Conectar
by Jiao Zhu, Min Yang, Cuiying Zhou, Houyong Kang, Deping Wang
BackgroundTo evaluate the global, regional, and national burdens of and trends in age-related and other hearing loss (ARoHL) from 1990–2021 based on the Global Burden of Disease 2021 database.
MethodsThis study examined trends and disparities in the prevalence and years lived with disability (YLDs) of patients with ARoHL across age, sex, and the sociodemographic index (SDI). The estimated annual percentage change (EAPC) was calculated to assess temporal trends. Decomposition analysis, cross-country inequality analysis, and frontier analysis were employed to reveal additional facets of the ARoHL burden, whereas Bayesian Age-Period-Cohort (BAPC) modeling projected future trends to 2040.
ResultsARoHL remains a critical public health challenge. The global age-standardized prevalence rate (ASPR) increased significantly from 1.71 (95% UI: 1.63–1.80) ×10⁴ to 1.81 (95% UI: 1.73–1.89) ×10⁴ per 100,000 (EAPC = 0.163; 95% CI: 0.154–0.172), whereas the age-standardized YLD rate (ASYR) increased from 499.37 to 525.87 per 100,000 (EAPC = 0.171; 95% CI: 0.161–0.180). Decomposition analysis revealed that epidemiological changes contributed 37.28% to the increase in YLDs. Globally and across all five SDI regions without age distinction, the male ASPR and ASYR were consistently greater than the female ASPR and ASYR at all time points. The relationship between the SDI and ARoHL burden is complex. BAPC projections indicate stable ASPRs and ASYRs through 2040 despite increasing cases and YLDs.
ConclusionsThe global ASPR of ARoHL increased by 5.63% and that of ASYR increased by 5.31% from 1990–2021, with the number of cases and YLDs doubling. Targeted interventions and policies must address this growing public health challenge.
Endotracheal intubation is a crucial intervention for mechanically ventilated patients in the intensive care unit (ICU). However, the presence of the tube and bite block in the mouth significantly raises the risk of mucosal pressure injuries (MMPI) and other oral complications. These complications not only compromise oral health but also prolong hospitalisation and increase medical costs. Despite advances in airway management, effective solutions to mitigate these risks remain limited. Few studies have explored reducing mucosal pressure and improving oral health by optimising the design and reducing the volume of oral devices. Therefore, this study aimed to design and evaluate a novel nested tracheal tube device to reduce oral MMPI and improve oral health outcomes in intubated patients. A prospective, non-blinded, randomised, parallel-controlled intervention study was conducted, involving 151 patients who were intubated for more than 48 h. Participants were randomly assigned into two groups: the intervention group (n = 75), which received the novel nested tracheal tube device, and the control group (n = 76), which received the standard endotracheal tube with bite block. The primary outcome measure was the incidence of MMPI. Secondary outcomes included the Beck Oral Health Score, plaque index, ventilator-associated pneumonia (VAP) and costs. Compared to the standard group, the nested tracheal tube group showed a significant reduction in MMPI (χ 2 = 8.796, p < 0.05). In addition, the nested tracheal tube group demonstrated significantly better outcomes in Beck Oral Health Scores (Z = −2.948, p < 0.05) and plaque index (Z = −2.010, p < 0.05), indicating improvements in oral function and hygiene. However, there were no significant differences between the two groups in VAP incidence and average daily ICU costs (p > 0.05). The nested tracheal tube effectively reduces localised pressure on oral tissues and improves oral function, offering a practical solution to mitigate MMPI in mechanically ventilated patients and enhance their oral health outcomes.
by Yanping Wang, Yan Xu
BackgroundPrior studies have linked the aspartate aminotransferase to alanine aminotransferase ratio (AAR) with negative health outcomes in the elderly and specific populations. However, the impact of AAR on the prognosis of the entire population in the intensive care unit (ICU) remains unclear. This study aimed to determine the correlation between AAR and the mortality among adult ICU patients.
