bluuebunny/crossref_metadata_2025 huggingface dataset:
Prognostic value of pretreatment plasma fibrinogen in patients with colorectal cancer
Authors: Li Menglei , Wu Yang , Zhang Jiwang , Huang Lijun , Wu Xianlan , Yuan Yongqiang
Published: September 2019

Background:

Growing evidence showed that high pretreatment plasma fibrinogen could be used as a potential prognostic marker in colorectal cancer (CRC). However, the conclusions were controversial. Therefore, this meta-analysis was conducted to evaluate the prognostic value of pretreatment plasma fibrinogen in patients with CRC.

Methods:

Relevant studies were searched in the databases including PubMed, EMBASE, Web of Science, Cochrane library, and China National Knowledge Infrastructure up until December 10th, 2018. Pooled hazard ratios (HRs) with their 95% confidence intervals (CIs) were used to estimate the effects.

Results:

A total of 17 articles with 6863 patients were included in this meta-analysis. The results revealed that elevated pretreatment plasma fibrinogen was significantly associated with both poor overall survival (univariate analysis: HR = 1.69, 95% CI 1.47–1.95, P = .000; multivariate analysis: HR = 1.50, 95% CI 1.28–1.77, P = .000) and poor disease-free survival (univariate analysis: HR = 1.90, 95% CI 1.49–2.41, P = .000; multivariate analysis: HR = 2.08, 95% CI 1.52–2.86, P = .000) in patients with CRC.

Conclusions:

High pretreatment plasma fibrinogen level is significantly associated with worse survival outcomes in CRC patients. Plasma fibrinogen may be used as an effective prognostic marker and potential therapeutic target. Further studies are required to support these results.
A meta-analysis comparing intramedullary with extramedullary fixations for unstable femoral intertrochanteric fractures
Authors: Sun Dawei , Wang Chunling , Chen Yuhui , Liu Xiaochun , Zhao Peng , Zhang Hongan , Zhou Hui , Qin Chenghe
Published: September 2019

Purpose:

To find out whether the intramedullary fixations are superior to the extramedullary fixations in treating unstable femoral intertrochanteric fractures (UFIFs).

Methods:

The meta-analysis of randomized controlled trials (RCTs) was conducted by searching the PubMed, Cochrane Library, and Embase databases to evaluate functional scores, surgical outcomes, and adverse events in adult patients receiving intramedullary fixations in comparison to extramedullary fixations. Risk ratio (RR) or weighted mean difference (WMD)/standard mean difference (SMD) with 95% confidence intervals (CIs) were calculated as effect sizes.

Results:

A total of 18 RCTs, comprising 2414 patients, were included in this meta-analysis. Primary efficacy outcome: Parker scores [weighted mean difference, 1.10, 95% confidence interval (CI), 0.64–1.55; P < .0001] and Harris hip scores [risk ratio, 1.24, 95%CI, 1.09 –1.41; P = .0008] were higher in the intramedullary fixation group. Moreover, blood loss, operative time, length of incision, hospital stay, and implant failure were superior in the intramedullary fixation group. Other secondary efficacy outcome: No significant differences were found between the 2 groups in terms of fluoroscopy time, mortality, cut-out, nonunion, superficial wound infection, later fracture, and reoperation.

Conclusions:

This meta-analysis suggested that intramedullary fixation is more effective and safer than extramedullary fixation in treating UFIFs. Furthermore, blood loss, operative time, length of incision, hospital stay, and implant failure were superior in the intramedullary fixation group.
Mapping international collaboration in tuberculosis research from 1998 to 2017
Authors: Chang Leilei , Su Yanbing , Zhu Ruifang , Duan Zhiguang
Published: September 2019

Background:

TB is one of the top 10 causes of death and the leading cause from a single infectious agent. The study characterize the developmental trends and collaboration features in the field of tuberculosis (TB) at the national level and identify high-impact countries.

Methods:

Scientometrics and social network analysis methods were used to analyze the research situation and collaboration behaviors based on TB research indexed in Web of Science from 1998 to 2017.

Results:

The publication output, national collaborative rate, and collaborative level have steadily increased from 1998 to 2017. However, domestic publications still account for a substantial proportion of a nation's publications. Over time, the numbers of national publications and international collaborative publications have increased in total, but the growth trend of their share as a proportion of total national publications is not significant. The United States of America has the largest number of highly cited publications, while Denmark, the Netherlands, Switzerland, and Sweden have higher values of average relative citation than do other countries. Notably, the United Kingdom and South Africa have established the strongest and most stable collaboration.

Conclusions:

There was increasing research activity and collaboration in the field of TB during the period 1998 to 2017, but growth shows wide variability between countries. Further comprehensive and full collaboration should be promoted.
Traditional Chinese medicine on treating ureteral calculi
Authors: Li Haisong , Deng Sheng , Wang Jisheng , Yu Xudong , Gong Xuefeng , Li Yanfeng , Yuan Hongwei
Published: September 2019

Background

Ureteral calculi generally refer to the temporary obstruction of the human body after the ureteral stenosis. When the ureteral stones are not discharged in time, they can grow in the original site, causing the patient to have corresponding clinical manifestations, such as: renal colic, hematuria, etc, when severe, can cause renal obstruction and hydronephrosis, seriously endangering the patient's health. Ureteral calculi usually occur in young and middle-aged people. The peak age of the disease is between 20 and 50 years old. It also occurs in the young and middle-aged labor force. The men incidence rate is 2 to 3 times that of women. Ureteral calculi is one of the current refractory diseases, and the effect after treatment with integrated Chinese and Western medicine is remarkable.

