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Effect of electronic health interventions on metabolic syndrome: a systematic review and meta-analysis

Por: Chen · D. · Ye · Z. · Shao · J. · Tang · L. · Zhang · H. · Wang · X. · Qiu · R. · Zhang · Q.
Objective

We aimed to examine whether eHealth interventions can effectively improve anthropometric and biochemical indicators of patients with metabolic syndrome (MetS).

Design

Systematic review and meta-analysis.

Methods

PubMed, the Web of Science, Embase, Medline, CINAHL, PsycINFO, the Cochrane Library, the Chinese National Knowledge Infrastructure, the Wanfang and Weipu databases were comprehensively searched for papers that were published from database inception to May 2019. Articles were included if the participants were metabolic syndrome (MetS) patients, the participants received eHealth interventions, the participants in the control group received usual care or were wait listed, the outcomes included anthropometric and biochemical indicators of MetS, and the study was a randomised controlled trial (RCT) or a controlled clinical trial (CCT). The Quality Assessment Tool for Quantitative Studies was used to assess the methodological quality of the included articles. The meta-analysis was conducted using Review Manager V.5.3 software.

Results

In our review, seven RCTs and two CCTs comprising 935 MetS participants met the inclusion criteria. The results of the meta-analysis revealed that eHealth interventions resulted in significant improvements in body mass index (standardised mean difference (SMD)=–0.36, 95% CI (–0.61 to –0.10), p

Conclusions

The results indicated that eHealth interventions were beneficial for improving specific anthropometric outcomes, but did not affect biochemical indicators of MetS. Therefore, whether researchers adopt eHealth interventions should be based on the purpose of the study. More rigorous studies are needed to confirm these findings.

Attitudes and willingness toward out-of-hospital cardiopulmonary resuscitation: a questionnaire study among the public trained online in China

Por: Jiang · Y. · Wu · B. · Long · L. · Li · J. · Jin · X.
Objectives

The incidence of bystander cardiopulmonary resuscitation (CPR) is low in China. CPR training could improve public attitudes and willingness, but at present, the attitudes of the public after online training are unclear. This study investigated individual attitudes towards CPR, the willingness to perform it in emergencies along with the main obstacles and the overall effects of online training.

Design

Questionnaires were distributed to investigate the public attitudes and willingness towards performing bystander CPR.

Setting

Questionnaires were accessible after the online course ‘First Aid’.

Participants

1888 students who attended ‘First Aid’ from December 2019 to 1 January 2020 and then completed the questionnaire voluntarily.

Results

The majority understood CPR (96.7%) and displayed a willingness to learn (98.4%) and to disseminate CPR knowledge (82.0%). Characteristics associated with more positive attitudes included women, the 26–35-year olds and those in medical-related occupations (p

Conclusions

The overwhelming majority of respondents showed positive attitudes and willingness towards CPR. In some cases, there is still reluctance, especially towards S-CPR. Obstacles arise mainly due to lack of confidence in administering CPR, while online CPR training can markedly improve it. Therefore, we should focus on disseminating CPR knowledge, targeting those who are less willing to perform CPR and helping overcome their obstacles by online training.

Perioperative patient-controlled regional analgesia versus patient-controlled intravenous analgesia for patients with critical limb ischaemia: a study protocol for a randomised controlled trial

Por: Chen · S. · Xu · Z. · Liu · H. · Zhang · Y. · Zhang · J. · Chen · Y. · Zheng · Y. · Huang · Y.
Introduction

Both regional analgesia and intravenous analgesia are frequently used perioperatively for patients with critical limb ischaemia (CLI). Nevertheless, the comparison of perioperative effect of regional and intravenous analgesia has not yet been thoroughly illustrated. This study will comprehensively compare patient-controlled regional analgesia (PCRA) and patient-controlled intravenous analgesia (PCIA) as two different perioperative analgesia approaches for patients with CLI. It investigates their effects on analgesia, reperfusion and the quality of recovery perioperatively, also aims to provide clinical evidence to those non-surgical patients with non-reconstructable arteries.