MethodPatient data were retrieved from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database and stratified into quartiles by AAR. Survival analysis using the Kaplan-Meier curves was conducted to compare survival across quartiles. The primary outcome was 28-day mortality, with secondary outcomes including 60-day, 90-day, and 365-day mortality, along with ICU-free, ventilator-free, and vasopressor-free days within the first 28 days. The association between AAR and mortality was evaluated using Cox proportional hazards regression analysis complemented by a restricted cubic spline. Furthermore, the eICU Collaborative Research Database (eICU-CRD) was used as an external validation cohort for sensitivity analysis.
ResultThe study included 20,225 patients with a mean age of 63.7 ± 17.5 years. Kaplan-Meier analysis indicated a higher risk of 28-day mortality for patients with higher AAR (log-rank P Conclusion
AAR demonstrated a significant association with 28-day, 60-day, 90-day, and 365-day mortality, characterized by an inverted L-shaped pattern.
Patients with chronic kidney disease on hemodialysis experience complex symptom clusters that impact their quality of life. Simplifying symptom management is essential to improve patient care and outcomes. However, there is no comprehensive evaluation of these simplification methods in current literature.
To evaluate and synthesize strategies for simplifying the symptomatology associated with hemodialysis to improve patient outcomes and management practices.
We conducted a systematic review. We performed a comprehensive literature search across Pubmed, CINAHL, Embase, Web of Science, Scopus, CNKI, VIP database, and Wanfang in April 2024. Data synthesis was narrative due to the heterogeneity of the methodologies. Studies were selected based on predefined criteria focused on symptom simplification strategies among adult hemodialysis patients. Articles were retrieved and assessed for relevance and quality through April 2024.
We identified 18 eligible studies from an initial pool of 18,324 records, focusing on variable-centered, person-centered approaches and approaches to identifying the main symptoms to symptom simplification. The studies varied significantly in their methodological quality and findings but commonly reported symptom clusters that correlated with poor patient outcomes.
This review underlines critical areas for advancement in hemodialysis patient care through strategic symptom management integration. Our findings emphasize the necessity of implementing simplified symptom assessment protocols in routine clinical practice, thereby enhancing patient engagement and outcomes. Additionally, the results advocate for ongoing research into personalized care approaches, underscoring the potential for these strategies to decrease symptom burden significantly. These insights should inform both policy and educational programs, encouraging the adoption of standardized practices across healthcare systems. Moreover, the study highlights the need for management strategies that align with patient-reported outcomes, fostering a more patient-centered approach in healthcare settings. Ultimately, this evidence should guide educational efforts to better equip healthcare providers with the tools necessary for effective symptom management in hemodialysis care.
PROSPERO: CRD42023473789
by Bin Li, Yating Chen, Maoxiang Zhao, Zhijie Chen, Zhuhui Lin, Jie Liu, Xueping Wang, Jiancheng Zhang, Yang Li
Obesity is associated with abnormal repolarization manifested by QT interval prolongation, and oxidative stress is an important link between obesity and arrhythmias. However, the underlying electrophysiological and molecular mechanisms remain unclear. The aim of this study is to evaluate the role of obesity in potassium current in ventricular myocytes and the potential mechanism of NADPH oxidase 2 (Nox2). We investigated the effect of Nox2 on cardiac repolarization without compromising its expression and function in other systems using mice with conditional cardiac-specific deletions of Nox2 (knockout [KO]). Wild-type, KO, and Flox littermate mice were randomized to either the control or high-fat diet (HFD) groups. Surface electrocardiograms were recorded to analyze repolarization in vivo. Whole-cell patch-clamp techniques were used to evaluate the electrophysiological phenotype of isolated myocytes in vitro. Western blotting was performed to assess protein expression levels. Compared with the control mice, the HFD group had a prolonged QTc. The consequences of an HFD were not attributed to delayed rectifier K+ and inward-rectifier K+ currents but were associated with reduced peak outward KV and fast transient outward K+ currents. Downregulated expression of KV4.2 and KChIP2, comprising functional Ito channel pore-forming (α) and accessory (β) subunits, was detected in HFD mice. Nox2-KO reversed the effect of obesity on Ipeak and Ito amplitude. Our data demonstrate that obesity mediates impaired cardiac repolarization in mice, manifested by QTc at the whole organism level and action potential duration at the cellular level, and correlated with Nox2. The electrophysiological and molecular aspects of this phenomenon were mediated by repolarizing outward K+ currents.
