Conectar
by Lin Chen, Jiayao Chen, Jindong Wan, Muqing Shao, Caiyu Chen, Shuo Zheng, Fuwei Zhang, Jian Yang
The angiotensin converting enzyme 2/angiotensin-(1–7)/Mas receptor axis plays an important role in the regulation of blood pressure. G protein-coupled receptor kinase 4 (GRK4) has attracted more attentions by modulating G protein-coupled receptors and blood pressure. However, it remains unknown whether renal Mas receptor is regulated by GRK4 and its role in the pathogenesis of hypertension. Compared with Wistar-Kyoto (WKY) rats, spontaneously hypertensive rats (SHRs) exhibited impaired Mas receptor-mediated diuresis and natriuresis, which was accompanied with increased phosphorylation levels of Mas receptors. Similarly, the phosphorylation of renal Mas receptor was increased and its-induced renal effects were decreased in human (h) GRK4γ 142V transgenic mice relative to wild-type littermates. There was a colocalization and a direct interaction of renal Mas receptor and GRK4, which were increased in SHRs and confirmed by rigid protein–protein docking. In vitro studies found that treatment with the Mas receptor agonist AVE0991 inhibited Na+-K+-ATPase activity in WKY renal proximal tubule (RPT) cells, which was failed in SHR cells. GRK4 silencing decreased the phosphorylation of Mas receptor and improved the impaired Mas receptor-mediated inhibition of Na+-K+-ATPase activity in SHR RPT cells. Further study showed that ultrasound-targeted microbubble destruction-targeted renal GRK4 depletion decreased Mas receptor phosphorylation and improved its-induced diuresis and natriuresis in SHRs. These suggest that GRK4 contributes to increased renal Mas receptor phosphorylation and dysfunction in hypertension, indicating that targeting GRK4 may be a viable therapeutic approach for hypertension.In December 2022, a large population infected with COVID-19 emerged in China, including frontline nurses. To maintain the medical system's function, many infected nurses returned to work before full recovery. This study aims to examine the characteristics of work resumption behaviour among the infected nurses and its influencing factors.
A nationwide cross-sectional study utilising questionnaire data.
An indicator was developed to assess the work resumption behaviour: work resumption type (autonomous work resumption, constrained work resumption). As the possible influencing factors of work resumption type, professional commitment, organisational commitment and psychological capital were included and measured by the Professional Commitment Scale (PCS), Organizational Commitment Questionnaire (OCQ), and Psychological Capital Questionnaire (PCQ). The logistic regression models were applied to estimate the association between the score of the PCS, OCQ, PCQ, and work resumption type.
A total of 30,062 nurses were included. The mean time of nurses returning to work after infection was 1.8 days, with 88.6% exhibiting autonomous work resumption behaviour. One standard deviation increment in the score of the PCS, OCQ, and PCQ was associated with a 41% (OR = 1.41), 29% (OR = 1.29) and 42% (OR = 1.42) average increase in the odds of having an autonomous work resumption, respectively.
The majority of nurses returned to work before full recovery during the pandemic. Elevated professional commitment, organisational commitment and psychological capital were associated with autonomous work resumption behaviour.
The large-scale work resumption in this emerging infectious disease outbreak demonstrated that the healthcare system should reevaluate nursing workforce growth targets for pandemics. It is still warranted for future research to explore the long-term effects of work resumption on individual and organisational levels.
Chinese clinical trial registry: ChiCTR2300067706 (January 8, 2023)
This study aims to compare the effectiveness of the case management model and the primary nursing care model by focusing on hospital stay length, readmission, follow-up resource utilisation and survival.
To improve patient continuity of care, a discharge planning team has been established at the hospital to implement the service concept of long-term medical care. The team works with a multidisciplinary medical team to provide case management, which ensures high-quality patient care.
Retrospective case–control study.
This study collected data from the medical record information system database and the Ministry of Health and Welfare's care service management information system to explore medical and follow-up care utilisation of patients discharged between 2017 and 2018. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines, with the checklist used to ensure transparent and complete reporting of the methodology and results.
To ensure comparability between the case management model group and the primary nursing model group, propensity score matching was used. After matching, 660 individuals from the case management model group and 2876 individuals from the primary nursing model group were selected for further analysis. In this study, patients were primarily involved in the research as participants, providing data through their medical records for analysis. However, no direct involvement from the public or patients was used in the planning or design stages of the research.
The study found that factors such as activities of daily living (ADL) score ≤ 60 points, catheterisation, poor chronic disease control and inadequate primary caregiver capacity can lead to longer hospitalisations. Males and patients with catheters have a higher risk of readmission within 30 days, and men, those aged ≥ 75 years, those with ADL score ≤ 60, catheterisation, pressure sores or unclean wounds, financial problems, insufficient primary caregiver capacity and those readmitted within 14 days after discharge had significantly increased mortality after discharge. Although the case management model group had higher hospitalisation days, they had lower readmission rates and higher survival rates than the primary nursing model group.
