To synthesize the effect of music intervention on patients with cancer‐related pain in randomized controlled trials.
A systematic review and meta‐analysis of randomized controlled trials following Cochrane methods.
Systematic searches were conducted in Science Direct, Web of Science, Springer Link, Networked Digital Library of Theses & Dissertations, Ovid, CINAHL, Pubmed, Cochrane Library, Proquest, Council of Higher Education National Thesis Center, ULAKBIM Turkish National Databases for studies published in English and Turkish without year limitation. The review period covered 1978‐March 2018.
The risk of bias of eligible studies was evaluated by two researchers using the Cochrane Collaboration tool.
Six studies with 593 participants met the inclusion criteria. Music intervention was generally applied by the passive listening method, which ranged from 30‐60 minutes and 1‐3 sessions. No significant publication bias was found in the main outcomes. As a result of the meta‐analysis, it was found that music interventions have a moderate effect on cancer‐related pain.
Music intervention can have a positive effect on the management of cancer pain. The studies reported no adverse events. Nurses can use music intervention to manage cancer‐related pain.
The meta‐analysis addressed the effect of music intervention on cancer‐related pain. The statistical result indicates that music intervention was moderately effective in cancer‐related pain. The findings of this study will contribute to the application of effective music intervention by nurses and will provide guidance for the development of studies related to the effect of music intervention on cancer‐related pain.
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The aims of this study were to: a) determine if self‐efficacy mediates the relationship between perceived stress and diabetes self‐management in adolescents with type 1 diabetes; and b) explore whether perceived stress moderated the self‐efficacy and diabetes self‐management relationship.
Non‐experimental, descriptive correlational design, conducted from January‐ December 2016.
Guided by the Adaptation to Diabetes framework, data on demographic and clinical characteristics, perceived stress, self‐efficacy and diabetes self‐management were collected. Descriptive analyses and regression analyses were generated by SPSS Version 22. Structural equation modeling was implemented with the MPlus program.
There was no direct effect of perceived stress on diabetes self‐management; however, self‐efficacy mediated the relationship between perceived stress and diabetes self‐management. Adolescents who had high self‐efficacy and low perceived stress demonstrated better diabetes care activities and diabetes communication than would be predicted from the main effects of self‐efficacy and perceived stress alone.
Decreasing perceived stress and improving self‐efficacy are important strategies to improve diabetes self‐management in adolescents with type 1 diabetes.
Adolescents with type 1 diabetes experience considerable stress with daily self‐management demands. This study highlights the mediating role of self‐efficacy on perceived stress and diabetes self‐management. Assessment of perceived stress and self‐efficacy in self‐management tasks in adolescents with T1D may help nurses individualize self‐management education and support. Incorporating strategies to promote stress management and self‐efficacy in diabetes education may also improve diabetes self‐management.
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To examine the effects of a transtheoretical model‐based WeChat health education program on self‐management in hemodialysis patients in China.
A longitudinal experimental intervention study.
Patients (n=120) who underwent hemodialysis from December 2015 ‐ November 2017 were recruited and randomly allocated to either group 1 (who received a 3‐month WeChat health education immediately after randomization) or group 2 (who was combined with group 1 and received the same intervention at the 5th month after enrollment in the study). Self‐management, knowledge and self‐efficacy were assessed at baseline (T0), 3‐month after enrollment in the study (T1), 21‐month after enrollment in the study (T2).
There were significant group effects on self‐efficacy; time effects on partnership, self‐care, emotion management with total self‐management; interaction effects on problem‐solving and emotion management within total self‐management according to the two‐way repeated measures ANCOVA. Further between‐group comparisons indicated that patients in group 1 had better self‐management than those in group 2 at T1. Within‐group comparisons demonstrated that, compared with the baseline values, group 1 had significantly improved self‐management at T1; however, group 2 had improved self‐management at T2.
The transtheoretical model‐based WeChat health education program had a potentially positive effect on improving the self‐management of hemodialysis patients.
Self‐management is often difficult yet crucial for hemodialysis patients. This study indicated that the transtheoretical model‐based WeChat health education resulted in improved self‐management in hemodialysis patients and can be implemented in continuing care during the interdialysis period to improve self‐management in patients.