Methods and analysis

We will search for PubMed, Cochrane Library, AMED, EMbase, WorldSciNet; Nature, Science online and China Journal Full-text Database (CNKI), China Biomedical Literature CD-ROM Database (CBM), and related randomized controlled trials included in the China Resources Database. The time is limited from the construction of the library to November 2018. We will use the criteria provided by Cochrane 5.1.0 for quality assessment and risk assessment of the included studies, and use the Revman 5.3 and Stata13.0 software for meta-analysis of the effectiveness, recurrence rate, and symptom scores of ureteral.

Ethics and dissemination

This systematic review will evaluate the efficacy and safety of Traditional Chinese medicine for ureteral. Because all of the data used in this systematic review and meta-analysis has been published, this review does not require ethical approval. Furthermore, all data will be analyzed anonymously during the review process Trial.

Registration number: PROSPERO CRD42019137095
Effects of nursing intervention on lung infection prevention in patients with tracheotomy
Authors: Li Hua , Mao Xiao-Hong
Published: September 2019

Background:

This study will evaluate the effects of nursing intervention (NIV) on lung infection prevention (LIP) in patients with tracheotomy.

Methods:

The electronic databases of MEDLINE, Cochrane Library, EMBASE, Web of Science, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure will be retrieved from inception to the June 1, 2019 for randomized controlled trials investigating the effects of NIV on LIP in patients with tracheotomy without any language limitations. In addition, we will also search grey literature to avoid missing any potential studies. Two independent authors will perform study selection, data extraction, and risk of bias evaluation.

Results:

This study will investigate the effects of NIV on LIP in patients with tracheotomy. The primary outcome is incidence of lung infection. The secondary outcomes include pulmonary function, quality of life, and complications post-surgery.

Conclusion:

The results of this study will summarize recent evidence for the effects of NIV on LIP in patients with tracheotomy.

No ethic approval is needed in this study, because it will not need any individual data. The results of this study will be published at a peer-reviewed journal.
The effect of folic acid in patients with cardiovascular disease
Authors: Wang Yuan , Jin Yang , Wang Yao , Li Li , Liao Yanhong , Zhang Yun , Yu Dan
Published: September 2019

Background:

The effectiveness of folic acid supplementation in stroke risk has been investigated, however, the available results are inconclusive and conflicting. The purpose of this systemic review and meta-analysis was to assess the effect of folic acid in patients with cardiovascular disease (CVD).

Methods:

By searching the PubMed, EMBASE, and Cochrane library databases, we conducted a meta-analysis to evaluate effect of folic acid supplementation in patients with CVD. All-cause mortality, cardiovascular mortality, the risk of coronary heart disease (CHD) and stroke were summarized; hazard ratios (HR), the relative risk (RR) and its 95% confidence interval (CI) were also calculated. Fixed effects models were used to combine the data. A total of 12 randomized controlled trials, which involved 47,523 participants, met the inclusion criteria in this systematic review and meta-analysis.

Results:

Our meta-analysis showed that cardiovascular patients who received folic acid therapy had significantly decreased risk of stroke (RR = 0.85, 95% CI = 0.77–0.94, P
heterogeneity = .347, I

2
 = 10.6%) compared with patients who received control treatment. However, no significant difference in all-cause mortality (HR, 0.97, 95% CI, 0.86–1.10, P
heterogeneity = .315, I

2
 = 15.4%), cardiovascular mortality (HR, 0.87, 95% CI, 0.66–1.15, P
heterogeneity = .567, I

2
 = 0) and risk of CHD (RR, 1.04, 95% CI, 0.99–1.10, P
heterogeneity = .725, I

2
 = 0) were found between the 2 groups.

Conclusion:

This meta-analysis suggested that folic acid supplementation significantly reduced the risk of stroke in patients with CVD.
Inpatient rehabilitation facilities
Authors: Forrest George , Reppel Alycia , Kodsi Mina , Smith Joshua
Published: September 2019

The aim of this study was to determine whether patients whose treatment is consistent with the 3-hour rule have better outcomes than patients whose treatment is not consistent with the 3-hour rule.

This is a retrospective review of the records of 581 patients. The authors compared the outcomes of 397 patients whose therapy was consistent with the 3-hour rule to the outcomes of 184 patients whose therapy was not consistent with the rule for at least one 7-day period during the stay on an inpatient rehabilitation facility.

Patients whose care was consistent with the rule did not have more improvement in function or shorter length of stay than patients whose care was not consistent with the 3-hour rule.

There is not good evidence to support the 3-hour rule as a determinant of the care that a patient at an IRF needs to achieve a good outcome.
Effect of Tai Chi alone or as additional therapy on low back pain
Authors: Qin Jiawei , Zhang Yi , Wu Lijian , He Zexiang , Huang Jia , Tao Jing , Chen Lidian
Published: September 2019

Background:

This is the first systematic review evaluating and statistically synthesis the current studies regarding the effects of Tai Chi on pain and disability in patients with low back pain (LBP).