Early consultation with the case manager for discharge planning can help patients to continue to receive care and utilise relevant resources after returning home.
Identifying and addressing patient-specific factors can significantly improve patient outcomes by reducing hospitalizations and readmissions, and lowering mortality rates. The case management model is more effective than the primary nursing care model in reducing readmission rates and increasing survival rates. Early consultation with case managers for discharge planning is crucial to ensuring patient care continuity and resource utilization.
In China, caregiving for cancer patients is primarily the responsibility of family members. This role often exposes family caregivers to the contemplation of mortality. Death anxiety among family caregivers may influence the care they offer to cancer patients.
This study aims to evaluate the prevailing level of death anxiety among Chinese family caregivers of cancer patients and identify its influencing factors.
This cross-sectional study followed the STROBE statement.
A total of 220 family caregivers of cancer patients were recruited from a prominent tertiary hospital in southern China. The survey included a general information questionnaire, the Collett–Lester Fear of Death Scale, the Social Support Rating Scale and the Simple Coping Style Questionnaire. In addition to descriptive statistics, ANOVA, mean differences, correlations and regression analyses were computed.
The average score for death anxiety among family caregivers of cancer patients was 104.27 ± 21.02. Death anxiety was negatively correlated with a positive coping style and social support. Multiple linear regression analysis revealed that marital status, death education, patients' fear of death and coping style accounted for 41.0% of the variance in death anxiety among family caregivers.
Family caregivers of cancer patients experienced a moderate level of death anxiety. Individuals who were unmarried or divorced, lacked death education, had negative coping styles or cared for patients with fear of death tended to have high levels of death anxiety.
Healthcare providers should act as credible educators to reduce caregivers' death anxiety by imparting positive coping styles and accurate knowledge and values about death so caregivers can provide high-quality care to patients.
To develop a predictive model for high-burnout of nurses.
A cross-sectional study.
This study was conducted using an online survey. Data were collected by the Chinese Maslach Burnout Inventory-General Survey (CMBI-GS) and self-administered questionnaires that included demographic, behavioural, health-related, and occupational variables. Participants were randomly divided into a development set and a validation set. In the development set, multivariate logistic regression analysis was conducted to identify factors associated with high-burnout risk, and a nomogram was constructed based on significant contributing factors. The discrimination, calibration, and clinical practicability of the nomogram were evaluated in both the development and validation sets using receiver operating characteristic (ROC) curve analysis, Hosmer–Lemeshow test, and decision curve analysis, respectively. Data analysis was performed using Stata 16.0 software.
A total of 2750 nurses from 23 provinces of mainland China responded, with 1925 participants (70%) in a development set and 825 participants (30%) in a validation set. Workplace violence, shift work, working time per week, depression, stress, self-reported health, and drinking were significant contributors to high-burnout risk and a nomogram was developed using these factors. The ROC curve analysis demonstrated that the area under the curve of the model was 0.808 in the development set and 0.790 in the validation set. The nomogram demonstrated a high net benefit in the clinical decision curve in both sets.
This study has developed and validated a predictive nomogram for identifying high-burnout in nurses.
The nomogram conducted by our study will assist nursing managers in identifying at-high-risk nurses and understanding related factors, helping them implement interventions early and purposefully.
The study adhered to the relevant EQUATOR reporting guidelines: TRIPOD Checklist for Prediction Model Development and Validation.
No patient or public contribution.
The triglyceride glucose (TyG) index has been confirmed a predictive value for type 2 diabetes mellitus (T2DM). However, no research has yet confirmed whether there is a linear correlation between the TyG index and MACCEs in DFUs. The present study aimed to delve into the association between the TyG index and the risk of MACCEs in patients with DFUs. A total of 960 inpatients with DFUs were recruited. All participants were followed up every 6 months for 11 years with a median of 83 months. According to the cut-off value of the TyG index acquired from receiver operating characteristic (ROC) analysis, the subjects were divided into two groups: low-level (<9.12, n = 480) and high-level (≥9.12, n = 480). The relationship between the TyG index and MACCEs was evaluated by the multivariable Cox regression model, restricted cubic spline (RCS) model, stratified analysis and the Kaplan–Meier survival analysis. Out of 960 participants, 271 experienced MACCEs (28.22%), of whom 79 (29.15%) died. ROC analysis got the optimal TyG index cut-off value of 9.12. Multivariable Cox regression analysis combined with the RCS model showed that the TyG index was positively associated with MACCEs in an S-shaped non-linear dose-dependent manner within the range of TyG index 7.5–9.5 (p < 0.001). The Kaplan–Meier survival analysis indicated the higher the TyG index, the greater the cumulative incidence of MACCEs (log-rank, p < 0.001). The study first confirmed an S-shaped non-linear dose-dependent positive relationship between the TyG index and the risk of MACCEs in DFUs. Consequently, lowering the TyG index level aids in improving the prognosis of patients with DFUs.