Methods and analysis

This trial is a randomised, single-centre, open-label, parallel trial with target sample size of 52 in total. Eligible participants will be randomly allocated to the PCRA group (group R) or the PCIA group (group I) after admission. Participants in group R will receive ultrasound-guided subgluteal sciatic catheterisation, followed by continuous PCRA infusion (0.2% ropivacaine 15 mL as loading dose, 8 mL/hour as background with a patient-controlled bolus of 6 mL). Participants in group I will receive PCIA (morphine is given in boluses of 1 mg as needed, background infusion at 1 mg/hour). Data will be collected at baseline (T0), 2 hours before revascularisation treatment (T1) and 2 hours before discharge (T2). The primary outcomes include the Numerical Rating Scale pain score at T1 and T2. The secondary outcomes include the perioperative transcutaneous oxygen pressure, the Tissue Haemoglobin Index, Hospital Anxiety and Depression Scale at T1 and T2; the Patient Global Impression of Change and patient satisfaction at T1 and T2; the perioperative cumulative morphine consumption, the length of postoperative hospital stay and adverse events.

Ethics and dissemination

This study received authorisation from the Institutional Review Board of Peking Union Medical College Hospital on 21 March 2017 (approval no. ZS-1289X). Study findings will be disseminated through presentations at scientific conferences or publications in peer-reviewed journals.

Trial registration number

Chinese Clinical Trial Registry (ChiCTR2000029298).

Protocol version

V.4CP.B2 (15 June 2020).

Stroke incidence and subtypes in Aboriginal people in remote Australia: a healthcare network population-based study

Por: Balabanski · A. H. · Goldsmith · K. · Giarola · B. · Buxton · D. · Castle · S. · McBride · K. · Brady · S. · Thrift · A. G. · Katzenellenbogen · J. · Brown · A. · Burrow · J. · Donnan · G. A. · Koblar · S. · Kleinig · T. J.
Objectives

We aimed to compare the incidence, subtypes and aetiology of stroke, and in-hospital death due to stroke, between Aboriginal and non-Aboriginal people in Central Australia, a remote region of Australia where a high proportion Aboriginal people reside (40% of the population). We hypothesised that the rates of stroke, particularly in younger adults, would be greater in the Aboriginal population, compared with the non-Aboriginal population; we aimed to elucidate causes for any identified disparities.

Design

A retrospective population-based study of patients hospitalised with stroke within a defined region from 1 January 2011 to 31 December 2014.

Setting

Alice Springs Hospital, the only neuroimaging-capable acute hospital in Central Australia, serving a network of 50 healthcare facilities covering 672 000 km2.

Participants

161 residents (63.4% Aboriginal) of the catchment area admitted to hospital with stroke.

Primary and secondary outcome measures

Rates of first-ever stroke, overall (all events) stroke and in-hospital death.

Results

Of 121 residents with first-ever stroke, 61% identified as Aboriginal. Median onset-age (54 years) was 17 years younger in Aboriginal patients (p

Conclusions

Stroke incidence (both subtypes) and in-hospital deaths for remote Aboriginal Australians are dramatically greater than in non-Aboriginal people, especially in patients aged

Safety and efficacy of larval therapy on treating leg ulcers: a protocol for systematic review and meta-analysis

Por: Fan · W. · Yang · B. · Hu · X. · Yang · X. · Shi · C. · Liu · G.
Introduction

Leg ulcers (LUs) not only seriously affect life and work of patients, but also bring huge economic burden to the society. As a potential underused biological debridement, larval therapy provides help for the treatment of LUs. The purpose of our research is to assess whether patients with LUs can benefit from larval therapy.

Methods and analysis

The following electronic databases will be searched: PubMed, EMBASE, Web of Science, the Cochrane Library, China National Knowledge Infrastructure Database, Wanfang Database and Chinese Biological Medicine. Randomised controlled trials are eligible for inclusion. There will be no restrictions with respect to language and search date is up to June 2020. Primary outcomes investigated are complete healing rate after treatment, time to ulcer healing, reduction of wound surface area and adverse events. Risk ratios will be used for categorical data; weighted mean difference will be used for measurement data. Subgroup analysis and sensitivity analysis will be considered if heterogeneity exists. The results of data synthesis will be performed by narrative summary and quantitative analysis.

Ethics and dissemination

This systematic review does not require the approval of the ethics committee because individual data on patients are not collected. The results of the study will be disseminated in peer-reviewed journals.