Methods:

Seven electronic databases including PubMed, EMBASE, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang and VIP information from inception to early March 2019 were searched. The Physiotherapy Evidence Database (PEDro) Scale was used to assess quality of all included randomized controlled trials (RCTs). The pooled effect size (weight mean difference, WMD) and 95% confidence interval (CI) were calculated to determine the effect of Tai Chi on pain and disability among LBP patients based on random effects model.

Results:

The aggregated results of the meta-analysis suggested that Tai Chi significantly decreased pain (WMD = −1.27, 95%CI −1.50 to −1.04, P < .00001, I
2 = 74%) and improve function disability, Oswestry disability index (ODI) subitems: pain intensity (WMD = −1.70, 95% CI −2.63 to −0.76, P = .0004, I
2 = 89%); personal care (WMD = −1.93, 95% CI −2.86 to −1.00, P < .0001, I
2 = 90%); lifting (WMD = −1.69, 95% CI −2.22 to −1.15, P < .0001, I
2 = 66%); walking (WMD = −2.05, 95% CI −3.05 to −1.06, P < .0001, I
2 = 88%); standing (WMD = −1.70, 95% CI −2.51 to −0.89, P < .0001, I
2 = 84%); sleeping (WMD = −2.98, 95% CI −3.73 to −2.22, P < .00001, I
2 = 80%); social life (WMD = −2.06, 95% CI −2.77 to −1.35, P < 0.00001, I
2 = 80%) and traveling (WMD = −2.20, 95% CI −3.21 to −1.19, P < .0001, I
2 = 90%), Japanese Orthopedic Association (JOA) score (WMD = 7.22, 95% CI 5.59–8.86, P < .00001, I
2 = 0%), Medical Outcomes Study Questionnaire Short Form 36 Health Survey (SF-36) physical functioning (WMD = 3.30, 95% CI 1.92–4.68, P < .00001), and Roland-Morris Disability Questionnaire (RMDQ) (WMD = −2.19, 95% CI −2.56 to −1.82, P < .00001).

Conclusion:

We drew a cautious conclusion that Tai Chi alone or as additional therapy with routine physical therapy may decrease pain and improve function disability for patients with LBP. Further trials are needed to be conducted with our suggestions mentioned in the systematic review.
The rate of missed diagnosis of lower-limb DVT by ultrasound amounts to 50% or so in patients without symptoms of DVT
Authors: Zhang Yuhong , Xia Haifa , Wang Yaxin , Chen Lin , Li Shengnan , Hussein Idrees Ali , Wu Yan , Shang You , Yao Shanglong , Du Ruofei
Published: September 2019

Background:

To assess whether the ultrasound (US) is a reliable approach in detecting lower-limb deep-vein thrombosis (DVT) in patients without symptoms of DVT.

Methods:

The research team performed a systematic search in PubMed, Ovid, Cochrane, and Web of Science without language or date restrictions. Full-text reports on prospective diagnostic studies involve the detection of lower-limb proximal and distal DVT in patients without symptoms of DVT using US and venography. A meta-analysis was performed using Meta-DiSc (version 1.4), providing the pooled sensitivity, specificity, positive (LR+) and negative (LR–) likelihood ratios of the detection accuracy of US. There were 4 different classes of subgroup analysis—the class of patients stratified by location of US exam (proximal, distal, whole leg), the class stratified by technique (color/doppler, compression, both modalities), the class stratified by kind of surgery (orthopedic, otherwise hospitalized) and the class stratified by era of publishing (1980s, 1990s, 2000s). The study quality and the risk of bias were evaluated using QUADAS-2, with heterogeneity was assessed and quantified by the Q score and I
2 statistics, respectively.

Results:

The meta-analysis included 26 articles containing 41 individual studies with a total of 3951 patients without symptoms of DVT. Using venography as the gold standard, US for proximal DVT had a pooled sensitivity of 59% (95% confidence interval (CI) = 51%–66%) and a pooled specificity of 98% (95% CI = 97%–98%), US for distal DVT had a poor sensitivity of 43% (95% CI = 38%–48%) and a pooled specificity of 95% (95% CI = 94%–96%), US for whole-leg DVT had a pooled sensitivity of 59% (95% CI = 54%–64%) and a pooled specificity of 95% (95% CI = 94%–96%), US for post-major orthopedic surgery patients had a pooled sensitivity of 52% (95% CI = 49%–55%), and US for other types of patients had a pooled sensitivity of 58% (95% CI = 43%–72%). Pure compression technique for DVT had a poor sensitivity of 43% (95% CI = 39%–48%), pure color/doppler technique for DVT had a pooled sensitivity of 58% (95% CI = 53%–63%), compression and color/doppler technique for DVT had a pooled sensitivity of 61% (95% CI = 48%–74%).

Conclusion:

US could be a useful tool for diagnosing DVT, but it has a lower positive rate and a higher false negative rate. The rate of missed diagnosis of lower-limb DVT by US amounts to 50% or so in the patients without symptoms of DVT. The negative results do not preclude the possibility of DVT and if appropriate heightened surveillance and continued monitoring or try a more accurate inspection method is warranted. The whole leg evaluation and color/doppler technique should be the preferred approach.
Effect of acupoint therapies on chemotherapy-induced nausea and vomiting
Authors: Hu Jiaqi , Shen Yifeng , Zhang Ge , He Jie , Sun Mingxi , Zhang Haishan , Hua Baojin , Zheng Honggang
Published: September 2019

Background:

Patients suffering from chemotherapy-induced nausea and vomiting (CINV) might have negative adherence of treatment. Acupoint therapies, including acupuncture, acupressure, acupoints injection, massage, and moxibustion, are safe medical procedures with minimal side effects for CINV, but studies about overall safety and effectiveness of acupoint therapies have not been scientifically and methodically evaluated in recent years. Evaluating the overall safety and effectiveness of acupoint therapies in patients with CINV is the purpose of this review.

