FreshRSS

🔒
❌ Acerca de FreshRSS
Hay nuevos artículos disponibles. Pincha para refrescar la página.
Ayer — Octubre 2nd 2025Tus fuentes RSS

Exploring Subjective Cognitive Decline and Its Related Factors Among Young‐Old Adults: A Perspective on Social Network Types

ABSTRACT

Aims

To identify distinct social network types among young-old adults based on the characteristics of social network structure and to explore the relationship between different types, socio-demographic characteristics and subjective cognitive decline.

Design

A cross-sectional study was conducted from July 2022 to October 2023.

Methods

A total of 652 young-old adults aged 60–74 years completed the sociodemographic questionnaire, the subjective cognitive decline questionnaire-9 and the self-designed egocentric social network questionnaire. The types of social networks were identified by latent profile analysis. Univariate analysis and binary logistic regression were used to analyse the influencing factors of subjective cognitive decline.

Results

The incidence of subjective cognitive decline was 38%. Social networks of young-old adults tended to be large, predominantly family-centred and characterised by strong contact strength, high density and significant demographic heterogeneity among network members. Four social network types were identified: diverse-moderate, family-dense, family-strong and friend-loose. Young-old adults embedded in the family-dense and family-strong types were more likely to develop subjective cognitive decline than those in the diverse-moderate type. Additionally, age, education level, previous occupation, daily sleep duration and exercise were related to the incidence of subjective cognitive decline.

Conclusions

The findings highlight the relatively high incidence of subjective cognitive decline in young-old adults that is notably influenced by the type of social network they are embedded in. More attention needs to be paid to identifying and supporting young-old adults at high risk of subjective cognitive decline, especially to promote their social integration and friend network building, to improve their subjective cognitive function.

Implications for the Profession and/or Patient Care

The findings emphasise the importance of considering the structure and composition of social networks when addressing subjective cognitive decline among young-old adults. A diversified social network incorporating both familial and friendship ties may provide enhanced cognitive protection. Therefore, interventions targeting subjective cognitive decline should promote the expansion of friendship-based relationships and foster the development of more heterogeneous and multi-source networks.

Reporting Method

STROBE checklist.

Patient or Public Contribution

Not applicable.

Effect of liposomal bupivacaine combined with bupivacaine hydrochloride for transversus thoracic muscle plane block and pectoral nerves block in modified radical mastectomy for breast cancer: protocol for a randomised controlled trial

Por: Zhou · J. · Zhou · R. · Tang · S.-H. · Chen · Z. · Zhang · J. · Yang · D.
Introduction

The incidence of acute pain subsequent to modified radical mastectomy (MRM) for breast cancer approximates 40%, with more than half of these cases evolving into chronic pain. Currently, the commonly employed analgesic schemes in clinical practice still have inadequacies. Liposomal bupivacaine (LB) is bupivacaine encapsulated in liposomes, and it is reported that its duration of action can extend up to 72 hours. This study will investigate the analgesic efficacy of LB in combination with bupivacaine hydrochloride (BHCl) for transversus thoracic muscle plane (TTP) block and pectoral nerves (PECS) block after MRM for breast cancer.

Methods and analysis

In this prospective, randomised, controlled trial, we will enrol 80 female patients aged 30 to 65 years who are scheduled to undergo MRM under general anaesthesia in combination with nerve block. They will be randomly assigned in a 1:1 ratio to the LB+BHCl group (Group A) and the BHCl group (Group B). All patients will undergo ultrasound-guided TTP+PECS block prior to surgery. The primary outcomes are the cumulative pain visual analogue scale (VAS) scores from 6 to 72 hours post-surgery and the quality of recovery, assessed using the QoR-40 score at 72 hours post-surgery. The secondary outcomes include the time to first analgesic rescue, the consumption of analgesic drugs within 72 hours postoperatively, the occurrence of adverse events and the VAS scores at 6 and 12 months postoperatively.

Ethics and dissemination

Ethical approval was obtained from the Ethics Committee of the Affiliated Hospital of Yangzhou University (2024 Ke Lun Shen (2024-07-01)). All patients will provide written informed consent. The results of this study will be published in a peer-reviewed journal.

Trial registration number

Chinese Clinical Trial Registry (ChiCTR2400089933).

AnteayerTus fuentes RSS

Natural history, clinical outcomes and predictors of disease course in paediatric IgA vasculitis: protocol for a multicentre prospective cohort study in Guangxi Zhuang Autonomous Region, China

Por: Jiang · H.-H. · Meng · X.-Y. · Liang · Q. · Li · R.-J. · Tang · Q. · Huang · L. · Yun · X. · Shan · Q.-W. · Chen · X.-Q.
Introduction IgA vasculitis (IgAV, formerly Henoch-Schönlein purpura) is a systemic small-vessel vasculitis. The aetiology of IgAV is multifactorial, involving environmental triggers in genetically susceptible individuals. Evolving socioeconomic and environmental factors may be altering the contemporary aetiological and precipitant spectrum of IgAV. Prospective observational studies are therefore crucial for elucidating disease management, prognostic factors and long-term outcomes. Although numerous studies exist on paediatric IgAV, prospective cohort data remain limited. This multicentre prospective observational study aims to characterise the natural history, aetiological/precipitant spectrum, incidence and outcomes of gastrointestinal and renal involvement, factors influencing therapeutic efficacy and the predictive value of biomarkers for disease activity.