Patients with coronary heart disease (CHD) will have a series of sexual problems, and their sexual life quality can be affected. However, a standardised evaluation tool for patients with CHD was lacking. Therefore, this study aimed to develop a sexual life quality questionnaire for patients with CHD and to evaluate its psychometric properties.
Based on previous phenomenological studies, literature analysis and group discussion, questionnaire items were formed. After two rounds of expert consultation and pre-survey, the questionnaire items were modified. Items were screened by item analysis. Exploratory factor analysis and confirmatory factor analysis were used to explore and confirm the structure of the questionnaire. Content validity and criterion validity were evaluated using the expert consultation and correlation analysis, respectively. The questionnaire reliability was evaluated using internal consistency, split half reliability, and test-retest reliability.
The sexual life quality questionnaire of patients with CHD was developed, which included two versions: male version and female version. The male version of the questionnaire contains 3 dimensions and 20 items, while the female version contains 3 dimensions and 17 items. After reliability and validity test, the two versions of the questionnaire have good reliability and validity.
In this study, the sexual life quality questionnaire of patients with CHD was developed and its psychometric properties were confirmed, which can be used to evaluate the sexual life quality of patients with CHD.
The development of a sexual life quality evaluation tool for patients with coronary heart disease to provide objective and quantitative tools for clinical staff to evaluate patients' sexual life status.
Patients were invited to participate in a questionnaire survey for this study.
To systematically evaluate the effects of quality nursing care on wound pain and anxiety in burn patients. Computerised searches of PubMed, Google Scholar, Cochrane Library, Embase, Wanfang, China Biomedical Literature Database and China National Knowledge Infrastructure databases randomised controlled trials (RCTs) on the application of quality nursing care to burn patients were carried out from database inception to October 2023. Literature was screened and evaluated by two researchers based on inclusion and exclusion criteria, and data were extracted from the final included literature. Stata 17.0 software was employed for data analysis. Overall, 15 RCTs and 1115 burn patients were included, including 563 and 552 in the quality care and routine care groups. It was found that, compared with routine care, burn patients who implemented quality care had significantly less wound pain (SMD: −1.79, 95% CI: −2.22 to −1.36, p < 0.001), anxiety (SMD: −2.71. 95% CI: −3.49 to −1.92, p < 0.001) and depression (SMD: −1.74, 95% CI: −2.35 to −1.14, p < 0.001) levels were significantly reduced post-trauma.
Various factors contribute to different types of surgical site infections (SSI) in gastric cancer patients undergoing surgery, and the risk factors remain uncertain. This meta-analysis aims to clarify the relationship between various factors and SSI, resolving existing controversies. Thirty-four eligible articles with 66 066 patients were included in the meta-analysis. Significant risk factors for SSI included age ≥65 years, male gender, BMI ≥25 kg/m2, diabetes, hypertension, advanced TNM stage ≥III, pathologic T stage ≥T3, pathologic N stage ≥N1, ASA ≥3, open surgery, blood transfusion, extensive resection, combined resection, splenectomy, D2 or more lymph node dissection, and operative time ≥240 min. Operative time showed a nonlinear relationship with SSI risk. Subgroup analysis revealed significant differences in the effects of risk factors among different infection types. These findings inform the development of targeted preventive measures to reduce SSI rates.