PROSPERO registration number

CRD42020176953.

Recovery Experiences of Younger Stroke Survivors Who Are Parents: A Qualitative Content Analysis

Abstract

Aims and objectives

To explore the experience of parenting for younger stroke survivors (aged 18 to 64 years at the time of the stroke).

Background

Stroke among younger adults increased 43% between 2000 and 2010. The social, emotional, and physical functioning of younger adults affects multiple aspects of their lives including parenting. There is limited research on the experience of parenting after stroke.

Design

This is a qualitative descriptive study.

Methods

We conducted individual semi‐structured interviews with 10 younger adults who were actively parenting children under the age of 18 years at the time of the stroke. Conventional content analysis was used to analyze the data. We report the methods and results using the COREQ checklist.

Results

Impairments from stroke disrupted participants’ identity, relationships, and roles as a parent. The degree to which parenting abilities and behaviors were affected by stroke was contingent upon the type and severity of impairments as well as the children's age. Participants also observed emotional and behavioral changes in their children in response to their stroke. Support from family, friends, healthcare providers, and children's school/daycare was crucial to participants throughout their stroke recovery. Two major themes emerged: 1) finding a new normal and 2) support for parenting post‐stroke.

Conclusions

Findings enable a deeper understanding of the distinct parenting challenges younger stroke survivors face and can inform future research on this population.

Relevance for clinical practice

Study findings highlight the need for continual and tailored follow‐up by nurses and other allied healthcare professionals to decrease the difficulty stroke survivors experience when trying to resume their role as parents.

Determinants of citation in the literature on diesel exhaust exposure and lung cancer: a citation analysis

Por: Duyx · B. · Urlings · M. J. E. · Swaen · G. M. H. · Bouter · L. M. · Zeegers · M. P.
Objectives

Epidemiological research on the association between diesel exhaust exposure and lung cancer risk has some methodological challenges that give rise to different conclusions and intense debates. This raises the question about the role of selective citation and of citation bias in particular. Our aim was to investigate the occurrence and prevalence of selective citation in this field.

Design

Citation analysis.

Setting

Web of Science Core Collection.

Participants

We identified 96 publications in this network, with 4317 potential citations. For each publication, we extracted characteristics such as study conclusion and funding source. Some of these characteristics are related to the study content: study design, sample size, method of diesel exposure assessment, type of diesel technology under investigation, and whether smoking had been adjusted for.

Primary and secondary outcome measures

Whether a citation occurs or not, measured and analysed according to the preregistered protocol. Exploratively we analysed the association between funding source and study conclusion.

Results

Methodological content of a study was clearly related to citation, studies using more sophisticated methods were more likely to be cited. There was some evidence for citation bias: supportive publications had a higher chance of being cited than non-supportive ones, but after adjustment for study quality, this effect decreased substantially (adjusted OR 1.3, 95% CI 1.0 to 1.7). Explorative analyses indicated that three quarters of non-profit funded publications had a supportive study conclusion against only one quarter of the industry-funded publications.

Conclusions

There is evidence for selective citation within this field, but the evidence for citation bias was weak. It seems that factors related to the methodology had more impact on citation than the conclusion of a study. Interestingly, publications that were funded by industry were more skeptical about a causal relationship between diesel exhaust and lung cancer compared to non-profit-funded publications.

Job burnout and turnover intention among Chinese primary healthcare staff: the mediating effect of satisfaction

Por: Ran · L. · Chen · X. · Peng · S. · Zheng · F. · Tan · X. · Duan · R.
Objectives

Although China has done a lot in strengthening the primary healthcare system, the high turnover intention is still a social problem to be reckoned with. The objective of this study is to explore the mediating effect of satisfaction between job burnout and turnover intention.

Design

Cross-sectional study.

Methods

A cross-sectional study was conducted to make sense of the job burnout, satisfaction and turnover intention among primary healthcare workers in central China. Structural equation modelling (SEM) was performed to study the mediating effect of satisfaction between job burnout and turnover intention with maximum likelihood estimation. The mediation effect test was carried out by using the bootstrap method.

