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Use of home negative pressure wound therapy in peripheral artery disease and diabetic limb salvage

Abstract

Use of negative pressure wound therapy (NPWT) in peripheral artery disease (PAD) and diabetic limb salvage (DLS) improves wound healing by providing moist wound conditions, reducing exudate, controlling wound‐bed infection, and stimulating granulation. NPWT duration may take several weeks, and home‐based NPWT allows patient to recover in the community while minimising risks of prolonged hospitalisation. The aim of this study is to review the use and outcomes of home NPWT in PAD and DLS. The methodology is the retrospective review of patients who were discharged with home NPWT after in‐patient PAD revascularisation and DLS debridement or minor amputations. The results included a total of 118 patients who received home NPWT between January 2017 and December 2017. The mean age was 62.8 years with 66% male and 34% female patients. The study population comprised 25% smokers, 98% patients with diabetics, 35% with ischemic heart disease, and 21% with end‐stage renal failure (ESRF). Of which, 56% of patients required revascularisation while 31% of patients underwent foot debridement, 48% underwent toe amputations, and 20% underwent forefoot amputations. All patients received in‐patient NPWT for a week before being discharged on home NPWT for 4 weeks. Then, 62% received targeted antibiotics regime while 36% received empirical antibiotics on discharge; 60% of patients achieved wound healing on home NPWT, with 9% requiring split‐thickness skin graft; 4% required further surgical debridement, 16% required further minor amputation while 20% required major amputation. 9% required further home NPWT extension, with a mean length of 7.1 ± 4.7 weeks' extension. Overall survival of 1 year was 89%. Risk factors that predict the failure of home NPWT includes subjects with a background of ESRF and wet gangrene on presentation. Home NPWT is a useful adjunct in the management of PAD and DLS foot wounds.

Genetic characteristics of Jiaji Duck by whole genome re-sequencing

by Lihong Gu, Feng Wang, Zhemin Lin, Tieshan Xu, Dajie Lin, Manping Xing, Shaoxiong Yang, Zhe Chao, Baoguo Ye, Peng Lin, Chunhui Hui, Lizhi Lu, Shuisheng Hou

Jiaji Duck (JJ) is a Muscovy duck species that possesses many superior characteristics, and it has become an important genetic resource in China. However, to date, its genetic characteristics and genetic relationship with other duck breeds have not been explored yet, which greatly limits the utilization of JJ. In the present study, we investigated the genome sequences of 15 individual ducks representing five different duck populations, including JJ, French Muscovy duck (FF), mallard (YD), hong duck (HD) and Beijing duck (BD). Moreover, we investigated the characteristics of JJ-specific single nucleotide polymorphisms (SNPs) and compared the genome sequences of JJ vs. YD and JJ vs. BD using integrated strategies, including mutation detection, selective screening, and Gene Ontology (GO) analysis. More than 40 Gb of clean data were obtained for each population (mean coverage of 13.46 Gb per individual). A total number of 22,481,367 SNPs and 4,156,829 small insertion-deletions (Indels) were identified for the five duck populations, which could be used as molecular markers in breeding and utilization of JJ. Moreover, we identified 1,447,932 JJ-specific SNPs, and found that genes covering at least one JJ-specific SNP mainly involved in protein phosphorylation and dephosphorylation, as well as DNA modification. Phylogenetic tree and principal components analysis (PCA) revealed that the genetic relationship of JJ was closest to FF, while it was farthest to BD. A total of 120 and 111 genes were identified as positive selection genes for JJ vs. BD and JJ vs. YD, respectively. GO and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses showed that the positive selection genes for JJ vs. BD ducks mainly involved in pigmentation, muscle contraction and stretch, gland secretion, and immunology, while the positive selection genes obtained from JJ vs. YD ducks mainly involved in embryo development, muscle contraction and stretch, and gland secretion. Taken together, our findings enabled us to better understand the characteristics of JJ and provided a molecular basis for the breeding and hybrid utilization of JJ in the future.

Effects of hospital‐family holistic care model on the health outcome of Patients with permanent enterostomy based on the theory of “Timing It Right”

Abstract

Aims and objectives

To explore the effects of hospital‐family holistic care model based on “Timing It Right” on the health outcome of Patients with permanent colostomy.

Background

Colorectal cancer is a common malignant tumor of digestive system, which seriously threatens human life and health. Colostomy is one of the main treatments for colorectal cancer, which effectively improves the 5‐year survival rate of patients. However, the postoperative psychological and physiological rehabilitation nursing is still faced with great challenges due to the change of body image and defecation pathway caused by colostomy.

