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Comparative analysis on the effect of Z‐plasty versus conventional simple excision for the treatment of sacrococcygeal pilonidal sinus: A retrospective randomised clinical study

Abstract

Sacrococcygeal pilonidal sinus is one of common diseases in general department. However, it is characterised, for surgeons, by high post‐surgical recurrence and high incidence of post‐surgical wound complications. Due to that fact, this retrospective randomised clinical study was designed to evaluate the surgical procedure effect of Z‐plasty (ZP), compared with convention simple excision (SE). A total of 67 patients from May 2015 to May 2019 in our department were studied into two groups randomly, the group of ZP and the group of SE. The patients' characteristics, surgical data, hospital length of stay (LOS), and post‐surgery complications were recorded. Statistical approaches were proceed with P‐value analysis. The results are as follows. No significant differences were found between these two groups of the ages, gender distribution, Body Mass Index (BMI), smoking history, diabetes mellitus, and blood hypertension. The estimated blood loss, specimen volume, distance to anus, and drain output on the first day of post‐surgery between the two groups were not statistically significant, either. However, surgical time in the ZP group was longer than that in the SE group (P < .0001). LOS in the ZP group was obviously shorter than that in the SE group (P = .0051). Furthermore, the patients of the ZP group were tending to suffer from fewer post‐surgical complications than the ones of the SE group. In a conclusion, we hold the point view that the surgical procedure of ZP can lead a better outcome than SE because it demonstrated shortened LOS and fewer post‐surgical complications.

The effectiveness of nurse‐led interventions for preventing urinary tract infections in older adults in residential aged care facilities: A systematic review

Abstract

Aims and Objectives

To explore the effectiveness of nurse‐led interventions to prevent urinary tract infections in older adults living in residential aged care facilities.

Background

While most empirical studies focus on the treatment of urinary tract infections, few studies have examined the effectiveness of nurse‐led interventions in preventing urinary tract infections.

Design

Systematic review.

Methods

Eight electronic databases were searched for relevant studies published between 2008–2018. The inclusion criteria were as follows: (a) a focus on older adults, (b) evaluation of nurse‐led interventions, focusing on prevention of urinary tract infection, (c) implemented in residential aged care facilities, and (d) outcomes reported as incidence or prevalence of urinary tract infection. The selected papers were critically appraised using the Mixed Methods Appraisal Tool. The data were analysed with narrative synthesis, and findings were reported following the PRISMA guidelines.

Results

A review of 1,614 titles and abstracts identified four studies that met the inclusion criteria. Three types of nurse‐led interventions were identified: (a) the appointment of advanced practice nurses, (b) those focused on a single specific nursing intervention, and (c) implementation of a multicomponent nursing intervention. All included studies reported at least some positive outcomes. However, the included studies were highly heterogeneous and it was impossible to determine the most effective intervention approach.

Conclusions

Nurses are leaders in health care and are well placed to lead prevention of urinary tract infections in residential aged care; however, evidence of the effectiveness of a nurse‐led approach is limited. High‐quality randomised controlled trials are warranted to address the knowledge gap and advance practice in this area.

Relevance to clinical practice

When developing an effective nurse‐led intervention programme, the programme should be grounded in nurse‐led principles and consider the complex staffing factors to ensure that nurse‐led programmes are tailored to an effective level.

Healthy life styles, sleep and fatigue in endometrial cancer survivors: A cross‐sectional study

Abstract

Aims and objectives

The primary aim of this study is to explore the influence of obesity, healthy lifestyle and sleep quality of endometrial cancer survivors on their fatigue level.

Background

As many as 30% of endometrial cancer survivors still suffer from fatigue 5 years after completing therapy. Fatigue may hinder cancer survivors from participating in daily activities or returning to their original roles and functions, thus affecting their health‐related quality of life.

Design

This study adopted a cross‐sectional correlational research design. The STROBE checklist for cross‐sectional studies was used as a reference for reporting the study.

Methods

A consecutive sample of 134 endometrial cancer survivors was recruited from the outpatient clinics of a medical centre in Taipei, Taiwan. Data were collected using structured questionnaires.

Results

Study subjects scored 44 points (SD = 7.09) on average for the fatigue levels. Results of linear regression showed that sleep quality (ß = −0.38), comorbidity index (ß = −0.024) and age (ß = 0.20) were important predictors of fatigue. However, differences in obesity, vegetable and fruit intake, physical activity did not lead to significant differences in fatigue level.

