Post operational recovery from cardiac surgery can be affected by many factors, including preoperative, intraoperative, and postoperative factors. Prolonged mechanical ventilation (PMV) , one of the major complications, has been widely accepted as a measure to evaluate the performance and outcomes of cardiac surgeries. Great progress has been made in the studies of risk factors contributing to PMV following cardiac surgeries in recent years. However, no clear and effective measures and approaches are available yet to prevent PMV. In this review, the authors try to summarize the risk factors that are associated with PMV throughout the perioperative period of cardiac surgery, as well as possible interventions when applicable.
ObjectiveTo introduce a Bayesian meta-analysis method for quantitatively integrating evidence from both randomized controlled trials (RCTs) and non-randomized studies of interventions (NRSIs), using concrete examples and R code, thereby supporting the combined utilization of both study types in empirical research. MethodsUsing a meta-analysis on the association between low-dose methotrexate exposure and melanoma as an example, we employed the jarbes package in R to conduct both a traditional Bayesian meta-analysis and a Bayesian nonparametric bias-correction meta-analysis model for quantitative integration. The differences between the two pooled results were then compared. ResultsThe traditional Bayesian meta-analysis indicated a posterior probability of 99% that low-dose methotrexate exposure increases melanoma risk. The Bayesian nonparametric bias-correction meta-analysis model showed a posterior probability of 92% that low-dose methotrexate exposure increases melanoma risk. ConclusionCompared with the traditional Bayesian meta-analysis model, the nonparametric bias-correction meta-analysis model is more suitable for quantitatively integrating evidence from RCTs and NRSIs, demonstrating potential for broader application. However, the comparability between the two evidence bodies should be carefully assessed prior to quantitative integration.
ObjectiveTo study the effect of new bundle interventions on medical staff’s cognition of occupational exposure protection and exposure rate, and provide evidence for reducing medical staff’s occupational exposure.MethodsThe 1 435 medical practitioners in 37 clinical/technical departments of Nanchong Central Hospital were selected as the research objects. Bundle intervention strategies about occupational exposure for whole population and high risk population were implemented, and the medical staff’s cognition of occupational exposure, occurrence of occupational exposure, and post-exposure reporting in 2017 (before intervention) and 2018 (after intervention) were investigated and compared to evaluate the intervention effects.ResultsThe numbers of valid survey forms collected before intervention and after intervention were 1 160 and 1 421, respectively. The total awareness rate increased from 91.10% before intervention to 96.10% after intervention (P<0.001). The exposure rate and average rank of exposure frequency after intervention were lower than those before intervention (10.98% vs. 17.50%, 1 250.74 vs. 1 340.32), the reporting rate of initial exposure after intervention (69.23%) was higher than that before intervention (57.64%), and the differences were all statistically significant (P<0.05).ConclusionThrough gradually implementing the new bundle interventions, medical staff can improve the cognition of occupational exposure, reduce the occurrence of occupational exposure, improve the enthusiasm of reporting, and create a safe atmosphere.
Objective To explore the effect of multimodal interventions in improving the compliance rate of core infection control measures on reducing the incidence rate of vessel catheter associated infection (VCAI). Methods Inpatients with intravascular catheters in 5 departments with high rates of vascular catheterization and infection of Dongguan People’s Hospital between January 2021 and December 2022 were selected. According to the hospital stay, patients were divided into a pre-intervention group (January to December 2021) and a post-intervention group (January to December 2022). The core infection control measures assessment pass rates of medical staff between the two periods and the differences in the incidence rate of VCAI, average catheterization days, and catheterization rate before and after intervention in both groups were compared. Results A total of 8174 patients were included. Among them, there were 3915 patients in the pre-intervention group and 4259 patients in the post-intervention group. In the pre-intervention group, the total length of hospital stay was 122885 days, the total number of catheterization days was 48028 days, and 28 cases of VCAI occurred. In the post-intervention group, the total length of hospital stay was 126966 days, the total number of catheterization days was 51253 days, and 12 cases of VCAI occurred. After intervention, the compliance rate of VCAI core infection control measures was improved [69.21% (2907/4200) vs. 91.24% (3832/4200); χ2=642.090, P＜0.001], the pass rate of medical staff’s core infection control measures assessment was improved [53.33% (128/240) vs. 91.67% (220/240); χ2=88.443, P＜0.001], the catheterization rate was increased [39.08% (48028/122885) vs. 40.37% (51253/126966); χ2=42.979, P<0.001], and the incidence rate of VCAI was reduced [0.58‰ (28/48028) vs. 0.23‰ (12/51253); incidence-rate ratios =0.40, 95% confidence interval (0.20, 0.79), P=0.008]. Conclusions Improving the compliance rate of VCAI core infection control measures through multimodal interventions can significantly improve the passing rates of core infection control measures of medical staffs. This will help to reduce the incidence of VCAI and ensuring patient safety, provide evidence-based support for the prevention and control of VCAI.