Results

SEM showed that job burnout was positively related to the turnover intention with the standard path coefficient of 0.845 (C.R.=34.055, p

Conclusions

The turnover intention is significantly affected by job burnout, satisfaction and demographical characteristics including age, education level, monthly income, hire form and night shift. Satisfaction can be regarded as a mediator between job burnout and turnover intention. Relative measures can be taken to promote enthusiasm and satisfaction thus decreasing the turnover rate.

Evaluation of cytokines as a biomarker to distinguish active tuberculosis from latent tuberculosis infection: a diagnostic meta-analysis

Por: Qiu · B. · Liu · Q. · Li · Z. · Song · H. · Xu · D. · Ji · Y. · Jiang · Y. · Tian · D. · Wang · J.
Objectives

With a marginally effective vaccine and no significant breakthroughs in new treatments, a sensitive and specific method to distinguish active tuberculosis from latent tuberculosis infection (LTBI) would allow for early diagnosis and limit the spread of the pathogen. The analysis of multiple cytokine profiles provides the possibility to differentiate the two diseases.

Design

Systematic review and meta-analysis.

Data sources

PubMed, Cochrane Library, Clinical Key and EMBASE databases were searched on 31 December 2019.

Eligibility criteria

We included case–control studies, cohort studies and randomised controlled trials considering IFN-, TNF-α, IP-10, IL-2, IL-10, IL-12 and VEGF as biomarkers to distinguish active tuberculosis and LTBI.

Data extraction and synthesis

Two students independently extracted data and assessed the risk of bias. Diagnostic OR, sensitivity, specificity, positive and negative likelihood ratios and area under the curve (AUC) together with 95% CI were used to estimate the diagnostic value.

Results

Of 1315 records identified, 14 studies were considered eligible. IL-2 had the highest sensitivity (0.84, 95% CI: 0.72 to 0.92), while VEGF had the highest specificity (0.87, 95% CI: 0.73 to 0.94). The highest AUC was observed for VEGF (0.85, 95% CI: 0.81 to 0.88), followed by IFN- (0.84, 95% CI: 0.80 to 0.87) and IL-2 (0.84, 95% CI: 0.81 to 0.87).

Conclusion

Cytokines, such as IL-2, IFN- and VEGF, can be utilised as promising biomarkers to distinguish active tuberculosis from LTBI.

PROSPERO registration number

CRD42020170725.

Acupuncture for chronic cancer-related pain: a systematic review and network meta-analysis protocol

Por: Yang · J. · Xu · G. · Yin · Z. · Cheng · Y. · Sun · S. M. · Zheng · Q. · Chen · J. · Liang · F.-r. · Zhao · L.
Introduction

Chronic cancer-related pain is one of the most common excruciating symptom that can be caused by the cancer (by the primary tumour or by metastases) or by its treatment (surgery, chemotherapy and radiotherapy). Although multiple clinical trials and systematic reviews have suggested that acupuncture could be effective in treating chronic cancer-related pain, the comparative efficacy and safety of these acupuncture methods remains unclear. We, therefore, performed this study to evaluate and rank the efficacy and safety of different acupuncture methods for chronic cancer-related pain.

Methods and analysis

Seven databases will be searched, including Cochrane Library, MEDLINE, Embase, Chinese National Knowledge Infrastructure (CNKI), Wanfang Database, the Chongqing VIP Chinese Science and Technology Periodical Database and Chinese Biomedical Literature Database (CBM) from their inception to March 2020. The primary outcome is the change of pain intensity. Bayesian network meta-analysis will be conducted using software R3.5.1. Finally, we will use the Grading of Recommendations Assessment, Development and Evaluation System (GRADE) to assess the quality of evidence.

Ethics and dissemination

Ethical approval is not required for literature-based studies. The results will be disseminated through peer-reviewed publication.

PROSPERO registration number

CRD42020165747

Protocol of a multicentre, prospective cohort study that evaluates cost-effectiveness of two perioperative care strategies for potential obstructive sleep apnoea in morbidly obese patients undergoing bariatric surgery

Por: van Veldhuisen · S. L. · Kuppens · K. · de Raaff · C. A. L. · Wiezer · M. J. · de Castro · S. M. M. · van Veen · R. N. · Swank · D. J. · Demirkiran · A. · Boerma · E.-J. G. · Greve · J.-W. M. · van Dielen · F. M. H. · Frederix · G. W. J. · Hazebroek · E. J.
Introduction

Despite the high prevalence of obstructive sleep apnoea (OSA) in obese patients undergoing bariatric surgery, OSA is undiagnosed in the majority of patients and thus untreated. While untreated OSA is associated with an increased risk of preoperative and postoperative complications, no evidence-based guidelines on perioperative care for these patients are available. The aim of the POPCORN study (Post-Operative Pulse oximetry without OSA sCreening vs perioperative continuous positive airway pressure (CPAP) treatment following OSA scReeNing by polygraphy (PG)) is to evaluate which perioperative strategy is the most cost-effective for obese patients undergoing bariatric surgery without a history of OSA.