Conclusions

Survivors who had poorer sleep quality, higher comorbidity index and younger age reported higher fatigue.

Relevance to clinical practice

The study findings are relevant for assessing and preventing fatigue in endometrial cancer survivors. Those with poorer sleep quality, higher comorbidity index and younger age are at a greater risk for fatigue and deserve further attention. Although the study results failed to support the link between obesity, vegetable and fruit intake, physical activity and fatigue, the ratio of survivors who comply with recommended healthy lifestyles was low. Hence, it is of urgent necessity that this population receives the help to maintain a healthy lifestyle.

Family caregivers’ lived experiences of caring for epidermolysis bullosa patients: a phenomenological study

Abstract

Aims and objectives

This paper explores the lived experiences of family caregivers of epidermolysis bullosa (EB) patients.

Background

Patients with EB need long‐term care. Their family experiences physical and mental stress while proving that care. However, very little research has explored the family caregivers’ actual lived experiences when caring for EB patients.

Design

This is a qualitative research using the phenomenological approach.

Methods

Data were collected with the assistance of the Taiwan Foundation for Rare Disorders (TFRD). Interviews were conducted between 2015–2017 with primary family caregivers (n=10) who had cared for EB patients for at least five years. Data were analyzed using Colaizzi’s (1978) seven‐step phenomenological method. COREQ reporting guidelines were utilized.

Results

Four themes and eleven subthemes emerged after data analysis: (1) Transformation and helplessness: changing expectations and helplessness associated with the rare, unknown disease; (2) Mother’s responsibility: mothers loving and protecting their children, surviving through adversity and challenges, and self‐experiencing a child’s pain; (3) Physical and mental fatigue experienced by the whole family: physical and mental exhaustion, and unbalanced lives; and (4) Adjustment and social support: providing mutual assistance to mitigate adversity, hopeful search for treatments, the importance of patient associations and rare disease foundations, and social assistance requirements.

Conclusion

Family caregivers experience many challenges when caring for EB patients and experience substantial stress and overwhelming burdens. Consequently, they would benefit greatly from various support systems to reduce the burden of caring for EB patients.

Relevance to clinical practice

Healthcare professionals can use the findings from this study to understand the circumstances faced by family caregivers and tailor care and education specifically to support each family’s financial, social, and household needs, thereby helping them reduce the stress of caring for EB patients.

Associations of occupational stress, workplace violence and organizational support on chronic fatigue symptoms among nurses

Abstract

Aims

Chronic fatigue syndrome is an agnogenic disease worldwide. Nurses are at a high risk of chronic fatigue syndrome. However, no research has been done to examine the associations of workplace violence, organizational support and occupational stress with chronic fatigue syndrome among Chinese nurses. This study aimed to examine effects of these factors on chronic fatigue syndrome in this occupational group.

Desine

Cross‐sectional. All participants voluntarily completed a questionnaire survey.

Methods

The study was conducted in Liaoning province from December 2017 to January 2018. Self‐administered questionnaires were distributed to 1200 nurses, including Effort‐Reward‐Imbalance, Workplace Violence Scale, Survey of Perceived Organizational Support, together with age, gender, marital status, education levels, physical activities, job rank, monthly income and weekly working hours. Complete responses were obtained from 1080 (90%) participants. Chronic fatigue syndrome was diagnosed by doctors according to the Centers for Disease Control and Prevention criteria. Multivariable logistic regression was performed to examine these independent risk factors.

Results

The prevalence of chronic fatigue syndrome was 6.76%. The results of logistic regression analysis showed that nurses who experienced serious higher levels of overcommitment, workplace violence and less organizational support were more likely to be classified as chronic fatigue syndrome.

Conclusion

There was a high prevelence of chronic fatigue syndrome. Lower workplace violence, more organizational support and lower overcommitment could be effective resources for reducing chronic fatigue syndrome.

