hepatectomy based on the Brisbane classification) with or without prior chemotherapy. The portal venous flow, hepatic artery flow and portal venous pressure are measured before and after each resection. All patients are followed-up for 3 months after the operation. During each evaluation, standard clinical data, posthepatectomy liver failure and overall morbidity and mortality will be recorded. THEFLOW study was initiated on 25 March 2018 and is expected to progress for 2 years.

Ethics and dissemination

This protocol study received approval from the Ethics Committee of the University of Heidelberg (registration number: S576/2017). The results of this study will be published in a peer-reviewed journal, and will also be presented at medical meetings.

Trial registration number

NCT03762876.

Platelet-Rich plasma Injection Management for Ankle osteoarthritis study (PRIMA): protocol of a Dutch multicentre, stratified, block-randomised, double-blind, placebo-controlled trial

Por: Paget · L. · Bierma-Zeinstra · S. · Goedegebuure · S. · Kerkhoffs · G. · Krips · R. · Maas · M. · Moen · M. · Reurink · G. · Stufkens · S. · de Vos · R. · Weir · A. · Tol · J.
Introduction

Platelet-rich plasma (PRP) is a potentially efficacious treatment for ankle osteoarthritis (OA), but its use has not been examined in high-quality studies. Systematic reviews show that PRP injections significantly decrease pain and improve function in patients with knee OA. Ankle OA is more common than hip or knee OA in the young active population; with a prevalence of 3.4%.

PRP injections in ankle OA are shown to be safe and improve quality of life over time, but no randomised controlled trial has been conducted. Our randomised controlled trial will evaluate the efficacy of PRP injections for symptom reduction and functional improvement, compared with placebo, in the treatment of ankle (talocrural) OA.

Methods and analysis

We will conduct the Platelet-Rich plasma Injection Management for Ankle OA study: a multicentre, randomised, placebo-controlled trial. One hundred patients suffering from ankle OA will be randomised into two treatment groups: PRP injection or placebo (saline) injection. Both groups will receive two injections of PRP or placebo at an interval of 6 weeks. Primary outcome is the American Orthopaedic Foot and Ankle Society score at 26 weeks. Secondary outcomes determined at several follow-up moments up to 5 years, include Ankle Osteoarthritis Score, Foot and Ankle Outcome Score, pain subscale of (0–40), Visual Analogue Scale score (0–100), Ankle Activity Score (0–10), subjective patient satisfaction Short Form Health Survey-36, Global Attainment Scaling and the EuroQol-5 dimensions-3 levels utility score. A cost-effectiveness analysis will be performed at 1 year.

Ethics and dissemination

The study is approved by the Medical Ethics Review Committee Amsterdam Medical Center, the Netherlands (ABR 2018–042, approved 23 July 2018) and registered in the Netherlands trial register (NTR7261). Results and new knowledge will be disseminated through the Dutch Arthritis Association (ReumaNederland), Dutch patient federation, conferences and published in a scientific peer-reviewed journal.

Trial registration number

NTR7261.

Awareness, current use of electronic cigarettes and associated smoking factors in Zhejiang Chinese adolescents

by Meng Wang, Ru-Ying Hu, Jin Pan, Hao Wang, Min Yu, Kai-Xu Xie, Wei-Wei Gong

Objectives

The present study aims at examining the prevalence of awareness and current use of electronic cigarettes (e-cigarettes) among middle and high school students from Zhejiang, China. Smoking-related factors associated with e-cigarettes use will also be explored.

Methods

This cross-sectional study was based on 2017 Zhejiang Youth Risk Behavior Survey. A total of 24,157 adolescents were recruited and relevant data of e-cigarettes and smoking-related factors were collected via a self-reported questionnaire. Logistic regression models were used to examine the association between e-cigarettes current use and the smoking-related factors. Odds ratios (ORs) and their 95% confidence intervals (CIs) were reported.

Results

Overall, 70.61% of middle and high school students reported hearing of e-cigarettes, while only 2.15% reported using e-cigarettes in the past month. Among smoking-related factors, cigarette smoking (ever and current), use of other tobacco products, second hand smoke exposure and previous attempts to quit smoking were significantly associated with higher current e-cigarettes use in adolescents.

Conclusions

These results presented high awareness of e-cigarettes while relatively low use in Chinese adolescents. Smoking-related factors were significantly associated with increased e-cigarettes use.

The effect of a web-based training for improving primary health care providers’ knowledge about diabetes mellitus management in rural China: A pre-post intervention study

by Mu-Hong Wei, Xian-Zhen Chen, Xing-Xin Zhan, Zhi-Xia Zhang, Shao-Jing Yu, Wei-Rong Yan

Background

The performance of primary health care providers regarding DM management is poor in rural China, and effective training methods for providers are urgently needed. This study aimed to evaluate the effect of web-based training for improving knowledge about DM management among primary health care providers in rural China and to further compare the effects of the training effect between primary health care providers with different backgrounds.

Methods

A pre-post intervention study was conducted from April to August 2014. In this study, a total of 901 primary health care workers were recruited from six counties in Hubei province. To evaluate the effect of the web-based training, the knowledge achievement of participants was measured with multiple choice questions (MCQ) at baseline, at the end of two weeks of training and at three months after training. A mixed linear model (MLM) was used to measure group differences in the mean scores at baseline and follow-up.