Methods and analysis:

Relevant randomized controlled trials (RCTSs) are being searched in the following electronic databases: PubMed, Cochrane Library, Web of Science, EMBASE, China National Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database (VIP database), Wanfang Data Knowledge Service Platform, and Chinese Biomedical Literature Database (CBM). We will also attempt to obtain the unpublished academic data by contacting the colleague, professor, or Institute of Traditional Chinese Medicine. The RCTs of the acupoint therapies for CINV patients will be searched in the databases from inception to July 2019. The primary outcomes are defined as severity, duration and frequency of nausea or vomiting, or both. The secondary outcomes are defined as any adverse events and quality of life. Performing the meta-analysis by using RevMan version 5 software. Mean difference (MD) or standardized mean difference (SMD) will express the continuous variables, while relative risk (RR) will express the categorical variables.

Results:

The results of this review will provide a high-quality synthesis to evaluate the effectiveness and safety of acupoint therapies for CINV.

Conclusion:

This review will provide evidence to estimate whether acupoint therapies are effective interventions for CINV.

Dissemination:

Evidence whether acupoint therapies are effective interventions for CINV will be provided by this systematic review. This knowledge will recommend better acupoint therapies and selections of acupoints which might be helpful in treating CINV. The findings of this systematic review will be disseminated via various forms of presentation and publication of the data in a journal or electronic databases.

PROSPERO registration number:

CRD42019125538.
Effectiveness of high frequency ultrasound on pressure ulcer
Authors: Gao Xiang-qin , Xue Xiao-mei , Zhang Jian-kang , Yan Fei , Mu Qiu-xia
Published: September 2019

Background:

This study aims to systematically assess the effectiveness of high frequency ultrasound (HFUS) on pressure ulcer (PU).

Methods:

In this study, PubMed, EMBASE, Cochrane Library, Web of Science, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure will be searched from inception to the present without any language limitations. The primary outcomes include change in ulcer area, and time complete healing. The secondary outcomes consist of proportion of ulcers healed within trial period, quality of life, pain intensity, and adverse events. Cochrane risk of bias tool will be used to assess methodological quality. RevMan 5.3 software (London, UK) will be used to analyze the data.

Results:

This study will analyze change in ulcer area, time complete healing, proportion of ulcers healed within study period, quality of life, pain intensity, and adverse events on HFUS in patients with PU.

Conclusion:

This study will provide most recent evidence for the effectiveness and safety of HFUS for patients with PU.

PROSPERO registration number:

PROSPERO CRD42019138177.
Safety and efficacy of acupuncture for the treatment of chronic obstructive pulmonary disease
Authors: Yu Mingxia , Gao Longxia , Kong Yanhua , Yan Yue , Shi Qi , Si Dongxu , Bao Haipeng , Sun Huizhuo , Li Lei , Li Youlin
Published: September 2019

Background:

Chronic obstructive pulmonary disease (COPD) is a common chronic respiratory disease with increasing morbidity and mortality that cause huge social and economic loss. Although recommended by guidelines, pulmonary rehabilitation has not been widely applied in clinics because of its inherent limitations. Acupuncture therapy (AT) as one of the most popular treatments in traditional Chinese medicine has been used to treat COPD. We aim to evaluate the safety and efficacy of acupuncture in the treatment of COPD.

Methods:

Web of science, PubMed, Springer, Medline, Cochrane Library, EBASE, WHO International Clinical Trials Registry Platform (ICTRP), China National Knowledge Infrastructure Database (CNKI), Wan Fang Database, Chinese Scientific Journal Database (VIP), and Chinese Biomedical Literature Database will be searched from their inception to May 10, 2019. Randomized controlled trials that evaluated the safety and efficacy of acupuncture for the treatment on patients with COPD will be included. The primary outcome measures will include Dyspnea scores, lung function and blood eosinophils. The secondary outcome measures will include St George's Respiratory Questionnaire and 6-minute walk distance. Study selection, data extraction, and risk of bias assessment will be independently undertaken, respectively. Statistical analysis will be conducted by RevMan software (version 5.3).

Results:

This study will provide high-quality synthesis based on current evidence of acupuncture treatment for COPD in several aspects, including symptom score, quality of life score, side effects and laboratory examination, such as lung function text, blood eosinophils (EOS) etc.

Conclusion:

The results of this study will provide updated evidence for weather acupuncture is an effective and safe intervention for COPD.

Ethics and dissemination:

It is not necessary for this systematic review to acquire an ethical approval. This review will be disseminated in a peer-reviewed journal or conference presentation.

PROSPERO registration number:

PROSPERO CRD42019136087.
Buyang Huanwu Tang (Boyang Hwano Tang) for the treatment of post-stroke fatigue
Authors: Jin Chul , Cho Seung-Yeon , Park Seong-Uk , Jung Woo-Sang , Moon Sang-Kwan , Park Jung-Mi , Ko Chang-Nam , Cho Ki-Ho , Kwon Seungwon
Published: September 2019

Background:

Buyang Huanwu Tang (BHT) is a well-known herbal complex used for stroke treatment and has been used mainly during post-stroke rehabilitation in East Asia. In this review, we aim to evaluate the efficacy and safety of BHT as a treatment for post-stroke fatigue (PSF).