Methods and analysis

We will recruit 478 paediatric patients with newly diagnosed IgAV across multiple centres. Participants will undergo prospective longitudinal assessment at disease onset and at 1, 3, 6 and 12 months postdiagnosis. Standardised evaluations will include clinical manifestations, physical examinations, laboratory parameters and patient-reported outcomes. The data will be analysed statistically with SPSS software (V.27.0), adopting a significance threshold of p

Ethics and dissemination

This study has been approved by the Medical Ethics Committee of the First Affiliated Hospital of Guangxi Medical University (2024-K0480), the Ethics Committee of the First People’s Hospital of Yulin (YLSY-IRB-SR-2025060), the Medical Research Ethics Committee of the Liuzhou Workers’ Hospital (KY2024356) and the Ethics Committee of the Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region (No. (2025–1)003) and written informed consent was obtained from all the parents or guardians of the patients involved. It will be disseminated by publication of peer-reviewed manuscripts and presentation in abstract form at national and international scientific meetings.

Trial registration number

ChiCTR2500099716.

Causal mediation analysis of a randomised controlled trial in China: evaluating whether the pay-it-forward strategy increases HPV vaccine uptake by reducing vaccine delay intention and increasing vaccine confidence

Por: Lu · Y. · Yang · Y. · Li · Y. · Qin · C. · He · Y. · Gong · W. · Tang · S. · Li · J. · Wu · D.
Objective

To explore whether vaccine confidence and vaccine delay intention mediated the effect of the pay-it-forward intervention on human papillomavirus (HPV) vaccine uptake.

Design

This secondary mediation analysis of a two-arm randomised controlled trial was conducted among female adolescents aged 15–18 years in Chengdu, China, from July 2022 to June 2023.

Setting

This study was conducted in four residential areas representing diverse economic backgrounds in Chengdu.

Participants

A total of 321 parents of girls aged 15–18 years who had not received the HPV vaccine participated in the study.

Intervention

Participants were randomly allocated into two arms. Pay-it-forward participants received a community-contributed subsidy (47.7 USD) to support the HPV vaccination, along with educational postcards and an opportunity to donate to support others. In the standard-of-care arm, participants paid for their vaccination.

Primary and secondary outcome measures

Primary outcome was the receipt of the first HPV vaccine dose within a 3-month period following an intervention. Based on previous literature, we hypothesised that vaccine confidence and vaccine delay intention were potential mediators. Vaccine confidence was measured using the vaccine confidence index. Vaccine delay intention refers to the caregiver’s preference to postpone HPV vaccination for their daughter until the preferred vaccine type becomes available, rather than accepting the immediately accessible HPV vaccine. Data on these mediators were collected via a self-administered online questionnaire conducted after the intervention but before vaccination.

Results

Among urban participants, when compared with the standard-of-care arm, about 39% of the effect of the pay-it-forward intervention on vaccine uptake was mediated by a reduction in vaccine delay intention. Notably, vaccine confidence did not appear to mediate the effect of the intervention on vaccine uptake. Among suburban participants, no mediation effects were observed. In the suburban setting, caregivers who vaccinated their daughters showed poorer prior awareness of the HPV vaccine before participating in the trial compared with those who did not vaccinate their daughters (41.5% vs 21.1%; p=0.011).

Conclusion

Our findings indicate that among urban participants, the pay-it-forward may have effectively reduced vaccine delay intention, which was associated with an increased uptake of the HPV vaccine. However, in suburban areas, enhanced awareness might be a potential contributing factor to improved vaccine uptake, but further research is necessary to affirm this.

Trial registration number

Chinese Clinical Trial Registry: ChiCTR2200055542.

Measurement of subjective cognitive decline and mild cognitive impairment using Brief Elderly Cognitive Screening Inventory in Chinese community older adults: a cross-sectional feasibility study

Por: Wu · Y. · Gao · Y. · Fan · J. · Tang · L. · Yang · B. · Mao · Z.
Background

Subjective cognitive decline (SCD) and mild cognitive impairment (MCI) are high-risk factors for dementia. We developed a cognitive measurement tool for screening SCD and MCI in community-dwelling elderly individuals.

Objective

This study investigated the feasibility of using the Brief Elderly Cognitive Screening Inventory (BECSI) as a screening measure for MCI and SCD in community elderly.