Methods

A randomized controlled trial was conducted and 119 patients with permanent enterostomy were randomly divided into two groups, with 60 cases in the intervention group and 59 cases in the control group. The intervention group received routine care、follow‐up and hospital‐family holistic care intervention based on “Timing It Right”, while the control group received routine care and follow‐up. The resilience, self‐care ability, complications and life quality of Patients with permanent enterostomy were compared between two groups before intervention,at discharge , 3 months and 6 months after discharge. CONSORT checklist was applied as the reporting guideline for this study (See supplementary File 1).

Results

108 patients with permanent enterostomy completed the study (90.76%). At 3 months and 6 months after discharge, the resilience and quality of life in the intervention group were significantly better than those in the control group (t = 4.158 vs 7.406, t = 4.933 vs 8.611, P < 0.05); while the complications in the intervention group were significantly lower than that in the control group (25.5% vs 41.51%, 14.45% vs 30.19% ; P < 0.05). The self‐care ability of the intervention group was significantly better than that in the control group (t = 1.543 vs 3.656 vs 6.273, P < 0.05) at discharge, 3 months and 6 months after discharge. The interaction between time and grouping showed that the effect of time factor varied with the grouping. After intervention, there were significant differences in psychological resilience、 self‐care ability、complications and quality of life between the two groups at different observation points (P < 0.01). The three evaluation indices of intervention group increased with the migration of observation time points and were significantly better than those of control group, especially the quality of life (84.35±4.25 vs 60.45±8.42, P < 0.01).

Conclusions

The hospital‐family holistic care model based on “Timing It Right” can effectively improve the psychological resilience, self‐care ability, quality of life, reduce complications and improve the health outcomes of patients with permanent enterostomy.

Relevance to clinical practice

Patients with permanent enterostomy have different needs for nursing care at different stages of the disease, and they are dynamically changing. The hospital‐family holistic care model based on “Timing It Right” can effectively improve the health outcomes of patients with permanent enterostomy, which is worthy of clinical application.

Consistency of postoperative pain assessments between nurses and patients undergoing enhanced recovery after gynaecological surgery

Abstract

Aims and objectives

To explore the consistency of pain intensity and pain location assessed by nurses and patients in gynaecology undergoing enhanced recovery after surgery pathway.

Background

Several studies have shown that clinical nurses' assessment of patients' pain is not always accurate. Little is known about the accuracy of nurses' pain assessments for gynaecological patients. Postoperative pain assessment and management is an essential part of enhanced recovery after surgery.

Design

Comparative cross‐sectional study.

Methods

A total of 160 patients were recruited and only 85 patients and 17 nurses participated. Patients and nurses recorded pain scores (using an 11‐point Numeric Rating Scale) and pain location (incision pain, surgical area pain in the abdominal cavity, other pain or no pain) on Pain Assessment Forms at 4 hr after surgery and on the first and second postoperative days. We used the STROBE guidelines to report our study.

Results

The patients' pain score was higher than that of nurses from 4 hr to second day after laparoscopic surgery at rest. The pain scores of both nurses and patients decreased over this period of time. All the intraclass correlation coefficients were between 0.214–0.296. At the three time points, surgical area pain in the abdominal cavity and abdominal incision pain were the main pain areas. All the kappa coefficients were between 0.164–0.255.

Conclusions

The consistency of postoperative pain assessment about pain score and pain location between nurses and patients was not high. We should attach importance to systematic pain assessment, and more detailed enhanced recovery after surgery pathways should be developed about pain assessment.

Relevance to clinical practice

Continuing education for nurses regarding pain assessment is necessary. Nurses should accept the patient's self‐reported pain. There should be a step that gives more time for pain assessment in enhanced recovery after surgery pathways.

The effectiveness of music therapy for patients with cancer: a systematic review and meta‐analysis

Abstract

Aims

To assess the effectiveness of music therapy on the quality of life, anxiety, depression, and pain of patients with cancer.

Design

Systematic review.

Data sources

Five electronic databases were searched in September 2018 for randomized controlled trials evaluating music therapy for patients with cancer.

Review methods

The quality of the studies was assessed using the risk of bias tool recommended by the Cochrane Handbook Version 5.1.0 and the Revman version 5.3 software was used to perform the meta‐analysis. The outcomes were overall quality of life, anxiety, depression and pain.

Results

A total of 19 trials evaluating 1548 patients were included in this study, of which 765 were in the control group and 783 in the experimental group. Compared with standard care, music therapy can significant increase the score of overall quality of life in patients with cancer. In addition, music therapy was found to be more effective for decreasing the score of anxiety, depression, and pain.