Methods and analysis

In this multicentre observational cohort study, data from 1380 patients who will undergo bariatric surgery will be collected. Patients will receive either postoperative care with pulse oximetry monitoring and supplemental oxygen during the first postoperative night, or care that includes preoperative PG and CPAP treatment in case of moderate or severe OSA. Local protocols for perioperative care in each participating hospital will determine into which cohort a patient is placed. The primary outcome is cost-effectiveness, which will be calculated by comparing all healthcare costs with the quality-adjusted life-years (QALYs, calculated using EQ-5D questionnaires). Secondary outcomes are mortality, complications within 30 days after surgery, readmissions, reoperations, length of stay, weight loss, generic quality of life (QOL), OSA-specific QOL, OSA symptoms and CPAP adherence. Patients will receive questionnaires before surgery and 1, 3, 6 and 12 months after surgery to report QALYs and other patient-reported outcomes.

Ethics and dissemination

Approval from the Medical Research Ethics Committees United was granted in accordance with the Dutch law for Medical Research Involving Human Subjects Act (WMO) (reference number W17.050). Results will be submitted for publication in peer-reviewed journals and presented at (inter)national conferences.

Trial registration number

NTR6991.

Comparison of PGS2.0 versus conventional embryo morphology evaluation for patients with recurrent pregnancy loss: a study protocol for a multicentre randomised trial

Por: Lei · C. · Sui · Y. · Ye · J. · Lu · Y. · Xi · J. · Sun · Y. · Jin · L. · Sun · X.
Introduction

Pregnancy loss (PL) is an adverse life event, and there is no proven effective treatment for recurrent PL (RPL). Preimplantation genetic screening (PGS) can be performed to reduce the risks of PL; however, there is still no solid scientific evidence that PGS improves outcomes for couples experiencing RPL. Comprehensive chromosome screening (PGS2.0) has become a routine practice in in vitro fertilisation (IVF) clinics. Previous studies based on PGS1.0 with a focus on RPL couples where the female is of advanced maternal age have reported contradictory results. Hence, a multicentre randomised trial is needed to provide evidence for the clinical benefits of PGS2.0 treatment for RPL couples.

Methods and analysis

Overall, 268 RPL couples undergoing IVF cycles will be enrolled. Couples will be randomised according to a unique grouping number generated by a random digital software into (1) PGS2.0 group and (2) non-PGS (conventional embryo morphology evaluation) group. This study aims to investigate whether the live birth rate (LBR) per initiated cycle after PGS2.0 is superior to the LBR per initiated cycle after conventional embryo evaluation (non-PGS group). Live birth will be defined as a live baby born after a gestation period of >28 weeks, with a birth weight of more than 1000 g. A multivariate logistic regression model will be used to adjust for confounding factors.

Ethics and dissemination

Ethical approval has been granted by the Ethics Committee of Obstetrics and Gynecology Hospital, Fudan University and the participating hospitals. Written informed consent will be obtained from each couple before any study procedure is performed. Data from this study will be stored in the Research Electronic Data Capture. The results of this trial will be presented and published via peer-reviewed publications and presentations at international conferences.

Trial registration number

NCT03214185; Pre-results.

Efficacy and safety of acupuncture for recurrent aphthous stomatitis: a systematic review protocol

Por: Zhang · F. · Zhou · H. · Ding · S. · Zhang · D. · Lian · D. · Chen · X. · Wang · C.
Introduction

Recurrent aphthous stomatitis (RAS) is a distressing symptom. There are many ways to treat RAS, such as pudilan anti-inflammatory oral liquid and doxycycline and laser therapy, but these take a long time to produce positive effects and compliance is low. Previous reviews of acupuncture treatment for RAS has been growing, but a systematic review is not available. To assess the efficacy and safety of acupuncture for the management of RAS.