Design

A cross-sectional validation study.

Participants

The study included 1642 community-dwelling older adults aged ≥60 years.

Outcome measures

The Cronbach’s α and split-half coefficients were calculated to test its reliability. The BECSI scores of the normal control group, SCD group and MCI group were compared. The internal consistency analysis, correlation analysis with the neuropsychiatric inventory (NPI) and core neuropsychological test (CNT) were conducted. The screening efficacy of BECSI was verified by receiver operating characteristic curve.

Results

BECSI was a self-report questionnaire. Its Cronbach’s α coefficient and split-half coefficient were respectively 0.923 and 0.888. The correlation coefficients between the total score and individual items ranged from 0.185 to 0.813, and were also significantly correlated with NPI and CNT. Statistically significant differences were observed among the three groups in the total scores. The areas under the curves for distinguishing SCD from normal cognitive and MCI from SCD are 0.835 and 0.889, respectively, with the optimal cut-off points of 12.5 and 16.5.

Conclusion

BECSI is quick and easy to administer, and can be used as a feasible and useful measure for screening SCD and MCI in community-dwelling older adults.

Perceptions of quality of care in oncological outpatient settings: a qualitative study of healthcare professionals

Por: Kittang · J. · Ohlsson Nevo · E. · Schröder · A. · Arnell · S.
Objectives

To explore and describe how healthcare professionals within the oncological outpatient setting perceive quality of care.

Design

A qualitative, descriptive design with a phenomenographic approach was used, with focus group discussions as the means of data collection.

Setting

Primary care in oncological outpatient units in four hospitals in Sweden.

Participants

Through purposive sampling, 20 healthcare professionals entered and completed the study by participating in four focus groups, five participants in each group. Inclusion criteria were assistant nurses, nurses or physicians delivering treatment and care with radiation and/or anticancer drugs in oncological outpatient units. Excluded were healthcare professionals who had worked less than 3 months at the oncological outpatient unit.

Results

Two descriptive categories emerged from the data: ‘The professional’s personal ability for good care’ and ‘The structural conditions for good care’. These categories consist of descriptions of quality of care being perceived as a good meeting with patients, patient participation, continuity, accessibility and care grounded in science.

Conclusions

According to the healthcare professionals, quality of care relies on organisational structures in combination with a professional and personal interaction between the patients and the healthcare professionals. Knowledge about what healthcare professionals believe constitutes quality of care should therefore be highly valuable to policymakers and hospital management.

Randomised, controlled, crossover clinical trial protocol of puerarin for the treatment of metabolic-associated fatty liver disease in China

Por: Cui · Y. · Ren · X. · Song · J. · Shang · Z. · Zhu · W. · Tang · Y. · Chen · B. · Yu · Z. · Gao · Y. · Huang · L.
Background

Although a number of preclinical studies have demonstrated the therapeutic potential of puerarin for metabolic-associated fatty liver disease (MAFLD), there is a lack of high-quality clinical evidence. This study aims to evaluate the safety and efficacy of puerarin in patients with MAFLD in a randomised, controlled, crossover trial.

Methods and analysis

This study will use the randomised, double-blind, placebo-controlled crossover trial design. We plan to enrol 50 patients diagnosed with MAFLD, and they will be randomly assigned in a 1:1 ratio to receive either puerarin or placebo (maltodextrin) after a 2-week adaptation period. Participants in the two groups will receive the daily intervention of puerarin (180 mg/day) and placebo (180 mg/day) for 12 weeks, respectively. After a 4-week washout period, puerarin-treated and placebo-treated participants will cross over to receive the daily intervention of placebo and puerarin for 12 more weeks. The primary outcome measure will be defined as the changes in liver fat content, which will be assessed using MRI-proton density fat fraction before and after 12 weeks of puerarin or placebo supplement in patients with MAFLD. The secondary outcome measures include liver and kidney function changes, lipid metabolism indicators, blood glucose levels, iron metabolism parameters, blood routine, serum high-sensitivity C-reactive protein and anthropometric measurements. Additionally, alterations in gut microbiota composition and metabolic activity will be evaluated using 16S ribosomal RNA gene sequencing and liquid chromatography-mass spectrometry.

Ethics and dissemination

The study protocol has been approved by the ethics committee of Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine (Approval Number 2024-1625-208-01). The findings will be published in international peer-reviewed journals and presented at relevant academic conferences.

Trial registration number

The trial has been registered with the Chinese Clinical Trial Registry (ChiCTR2400094017).

Development and validation of a prediction model for all-cause death in heart failure patients with preserved ejection fraction: a single-centre cohort study in China

Por: Zhu · Y. · Zhao · W. · Liu · Z. · Tan · D. · Tao · L. · He · W. · Jiang · K. · Huang · H. · Wu · M. · Tang · L. · Zeng · J. · Zhou · S.
Objectives

To identify risk factors and develop a predictive model for postdischarge all-cause mortality in patients with heart failure with preserved ejection fraction (HFpEF).