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To investigate the relationship between gay app use and HIV testing among men who have sex with men (MSM).
Serial cross-sectional study.
A newly well-developed city in China.
4935 MSM were recruited through offline sampling methods from 2015 to 2017.
The primary outcome is the difference in HIV testing between app and non-app users.
2872 (58.2%) and 2159 (43.7%) participated MSM had been tested for HIV within lifetime and the past year, respectively. Compared with non-app-using MSM, app-using MSM had a significantly higher prevalence of HIV testing within lifetime (adjusted OR (AOR): 1.48, 95% CI 1.27 to 1.72) and the past year (AOR: 1.36, 95% CI 1.18 to 1.57). App-using MSM were more likely to take an HIV test at the Centers for Disease Control and Prevention (AOR: 1.48, 95% CI 1.24 to 1.76) and community-based organisations (AOR: 1.71, 95% CI 1.44 to 2.03), but less often at gay venues (AOR: 0.49, 95% CI 0.37 to 0.63). Meanwhile, app-using MSM were more likely to take self-testing (AOR: 1.61, 95% CI 1.21 to 2.14). Predictors of HIV testing in the past year were: having an education level of college or higher (AOR: 1.29, 95% CI 1.01 to 1.65), being self-identified as a homosexual (AOR: 1.23, 95% CI 1.02 to 1.46), being recruited through clinic-based sampling (AOR: 1.30, 95% CI 1.06 to 1.60), using gay app (AOR: 1.49, 95% CI 1.21 to 1.83), engaging in group sex (AOR: 1.64, 95% CI 1.23 to 2.19), having received HIV-related service (AOR: 5.49, 95% CI 4.57 to 6.60), having a high level of HIV-related knowledge (AOR: 1.33, 95% CI 1.10 to 1.61) and high-risk perception (AOR: 2.95, 95% CI 1.40 to 6.23).
Gay app use was significantly associated with increased HIV testing among MSM hard to reach by traditional outreach. Therefore, it is imperative to expand HIV testing among non-app-using MSM. Continued efforts, innovative strategies and increased resource are highly needed to realise the first ‘90’ target.
In this study, we aimed to present the epidemiological characteristics of elevated blood pressure among middle and high school students aged 12–17 years in Jiangsu Province.
Hypertension, which is considered a rare disease in children, is an important early precursor to long-term cardiovascular damage, and elevated blood pressure in childhood is a strong predictor of hypertension in adulthood.
Physical examination and questionnaire investigation among children aged 12–17 years in Jiangsu Province were conducted from 2017 to 2018.
Physical measurements included height, weight, blood pressure and history of menarche/first spermatorrhoea. Questionnaire investigation included family type, delivery mode, lifestyle habits and psychological test.
In our study we investigated 17 791 middle and high school students, consisting of 8701 female students and 9090 male students. The prevalence of screening elevated blood pressure among students aged 12–17 years was 20.0% (95% CI 19.2% to 20.9%) for female students and 22.3% (95% CI 21.5% to 23.2%) for male students. The prevalence of screening elevated blood pressure for urban male middle and high school students was higher than that of elevated blood pressure for rural male middle and high school students. However, similar phenomenon cannot be observed among female students. For both male and female students, body mass index (BMI), obesity/overweight and menarche/first spermatorrhoea can be a risk factor contributing to elevated blood pressure, and sleep time and regional distribution might be important factors that need to be investigated in depth.
We found a relatively high prevalence of screening elevated blood pressure among students aged 12–17 years for both female and male students in Jiangsu Province. The risk factors can be BMI, obesity/overweight and menarche/first spermatorrhoea.
To study the association of educational level and risk of death from all causes, cardiovascular disease (CVD) and cancer among Asian populations.
A pooled analysis of 15 population-based cohort studies.
694 434 Asian individuals from 15 prospective cohorts within the Asia Cohort Consortium.
HRs and 95% CIs for all-cause mortality, as well as for CVD-specific mortality and cancer-specific mortality.