Impact

Workplace violence, organizational support and occupational stress were related to chronic fatigue syndrome, which helped to explain why Chinese nurses suffered higher prevelance of chronic fatigue syndrome. Overcommitment explained chronic fatigue syndrome better than Effort/Reward Ratio, so intrinsic stress played a more critical role than extrinsic stress in chronic fatigue syndrome. Chinese nurses suffered serious sleep disorders and impairment of concentration and memory. These symptoms might also atributed to serious occupational stress, unsafe and unsupportive working environment. Creating a safe and supportive working emvironment, releiving intrinsic occupational stress should be considered as an institutional strategy to early prevent chronic fatigue syndrome.

A town level comprehensive intervention study to reduce salt intake in China: protocol for a cluster randomised controlled trial

Por: Xu · J. · Tang · B. · Liu · M. · Bai · Y. · Yan · W. · Zhou · X. · Xu · Z. · He · J. · Jin · D. · Sun · J. · Li · Y. · He · F. J. · MacGregor · G. A. · Wu · J. · Zhang · P.
Introduction

Salt intake in China (12 g/day) is more than twice the upper limit recommended by the WHO (5 g/day). To reduce salt intake, Action on Salt China (ASC) was launched in 2017. As one of four randomised controlled trials (RCTs) in the ASC programme, a comprehensive intervention study was designed to test whether all the components of the interventions adopted by other RCTs are acceptable, scalable and effective when provided to a region in the real world.

Methods and analysis

Using a cluster RCT design, 2688 participants were selected from 48 towns (clusters) in 12 counties in 6 provinces and assigned to the intervention group or the control group. Randomisation was performed after the baseline survey was completed. Information on salt-related knowledge, attitude and practice (KAP), blood pressure and 24-hour urinary sodium were collected. The intervention includes government engagement, health education and other intervention components targeting restaurants, home cooks and primary school students and their families that have been used in other RCTs. The control group will not receive the intervention. The project will be followed up for 2 years, with the intervention being carried out for the first year only. The primary outcome is salt intake measured by 24-hour urinary sodium excretion after 1 year. The secondary outcomes are the long-lasting effectiveness on salt intake and blood pressure measured by the same method, as well as salt-related KAP and blood pressure at the 1-year and 2-year follow-ups. Process evaluation and health economics analysis will be conducted as well.

Ethics and dissemination

The study was reviewed and approved by the Institutional Review Board of the National Center for Chronic and Noncommunicable Disease Control and Prevention, the Chinese Center for Disease Control and Prevention, and Queen Mary Research Ethics Committee. Results will be disseminated through presentations, publications and social media.

Trial registration number

ChiCTR1800018119

Differences in reimbursement listing of anticancer therapies in China: an observational study

Por: Guan · X. · Zhang · Y. · Wushouer · H. · Shi · L. · Ross-Degnan · D. · Wagner · A. K.
Objective

Access to highly priced anticancer medications usually requires insurance coverage. A first step towards coverage of such medications is their inclusion in reimbursement lists. We assessed listing for reimbursement in China between 2009 and 2018 of anticancer medications on the WHO’s Essential Medicines List.

Setting and study design

Using publicly available data, we assessed which anticancer medications listed in the 20th WHO Model List of Essential Medicines (EML) were included in China’s National Reimbursement Drug List (NRDL). For five targeted anticancer medications on the WHO EML, we also assessed inclusion in the 31 Chinese Provincial Reimbursement Drug Lists (PRDLs). Logistic regression was used to test whether inclusion of targeted anticancer medications was associated with provincial economic levels.

Primary outcome measures

Inclusion of five targeted anticancer medications in the NRDL and PRDLs before and after 2017.

Results

The 2017 NRDL included all anticancer medications on the WHO EML (except for one not approved in China at the time), and by 2018, all 31 PRDLs listed the targeted anticancer medications except for nilotinib; four provinces had covered all five targeted medications before the 2017 NRDL coverage mandate. Provincial economic level and regional incidence of specific cancers seemed unrelated to the inclusion of five targeted anticancer medications in PRDLs.

Conclusion

Our findings suggest that by including medications in the national and provincial reimbursement lists, China has taken an important first step in promoting access to targeted anticancer medications. Further research is needed to determine whether inclusion in PRDLs improved the availability, appropriate use and affordability of highly priced targeted anticancer medications in China.