Conclusion

Music therapy can improve the overall quality of life of patients with cancer, with an observed optimal intervention duration of 1‐2 months. Meanwhile, anxiety, depression, and pain are improved as well. Nevertheless, high‐quality trials are still needed to further determine the effects of music intervention in supportive cancer care.

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

Occupational exposure to silica and risk of heart disease: a systematic review with meta-analysis

Por: Liu · K. · Mu · M. · Fang · K. · Qian · Y. · Xue · S. · Hu · W. · Ye · M.
Objective

To search for evidence of the relationship between occupational silica exposure and heart disease.

Design

A systematic review and meta-analysis.

Background

Growing evidence suggests a relationship between occupational silica exposure and heart disease; however, the link between them is less clear.

Data sources

PubMed, ScienceDirect, Springer and EMBASE were searched for articles published between 1 January 1995 and 20 June 2019. Articles that investigated the effects of occupational silica exposure on the risk of heart disease were considered.

Study selection

We included cohort studies, including prospective, retrospective and retroprospective studies.

Data extraction and synthesis

We extracted data using a piloted data collection form and conducted random-effects meta-analysis and exposure-response analysis. The meta-relative risk (meta-RR), a measure of the average ratio of heart disease rates in those with and without silica exposure, was used as an inverse variance-weighted average of relative risks from the individual studies. The Newcastle-Ottawa Quality Assessment Scale for cohort studies was used for study quality assessment.

Outcome measure

We calculated the risk of heart diseases such as pulmonary heart disease, ischaemic heart disease and others.

Results

Twenty cohort studies were included. The results suggest a significant increase in the risk of overall heart disease (meta-RR=1.08, 95% CI 1.03 to 1.13). Stronger evidence of association with pulmonary heart disease was found in the risk estimate of both categories of heart disease (meta-RR=1.24, 95% CI 1.08 to 1.43) and in the exposure-response analysis (meta-RR=1.39, 95% CI 1.19 to 1.62). Our subgroup analyses also revealed that the statistical heterogeneity among studies could be attributed mainly to the diversity in reference group, occupation and study quality score.

Conclusions

Silica-exposed workers are at an increased risk for overall heart disease, especially pulmonary heart disease. Further research is needed to better clarify the relationship between occupational silica exposure and ischaemic heart disease.

PROSPERO registration number

CRD42019124673.

Effects of photoelectric therapy on proliferation and apoptosis of scar cells by regulating the expression of microRNA‐206 and its related mechanisms

Abstract

Human skin fibroblast (HSF) cells were irradiated with different energy lasers to detect cell proliferation, apoptosis, and expression of microRNA‐206 and protein, and to further summarise the therapeutic effect of laser on scar cells. Human scar cell line HSF cells were cultured in three groups. The control group was not irradiated by laser, the low‐energy group was irradiated by 10 J/cm2 laser, and the high‐energy group was irradiated by 20 J/cm2 laser. After irradiation, HSF cells were cultured for 20 hours. Cell proliferation was detected by MTT assay. Cell cycle and apoptosis were detected by flow cytometry. Transwell migration assay was used to detect cell migratory ability. Reverse transcription polymerase chain reaction (RT‐PCR) was used to detect miR‐206 and mTOR gene levels. The levels of MMP‐9, Bax, Bcl‐2, cyclin D1, and mTOR signalling pathway proteins were detected by Western blotting assays. The results showed that after laser irradiation, the proliferation of cells decreased, and the difference between the control group and the experimental group was significant (P < .05). The higher the energy was, the greater the upregulation of apoptosis was. Apoptosis and cell migration increased (P < .05). The expressions of microRNA‐206, MMP‐9, and Bax were upregulated, while the expressions of mTOR, Bcl‐2, and cyclin D1 were downregulated. To sum up, laser irradiation can significantly inhibit the proliferation of HSF cells, affect cell cycle, and increase cell apoptosis and migratory ability.

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

Abstract

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

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

Abstract

Aims

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

Design

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

Methods

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

Results

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

Conclusion

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

Impact

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

目的

研究情绪劳动策略与情绪枯竭和职业认同的相互关系。

设计

本研究采用四波交叉滞后组设计。

方法

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

结果

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

结论

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

影响

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

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

Abstract

Aims

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

Design

A secondary analysis of cross‐sectional survey data.