A total of 694 434 participants (mean age at baseline=53.2 years) were included in the analysis. During a mean follow-up period of 12.5 years, 103 023 deaths were observed, among which 33 939 were due to cancer and 34 645 were due to CVD. Higher educational levels were significantly associated with lower risk of death from all causes compared with a low educational level (≤primary education); HRs and 95% CIs for secondary education, trade/technical education and ≥university education were 0.88 (0.85 to 0.92), 0.81 (0.73 to 0.90) and 0.71 (0.63 to 0.80), respectively (ptrend=0.002). Similarly, HRs (95% CIs) were 0.93 (0.89 to 0.97), 0.86 (0.78 to 0.94) and 0.81 (0.73 to 0.89) for cancer death, and 0.88 (0.83 to 0.93), 0.77 (0.66 to 0.91) and 0.67 (0.58 to 0.77) for CVD death with increasing levels of education (both ptrend
Higher educational level was associated with substantially lower risk of death among Asian populations.
Investigating the association between total physical activity, physical activity in different domains and sedentary time with clustered metabolic risk in patients with type 2 diabetes from Jiangsu province, China.
Interview-based cross-sectional study conducted between December 2013 and January 2014.
44 selected townships across two cities, Changshu and Huai’an, in Jiangsu province.
20 340 participants selected using stratified cluster-randomised sampling and an interviewer-managed questionnaire.
We constructed clustered metabolic risk by summing sex-specific standardised values of waist circumference, fasting triacylglycerol, fasting plasma glucose, systolic blood pressure and the inverse of blood high-density lipoprotein cholesterol (HDL-cholesterol). Self-reported total physical activity included occupation, commuting and leisure-time physical activity. The un-standardised regression coefficient [B] and its 95% CI were calculated using multivariate linear regression analyses.
This study included 17 750 type 2 diabetes patients (aged 21–94 years, 60.3% female). The total (B=–0.080; 95% CI: –0.114 to –0.046), occupational (B=–0.066; 95% CI: –0.101 to– 0.031) and leisure-time physical activity (B=–0.041; 95% CI: –0.075 to –0.007), and sedentary time (B=0.117; 95% CI: 0.083 to 0.151) were associated with clustered metabolic risk. Total physical activity, occupational physical activity and sedentary time were associated with waist circumference, triacylglycerol and HDL-cholesterol, but not with systolic blood pressure. Commuting physical activity and sedentary time were significantly associated with triacylglycerol (B=–0.012; 95% CI: –0.019 to –0.005) and fasting plasma glucose (B=0.008; 95% CI: 0.003 to 0.01), respectively. Leisure-time physical activity was only significantly associated with systolic blood pressure (B=–0.239; 95% CI: –0.542 to– 0.045).
Total, occupational and leisure-time physical activity were inversely associated with clustered metabolic risk, whereas sedentary time increased metabolic risk. Commuting physical activity was inversely associated with triacylglycerol. These findings suggest that increased physical activity in different domains and decreased sedentary time may have protective effects against metabolic risk in type 2 diabetes patients.
In England, for babies born at 23–26 weeks gestation, care in a neonatal intensive care unit (NICU) as opposed to a local neonatal unit (LNU) improves survival to discharge. This evidence is shaping neonatal health services. In contrast, there is no evidence to guide location of care for the next most vulnerable group (born at 27–31 weeks gestation) whose care is currently spread between 45 NICU and 84 LNU in England. This group represents 12% of preterm births in England and over onr-third of all neonatal unit care days. Compared with those born at 23–26 weeks gestation, they account for four times more admissions and twice as many National Health Service bed days/year.
In this mixed-methods study, our primary objective is to assess, for babies born at 27–31 weeks gestation and admitted to a neonatal unit in England, whether care in an NICU vs an LNU impacts on survival and key morbidities (up to age 1 year), at each gestational age in weeks. Routinely recorded data extracted from real-time, point-of-care patient management systems held in the National Neonatal Research Database, Hospital Episode Statistics and Office for National Statistics, for January 2014 to December 2018, will be analysed. Secondary objectives are to assess (1) whether differences in care provided, rather than a focus on LNU/NICU designation, drives gestation-specific outcomes, (2) where care is most cost-effective and (3) what parents’ and clinicians' perspectives are on place of care, and how these could guide clinical decision-making. Our findings will be used to develop recommendations, in collaboration with national bodies, to inform clinical practice, commissioning and policy-making. The project is supported by a parent advisory panel and a study steering committee.