Design

Retrospective cohort study.

Setting

Tertiary care, Xiangtan Central Hospital, Hunan, China.

Participants

9419 patients with HFpEF, diagnosed between May 2014 and January 2023 according to 2021 European Society of Cardiology criteria (N-terminal pro-B-type natriuretic peptide (NT-proBNP) ≥125 pg/mL, left ventricular ejection fraction ≥50%, New York Heart Association (NYHA) class II-IV). Exclusions were age

Primary outcome measures

All-cause mortality within 3 years of hospital discharge.

Results

10 independent predictors were identified: NT-proBNP, albumin, age, NYHA class III-IV, C reactive protein, right atrial end-systolic diameter, haemoglobin, chronic obstructive pulmonary disease, hyponatraemia and prior percutaneous coronary intervention. The prediction model demonstrated good discrimination, an area under the receiver operating characteristic curve of 0.756 (95% CI 0.743 to 0.769) in the training cohort and 0.764 in the validation cohort. Based on calculated risk scores, patients were classified into low-risk (≤200.36), medium-risk (200.37–232.24) and high-risk (≥232.25) groups, corresponding to 3-year mortality rates of 12.6%, 40.8% and 68.0%, respectively.

Conclusions

A simple clinical model using routinely available parameters enables effective 3-year mortality risk stratification in HFpEF patients after discharge. External validation is needed to confirm its generalisability.

Trial registration number

NCT06487468.

Cost and cost-effectiveness analysis of point-of-care ultrasound (POCUS) in obstetrics: a systematic review protocol

Por: Li · Y. · Jia · Z. · Zhang · R. · Zhuge · J. · Shi · W. · Xiao · R. · Wang · Z. · Tang · K.
Introduction

Facing the profound health impacts and economic challenges posed by the high maternal mortality ratio worldwide, point-of-care ultrasound (POCUS) has shown its potential to enhance diagnostic efficiency, reduce healthcare costs and improve health outcomes. However, concerns regarding the explicit and implicit costs as well as actual clinical outcomes of POCUS also exist. This systematic review protocol aims to synthesise existing evidence regarding the costs and cost-effectiveness of POCUS in obstetric care to provide a clearer understanding of its economic and clinical impact, ultimately guaranteeing global maternal and neonatal health and supporting the vision of the 2030 sustainable development goals.

Methods and analysis

This systematic review has been registered in Prospective Register of Systematic Reviews (PROSPERO; CRD42024572715) and follows the Joanna Briggs Institute Manual for Evidence Synthesis and Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. A comprehensive search was conducted across eight international and Chinese databases, as well as five specialised health economics retrieval databases. Eligible studies include formal economic evaluations and cost-related analyses of POCUS in obstetrics, selected using the ‘Participants, Intervention, Comparison, Outcome and Study Design framework. The quality of included studies will be assessed using the Consensus Health Economic Criteria list, while data extraction will follow a standardised form based on the National Health Service Economic Evaluation Database Handbook. Narrative synthesis will be applied to summarise economic and clinical data, and, where appropriate, meta-analysis will be conducted for clinical outcomes. Heterogeneity will be assessed using Cochran’s Q test and Higgins’ I² statistic, and subgroup and meta-regression analyses will be used to explore the effect modification. All analyses will be conducted using Stata V.18.0, and a two-tailed p value of less than 0.05 will be considered statistically significant.

Ethics and dissemination

Since this systematic review will exclusively use published and publicly available data, ethical approval is not required. The findings from this study will be published in peer-reviewed journals or presented at academic conferences.

PROSPERO registration number

CRD42024572715.

Peritraumatic distress and its relationship to appliance-related orthodontic emergencies in orthodontic patients during the COVID-19 lockdown in Shanghai, China: a cross-sectional study

Por: Yang · L. · Zhang · J. · Choi · Y. · Zhang · S. · Li · W. · Liu · K. · Tang · P. · Wu · J. · Yang · X.
Objectives

The primary objective was to determine peritraumatic distress among orthodontic patients during the COVID-19 lockdown. And the secondary objective was to determine the relationship between peritraumatic distress in relation to different appliance types.

Design

Cross-sectional study.

Setting

Primary hospital between May and June 2022.

Participants

Patients in the process of orthodontic treatment, able to read Mandarin online, provided informed consent for the use of the data recorded and completed the questionnaire within a reasonable time.

Interventions

None.

Primary and secondary outcome measures

The demographic information and orthodontic urgencies were collected using online questionnaires. The peritraumatic distress symptoms were assessed by the COVID-19 Peritraumatic Distress Index (CPDI). The temporomandibular joint (TMJ) pain was evaluated using a Visual Analogue Scale.