Methods:

Eight databases will be searched for relevant studies from inception to the present date. We will include randomized controlled trials (RCTs), which assess the effect and safety of BHT for the treatment of PSF. The methodological qualities, including the risk of bias (RoB), will be evaluated using the Cochrane RoB assessment tool. After screening the studies, a meta-analysis of the RCTs will be done.

Results:

This study will provide high-quality synthesis of current evidence of BHT for PSF.

Conclusion:

The conclusion of our systematic review will provide evidence to judge whether BHT is an effective intervention for patients with PSF.

Ethics and dissemination:

Ethical approval is not required, as this study is based on the review of published research. This review will be published in a peer-reviewed journal and disseminated both electronically and in print.

Trial registration number:

PROSPERO CRD42019130178.
The impact of global budgeting in Taiwan on inpatients with unexplained fever
Authors: Liu Keh-Sen , Yu Tsung-Fu , Wu Hsing-Ju , Lin Chun-Yi
Published: September 2019

Unexplained fever is one of the most common and difficult diagnostic problems faced daily by clinicians. This study evaluated the differences in health service utilization, health care expenditures, and quality of care provided to patients with unexplained fever before and after global budget (GB) implementation in Taiwan.

The National Health Insurance Research Database was used for analyzing the health care expenditures and quality of care before and after implementation of the GB system. Patients diagnosed as having unexplained fever during 2000–2001 were recruited; their 2000–2001 and 2004–2005 data were considered baseline and postintervention data, respectively.

Data of 259 patients with unexplained fever were analyzed. The mean lengths of stay (LOSs) before and after GB system implementation were 4.22 ± 0.35 days and 5.29 ± 0.70 days, respectively. The mean costs of different health care expenditures before and after implementation of the GB system were as follows: the mean diagnostic, drug, therapy, and total costs increased respectively from New Taiwan Dollar (NT$) 1440.05 ± NT$97.43, NT$3249.90 ± NT$1108.27, NT$421.03 ± NT$100.03, and NT$13,866.77 ± NT$2,114.95 before GB system implementation to NT$2224.34 ± NT$238.36, NT$4272.31 ± NT$1466.90, NT$2217.03 ± NT$672.20, and NT$22,856.41 ± NT$4,196.28 after implementation. The mean rates of revisiting the emergency department within 3 days and readmission within 14 days increased respectively from 10.5% ± 2.7% and 8.3% ± 2.4% before implementation to 6.3% ± 2.2% and 4.0% ± 1.7% after implementation.

GB significantly increased LOS and incremental total costs for patients with unexplained fever; but improved the quality of care.
A case of Ehlers–Danlos syndrome presenting with widened atrophic scars of forehead, elbow, knee, and pretibial area
Authors: Xu Xiangwen , Wang Zhichao , Zan Tao
Published: September 2019

Rational:

Ehlers–Danlos syndrome (EDS) is a heritable connective tissue disorder. Currently, the genotype-phenotype correlations of classical EDS (cEDS) are still controversial. Hence, this study reported a case of cEDS with both clinical manifestations and COL5A2 gene mutation.

Patient concerns:

A 30-year-old female presented to the plastic-surgery clinic with widen atrophic scars on forehead, elbows, knees and pretibial area that had developed since childhood.

Diagnosis:

With the skin hyperextensibility, joint hypermobility, papyraceous scar revealed by physical examination, and the heterozygous pathogenic variant c1997G > A (p.P659P) in COL5A2 gene revealed by whole exome sequencing, the diagnosis of the classical Ehlers–Danlos syndrome was made.

Interventions:

The patient underwent facial scar resection and sutured in minimizing tension and perfect apposition to avoid the post-surgery scar formation.

Outcomes:

Follow-up 6 months after surgery, the wound remained a fine line scar.

Lessons:

Our findings suggested that COL5A2 gene mutation (c1997G > A p.P659P) may be associated with cEDS but did not reveal other severe complications.
Measurement of talar morphology in northeast Chinese population based on three-dimensional computed tomography
Authors: Han Qing , Liu Yang , Chang Fei , Chen Bingpeng , Zhong Lei , Wang Jincheng
Published: September 2019

Morphological data of talus are important for the design of talar prostheses. The talar morphology of Chinese population has been rarely reported. This study adopted a three-dimensional (3D) measurement approach to provide accurate data for the anatomical morphology of talus in Northeast Chinese population and compared it with that of foreigners.

One hundred forty-six healthy subjects form Northeast China underwent computed tomography (CT) arthrography. 3D digital talar model was reconstructed and thirteen morphological parameters were measured through Mimics and Magics software. Length and breadth indexes of total talus, trochlea, medial and lateral malleolus articular surface were mainly selected. Statistical analysis was conducted by independent-samples and paired-samples t test through SPSS software.

All the indexes were normally distributed. No significant difference between left and right talus was identified in either males or females (P > .05). Most of the indexes showed significant sexual differences except the radian of lateral malleolus articular surface and the posterior breadth of trochlea (P < .05). The talar anatomy of Chinese subjects is different from the published data in other populations.