Research ethics approval has been obtained (IRAS 212304). Dissemination will be through publication of findings and development of recommendations for care.
To adapt the Child Food Neophobia Scale (CFNS) cross-culturally for use among 12-36-month-old Chinese toddlers and to perform a preliminary assessment of its construct validity and reliability.
Food neophobia is the fear of eating new or unfamiliar foods, which affects the type and quality of individual dietary intake, especially during early childhood. However, measurements of child food neophobia have rarely been reported in China due to a lack of reliable and valid measurements.
The CFNS was translated and adapted into a Chinese version (CFNS-CN) through a forward translation, reconciliation, a back translation, expert review and pretesting. The construct validity and reliability of the CFNS-CN were tested in 390 caregivers of 12–36 months old Chinese toddlers through convenience sampling in Changsha Maternal and Child Health Care Hospital, Hunan Province, China. The internal consistency, confirmatory factor analysis (CFA) and reliability were estimated.
The kappa coefficients indicated moderate to perfect agreement between the test and retest, and Cronbach’s α coefficient was 0.91. A normal 2/df, CMIN/DF=3.302, Comparative Fit Index, CFI=0.993, Tucker-Lewis Index, TLI=0.986 and root mean square error of approximation, RMSEA=0.077 were found. The CFA results showed that the model indicators were acceptable. High food neophobia was observed in 25.1% of individuals.
The CFNS-CN showed good internal consistency reliability and construct validity. The CFNS-CN may become an effective tool for assessing food neophobia in Chinese toddlers.
This trial was pre-registered at the China Clinical Trial Registration Center under registration number ChiCTR1800015890.
Neck pain (NP) is a common condition that can be effectively treated by acupuncture. However, several treatment point prescriptions (ie, local acupoints, distal acupoints, and sensitised acupoints) may be used. The present study aims to identify the types of sensitisation and the distribution of sensitised points in patients with NP, to analyse the cut-off values and sensitisation rate for acupoint sensitisation, and to summarise the dominant forms of optimally sensitised points. This information will be helpful when choosing the optimal points to treat NP.
This multicentre, matched, case–control study will enrol 224 patients with NP, and 224 age-matched and sex-matched healthy participants as controls. Body surface temperature, mechanical pain threshold, pressure pain threshold and skin resistance will be assessed at the 15 acupoints most frequently used to treat NP, and at the five body regions in which pain occurs most frequently. Hypothesis testing will be used to compare the differences in variables between cases and controls. In addition, receiver operating characteristic curve analysis will be used to explore the cut-off values of the sensitive states of heat, pain and electrical resistance, which indicate sensitisation of the acupoint. The optimal points will be comprehensively determined by the acupoint sensitisation rate and OR.
Ethical approval of this study has been granted by the Research Ethical Committee of the Teaching Hospital of Chengdu University of Traditional Chinese Medicine (ID: 2018 KL-016). The outcomes of the study will be disseminated through peer-reviewed publications.
The objective of this meta-analysis was to assess whether depression in percutaneous coronary intervention (PCI) patients is associated with higher risk of adverse outcomes.
Systematic review and meta-analysis.
EMBASE, PubMed, CINAHL and PsycINFO were searched as data sources. We selected prospective cohort studies evaluating the relationship between depression and any adverse medical outcome, including all-cause mortality, cardiac mortality and non-fatal events, from inception to 28 February 2019. Two reviewers independently extracted information and calculated the risk of cardiovascular events in patients with preoperative or postoperative depression compared with non-depressed patients.
Eight studies (n=3297) met our inclusion criteria. Most studies found a positive association between depression and adverse cardiovascular outcomes. Meta-analysis yielded an aggregate risk ratio of 1.57 (95% CI 1.28 to 1.92, p
Our systematic review and meta-analysis suggests that depression is associated with an increased risk of worse clinical outcome or mortality in patients undergoing PCI. Assessment time and length of follow-up do not have a significant effect on this conclusion.