Methods and analysis

The following databases will be searched from their inception to 1 February 2020: PubMed, Embase, Cochrane Library, CINAHL, Chinese Biomedical Literature Database, VIP Database for Chinese Technical Periodicals, China National Knowledge Infrastructure and Wanfang. The randomised controlled trials in English or Chinese associated with acupuncture for patients with RAS will be included. Eligible study conference abstracts and reference lists of manuscripts will also be searched. Two reviewers will select the studies, extract data independently. The Cochrane risk of bias tool will be used to assess the risk of bias for the studies. According to heterogeneity testing, data will be synthesised using a random-effects model. A meta-analysis will be performed using Rev Man V.5.3.5 statistical software for each outcome. Subgroup analysis and sensitivity analysis are planned according to clinical evidence. Mean difference or standardised mean difference for continuous data and risk ratio for dichotomous data will be calculated.

Ethics and dissemination

No ethical approval is required. This protocol will not involve individual patient information and endangering participant rights. The results will be reported in a peer-reviewed journal or disseminated in relevant conferences.

OSF registration number

DOI 10.17605/OSF.IO/QASUY.

Cohort profile: the eLIXIR Partnership--a maternity-child data linkage for life course research in South London, UK

Por: Carson · L. E. · Azmi · B. · Jewell · A. · Taylor · C. L. · Flynn · A. · Gill · C. · Broadbent · M. · Howard · L. · Stewart · R. · Poston · L. · on behalf of the eLIXIR Partnership
Purpose

Linked maternity, neonatal and maternal mental health records were created to support research into the early life origins of physical and mental health, in mothers and children. The Early Life Cross Linkage in Research (eLIXIR) Partnership was developed in 2018, generating a repository of real-time, pseudonymised, structured data derived from the electronic health record systems of two acute and one Mental Health Care National Health Service (NHS) Provider in South London. We present early descriptive data for the linkage database and the robust data security and governance structures, and describe the intended expansion of the database from its original development. Additionally, we report details of the accompanying eLIXIR Research Tissue Bank of maternal and neonatal blood samples.

Participants

Descriptive data were generated from the eLIXIR database from 1 October 2018 to 30 June 2019. Over 17 000 electronic patient records were included.

Findings to date

10 207 women accessed antenatal care from the 2 NHS maternity services, with 8405 deliveries (8772 infants). This diverse, inner-city maternity service population was born in over 170 countries with an ethnic profile of 46.1% white, 19.1% black, 7.0% Asian, 4.1% mixed and 4.1% other. Of the 10 207 women, 11.6% had a clinical record in mental health services with 3.0% being treated during their pregnancy. This first data extract included 947 infants treated in the neonatal intensive care unit, of whom 19.1% were postnatal transfers from external healthcare providers.

Future plans

Electronic health records provide potentially transformative information for life course research, integrating physical and mental health disorders and outcomes in routine clinical care. The eLIXIR database will grow by ~14 000 new maternity cases annually, in addition to providing child follow-up data. Additional datasets will supplement the current linkage from other local and national resources, including primary care and hospital inpatient data for mothers and their children.

Effect of a real-time feedback smartphone application (TCPRLink) on the quality of telephone-assisted CPR performed by trained laypeople in China: a manikin-based randomised controlled study

Por: Dong · X. · Zhang · L. · Myklebust · H. · Birkenes · T. S. · Zheng · Z.-J.
Objectives

To determine the effect of a free smartphone application (TCPRLink) that provides real-time monitoring and audiovisual feedback on chest compressions (CC) on trained layperson telephone-assisted cardiopulmonary resuscitation (T-CPR) performance.

Design

A manikin-based randomised controlled study.

Setting

This study was conducted at a multidisciplinary university and a community centre in China.

Participants

One hundred and eighty-six adult participants (age 18–65 years) with T-CPR training experience were randomly assigned to the TCPRLink (n=94) and T-CPR (n=92) groups with age stratification.

Interventions

We compared the participants’ performance for 6 min of CC in a simulated T-CPR scenario both at the baseline and after 3 months.