Results

After the web-based training, the knowledge scores of the village doctors increased from 73.58 at baseline to 89.98 at posttest and to 84.57 three months after the training. For township health workers, we observed an upward trend in scores from 78.87 at the pre-test to 91.72 at the second test, and at the three months after the training, the scores increased to 94.91. For village doctors, greater knowledge achievement was observed between the scores at baseline and after two weeks of training(adjusted difference: 3.55, P = 0.03) compared to that observed for the township health workers, while decreased their knowledge achievement between baseline and the third-test compared with that of township health workers (adjusted difference: 5.05, P = 0.01).

Conclusions

This study suggested that web-based training was an effective method for improving the knowledge of primary health care providers about management of DM in remote areas. Compared with the effect of the training on village doctors, the training had a poor short-term effect on township health workers but a better long-term effect.

Incidence of retinal vein occlusion with long-term exposure to ambient air pollution

by Han-Wei Zhang, Chao-Wen Lin, Victor C. Kok, Chun-Hung Tseng, Yuan-Pei Lin, Tsai-Chung Li, Fung-Chang Sung, Chi Pang Wen, Chao A. Hsiung, Chung Y. Hsu

This study aimed to investigate whether long-term exposure to airborne hydrocarbons, including volatile organic compounds, increases the risk of developing retinal vein occlusion (RVO) among the population of Taiwan. A retrospective cohort study involving 855,297 people was conducted. Cox proportional hazards regression analysis fitted the multiple pollutant models for two targeted pollutants, including total hydrocarbons (THC), nonmethane hydrocarbons (NMHC) were used, and the risk of RVO was estimated. The chi-squared test and one-way analysis of variance were used to test differences in demographics and comorbidity distribution among tertiles of the targeted pollutants. Before controlling for multiple pollutants, hazard ratios for the overall population were 19.88 (95% CI: 17.56–22.50) at 0.51-ppm increases in THC and 4.33 (95% CI: 3.97–4.73) at 0.27-ppm increases in NMHC. The highest adjusted hazard ratios for different multiple pollutant models of each targeted pollutant were statistically significant (all p values were ≤0.05) for all patients at 29.67 (95% CI: 25.57–34.42) for THC and 16.24 (95% CI: 14.14–18.65) for NMHC. Our findings suggest that long-term exposure to THC and NMHC contribute to RVO development.

Using healthcare failure mode and effect analysis as a method of vaginal birth after caesarean section management

Abstract

Aims and objectives

This research was conducted to explore the effectiveness of employing the healthcare failure mode and effect analysis method in the management of trial of labour after caesarean, with the aims of increasing vaginal birth after caesarean section rate and reducing potential risks that might cause severe complications.

Background

Previously high caesarean section rate in China and the “two children” policy leads to the situation where multiparas are faced with the choice of another caesarean or trial of labour after caesarean. Despite evidences showing the benefits of vaginal birth after caesarean, obstetricians and midwives in China tend to be conservative due to limited experience and insufficient clinical routines. Thus, its management needs further optimisation in order to make the practice safe and sound.

Design

A prospective quality improvement programme using the healthcare failure mode and effect analysis.

Methods

With the structured methodology of healthcare failure mode and effect analysis, we determined core processes of antepartum and intrapartum management, conducted risk priority numbers and devised remedial protocols for failure modes with high risks. The programme was then implemented as a clinical routine under the agreement of the institutional review board and vaginal birth after caesarean success rates were compared before and after the quality improvement programme, both descriptively and statistically. Standards for Quality Improvement Reporting Excellence 2.0 checklist was chosen on reporting the study process.

Results

Seventy failure modes in seven core processes were identified in the management process, with 14 redressed for actions. The 1‐year follow‐up trial of labour after caesarean and vaginal birth after caesarean rate was increased compared with the previous 3 years, with a vaginal birth after caesarean rate of 86.36%, whereas the incidence of uterine rupture was not compromised.

Conclusions

The application of healthcare failure mode and effect analysis can not only promote trial of labour after caesarean and vaginal birth after caesarean rate, but also maintaining a low risk of uterine rupture.

Relevance to clinical practice

This modified vaginal birth after caesarean management protocol has been shown effective in increasing its successful rate, which can be continued for further comparison of severe complications to the previous practice.

Analgesic efficacy and safety of ketamine after total knee or hip arthroplasty: a meta-analysis of randomised placebo-controlled studies

Por: Xu · B. · Wang · Y. · Zeng · C. · Wei · J. · Li · J. · Wu · Z. · He · H. · Lei · G. · Xie · D. · Ding · X.
Objective

To examine the analgesic efficacy and safety of ketamine after total knee or hip arthroplasty.

Design

Systematic review and meta-analysis.

Data sources

PubMed, EMBASE and Cochrane Library from inception to 22 May 2019.

Eligibility criteria for selecting studies

Randomised controlled trials comparing the efficacy and safety of ketamine with placebo for postoperative pain relief in patients undergoing total knee or hip arthroplasty.

Data extraction and synthesis

Data (ie, pain intensity, morphine consumption, gastrointestinal and psychotic adverse effects) were extracted by two reviewers independently. The Cochrane Collaboration’s recommended tool was used to determine the methodological quality of included studies.

Results

A total of 10 studies were included. One of them was rated as low quality. Compared with placebo, intravenous ketamine was effective for pain relief during 0–8-hour (weighted mean difference (WMD) –1.21, 95% CI –1.45 to –0.98, p

Conclusions

Intravenous administration of ketamine is effective and safe for postoperative pain relief in patients undergoing total knee or hip arthroplasty. Nevertheless, the analgesic efficacy and safety of ketamine in such patients seem to vary by different administration routes and still warrant further studies to explore.

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