Colonoscopy is the reference method in screening and diagnosis of colorectal neoplasm, but its efficacy is closely related to the quality of bowel preparation. Poor patient compliance is a major risk factor for inadequate bowel preparation likely due to poor patient education. Such an education is usually provided via either oral or written instructions by clinicians. However, multiple education methods, such as smartphone applications, have been proved useful in aiding patients through bowel preparation. Also, it was reported that a large proportion of patients feel anxious before colonoscopy. Virtual reality (VR) is a novel method to educate patients and provides them with an immersive experience. Theoretically, it can make patients better prepared for bowel preparation and colonoscopy. However, no prospective studies have assessed the role of this novel technology in patient education before colonoscopy. We hypothesise that VR videos can improve bowel preparation quality and reduce pre-procedure anxiety.
The trial is a prospective, randomised, single-blinded, single-centre trial. Outpatients who are scheduled to undergo colonoscopy for screening or diagnostic purposes for the first time will be randomised to receive either the conventional patient education or the conventional methods plus VR videos, and 322 patients will be enrolled from the Peking Union Medical College Hospital. The primary endpoint is the quality of bowel preparation, measured by the Boston bowel preparation score. Secondary endpoints include polyp detection rate, adenoma detection rate, cecal intubation rate, patient compliance to complete bowel cleansing, withdrawal time, pre-procedure anxiety, overall satisfaction and willingness for the next colonoscopy.
The study has been approved by the institutional review board of the Peking Union Medical College Hospital (No. ZS-1647). The results of this trial will be published in an open-access way and disseminated among gastrointestinal physicians and endoscopists.
To investigate the association between the Tangshan earthquake and depression after 37 years.
A cross-sectional study conducted in Tangshan from 2013 to 2014.
The sample included 5024 participants born before 28 July 1976 the date of the Tangshan earthquake, with available data on their earthquake experiences and depression 37 years post-earthquake.
The outcome was depression measured using the Center for Epidemiological Study and Depression Scale. The independent variable was earthquake experience, which was classified into three groups: no earthquake experience, earthquake experience without bereavement and earthquake experience with bereavement. Multivariable logistic regression analysis was used to evaluate the association between earthquake experience and depression after adjusting for gender, age at the time of the earthquake, smoking status, drinking status, education, income, residence in Tangshan 1 to 2 years post-earthquake, hypertension, diabetes and dyslipidaemia.
Of the 5024 participants, 641 experienced the Tangshan earthquake, and 98 experienced bereavement due to the earthquake. 37 years after the earthquake, survivors who had lost relatives during the earthquake were nearly three times (OR 2.82, 95% CI 1.24 to 6.39) as likely to have depression as those who had not experienced the earthquake, while those who had not lost relatives were 1.69 times as likely (OR 1.69, 95% CI 0.93 to 3.08). Stratified analyses showed that earthquake was significantly associated with depression in women with (OR 3.51, 95% CI 1.21 to 10.16) or without bereavement (OR 3.07, 95% CI 1.44 to 6.56) but not in men; this association was also significant in individuals over 18 years old at the time of the earthquake with (OR 13.16, 95% CI 3.08 to 56.3) or without bereavement (OR 3.39, 95% CI 1.31 to 8.87) but not in individuals less than 18 years old.
37 years after the Tangshan earthquake, earthquake experience was associated with depression among bereaved survivors, women and individuals over 18 years old at the time of the earthquake.
To identify the situation of organisational justice, organisational support, work engagement and turnover intention among community nurses and clarify the relationship among them.
Nurse shortage has become a worldwide issue, and the shortage of community nurses is more serious. Nurse turnover is one important factor for this situation. While previous studies about turnover intention mostly focused on hospital nurses, few involved community nurses.
A descriptive, cross‐sectional design was adopted.
Questionnaire investigation was implemented among 410 community nurses to collect data about organisational justice, organisational support, work engagement and turnover intention. Structural equation modelling was applied to test the hypothesised model. The STROBE statement for observational studies was followed.
Results showed the average score of turnover intention was 2.50 ± 0.75. The final model indicated: (a) work engagement had a direct negative effect on turnover intention; (b) organisational support had both direct and indirect effects on turnover intention, and the indirect effect was mediated by work engagement; and (c) organisational justice had an indirect effect on turnover intention mediated by organisational support.
Turnover intention could be reduced directly or indirectly by improving work engagement, organisational support and organisational justice.
This study provides evidence for community health centre managers and policymakers to improve the level of nurses' engagement and to retain more nurses in primary healthcare service.