Results

A total of 480 participants were enrolled, including 331 with fixed appliances, 131 with clear aligners and 18 with removable appliances. For all participants, the median CPDI score was 12 (4, 19). Higher CPDI scores were observed in participants with urgency (14 (6, 21) vs 8 (2, 15), p18 years (β=0.271, p

Conclusions

The study suggested that during catastrophic events such as the COVID-19 lockdown, orthodontic urgencies may exacerbate patients’ peritraumatic distress, especially among adult patients and those who suffer from TMJ pain.

Trajectories and Co‐Occurrence of Perceived Control in Patients With Heart Failure and Self‐Efficacy in Their Caregivers: A Three‐Month Longitudinal Study of Dual Trajectories

ABSTRACT

Aim

This study aims to explore the trajectories and co-occurrence of perceived control and caregiver self-efficacy among patients with heart failure (HF) and their caregivers within 3 months post-discharge and identify associated risk factors.

Design

A prospective cohort design.

Methods

A prospective cohort study was conducted from March to June 2024 in Tianjin, China. Information on perceived control and caregiver self-efficacy was collected 24 h before discharge, 2 weeks, 1 month, and 3 months after discharge. Group-Based Dual Trajectory Modelling (GBDTM) and logistic regression were used for analysis.

Results

The study included 203 dyads of patients with HF and their caregivers (HF dyads). Perceived control identified three trajectories: low curve (15.3%), middle curve (57.1%) and high curve (27.6%). Caregiver self-efficacy demonstrated three trajectories: low curve (17.2%), middle curve (56.7%) and high stable (26.1%). GBDTM revealed nine co-occurrence patterns, with the highest proportion (36.7%) being ‘middle-curve group for perceived control and middle-curve group for caregiver self-efficacy’, and 16.7% being ‘high-curve group for perceived control and high-stable group for caregiver self-efficacy’. Age, gender, household income, NYHA class, symptom burden and psychological resilience were identified as risk factors for perceived control trajectories; marital status, regular exercise and psychological resilience were identified as risk factors for caregiver self-efficacy trajectories.

Conclusion

We identified distinct trajectories, co-occurrence patterns and risk factors of perceived control and caregiver self-efficacy among HF dyads. These findings help clinical nurses to better design and implement interventions, strengthening the comprehensive management and care outcomes for HF dyads.

Impact

These findings highlighted the interactive relationship between perceived control and caregiver self-efficacy trajectories, suggesting that interventions should boost both to improve personalised treatment plans and outcomes for HF dyads.

Reporting Method

This study adhered to the STROBE checklist.

Patient or Public Contribution

Patients and their caregivers contributed by participating in the study and completing the questionnaire.

Rationale and design of SCOPE trial: a prospective, multicentre, open-label, randomised controlled trial to evaluate the overall efficacy and safety of a short-term anticoagulation strategy versus conventional single antiplatelet therapy in patients with

Por: Yan · Y. · Li · Y. · Liu · R. · Zhang · L. · Liu · X. · Yuan · F. · Jiang · Z. · Luo · T. · Lu · Z. · Wang · Y. · Zhu · Y. · Tang · Y.-D. · Zhang · H. · Wu · W. · Li · Y. · Guo · L. · Pocock · S. · Song · G. · Investigators · S.
Introduction

While transcatheter aortic valve replacement (TAVR) has become a well-established standard of care for patients with symptomatic severe aortic stenosis, the optimal antithrombotic strategy post-TAVR remains a subject of debate, particularly in patients without clear indications for anticoagulation or dual antiplatelet therapy. This study aims to investigate the safety and efficacy of rivaroxaban compared with antiplatelet monotherapy in this specific patient population.

Methods and analysis

This study is designed as a prospective, multicentre, open-label, randomised controlled trial. A total of 454 patients, who have successfully undergone TAVR and do not have indications for long-term anticoagulation or dual antiplatelet therapy, will be consecutively enrolled from seven centres across China. Participants will be randomly assigned to receive either anticoagulation with rivaroxaban (20/15 mg) or conventional antiplatelet therapy (aspirin or clopidogrel) for 1 month. Follow-up evaluations are scheduled at 1, 3, 6 and 12 months post-procedure. After the initial 1-month antithrombotic therapy, the regimen may be adjusted by the investigator based on the patient’s clinical and imaging follow-up results. The primary endpoint is a hierarchical composite of cardiovascular death, first occurrence of myocardial infarction or stroke, first occurrence of life-threatening, disabling or major bleeding, and grade 3 or higher hypo-attenuated leaflet thickening and reduced leaflet motion at 12 months post-TAVR. The win ratio method will be employed to analyse the primary endpoint.

Ethics and dissemination

This trial was approved by the Ethics Committee of the Beijing AnZhen Hospital. All relevant results will be disseminated through publications in peer-reviewed journals and presentations at conferences.

Trial registration number

ChiCTR2400087453.