The effect of obesity on wound-related outcomes in post-ovarian cancer patients is not clear. A number of studies on the association of fat with post-operation injury in ovarian carcinoma have produced contradictory findings. This study aims to conduct a study of the available data to assess the association of obese individuals with significant surgery results in ovarian cancer. We looked up Cochrane Library, Embase, and PubMed for qualifying research on ovarian cancer operations to determine the primary evidence for evaluating the association of obesity with post-surgical wound injury in ovarian cancer. The odds ratio (OR) was analysed with a fixed effect model if the variability of the study was small; otherwise, the analysis of the data was done with a random effect model. Out of 1259 related trials which were reviewed for eligibility, 6 publications were chosen from 2009 to 2019, 3076 patients who had had an operation for ovarian cancer. Obesity has been linked to an increased rate of wound-related complications in ovarian cancer operations compared to those without obesity (OR, 0.50; 95% CI, 0.37, 0.69 p < 0.0001). Non-obesity was significantly less likely to occur with respect to operation time compared to those with obesity (MD, −48.00; 95% CI, −55.33, −40.68 p < 0.00001). There were no statistically significant differences in the rate of haemorrhage after the operation (OR, 0.26; 95% CI, 0.04, 1.57, p = 0.14). Because of the limited number of trials in this meta-analysis, caution should be exercised in their treatment. More high-quality research with a large sample is required in order to confirm the findings.
In a meta-study, we evaluated the effectiveness and security of the combination of topical anaesthetic and dexmedetomidine in the treatment of postoperative pain in patients with lumbar disease. Four databases were systematically searched for possible related articles. Only English-language research was taken into account on the Internet. Furthermore, we only took into account the studies that were published prior to 2023. Only those that fulfilled the eligibility criteria were considered: (1) in adults who were about to undergo spine operation, (2) dexmedetomidine combined with local anaesthesia, (3) Visual Analog Scale scores at 4 and 24 h after the event and (4) this was a randomized or nonrandomized, controlled study. The meta-analysis was carried out with Revman 5.3 software. A ROBINS-I-based instrument was used to evaluate controlled studies. All trials were synthesized by computing the end results with either a fixed or a random effect model, which was dependent on statistical diversity. Five trials showed a marked reduction in wound pain at 4 h after the operation in patients who were treated with dexmedetomidine for lumbar spinal surgery (MD, −0.81; 95% CI, −1.24, −0.35; p = 0.0005). In the case of lumbar spinal operations, the addition of dexmedetomidine to the postoperative treatment resulted in a marked reduction in the pain at 24 h post-operation (MD, −0.64; 95% CI, −0.79, −0.48; p < 0.0001). The quality of the data we evaluated was ‘moderate’ to ‘good’; thus, we have limited confidence in the impact estimation, and the actual impact might be significantly different from what we had expected. Additional studies should concentrate on practices that are well known to cause severe postoperative pain, especially for cases where the improvement of pain management may lead to substantial clinical benefits in terms of reduction of morbidity or cost-effectiveness in terms of quicker healing and release.
This meta-analysis evaluated the role of evidence-based nursing interventions in preventing pressure ulcers in patients with stroke. Computer systems were used to retrieve randomised controlled trials (RCTs) on evidence-based nursing interventions for patients with stroke and comorbid pressure ulcers from PubMed, EMBASE, Scopus, Cochrane Library, China National Knowledge Infrastructure, Chinese Biomedical Literature Database and Wanfang Data from database inception until April 2023. Two researchers independently screened the literature, extracted the data and evaluated the quality of the included studies according to the inclusion and exclusion criteria. RevMan 5.4 software was used for the meta-analysis. A total of 23 articles with results on 2035 patients were included, with 1015 patients in the evidence-based nursing group and 1020 patients in the routine nursing group. The meta-analysis results showed that evidence-based nursing interventions significantly reduced the incidence of pressure ulcers in patients with stroke (5.22% vs. 22.84%, odds ratio [OR]: 0.18, 95% confidence interval [CI]: 0.13–0.24, p < 0.001), delayed the onset of pressure ulcers (standardised mean difference [SMD]: 3.41, 95% CI: 1.40–5.42, p < 0.001) and improved patient quality of life (SMD: 2.95, 95% CI: 2.35–3.56, p < 0.001). Evidence-based nursing interventions are effective at preventing pressure ulcers in patients with stroke, delaying the onset of pressure ulcers and improving their quality of life. Evidence-based nursing should be promoted for patients with stroke. However, owing to differences in sample size between studies and the methodological inadequacies of some studies, these results should be verified by large, high-quality RCTs.