Metabolic syndrome in native populations living at high altitude: a cross-sectional survey in Derong, China

Por: Huang · X. · Hu · Y. · Du · L. · Lin · X. · Wu · W. · Fan · L. · Li · L. · Zhong · X. · Gong · Q. · Gao · L. · Kuang · W.
Objective

The metabolic syndrome is a major risk factor for cardiovascular disease. Little information exists on the prevalence of the metabolic syndrome at high-altitude areas in China. We aimed to estimate the prevalence of metabolic syndrome and its individual components at high altitude.

Methods

A cross-sectional survey of 5053 adults living in Derong from elevation of 2060 to 3820 m was carried out in 2013. Metabolic syndrome was defined according to the Chinese Diabetes Society criteria.

Results

The overall prevalence of metabolic syndrome was 3.6% (5.9% in men and 1.8% in women) in Derong, China. Obesity and hypertension were more prevalent among adults than dyslipidaemia and hyperglycaemia at high altitude. The prevalence of metabolic syndrome was higher in township than countryside residents (6.6%, 11.9% in men and 1.5% in women vs 3.0%, 4.6% in men and 1.8% in women). Men with age 30–59 years old had a much higher prevalence of metabolic syndrome than women. Men, township, middle and old age residents had a higher risk of metabolic syndrome. The risk of obesity and dyslipidaemia decreased and the risk of hypertension increased in very high altitude (≥3000 m) residents.

Conclusion

In Derong, despite the relatively low prevalence of metabolic syndrome, hypertension and obesity are more prevalent in adult residents. And metabolic syndrome is more concentrated in township and male residents. These people also have a higher risk of metabolic syndrome. Therefore, it is necessary to develop a national strategy for the prevention and treatment of metabolic syndrome for high-risk population at high altitude in China.

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.

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.

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。

Thirty‐day readmission, length of stay and self‐management behaviour among patients with acute coronary syndrome and type 2 diabetes mellitus: A scoping review

Abstract

Aims and Objectives

To summarise the current evidence on comorbid type 2 diabetes mellitus (T2DM) related to 30‐day readmission and hospital length of stay (LOS) among patients with acute coronary syndrome (ACS) and evidence on the effectiveness of self‐management programmes for patients with both conditions.

Background

Acute coronary syndrome and T2DM remain two major diseases leading to serious consequences. Thirty‐day readmission and LOS were considered indicators of the quality of care, with the understanding that the potential significant effects of these outcomes could be varied.

Design

This scoping review followed the methodology described by Arksey and O'Malley.

Methods

Five databases including PubMed, Embase, Cochrane Library, Web of Science and CINAHL were searched, and a total of 20 articles involving 913,807 patients were included. Results were reported in accordance with PRISMA‐ScR guidelines.

Results

The results indicated that patients with both ACS and T2DM have prolonged LOS and increased 30‐day readmission rates. The findings supported that improvements in patient self‐management behaviour for optimal health outcomes were partially successful by effective self‐management programmes; however, few articles on intervention programmes specifically designed for patients with two conditions were found.

Conclusion

Prolonged LOS and increased 30‐day readmission rates are found among patients with ACS and T2DM. Based on few pilot studies building on each other, the effectiveness of self‐management programmes in promoting self‐care behaviour, self‐efficacy and knowledge for patients with ACS and T2DM cannot be concluded.

Relevance to clinical practice

Findings from this review provide valuable information on and a better understanding of readmissions and LOS among patients with ACS and T2DM for healthcare providers. Future developments and implementations of effective self‐management programmes should target patients with dual diagnoses to improve health behaviour and reduce readmission and LOS.

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.

Patterns of delivery assistance among adolescent mothers in Nigeria

This study examined the sociodemographic and sociocultural factors associated with the pattern of birth assistance used among adolescent mothers aged 15–19 in Nigeria.

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.

Nurse‐Led Tele‐Coaching on Modifiable Cardiovascular Risk Factors in People with Type 2 Diabetes Mellitus: A Systematic Review and Meta‐Analysis

Abstract

Background

Tele‐coaching has been used by nurses as one of the accessible and sustainable interventions for individuals with type 2 diabetes mellitus. However, evidence has been lacking to demonstrate its effectiveness in mitigating the related cardiovascular risk factors.

Aims

To systematically evaluate the effectiveness of nurse‐led tele‐coaching on the modifiable cardiovascular risk factors (glycated hemoglobin, blood pressure, & lipid levels) among individuals with type 2 diabetes mellitus.