The promising approach adopted in this study addresses some inconvenience with previous conventional methods on cadaver specimens. The geometric parameters of talus in Chinese population differ from those in other populations. The talar measurements and morphology analysis in this study suggest that population characteristics should be taken into account. This study will provide references for the design of talar prostheses in Chinese population.
Antimicrobial resistance surveillance and prediction of Gram-negative bacteria based on antimicrobial consumption in a hospital setting
Authors: Guo Wei , Sun Fengjun , Liu Fang , Cao Liya , Yang Jie , Chen Yongchuan
Published: September 2019

Antimicrobial resistance, a major threat to human health, is mainly driven by the overuse of antimicrobials. The purpose of this study was to further investigate the relationship between antimicrobial use and resistance with a 15-year record in Southwest hospital, one of the largest hospitals in Southwest China and a university affiliated hospital, thus to further predict the antimicrobial resistance in an autoregressive integrated moving average (ARIMA) manner. Kirby-Bauer tests were carried out to figure out the drug sensitivity of Gram-negative bacterial. Antimicrobials (β-lactamase inhibitor complex, aminoglycosides, quinolones, third and fourth-generation cephalosporins, carbapenems, cephamycins, oxacephems, and sulfonamides) consumption were calculated according to World Health Organization (WHO) anatomical therapeutic chemical classification index and expressed as annual defined daily dose (DDD) or DDD per 1000 out patients. Resistance rates of levofloxacin-resistant Escherichia coli, ceftazidime-resistant Klebsiella pneumoniae, amikacin-resistant Bacterium levans, imipenem-resistant Pseudomonas aeruginosa is positively correlated with the usage of aminoglycosides and quinolones; resistance rates of imipenem-resistant Acinetobacter baumanii is positively correlated with the usage of carbapenemes (P-value between the drug resistance of levofloxacin-resistant E. coli, ceftazidime-resistant K. pneumoniae and the usage of aminoglycosides is under .05, the other P-value are under .01); resistance rates of the drug resistance of levofloxacin-resistant E. coli is positively correlated with the usage of oxacephems (P < .01); resistance rates of imipenem-resistant P. aeruginosa is positively correlated with the usage of oxacephems and sulfonamides (P < .01).

The present study presents one of the largest and longest retrospective analyses in China between antimicrobial consumption and antimicrobial resistance. Change of the usage of several antibacterial drugs has great influence on the drug resistance of Gram-negative bacterial. Of particular, ARIMA forecasting revealed that carbapenem related bacterial resistance should be closely watched.
Negative life events and major depressive disorder among HIV-positive individuals in Guangdong, China
Authors: Jiang Hongbo , Tan Zhimin , Cheng Weibin , Xu Meizhen , Lin Peng , Huang Xingmei , Huang Ruoyan , Liu Jun , Yang Fang , Li Yan , Gao Yanhui , Yang Yi
Published: September 2019

HIV-positive individuals encounter a number of negative life events (NLEs). This cross-sectional study aimed to evaluate the association between NLEs and major depressive disorder (MDD) among HIV-positive individuals in Guangdong, China, about which little is known.

HIV-positive individuals were recruited from the Centers for Disease Prevention and Control of Guangzhou, Zhongshan, and Yangjiang from September 2007 to September 2008. Data on NLEs were collected using a questionnaire. The Structured Clinical Interview for DSM-IV-TR Axis I Disorders-Patient Edition (SCID-I/P) based on the DSM-IV criteria was used to diagnose MDD. Multiple logistic regression analyses were conducted to evaluate the association between NLEs and MDD.

Among the 339 participants, 306 (90.27%) reported that one or more NLEs had ever occurred. Participants who reported NLEs that included HIV infection, financial problems, AIDS diagnosis, HIV/AIDS discrimination, conflict with spouse or lover, conflict with other family members, problems in childbearing, and conflict with nonfamily were at a higher risk of MDD. Participants who reported more NLEs in the last year had a higher risk of MDD (OR = 2.86, 95%CI: 1.76–4.65) than individuals who reported fewer NLEs. Individuals with higher chronic stress scores had a higher risk of MDD (OR = 4.36, 95%CI: 2.44–7.78) than individuals with lower chronic stress scores. However, acute stress was not associated with MDD.

NLEs were common among HIV-positive individuals. MDD was associated with a greater number of NLEs and the increased chronic stress caused by the NLEs. Interventions should be tailored to those who reported NLEs to help reduce the risk of MDD and increase the quality of life among HIV-positive individuals.
An investigation into the stress-relieving and pharmacological actions of an ashwagandha (Withania somnifera) extract
Authors: Lopresti Adrian L. , Smith Stephen J. , Malvi Hakeemudin , Kodgule Rahul
Published: September 2019

Background:

Ashwagandha (Withania somnifera (L.) Dunal) is a herb traditionally used to reduce stress and enhance wellbeing. The aim of this study was to investigate its anxiolytic effects on adults with self-reported high stress and to examine potential mechanisms associated with its therapeutic effects.

Methods:

In this 60-day, randomized, double-blind, placebo-controlled study the stress-relieving and pharmacological activity of an ashwagandha extract was investigated in stressed, healthy adults. Sixty adults were randomly allocated to take either a placebo or 240 mg of a standardized ashwagandha extract (Shoden) once daily. Outcomes were measured using the Hamilton Anxiety Rating Scale (HAM-A), Depression, Anxiety, and Stress Scale -21 (DASS-21), and hormonal changes in cortisol, dehydroepiandrosterone-sulphate (DHEA-S), and testosterone.