The purpose of this study is to determine the impact of maggot debridement therapy (MDT) on macrophages during the healing process of diabetic foot ulcers (DFU). The activation phenotype of macrophages during wound healing following MDT was evaluated using double staining immunohistochemistry (IHC). In addition, markers associated with macrophage activation were discovered using immunoblotting and real-time polymerase chain reaction (PCR). During the process of diabetic wound healing following MDT, the presence and over-expression of M2 macrophages were observed, while the under-expression of M1 macrophages was noted. In addition, the activation markers of macrophages exhibited a correlation with the indicated Th1/Th2 cytokines. MDT interventions have the potential to modulate macrophage activity, thereby aiding in the healing of diabetic foot wounds.
To develop and validate a behavioural driving model for adherence to home-based cardiac rehabilitation exercise in patients with chronic heart failure, and to explain the potential driving mechanism of social support on exercise adherence.
Despite the benefits of home-based cardiac rehabilitation exercise, adherence among patients with chronic heart failure remains suboptimal. Several factors contributing to adherence have been confirmed; however, the specific pathway mechanisms by which these factors impact exercise adherence have not been thoroughly explored.
An exploratory sequential mixed-methods study was conducted in this study.
A total of 226 patients with chronic heart failure were recruited using convenience sampling. Quantitative data were collected using a series of self-report questionnaires. Hierarchical regression analysis was performed to verify multiple pathways. Subsequently, 12 patients with chronic heart failure were drawn from the quantitative stage. The interview data were thematically analysed. This study followed the Good Reporting of a Mixed Methods Study (GRAMMS) guidelines (Appendix S1).
Perceived social support had a direct positive predictive effect on exercise adherence. Importantly, exercise self-efficacy and exercise fear played a chain-mediating role between perceived social support and exercise adherence. As a result of the qualitative phase, scale, tightness and homogeneity of social support networks emerged as potential drivers of the effectiveness of social support on exercise adherence.
This study reveals a potential pathway mechanism for social support to improve adherence to home-based cardiac rehabilitation exercises. Social support network plays a crucial role in the effect of social support on exercise adherence.
To enhance exercise adherence in home-based cardiac rehabilitation for patients with chronic heart failure, establishing a social support network is recommended. This strategy has the potential to promote exercise self-efficacy and alleviate exercise fear.
None.
We conducted a meta-analysis to assess the effects of bundle-care interventions on pressure ulcers in patients with stroke to provide a basis for clinical work. Randomised controlled trials on the effects of bundle-care interventions in patients with stroke were identified using computerised searches of the PubMed, Embase, Cochrane Library, Chinese National Knowledge Infrastructure, VIP and Wanfang databases, from the time of inception of each database to July 2023, supplemented by manual literature searches. Two researchers independently retrieved and screened the articles, extracted the data and evaluated the quality of the included studies. After reaching consensus, meta-analysis was performed using RevMan 5.4. Twenty-four papers were included, involving 3330 patients of whom 1679 were in the intervention group and 1651 were in the control group. The results showed that, compared with standard care, bundle-care interventions significantly reduced the incidence of pressure ulcers (3.28% vs. 14.84%, odds ratio [OR]: 0.19, 95% confidence interval [CI]: 0.14–0.26, p < 0.001), and aspiration (5.60% vs. 18.84%, OR: 0.25, 95% CI: 0.17–0.39, p < 0.001), and improved patient satisfaction with nursing care (96.59% vs. 84.43%, OR. 5.45, 95% CI: 3.76–7.90, p < 0.001). Current evidence suggests that care bundles are significantly better than conventional nursing measures in preventing pressure ulcers and aspiration, and improving patient satisfaction with nursing care in patients with stroke, and are worthy of clinical promotion and application.
FreshRSS