Methods

A systematic search of eight databases (Cochrane Library, PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, Scopus, PsycINFO, Web of Science, & ProQuest Dissertations and Theses) was conducted for randomized controlled trials of nurse‐led tele‐coaching for individuals with type 2 diabetes mellitus published in English up to October 30, 2018. A meta‐analysis was conducted for the primary outcomes of the studies.

Results

Twelve randomized controlled trials were selected that included 3,030 participants. Results from the meta‐analysis revealed statistically significant reductions for not only glycated hemoglobin (pooled mean difference = −1.23, 95% CI: −1.63 to −0.8, I 2 = 0%, p < .00) but also systolic blood pressure (SBP; pooled mean difference = −2.22, 95% CI: −3.95 to −0.49, I 2 = 0%, p < .01); such findings are supportive of the use of nurse‐led tele‐coaching on the primary outcome.

Linking Evidence to Action

Results from the meta‐analyses have shown that nurse‐led tele‐coaching is an effective and accessible intervention that could improve the glycemic control and SBP among individuals with type 2 diabetes mellitus.

Integration of Different Sensory Interventions From Mother’s Breast Milk for Preterm Infant Pain During Peripheral Venipuncture Procedures: A Prospective Randomized Controlled Trial

Abstract

Purpose

To compare the effects of integrating mother’s breast milk (BM) with three different combinations of sensory stimuli on preterm infant pain during peripheral venipuncture procedures.

Design

A prospective, repeated‐measures randomized controlled trial.

Methods

Preterm infants (gestational age between 28 and 37 weeks, and in stable condition) needing venipuncture were recruited by convenience sampling (N = 140) and randomly assigned to four treatment conditions: (a) routine care (condition 1); (b) BM odor or taste (condition 2); (c) BM odor or taste + heartbeat sounds (HBs; condition 3), and (d) BM odor or taste + HBs + non‐nutritive sucking (NNS; condition 4). Pain scores were assessed based on the Premature Infant Pain Profile‐Revised (PIPP‐R) over nine phases: baseline (phase 0, 5 min without stimuli before venipuncture), disinfecting (phase 1), during venipuncture (phase 2), and a 10‐min recovery (phases 3–8).

Findings

Infants who received BM odor or taste + HBs + NNS had significantly lower increases in pain scores from baseline compared with controls across phases 1 through 8. Infants treated with either condition 2 or 3 demonstrated significant reductions in mild pain during disinfecting and recovery phases, as compared with the controls. When condition 2 was used as the reference, there were no significant differences in pain scores between the infants receiving condition 3 across the nine phases, suggesting mothers’ HBs have only mild analgesic effects on venipuncture pain.

Conclusions

Integration of mother’s BM odor or taste, HBs, and tactile NNS should be considered as an intervention for alleviation of procedural pain for preterm infants.

Clinical Relevance

Clinicians should incorporate the integrated sensory intervention into caregiving support for preterm infants undergoing short painful procedures.

Innate immune molecule surfactant protein D attenuates sepsis‐induced acute kidney injury through modulating apoptosis and NFκB‐mediated inflammation

Abstract

The objective of this study is to investigate the mechanism whereby innate immune molecule surfactant protein D (SP‐D) attenuates sepsis‐induced acute kidney injury (AKI) through modulating apoptosis and nuclear factor kappa‐B (NFκB)‐mediated inflammation. In the present study, a mouse sepsis model was established by cecal ligation and puncture in SP‐D knockout (KO) mice and wild‐type (WT) mice. A sham‐operated group was included as the control. The experimental materials were extracted 6 and 24 hours postoperatively. The plasma levels of tumour necrosis factor alpha (TNF‐α) and MCP‐1 were determined by enzyme‐linked immunosorbent assay (ELISA). Apoptosis was measured by double staining with Annexin V/propidium iodide and flow cytometry. The levels of NFκB in renal tissues were measured by ELISA and Western blotting assay. Apoptosis was detected by TUNEL assays. There were no significant differences in plasma TNF‐α levels between the WT sham group and the KO sham group at 6 and 24 hours postoperatively (P < .05), but the levels of TNF‐α in the WT sepsis and KO sepsis groups were significantly higher than those in controls (P < .05). The levels of TNF‐α in the KO sepsis group were significantly higher than those of the WT sepsis group (P < .05). TNF‐α levels in the WT sepsis group and the KO sepsis group at 24 hours postoperatively were significantly higher than those at 6 hours postoperatively (P < .05). The levels of MCP‐1 in the WT sepsis group and the KO sepsis group at 6 and 24 hours postoperatively were significantly higher than those in the control group (P < .05), and MCP‐1 levels in the KO sepsis group were significantly higher than those in the WT sepsis group (P < .05). MCP‐1 levels in the WT sepsis group and the KO sepsis group at 24 hours postoperatively were significantly higher than those at 6 hours postoperatively (P < .05). The expression of SP‐D in WT kidneys was significantly lower at 6 and 24 hours postoperatively (P < .05). The number of TUNEL‐positive cells in the kidneys from septic SP‐D KO mice was significantly higher (P < .05). The levels of NFκB in septic mice were significantly increased at 6 and 24 hours after induction of sepsis compared with the sham‐operated group compared with those of septic SP‐D KO mice and WT mice (P < .05). Innate immune molecule SP‐D significantly decreased plasma levels of inflammatory cytokines in mice and attenuated sepsis‐induced AKI by inhibiting NFκB activity and apoptosis.