Results:

All participants completed the trial with no adverse events reported. In comparison with the placebo, ashwagandha supplementation was associated with a statistically significant reduction in the HAM-A (P = .040) and a near-significant reduction in the DASS-21 (P = .096). Ashwagandha intake was also associated with greater reductions in morning cortisol (P < .001), and DHEA-S (P = .004) compared with the placebo. Testosterone levels increased in males (P = .038) but not females (P = .989) over time, although this change was not statistically significant compared with the placebo (P = .158).

Conclusions:

These findings suggest that ashwagandha's stress-relieving effects may occur via its moderating effect on the hypothalamus-pituitary-adrenal axis. However, further investigation utilizing larger sample sizes, diverse clinical and cultural populations, and varying treatment dosages are needed to substantiate these findings.

Trial registration:

Clinical Trials Registry—India (CTRI registration number: CTRI/2017/08/009449; date of registration 22/08/2017)
Research Lifecycle to Increase the Substantial Real-world Impact of Research
Authors: Kilbourne Amy M. , Braganza Melissa Z. , Bowersox Nicholas W. , Goodrich David E. , Miake-Lye Isomi , Floyd Nicole , Garrido Melissa M. , Frakt Austin B. , Bever Christopher T. , Vega Ryan , Ramoni Rachel
Published: September 2019

Background:

US health care systems face a growing demand to incorporate innovations that improve patient outcomes at a lower cost. Funding agencies increasingly must demonstrate the impact of research investments on public health. The Learning Health System promotes continuous institutional innovation, yet specific processes to develop innovations for further research and implementation into real-world health care settings to maximize health impacts have not been specified.

Objective:

We describe the Research Lifecycle and how it leverages institutional priorities to support the translation of research discoveries to clinical application, serving as a broader operational approach to enhance the Learning Health System.

Methods:

Developed by the US Department of Veterans Affairs Office of Research and Development Research-to-Real-World Workgroup, the Research Lifecycle incorporates frameworks from product development, translational science, and implementation science methods. The Lifecycle is based on Workgroup recommendations to overcome barriers to more direct translation of innovations to clinical application and support practice implementation and sustainability.

Results:

The Research Lifecycle posits 5 phases which support a seamless pathway from discovery to implementation: prioritization (leadership priority alignment), discovery (innovation development), validation (clinical, operational feasibility), scale-up and spread (implementation strategies, performance monitoring), and sustainability (business case, workforce training). An example of how the Research Lifecycle has been applied within a health system is provided.

Conclusions:

The Research Lifecycle aligns research and health system investments to maximize real-world practice impact via a feasible pathway, where priority-driven innovations are adapted for effective clinical use and supported through implementation strategies, leading to continuous improvement in real-world health care.
Assessing the Effectiveness of Complex Interventions to Meet the Needs of VA Stakeholders
Authors: Wilt Timothy J. , Greer Nancy , Duan-Porter Wei
Published: September 2019

Background:

Complex health care interventions involve multiple distinct elements that contribute to their functioning. Conducting systematic reviews of complex interventions has substantial challenges. Although methodological guidance exists, less is known about the practical strategies and approaches undertaken by systematic review groups to navigate common challenges and enhance impacts of systematic review findings.

Objectives:

Describe pragmatic approaches taken by Department of Veterans Affairs Evidence Synthesis Programs (VA ESP) in conducting systematic reviews of effectiveness and implementation barriers and facilitators for complex interventions to provide VA stakeholders with evidence to guide national health care practice and policy.

Results:

We describe 3 systematic reviews conducted by VA ESP teams to evaluate the evidence for complex health care interventions. We summarize key findings, implications for future research needs and policy, dissemination of findings, and approaches taken to address common challenges. The VA ESP experience adds to existing systematic review methods and provides a perspective on generating rigorous and relevant reviews of complex interventions.

Conclusions:

Reviews of complex interventions often encounter challenges related to sources of variability in many dimensions, and lack of clarity and information in reporting of intervention elements, local context, and implementation factors. Evidence synthesis teams should work closely with stakeholders to understand their needs, synthesize and interpret results in meaningful ways, and explore implications that are most relevant for day-to-day clinical practice and operational decisions of learning health care systems. More evaluation of the impact of systematic reviews may improve uptake of findings from future reviews and enhance translation of evidence into practice and policy.
“It Would’ve Been Nice if They Interpreted the Data a Little Bit. It Didn’t Really Say Much, and It Didn’t Really Help Us.”
Authors: Christensen Vivian , Floyd Nicole , Anderson Johanna
Published: September 2019

Background:

Patient health outcomes improve when learning health care systems use evidence to implement promising services and allocate resources effectively. Here, we examine the unique environment in which Veterans Health Administration (VHA) leadership use evidence and the facilitators and barriers to using evidence synthesis products in decision-making. We end by describing the steps researchers can take to better support the needs of health system leadership.

Methods:

We conducted 20 semistructured phone interviews with individuals in VHA leadership positions. We used an inductive approach to identify themes observed across key informant interviews.

Results:

Key informants identified several factors that fostered the use of evidence including, timeliness, lack of bias, flexible approaches, and concise reports with a clear bottom line. Barriers included lack of relevant evidence and lack of information on how to translate evidence into practice, resistance to change among providers and within the larger health system, and political pressures to implement therapies or technologies with little evidence or uncertainty. Researchers can foster evidence uptake by developing a review scope and key questions that are important to multiple stakeholders, including frontline clinicians and health system leadership.