Methods

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

Results

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

Conclusion

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

Impact

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

目的

通过比较性别差异,探讨工作场所暴力与护士结局的关系。

设计

横向调查数据的二次分析。

方法

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

结果

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

结论

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

影响

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

Improving the quality of bowel preparation through an app for inpatients undergoing colonoscopy: A randomized controlled trial

Abstract

Aims

To explore whether educational information delivered via a medical smartphone app in conjunction with verbal and written instructions, compared with traditional booklet‐based and verbal instructions, could improve the quality of bowel preparation for hospitalized patients undergoing colonoscopy.

Design

A prospective, single‐blinded, randomized controlled trial.

Methods

We performed a prospective, endoscopist‐blinded, randomized, controlled trial at Qilu Hospital of Shandong University in China between October 2017–March 2018. Inpatients who are eligible, based on the inclusion criteria, were randomized into two groups. Both groups received oral and written instructions for bowel preparation. In addition, the smartphone app group received instructions through a medical smartphone app. The primary outcome was the rate of adequate bowel preparation according to the Boston bowel preparation scale score. The secondary outcomes included patient compliance with instructions on how to take laxatives, side effects and rates of adenoma detection.

Results

A total of 293 patients were enrolled in this study. Demographic characteristics were comparable between the two groups. The χ2 test showed that the medical smartphone app group showed significant improvement in the rate of adequate bowel preparation compared with the control group (77.2% vs. 56.8%, p < .001). The adenoma detection rate (ADR) was significantly higher in the smartphone app group than in the control group (21.4% vs. 12.8%, p = .029) based on the χ2 test. The rates of incomplete compliance with instructions were 15.17% in the smartphone app group and 33.11% in the control group (p < .001) based on the χ2 test. The overall adverse events were 23.45% and 37.84% in the smartphone app and control groups, respectively (p = .008), based on the χ2 test.

Conclusion

Instructions provided via a mobile social media app in conjunction with traditional verbal and written methods could improve the quality of bowel preparation, increase the ADR and decrease adverse effects. App instructions could be an effective addition to oral and written instructions for inpatients undergoing colonoscopy.

Impact

This study suggested that clinical personnel could deliver information via smartphone as a powerful addition to traditional educational methods that could improve work efficiency and help patients increase the success rate of bowel preparation.

Trial registration: Chinese clinical trial registration number: ChiCTR1900024666.

Publishing studies in traditional Chinese medicine

Abstract

Traditional Chinese medicine (TCM) has a history of thousands of years in China and is officially sanctioned by the government as a treatment option for Chinese citizens alongside, what we will refer to here as western medicine, which is also very well developed in China. In the west, TCM is becoming increasingly popular with some people who become worried about the efficacy and side‐effects of western medicine.

Development of a revised Jalowiec Coping Scale for use by emergency clinicians: a cross-sectional scale development study

Por: Greenslade · J. H. · Wallis · M. C. · Johnston · A. · Carlström · E. · Wilhelms · D. · Thom · O. · Abraham · L. · Crilly · J. · The WES investigators · Xu · Elder · Hughes · A Magnusson
Objectives

The aim of this study was to develop and validate a scale to measure the coping strategies used by emergency staff in response to workplace stress. To achieve this aim, we developed a refined Jalowiec Coping Scale (JCS), termed the Jalowiec Coping Scale-Emergency Department (JCS-ED) and validated this scale on a sample of emergency clinicians.

Design

A cross-sectional survey incorporating the JCS, the working environment scale-10 and a measure of workplace stressors was administered between July 2016 and June 2017. The JCS-ED was developed in three stages: 1) item reduction through content matter experts, 2) exploratory factor analysis for further item reduction and to identify the factor structure of the revised scale and 3) confirmatory factor analyses to confirm the factors identified within the exploratory factor analysis.

Setting

Six Emergency Departments (EDs) in Australia and four in Sweden. There were three tertiary hospitals, five large urban hospitals and two small urban hospitals.

Participants

Participants were eligible for inclusion if they worked full-time or part-time as medical or nursing staff in the study EDs. The median age of participants was 35 years (IQR: 28–45 years) and they had been working in the ED for a median of 5 years (IQR: 2–10 years). 79% were females and 76% were nurses.

Results

A total of 875 ED staff completed the survey (response rate 51%). The content matter experts reduced the 60-item scale to 32 items. Exploratory factor analyses then further reduced the scale to 18 items assessing three categories of coping: problem-focussed coping, positive emotion-focussed coping and negative emotion-focussed coping. Confirmatory factor analysis supported this three-factor structure. Negative coping strategies were associated with poor perceptions of the work environment and higher ratings of stress.

Conclusions

The JCS-ED assesses maladaptive coping strategies along with problem-focussed and emotion-focussed coping styles. It is a short instrument that is likely to be useful in measuring the types of coping strategies employed by staff.