To systematically evaluate the efficacy of auricular acupressure on lung function, sleep quality and quality of life in chronic obstructive pulmonary disease patients.
Auricular acupressure has been increasingly used in chronic obstructive pulmonary disease patients, such as lung function and sleep quality, but the efficacy has not yet been unified.
A meta-analysis of randomised controlled trials.
Randomised controlled trials comparing auricular acupressure intervention with non-auricular acupressure intervention in chronic obstructive pulmonary disease patients were included. We searched English databases and Chinese databases from the inception to 26 December 2022. The risk of bias was assessed by the Cochrane risk of bias tool. The PRISMA statement was used to report a meta-analysis.
A total of 12 randomised controlled trials with 987 chronic obstructive pulmonary disease patients were included. The meta-analysis showed that auricular acupressure had significant differences in improving lung function, including FEV1 (MD = 0.29, 95% CI: 0.21 to 0.37, p < .0001), FVC (MD = 0.24, 95% CI: 0.14 to 0.34, p < .0001) and FEV1/FVC (MD = 4.70, 95% CI: 3.63 to 5.78, p < .0001). There was also a positive effect on sleep quality (MD = −0.71, 95% CI: −0.89 to −0.53, p < .0001) and quality of life (MD = −3.20, 95% CI: −3.92 to −2.49, p < .0001).
The results indicated auricular acupressure had a positive efficacy in chronic obstructive pulmonary disease patients to improve lung function, sleep quality and quality of life, but these results should be treated with caution due to the low quality of included studies. Future researchers need to conduct more high-quality randomised controlled trials to provide a solid basis to demonstrate the efficacy of auricular acupressure in chronic obstructive pulmonary disease patients.
Auricular acupressure has the advantages of being non-invasive, convenient and without significant side effects. This review suggested auricular acupressure could be considered a non-pharmacological intervention for patients. Clinical nurses can teach chronic obstructive pulmonary disease patients to perform auricular acupressure to help self-manage complications.
No Patient or Public Contribution.
In a meta-analysis, we assessed the impact of different surgical approaches on the outcome of hepatectomy with hepatocellular carcinoma. Four databases, including PubMed, Embase, Cochrane Library, and the Web of Science, have been critically reviewed through the full literature through June 2023. Eleven related trials were examined once they had met the trial's classification and exclusion criteria, as well as the assessment of the quality. A random effects approach was applied to analysis of operative organ infections, and a fixed-effect model was applied to determine the 95% CI and OR. Analysis of the data was done with RevMan 5.3. Our findings indicated that patients undergoing minimally invasive liver cancer surgery had significantly lower risks of surgical organ infection (OR, 0.35; 95% CI, 0.16–0.77; p = 0.009) and wound infection (OR, 0.19; 95% CI, 0.13–0.28; p < 0.001) compared to those undergoing open surgery. There was no heterogeneity observed between the two groups (I 2 = 0) in wound infection. Nevertheless, because of the limited number of randomised controlled trials in this meta-analysis, care should be taken and carefully considered in the treatment of these values. Further high-quality studies involving a large number of samples are needed to validate and reinforce the results.
We examined whether small incision aortic root replacement could reduce the amount of blood transfusion during operation and the risk of postoperative complications. An extensive e-review of the 4 main databases (PubMed, Cochrane, Web of Science and EMBASE) was carried out to determine all the published trials by July 2023. The search terms used were associated with partial versus full sternotomy and aortic root. This analysis only included the study articles that compared partial and full sternotomy. After excluding articles based on titles or abstracts, selected full-text articles had reference lists searched for any potential further articles. We analysed a total of 2167 subjects from 10 comparable trials. The minimally invasive aortic root graft in breastbone decreased the duration of hospitalization (MD, −2.58; 95% CI, −3.15, −2.01, p < 0.0001) and intraoperative red blood cell transfusion (MD, −1.27; 95% CI, −2.34, −0.19, p = 0.02). However, there were no significant differences in wound infection (OR, 0.88; 95% CI, 0.16, 4.93, p = 0.88), re-exploration for bleeding (OR, 0.96; 95% CI, 0.60, 1.53, p = 0.86), intraoperative blood loss (MD, −259.19; 95% CI, −615.11, 96.73, p = 0.15) and operative time (MD, −7.39; 95% CI, −19.10, 4.32, p = 0.22); the results showed that the microsternotomy did not differ significantly from that of the routine approach. Small sternotomy may be an effective and safe substitute for the treatment of the aorta root. Nevertheless, the wide variety of data indicates that larger, well-designed studies are required to back up the current limited literature evidence showing a benefit in terms of complications like postoperative wound infections or the volume of intraoperative red blood cell transfusion.
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