Primary and secondary outcome measures

The primary outcomes were the CC rate and proportion of adequate CC rate (100–120 min–1). The secondary outcomes included the proportion of participants counting the CC rhythm, time to first CC, CC depth, hands-off time and CC full-release ratio.

Results

Participants in the TCPRLink feedback group more consistently performed CC with higher rate, both initially and 3 months later (median 111 (IQR 109–113) vs 108 (103–112) min–1, p=0.002 and 111 (109–113) vs 108 (105–112) min–1, p

Conclusions

The TCPRLink application improved T-CPR quality in trained laypersons to provide more effective CCs and lighten the load of counting out the CC with the dispatcher in a simulated T-CPR scenario. Further investigations are required to confirm this effectiveness in real-life resuscitation attempts.

5-HT3 receptor antagonists for the prevention of perioperative shivering undergoing spinal anaesthesia: a systematic review and meta-analysis of randomised controlled trials

Por: Shen · Q.-H. · Li · H.-F. · Zhou · X. · Lu · Y. · Yuan · X.-Z.
Objective

Perioperative shivering (POS) is a common complication in patients undergoing spinal anaesthesia. The present study investigated the efficacy of 5-HT3 receptor antagonists in preventing POS following spinal anaesthesia.

Design

Systematic review and meta-analysis.

Data sources

Pubmed, Embase, the Web of Science and Cochrane Library were searched from database establishment on 31 July 2019.

Eligibility criteria

Randomised controlled trials that reported the effects of 5-HT3 receptor antagonists in the prevention of POS in patients after spinal anaesthesia.

Data extraction and synthesis

Two reviewers independently extracted data. The primary outcome of the present study was the incidence of POS. The risk of bias for the included studies was assessed according to the Cochrane Handbook. The quality of primary outcome was evaluated by Grading of Recommendations Assessment, Development and Evaluation. Trial sequential analysis for the primary outcome was performed to reduce the type 1 error caused by repeated meta-analysis and the required information size was calculated.

Results

A total of 13 randomised controlled trials consisting of 1139 patients were included. The overall incidence of POS was significantly lower in the 5-HT3 receptor antagonists group (risk ratio 0.31; 95% CI 0.26 to 0.38; p2=0%). Subgroup analysis for different types of 5-HT3 receptor antagonists and timing of administration produced similar results. Also, patients had a lower incidence of postoperative nausea and vomiting after administrating 5-HT3 receptor antagonists. No statistically significant differences in drug-related adverse effects were observed. Grading of Recommendations Assessment, Development and Evaluation revealed a high level of evidence. The cumulative z-curve crossed the trial sequential monitoring boundary.

Conclusions

The present study revealed that prophylactic 5-HT3 receptor antagonists were an effective measure for reducing the incidence of POS in patients after spinal anaesthesia. However, further studies investigating the different types of surgeries are required.

PROSPERO registration number

CRD42019148191.

HIV prevalence among men who have sex with men following the implementation of the HIV preventive guideline in Tanzania: respondent-driven sampling survey

Por: Alexander Ishungisa · M. · Moen · K. · Leyna · G. · Makyao · N. · Ramadhan · A. · Lange · T. · Meyrowitsch · D. W. · Mizinduko · M. · Likindikoki · S. · Leshabari · M. · Mmbaga · E. J.
Objectives

To estimate HIV prevalence and associated risk factors among men who have sex with men (MSM) in Dar es Salaam, Tanzania following the implementation of the national comprehensive package of HIV interventions for key population (CHIP).

Design

A cross-sectional survey using respondent-driven sampling.

Setting

Dar es Salaam, Tanzania’s largest city.

Participants

Men who occasionally or regularly have sex with another man, aged 18 years and above and living in Dar es Salaam city at least 6 months preceding the study.

Primary outcome measure

HIV prevalence was the primary outcome. Independent risk factors for HIV infection were examined using weighted logistics regression modelling.