Health Literacy Risk in Older Adults With and Without Mild Cognitive Impairment

imageBackground The relationship between an increasing elderly population and wide-ranging neurological conditions has led to heightened rates of cognitive function impairment. Some researchers have found that health literacy risk may be associated with cognitive impairment in older adults. Objectives The purpose of this study was to delineate the difference in health literacy risk between older adults with mild cognitive impairment and those with normal cognitive function. Methods We conducted a survey study to explore the health literacy risk in older adults with and without mild cognitive impairment. Data were collected from 412 subjects between 60 and 91 years of age (260 without and 152 with mild cognitive impairment) between June and December 2016 in China. Cognitive function was measured using the Mini-Mental Status Examination, Montreal Cognitive Assessment, Global Deterioration Scale, Activities of Daily Living, and Hamilton Depression Rating Scale. Health literacy was measured using the Chinese Citizen Health Literacy Questionnaire. Results The scores of total health literacy and its three dimensions (basic health knowledge and mind, basic skills, and health lifestyle and behavior) were lower in those with mild cognitive impairment. Older adults with normal cognitive function had adequate or marginal health literacy levels, whereas those with mild cognitive impairment had marginal or inadequate health literacy levels. Using multiple logistic regression analysis, we found that health literacy risk, education level, age, marital status, and body mass index were independent risk factors for mild cognitive impairment. Discussion These results suggest that low health literacy may be a predictor of mild cognitive impairment. Screening for lower health literacy risk should be included in multidimensional geriatric evaluation.

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.

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

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

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

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

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

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

Methods and analysis

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

Ethics and dissemination

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

Trial registration number

NCT03665857.

Factors influencing medication‐taking behaviour with adjuvant endocrine therapy in women with breast cancer: A qualitative systematic review 患有乳腺癌女性辅助内分泌疗法中影响服药行为的因素:定性系统评估

Abstract

Aims

To explore the experience and feelings associated with the endocrine therapy treatment trajectory in women with breast cancer and what affects medication taking behaviour.

Design

Qualitative systematic review.

Data sources

Qualitative studies were extracted from PubMed, EMBASE, CINAHL, PsycINFO from inception of each database until February 2019.

Review methods

The systematic search method SPIDER (sample, phenomenon of interest, design, evaluation, research type) was used. Thematic synthesis of the qualitative data was used.

Results

A total of 478 were identified in the initial search. Only 17 articles met inclusion criteria and were included in this review. Five analytical themes and 17 descriptive subthemes were identified.

Conclusions

The systematic review highlights knowledge, balancing the scales, self‐efficacy and support influence medication taking behaviour to women with breast cancer.

Impact

The medication taking behaviour of breast cancer women can be classified into four types: acceptance/persistence, bearing/suffering, hesitation/adjustment, refusing/abandoning. The four types can switch from one to another. Medication taking behaviour is affected by knowledge, balancing the scales, self‐efficacy, and support. The medical institutions, communities, and families can gain knowledge of the treatment experiences of women to better understand medication taking behaviour and those at risk for non‐adherence. Women wanted different types and amounts of information. Healthcare providers should be aware of patient preferences and take targeted interventions to help them receive treatment.

目的

探讨患有乳腺癌女性内分泌疗法治疗轨迹的相关经历和感受,以及影响服药行为的因素。

设计

定性系统评估。

数据来源

通过 PubMed、EMBASE、CINAHL、PsycINFO 进行检索(从数据库建立之初到2019年2月),提取相关文献展开定性研究。

评估方法

采用系统搜索法SPIDER(样本、兴趣现象、设计、评价、研究类型)。定性数据采用专题综合法。

结果

初步搜索中共确定478篇相关文章。只有17篇文章符合纳入标准,因此将它们纳入本次评估之中。最终确定了5项分析主题和17项描述性次级主题。

结论

本项系统评估突出说明了个人认识,量表平衡、自我效能感和支持帮助可对患有乳腺癌女性服药行为产生影响。

影响

患有乳腺癌女性的服药行为可分为四种类型:接受/坚持、承受/痛苦、犹豫/调整、拒绝/放弃。这四种类型之间会相互转换。服药行为受个人认识、量表平衡、自我效能感和支持帮助的影响。医疗机构、社区和家庭可通过获知女性的治疗经历,来更好地了解服药行为影响因素和可能出现不依从的情况。女性希望获取不同类型和数量的信息。医疗服务提供者应了解患者的偏好,并采取有针对性的干预措施,帮助他们接受治疗。

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