To explore the experiences of how Chinese adults cope with multiple chronic conditions in everyday life.
Having multiple chronic conditions is stressful, requiring people to make physical and mental adaptations. There is little evidence exploring how people cope with multiple chronic conditions, especially in an Asian context.
A qualitative descriptive design was employed. The Consolidated criteria for reporting qualitative research (COREQ) was used to report this study.
This study was conducted in a tertiary referral and teaching hospital in Bengbu, Anhui, China, between August and October 2018. A purposive sample of 14 people with multiple chronic conditions, aged between 32 and 75 years, completed a demographic questionnaire and semi‐structured face‐to‐face interviews. The interviews were digitally recorded and transcribed verbatim. Qualitative content analysis guided data analysis.
Four distinctive themes comprising subthemes were developed from participants' narratives pertaining to coping with multiple chronic conditions: (a) appraising multiple chronic conditions, (b) addressing multiple chronic conditions management, (c) maintaining psychological well‐being and (d) fulfilling a social role. Illustrative quotations were cited to support each theme.
This study underscores that people cope with multiple chronic conditions in everyday life by using a compendium of coping strategies. As one of the influencing factors, culture dominates the ways of coping at different levels among people with multiple chronic conditions. These findings expand the current literature on coping based on an Asian perspective and inform further cross‐culture research on this topic.
Healthcare professionals should understand peoples' experiences of coping with multiple chronic conditions to provide more holistic and dynamic health care to address their actual needs. Healthcare professionals should be acquainted with how culture impacts individuals' coping and develops culture‐tailored supportive programmes such as family‐based interventions, to promote the health of people with multiple chronic conditions.
by Kyoungmin Lee, So Jung Lee, Shinkyo Yoon, Baek-Yeol Ryoo, Sang-We Kim, Sang Hyun Choi, Sang Min Lee, Eun Jin Chae, Yangsoon Park, Se-Jin Jang, Soo-Yeon Park, Young-Kwang Yoon, Seong Ho Park, Tae Won KimObjective
Research biopsies are an essential component of cancer clinical trials for studying drug efficacy and identifying biomarkers. Site-level clinical investigators, however, do not have access to results on the adequacy of research biopsies for histological or molecular assays, because samples are sent to central labs and the test results are seldom reported back to site-level investigators unless requested. We evaluated the feasibility, safety, and adequacy of research biopsies performed at an academic medical center.Materials and methods
We retrospectively reviewed the data on 122 research biopsy sessions conducted in 99 patients via percutaneous core needle biopsy for 39 clinical trials from January 2017 to February 2018 at a single institute. We asked the sponsors of each clinical trial for the adequacy of the biopsy samples for histological or molecular assays.Results
The biopsy success rate was 93.4% (113/122), with nine samples categorized as inadequate for obtaining pathologic diagnosis. Post-biopsy complications occurred in 9.8% (12/122) of biopsies, all of which were mild and completely recovered by the day after the biopsy. The sponsors of clinical trials provided feedbacks on the adequacy of 76 biopsy samples, and noted that a total of 8 biopsy samples from 7 patients were inadequate for analysis, resulting in an adequacy rate of 89.5% (68/76): the reasons for inadequacy were insufficient tumor content for immunohistochemistry (n = 3) and low RNA yield for sequencing (n = 5).Conclusion
Research biopsies performed at an experienced, multidisciplinary center had acceptable safety for patients as well as practicality in terms of obtaining adequate tissue samples for molecular studies.
To describe a protocol that examines the feasibility and effectiveness of a face‐to‐face guided self‐disclosure intervention for facilitating benefit finding and other related psychological outcomes for breast cancer patients.
Benefit finding can promote a positive attitude among patients facing disease. However, limited studies have focused on improving benefit finding among breast cancer patients. Previous research has been based on group interventions, which may not suit all patients. Self‐disclosure was recognized as a strong predictor of benefit finding. This protocol is based on a brief face‐to‐face disclosure intervention to improve benefit finding for breast cancer patients.
A non‐blinded randomized controlled trial.