Impact of Charlson Comorbidity Index on clinical outcomes of patients with non-ST segment elevation acute coronary syndrome: a propensity score matching method

Por: He · R. · Zhou · Q. · Gu · M. · Tang · W.
Objective

Patients with non-ST segment elevation acute coronary syndrome (NSTEACS) admitted into emergency department are usually combined with a high number of comorbidities. Charlson Comorbidity Index (CCI) is the most commonly used measure to assess comorbidity in clinical practice. However, the impact of CCI on the clinical outcomes of patients with NSTEACS are still unclear.

Design

A multicenter retrospective cohort study.

Setting

We used data from the Chongqing Medical University Medical Data Science Academy in Chongqing, China, which contains data from seven tertiary hospitals.

Participants

Data from 3308 consecutive patients aged over 18 diagnosed with NSTEACS admitted to emergency departments of seven hospitals from August 2012 to March 2023 were retrospectively analysed.

Methods

Patients were divided into two groups based on CCI: CCI

Primary and secondary outcome measures

In-hospital mortality rate, major adverse cardiovascular events (MACEs), length of stay and readmission rate.

Results

876 and 2432 patients belonged to the high CCI group (CCI ≥3) and the low CCI group (CCI 0.05). In patients with high CCI, in-hospital mortality, the incidence of MACEs, length of stay (LOS) and readmission rate were significantly higher compared with those with low CCI. Univariate analysis revealed that a higher CCI was associated with an increased incidence of MACEs, prolonged LOS and a higher readmission rate. Multivariate analysis demonstrated that even after adjusting for various confounding factors, a higher CCI remained an independent risk factor for an increased incidence of MACEs, prolonged LOS and higher readmission rate.

Conclusion

A high CCI not only increases the risk of in-hospital MACEs but also prolongs the length of stay and increases the readmission rate. We recommend that the CCI be used as a crucial risk indicator for clinical practitioners to identify and manage patients with a poor prognosis.

Euglycaemic diabetic ketoacidosis and its risk factors in patients undergoing coronary artery bypass grafting surgery: a single-centre nested case-control study in China

Por: Hu · R. · Lu · C. · Liu · Y. · Yang · M. · Xing · H. · Dai · K. · Li · J. · Zheng · H. · Chen · X. · Tang · N.-J.
Objectives

This study examines the incidence and risk factors of euglycaemic diabetic ketoacidosis (euDKA) in patients undergoing coronary artery bypass grafting (CABG) and evaluates their postoperative outcomes over a 6-month follow-up period.

Design

This study is a single-centre, nested case-control study, conducted in Tianjin, China.

Setting

An international cardiovascular hospital.

Participants

A total of 1524 patients, with a mean age of 64 (9) years, who underwent isolated elective CABG surgery were reviewed.

Primary and secondary outcome measures

Data were extracted from electronic medical records. EuDKA cases were identified by reviewing laboratory examination results until discharge, including arterial blood gas analysis and urine samples. Logistic regression analysis was used in a case-control design to identify potential risk factors of sodium-glucose cotransporter 2 inhibitor (SGLT2i)-associated euDKA. Post-discharge follow-up was conducted through regular outpatient visits.

Results

15 patients with euDKA, all with type 2 diabetes, were identified post-surgery, 13 of whom were SGLT2i users. The cumulative incidence of euDKA within 7 days after surgery was 1% in the cohort, increasing to 7.6% among those who discontinued SGLT2i 1–6 days (n=171) before surgery. A case-control study added seven additional confirmed euDKA patients to the case group, resulting in 20 cases and 95 controls. Univariate regression analysis revealed that the risk of euDKA was 7.304 times higher (95% CI 2.517 to 21.197; p–1 (OR: 6.882, 95% CI 1.822 to 25.997; p=0.004) were associated with a higher risk of euDKA. Compared with controls, euDKA patients experienced a higher rate of type 5 myocardial infarction (6/20 (30%) vs 9/95 (9.5%); p=0.035) and recurrent ketosis post-discharge (3/19 (15.8%) vs 0/87 (0%); p=0.005).

Conclusions

This cohort study highlights a notable incidence of euDKA following CABG, particularly among patients using SGLT2i. Close monitoring in the ICU is recommended for patients with intraoperative abnormal blood glucose and pH levels to prevent euDKA.

Pay-it-forward and social network distribution to increase doxycycline post-exposure prophylaxis uptake among men who have sex with men and transgender women in China: study protocol for a three-arm randomised controlled trial

Por: Zhao · P. · Xu · W. · Tucker · J. D. · Tang · W. · Weideman · A. M. · Enders · K. · Liang · P. · Huang · S. · Fitzpatrick · T. · Wang · C.
Introduction

Doxycycline postexposure prophylaxis (doxy-PEP) can prevent sexually transmitted infections (STIs) among men who have sex with men (MSM) and transgender women (TGW). STI rates are high among MSM and TGW in China, and implementation strategies are needed to optimise doxy-PEP services. Pay-it-forward and social network distribution approaches may increase uptake of STI services and could increase the uptake of doxy-PEP. We present the protocol for a randomised controlled trial evaluating the effectiveness of pay-it-forward strategies with and without adjunctive social network distribution among MSM and TGW in China.