Conclusions:

The VHA’s evidence needs resemble other health systems, but evidence synthesis products should include a translational component to enhance implementation. Resistance to change and political pressures can further hinder the uptake of evidence within VHA.
Establishing an Evidence Synthesis Capability For Psychological Health Topics in the Military Health System
Authors: Belsher Bradley E. , Beech Erin H. , Kelber Marija S. , Hempel Susanne , Evatt Daniel P. , Smolenski Derek J. , Campbell Marjorie S. , Otto Jean L. , Morgan Maria A. , Workman Don E. , Stewart Lindsay , Morgan Rebecca L. , Khusid Marina , Edwards-Stewart Amanda , O’Gallagher Kevin , Bush Nigel
Published: September 2019

Background:

To promote evidence-based health care, clinical providers and decision makers rely on scientific evidence to inform best practices. Evidence synthesis (ES) is a key component of this process that serves to inform health care decisions by integrating and contextualizing research findings across studies.

Objective:

This paper describes the process of establishing an ES capability in the Military Health System dedicated to psychological health topics.

Research Designs:

The goal of establishing the current ES capability was to facilitate evidence-based decision-making among clinicians, clinic managers, research funders, and policymakers, through the production and dissemination of trustworthy ES reports. We describe how we developed this capability, provide an overview of the types of evidence syntheses products we use to respond to different stakeholders, and detail the procedures established for selecting and prioritizing synthesis topics.

Results:

We report on the productivity, acceptability, and impact of our efforts. Our reports were used by a variety of stakeholders and working groups, briefed to major committees, included in official reports and policies, and cited in clinical practice guidelines and the peer-reviewed literature.

Conclusions:

Our experiences thus far suggest that the current ES capability offers a needed service within our health system. Our framework may help inform other agencies interested in developing or sponsoring a similar capability.
Prioritizing Evidence-based Interventions for Dissemination and Implementation Investments
Authors: Huppert Jill S. , Fournier Alaina K. , Bihm Jasmine L. , Chang Christine S. , Miller Therese L. , Nourjah Parivash , Chang Stephanie M. , Bierman Arlene S.
Published: September 2019

Background:

The Agency for Healthcare Research and Quality (AHRQ) is mandated to implement patient-centered outcomes research (PCOR) to promote safer, higher quality care. With this goal, we developed a process to identify which evidence-based PCOR interventions merit investment in implementation. We present our process and experience to date.

Materials and Methods:

AHRQ developed and applied a systematic, transparent, and stakeholder-driven process to identify, evaluate, and prioritize PCOR interventions for broad dissemination and implementation. AHRQ encouraged public nominations, and assessed them against criteria for quality of evidence, potential impact, and feasibility of successful implementation. Nominations with sufficient evidence, impact, and feasibility were considered for funding.

Results:

Between June 2016 and June 2018, AHRQ received 35 nominations from researchers, nonprofit corporations, and federal agencies. Topics covered diverse settings, populations, and clinical areas. Twenty-eight unique PCOR interventions met minimum criteria; 16 of those had moderate to high evidence/impact and were assessed for feasibility. Fourteen topics either duplicated other efforts or lacked evidence on implementation feasibility. Two topics were prioritized for funding (cardiac rehabilitation after myocardial infarction and screening/treatment for unhealthy alcohol use).

Conclusions:

AHRQ developed replicable criteria, and a transparent and stakeholder-driven framework that attracted a diverse array of nominations. We identified 2 evidence-based practice interventions to improve care with sufficient evidence, impact, and feasibility to justify an AHRQ investment to scale up practice. Other funders, health systems or institutions could use or modify this process to guide prioritization for implementation.
Patients and Caregivers Rate the PAINReportIt Wireless Internet-Enabled Tablet as a Method for Reporting Pain During End-of-Life Cancer Care
Authors: Schoppee Tasha M. , Dyal Brenda W. , Scarton Lisa , Ezenwa Miriam O. , Singh Prashant , Yao Yingwei , Suarez Marie L. , Wang Zaijie J. , Molokie Robert E. , Wilkie Diana J.
Published: September 2019

Background

In several studies, investigators have successfully used an internet-enabled PAINReportIt tablet to allow patients to report their pain to clinicians in real-time, but it is unknown how acceptable this technology is to patients and caregivers when used in their homes.

Objective

The aims of this study were to examine computer use acceptability scores of patients with end-stage cancer in hospice and their caregivers and to compare the scores for differences by age, gender, race, and computer use experience.

Intervention/Methods

Immediately after using the tablet, 234 hospice patients and 231 caregivers independently completed the Computer Acceptability Scale (maximum scores of 14 for patients and 9 for caregivers).

Results

The mean (SD) Computer Acceptability score was 12.2 (1.9) for patients and 8.5 (0.9) for caregivers. Computer Acceptability scores were significantly associated with age and with previous computer use for both patients and caregivers.

Conclusions

This technology was highly acceptable to patients and caregivers for reporting pain in real time to their hospice nurses.

Implications for Practice

Findings provide encouraging results that are worthy of serious consideration for patients who are in end stages of illness, including older persons and those with minimal computer experience. Increasing availability of technology can provide innovative methods for improving care provided to patients facing significant cancer-related pain even at the end of life.