Factors influencing the local cure rate of hidradenitis suppurativa following wide local excision

Abstract

Wide local excision is the gold standard and only potential curative therapy for recalcitrant hidradenitis suppurativa. However, high recurrence rates persist even post‐surgery with little known on the influencing factors for remission. We evaluated the effect of patient, disease, and operative factors on local cure rate of moderate to severe hidradenitis following wide local excision. We performed a retrospective chart review for all patients who had undergone surgical excision of hidradenitis at a university hospital from 2012 to 2018. We identified 79 patients with a total of 220 operative sites. The majority were obese (mean body mass index [BMI] 32.5), female (71%), African‐American (84%), and had a mean age of 31 years. A quarter of operative sites experienced a recurrence (n = 56). Patients who achieved remission had a significantly lower number of affected regions than those who experienced a recurrence (2.3 vs 3.6, P = .0023). Additionally, recurrence rate differed significantly between body locations (P = .0440). Smoking, BMI, Hurley grade, closure method, and excision size did not influence local cure rate. Surgical excision remains a worthy management option for hidradenitis patients with three quarters achieving remission after a single operation. Number of affected regions and location of hidradenitis may play a factor in recurrence.

A qualitative research synthesis of contextual factors contributing to female overweight and obesity over the life course in sub-Saharan Africa

by Ifeoma D. Ozodiegwu, Mary Ann Littleton, Christian Nwabueze, Oluwaseun Famojuro, Megan Quinn, Richard Wallace, Hadii M. Mamudu

Objective

Adult women are disproportionately affected by overweight and obesity in Sub-Saharan African (SSA) countries. Existing evidence on the sociocultural context remains unconsolidated. In this qualitative research synthesis, we aggregate research literature on contextual factors that potentially predispose adult women and adolescent girls to overweight and obesity to inform research, policies and programs over the life course.

Methods

PubMed, CINAHL, PsychInfo, ProQuest Central, EMBASE, and Web of Science were searched to locate qualitative research articles conducted in SSA countries beginning in the year 2000. After assessment for eligibility and critical appraisal, 17 studies were included in the synthesis. Textual data and quotes were synthesized using meta-aggregation methods proposed by the Joanna Briggs Institute.

Results

The synthesized studies were conducted in South Africa, Ghana, Kenya and Botswana. The three overarching themes across these studies were body size and shape ideals, barriers to healthy eating, and barriers to physical activity, with cultural and social factors as cross-cutting influences within the major themes. Culturally, the supposedly ideal African woman was expected to be overweight or obese, and voluptuous, and this was associated with their identity. Although being overweight or obese was not acceptable to adolescent girls, they desired to be voluptuous. Healthy food choices among women and adolescent girls were hampered by several factors including affordability of nutritious foods and peer victimization. Both adult women and adolescent girls experienced ageism as a barrier to physical activity.

Significance

This is the first qualitative research synthesis to amplify the voices of women and girls in SSA countries highlighting the challenges they face in maintaining a healthy body weight. Sociocultural, institutional and peer-related factors were powerful forces shaping body size preferences, food choices and participation in physical activity. Our study findings provide insights for the design of contextually appropriate obesity prevention interventions and lay the foundation for further research studies.

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