Methods and analysis

A total of 399 MSM and TGW will be recruited at seven sites in China and randomly allocated in a 1:1:1 ratio to (1) self-pay, (2) pay-it-forward alone or (3) pay-it-forward with adjunctive social network distribution of doxy-PEP. Participants assigned to the self-pay arm can purchase a doxy-PEP packet out-of-pocket. Participants in the pay-it-forward arm will be offered a free doxy-PEP packet and the opportunity to donate to support doxy-PEP for future participants. Participants in the pay-it-forward arm with social network distribution will receive the pay-it-forward intervention as well as additional free doxy-PEP packets to distribute to peers. Those randomised to the self-pay and the pay-it-forward with social network distribution arms (ie, index participants) will receive and distribute referral cards to recruit additional peers (ie, alter participants). Alter participants recruited through the control arm will be referred to the clinic to purchase doxy-PEP. Alter participants recruited through the pay-it-forward with adjunctive social network distribution arm will receive doxy-PEP directly from referring index participants. Both index and alter participants in each arm will be asked to complete a follow-up survey 3 and 6 months after enrolment. The primary outcome will be the proportion of participants who report using doxy-PEP within 72-hours of condomless anal or oral sex on one or more occasions during follow-up.

Ethics and dissemination

Ethical approval was obtained from the ethics review committee of the Dermatology Hospital of Southern Medical University (Approval number: 2023109). The findings will be disseminated in peer-reviewed publications.

Trial registration number

The study has been registered with the Chinese Clinical Trial Registry (trial ID ChiCTR2300074903). Date of registration: 18 August 2023.

Developing and validating a prognostic model to predict ICU mortality in patients with sepsis-associated thrombocytopenia: a retrospective cohort study based on MIMIC-IV

Por: Ye · W. · Li · Y. · Zhang · M. · Liu · S. · Li · P. · Tang · X. · Li · J.
Objective

Given the high morbidity and mortality of patients with sepsis-associated thrombocytopenia (SATP) in the intensive care unit, this study retrospectively analysed the influencing factors for poor prognosis in patients with SATP using the MIMIC database, constructed a nomogram model and verified the predictive performance of the model.

Design

A retrospective cohort study.

Setting

The data from MIMIC-IV, V.2.2.

Clinical characteristics

The clinical features of SATP, including demographics, comorbidities, vital signs, laboratory parameters, treatments and clinical management, were extracted from the MIMIC-IV database.

Methods

1409 patients with SATP were included in this study and randomly divided into a training set and a validation set in a ratio of 7:3. The least absolute shrinkage and selection operator and multivariable Cox regression analysis were used to determine the optimal predictors and establish a prediction model. The receiver operating characteristic curve, calibration curve and decision curve analysis (DCA) were used to verify the accuracy and application value of the model.

Results

The nomogram model incorporates nine factors, including clinical characteristics, laboratory test indicators, comorbidities and treatment methods, which were identified as predictors of SATP and used to construct the model. The area under the curve of the model was 0.868 (95% CI: 0.794 to 0.942) in the training set and 0.836 (95% CI: 0.681 to 0.991) in the validation set. The calibration curve and DCA confirmed the clinical application value of the nomogram.

Conclusions

The constructed nomogram for predicting patients with SATP has favourable predictive ability and is helpful to further optimise clinical management strategies.

Anxiety and Depression Symptoms of Adolescents With Non‐Suicidal Self‐Injury: A Network Analysis Study

ABSTRACT

Aims

To explore the complex relationships among non-suicidal self-injury, depression and anxiety symptoms in adolescents, identify key symptoms and provide a theoretical foundation for targeted interventions.

Design

A cross-sectional study.

Methods

In total, 1126 adolescents from a tertiary hospital in Shandong Province were assessed using the Adolescent Self-Injury Questionnaire, Patient Health Questionnaire and Generalised Anxiety Disorder Scale. Network analysis was employed to construct symptom networks and identify central and bridging symptoms.

Results

The network analysis revealed that nodes GAD5 (Restlessness), GAD2 (Uncontrollable worry), and GAD4 (Trouble relaxing) exhibited the highest centrality indices, establishing them as core symptoms within the overall symptom network. The highest bridge intensity nodes were GAD1 (Nervousness), GAD5 (Restlessness) and non-suicidal self-injury.

Conclusion

By accurately identifying core and bridging symptoms, a scientific foundation is provided for developing precise and effective symptom management plans.

Impact

The study identified the most influential nodes in anxiety and depression among adolescents with non-suicidal self-injury. The findings would help in carrying out personalised and precise interventions to reduce non-suicidal self-injury occurrence and alleviate anxiety and depression symptoms among adolescents.