A total of 154 patients with breast cancer who have undergone radical mastectomy will be randomly assigned to either the experimental group, which will participate in a six‐session face‐to‐face individual intervention, or the control group at a ratio of 1:1. Baseline assessments will take place after the breast cancer diagnosis, with follow‐up assessments at 3, 6 and 9 months after baseline. The primary outcome is benefit finding; other outcomes are self‐disclosure, cognitive reappraisal, social support, optimism and medical coping modes.
This study is to design a protocol for guided self‐disclosure interventions to promote benefit finding in Chinese breast cancer patients. If this intervention is feasible and effective, it could be implemented in clinical practice.
This study will provide useful advice for health professionals to guide breast cancer patients in benefit finding during stressful events. If it is effective, it will be implemented broadly in clinical practice.
Limited research has assessed the association between patterns of body mass index (BMI) change across adulthood and mortality. We aimed to identify groups of individuals who followed specific group-based BMI trajectories across adulthood, using weight collected on three occasions and recalled data from early adulthood, and to examine associations with all-cause and cause-specific mortality.
Prospective cohort study.
Adults (n=29 881) enrolled in the Melbourne Collaborative Cohort Study, who were aged from 40 to 70 years between 1990 and 1994, and had BMI data for at least three time points.
Deaths from any cause before 31 March 2017 and deaths from obesity-related cancers, cardiovascular diseases (CVDs) and other causes before 31 December 2013.
We identified six group-based BMI trajectories: lower-normal stable (TR1), higher-normal stable (TR2), normal to overweight (TR3), chronic borderline obesity (TR4), normal to class I obesity (TR5) and overweight to class II obesity (TR6). Generally, compared with maintaining lower-normal BMI throughout adulthood, the lowest mortality was experienced by participants who maintained higher-normal BMI (HR 0.90; 95% CI 0.84 to 0.97); obesity during midlife was associated with higher all-cause mortality even when BMI was normal in early adulthood (HR 1.09; 95% CI 0.98 to 1.21) and prolonged borderline obesity from early adulthood was also associated with elevated mortality (HR 1.16; 95% CI 1.01 to 1.33). These associations were stronger for never-smokers and for death due to obesity-related cancers. Being overweight in early adulthood and becoming class II obese was associated with higher CVD mortality relative to maintaining lower-normal BMI (HR 2.27; 95% CI 1.34 to 3.87).
Our findings highlight the importance of weight management throughout adulthood to reduce mortality.
‘National Special Stewardship in the Clinical Use of Antibiotics’ was put forward in July 2011 in China. We aimed to retrospectively evaluate the impact of antimicrobial stewardship (AMS) managed by clinical pharmacists on antibiotic utilisation, prophylaxis and antimicrobial resistance (AMR).
This was a retrospective observational study of trends in antibiotic use and AMR in the context of AMS.
Beijing Chaoyang Hospital, a 1400-bed tertiary hospital, in China.
Antibiotic prescriptions from 820 doctors included all outpatients (n=17 766 637) and inpatients (n=376 627) during 2010–2016. Bacterial resistance data were from all inpatients (n=350 699) during 2011–2016.
Multiaspect intervention measures were implemented by clinical pharmacists (13 persons), for example, formulating the activity programme and performance management, advising on antibacterial prescriptions and training.
The proportion of antibiotic prescriptions among outpatients and inpatients, intensity of consumption in defined daily dose (DDD)/100 bed-days, antibiotic prophylaxis in type I incision operations and resistance rates of Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa were retrospectively analysed.
The proportion of antibiotic prescriptions decreased in outpatients (from 19.38% to 13.21%) and in inpatients (from 64.34% to 34.65%), the intensity of consumption dropped from 102.46 to 37.38 DDD/100 bed-days. The proportion of antibiotic prophylaxis decreased from 98.94% to 18.93%. The proportion of rational timing of initial dose increased from 71.11% to 96.74%, the proportion of rational duration rose from 2.84% to 42.63%. Time series analysis demonstrated the resistance rates of E. coli and P. aeruginosa to fluoroquinolones decreased, the incidence rate of methicillin-resistant Staphylococcus aureus also decreased, whereas the resistance rates of E. coli and K. pneumoniae to carbapenems increased. The antibiotic use was partly positively correlated with AMR.
AMS had an important role in reducing antibiotic use and surgical antibiotic prophylaxis. The AMR was positively correlated with antibiotic consumption to some extent.