Results

A total of 777 MSM with a mean age of 26 years took part in the study. The weighted HIV prevalence was 8.3% (95% CI: 6.3%–10.9%) as compared with 22.3% (95% CI: 18.7%–26.4%) observed in a similar survey in 2014. Half of the participants had had sex with more than two partners in the month preceding the survey. Among those who had engaged in transactional sex, 80% had used a condom during last anal sex with a paying partner. Participants aged 25 and above had four times higher odds of being infected than those aged 15–19 years. HIV infection was associated with multiple sexual partnerships (adjusted OR/AOR, 3.0; 95% CI: 1.8–12.0), not having used condom during last sex with non-paying partner (AOR, 4.1; 95% CI: 1.4–7.8) and ever having engaged in group sex (AOR, 3.4; 95% CI: 1.7–3.6).

Conclusion

HIV prevalence among MSM in Dar es Salaam has decreased by more than a half over the past 5 years, coinciding with implementation of the CHIP. It is nonetheless two times as high as that of men in the general population. To achieve the 2030 goal, behavioural change interventions and roll out of new intervention measures such as pre-exposure prophylaxis are urgently needed.

Information sharing challenges in end-of-life care: a qualitative study of patient, family and professional perspectives on the potential of an Electronic Palliative Care Co-ordination System

Por: Standing · H. · Patterson · R. · Lee · M. · Dalkin · S. M. · Lhussier · M. · Bate · A. · Exley · C. · Brittain · K.
Objectives

To explore current challenges in interdisciplinary management of end-of-life care in the community and the potential of an Electronic Palliative Care Co-ordination System (EPaCCS) to facilitate the delivery of care that meets patient preferences.

Design

Qualitative study using interviews and focus groups.

Setting

Health and Social Care Services in the North of England.

Participants

71 participants, 62 health and social care professionals, 9 patients and family members.

Results

Four key themes were identified: information sharing challenges; information sharing systems; perceived benefits of an EPaCCS and barriers to use and requirements for an EPaCCS. Challenges in sharing information were a source of frustration for health and social care professionals as well as patients, and were suggested to result in inappropriate hospital admissions. Current systems were perceived by participants to not work well—paper advance care planning (ACP) documentation was often unavailable or inaccessible, meaning it could not be used to inform decision-making at the point of care. Participants acknowledged the benefits of an EPaCCS to facilitate information sharing; however, they also raised concerns about confidentiality, and availability of the increased time and resources required to access and maintain such a system.

Conclusions

EPaCCS offer a potential solution to information sharing challenges in end-of-life care. However, our findings suggest that there are issues in the initiation and documentation of end-of-life discussions that must be addressed through investment in training in order to ensure that there is sufficient information regarding ACP to populate the system. There is a need for further qualitative research evaluating use of an EPaCCS, which explores benefits and challenges, uptake and reasons for disparities in use to better understand the potential utility and implications of such systems.

Outbreak response intervention models of vaccine-preventable diseases in humans and foot-and-mouth disease in livestock: a protocol for a systematic review

Por: Azam · J. M. · Are · E. B. · Pang · X. · Ferrari · M. J. · Pulliam · J. R. C.
Introduction

Outbreaks of vaccine-preventable diseases continue to threaten public health, despite the proven effectiveness of vaccines. Interventions such as vaccination, social distancing and palliative care are usually implemented, either individually or in combination, to control these outbreaks. Mathematical models are often used to assess the impact of these interventions and for supporting outbreak response decision making. The objectives of this systematic review, which covers all human vaccine-preventable diseases, are to determine the relative impact of vaccination compared with other outbreak interventions, and to ascertain the temporal trends in the use of modelling in outbreak response decision making. We will also identify gaps and opportunities for future research through a comparison with the foot-and-mouth disease outbreak response modelling literature, which has good examples of the use of modelling to inform outbreak response intervention decision making.

Methods and analysis

We searched on PubMed, Scopus, Web of Science, Google Scholar and some preprint servers from the start of indexing to 15 January 2020. Inclusion: modelling studies, published in English, that use a mechanistic approach to evaluate the impact of an outbreak intervention. Exclusion: reviews, and studies that do not describe or use mechanistic models or do not describe an outbreak. We will extract data from the included studies such as their objectives, model types and composition, and conclusions on the impact of the intervention. We will ascertain the impact of models on outbreak response decision making through visualisation of time trends in the use of the models. We will also present our results in narrative style.

Ethics and dissemination

This systematic review will not require any ethics approval since it only involves scientific articles. The review will be disseminated in a peer-reviewed journal and at various conferences fitting its scope.

PROSPERO registration number

CRD42020160803.

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