Reporting Method

This study adheres to the STROBE guideline of reporting.

Patient or Public Contribution

This study did not include patient or public involvement in its design, conduct or reporting.

Ignite the Parent–Child Bond: A Qualitative Exploration of Perspective and Need About Family Functioning Among Patients With Advanced Cancer and Their Adolescent Children

ABSTRACT

Background

Advanced cancer not only affects the physical, psychological, and social functions of patients, but it also impacts their adolescent children. There is a dearth of information regarding the understanding of family functioning and specific needs of patients with advanced cancer and their adolescent children.

Purpose

This qualitative study aimed to explore the experience and needs regarding family functioning of patients with advanced cancer and their adolescent children, as well as understanding potential approaches for maintaining positive family functioning.

Design

A descriptive qualitative study was employed.

Settings and Participants

This study was conducted at three tertiary hospitals in Changsha, China, from January to September 2023. Purposive sampling was adopted to recruit participants. 17 stage III and IV patients with cancer and 11 adolescent children were interviewed.

Methods

Face-to-face individual interviews were conducted among patients with advanced cancer and their adolescent children. The data analysis employed Braun and Clarke's thematic analysis method. The McMaster family functional model theoretical framework was utilised to facilitate the identification and organisation of topics, ensuring a comprehensive analysis of the data.

Findings

Six themes were identified: communication challenges; impaired family role functioning; positive/negative feelings; over-involvement; change of behaviour control pattern; Needs for medical and psychological support. Both patients with advanced cancer and their adolescent children expressed collective views and needs regarding family functioning.

Conclusions

The findings of this study reveal an understanding of family functioning and needs among patients with advanced cancer and their adolescent children. The identified themes provide valuable insights for designing and implementing targeted intervention strategies.

Clinical Relevance

Nursing interventions should focus on helping patients with advanced cancer and their adolescent children improve family functioning and communication skills. The findings indicate that communication challenges are a significant aspect of impaired family functioning, necessitating targeted interventions to enhance communication. Healthcare providers should be trained to recognise the diverse communication needs of families, which include providing resources for age-appropriate communication, counselling, and guidance on maintaining family routines. Enhancing the communication skills of patients and their children is crucial for addressing problem-solving needs and mitigating negative feelings, thereby fostering a more supportive family environment.

Study protocol for a multi-centre randomised controlled trial of the Thai early intervention for autism: Assistive Technology for Caregivers (TEI4A-ATC) across nine hospitals in health region 1, northern Thailand

Por: Tangviriyapaiboon · D. · Sirithongthaworn · S. · Thaineua · V. · Kanshana · S. · Sriminipun · A. · Lersilp · S. · Panyo · K. · Changsom · K. · Panyaphab · M. · Srikummoon · P. · Thumronglaohapun · S. · Sricharoen · N. · Traisathit · P.
Introduction

The management of autism spectrum disorder (ASD) involves a varied and comprehensive range of support services at various stages of an autistic individual’s life. In Thailand, parents/legal guardians of children with ASD often encounter challenges such as difficulty travelling from rural areas to access support services. The aim of the present study is to investigate the effectiveness of a computer-based intervention programme for caregivers of children with ASD called the Thai Early Intervention for Autism—Assistive Technology for Caregivers (TEI4A-ATC), designed and implemented by a multidisciplinary team.

Method and analysis

160 children and their caregivers are being recruited. They will be randomised 1:1 into two treatment arms: access to TEI4A-ATC for the intervention group and standard care for the control group. Before enrolment, ASD diagnosis will be conducted using the Thai Diagnostic Autism Scale: children’s ASD scores will be determined using the Thai Autism Treatment Evaluation Checklist for evaluating communication, sociability and sensory/cognitive awareness and the Thai Early Developmental Assessment for Intervention for evaluating motor skills, social interaction, language development and problem-solving. Both assessment tools will be used again after 3 months of treatment. Similarly, the caregivers’ knowledge, attitude and practice (KAP) for ASD care will be assessed using a questionnaire at enrolment and again after treatment. Comparison of the children’s ASD scores and caregivers’ KAP responses between the treatment groups and before and after treatment will be performed based on the intention-to-treat principle.

Ethics and dissemination

This study was approved by the Human Research Ethics Committee for Mental Health and Psychiatry, Department of Mental Health, Ministry of Public Health (DMH.IRB.COA 037/2565). Written informed consent will be obtained from the participants prior to enrolment. The study’s findings may be disseminated through scientific publications and conference presentations. The results of the study will be shared with key stakeholders, including caregivers, psychiatrists, policymakers and the general public, via appropriate dissemination channels to aid in creating appropriate practice and policy guidelines.

Trial registration number

This study was registered with the Thai Clinical Trials Registry (TCTR20240320010) on 20 March 2024.

❌