ObjectiveTo systematically review the economy of non-pharmaceutical interventions (NPIs) for COVID-19. MethodsThe Web of Science, PubMed, EMbase, Cochrane Library, INAHTA, CNKI, WanFang Data and SinoMed databases were electronically searched to collect studies on health economic evaluations from 1 January 2020 to 20 August 2022. Then the included materials were reviewed, extracted and data integration analysis were conducted based on inclusion and exclusion criteria. ResultsSeventy-one academic publications were finally included, which contained 25 papers about nucleic acid testing, antigen testing and screening, 5 papers about personal protection, 12 papers about social distancing, quarantine and isolation, 11 papers about regional or national lockdown and 18 papers about multiple NPIs. The results showed that compared with no intervention, nucleic acid testing, antigen testing, screening and personal protection measures were economical. Social distancing, quarantine and isolation were also economical compared with no intervention. However, in low-income countries, movement restriction and factory shutdown may exact a heavy toll on the poorest and most vulnerable. Moreover, compared with a single long-term lockdown, multiple short-term lockdowns could be more economical, but the cost was still huge overall. ConclusionNPIs such as nucleic acid testing, antigen testing, personal protection, social distancing, quarantine, isolation and factory shutdown are economical. Although regional or national lockdown can save lives, it is not suitable for wide use. The researches on specific populations, specific variants (especially Omicron) and in the context of China need to be carried out.
針刺平行隨機對照試驗通常沒有準確報告試驗組和對照組的干預方法.為促進標準化,國際上有經驗的針刺醫師和研究者組成的小組制定了一些原則,即針刺臨床對照試驗中干預措施報告的標準(縮寫為STRICTA).在征求意見過程中,一些期刊編輯協助對此標準進行了修改,使之與隨機對照試驗報告的標準(CON-SORT)格式一致,作為該指南對針剌研究報告的延伸.參與此事的雜志編輯已確定要發表該標準,建議其作者群按照此標準準備論文,并將邀請更多雜志采用該標準.目的是使針剌對照試驗的干預措施充分報告,從而有利于對這些研究的嚴格評價、分析及這些措施的推廣.
ObjectivesTo systematically review the efficacy of seven types of cognitive interventions for older adults with mild to moderate Alzheimer's Disease (AD).MethodsWe searched The Cochrane Library, PubMed, EMbase, CNKI, WanFang Data, VIP and CBM databases to collect randomized controlled trials on cognitive interventions for mild to moderate Alzheimer's Disease (AD) from inception to January 2018. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. STATA 14.0 software was then used to perform a meta-analysis.ResultsA total of 49 randomized controlled trials (RCTs) were included. The results of network meta-analysis revealed that each cognitive intervention had significantly improved the cognitive ability of AD patients. Specifically, nursing intervention (NI) (MD=3.01, 95%CI 1.70 to 4.50, P<0.005) was the most effective enhancer of cognitive ability, followed by music therapy (MT) (MD=2.60, 95%CI 0.96 to 4.30, P<0.001), physical exercise (PE) (MD=2.4, 95%CI 1.0 to 3.9, P<0.001), cognitive rehabilitation (CR) (MD=2.3, 95% CI 0.92 to 3.7, P=0.013), cognitive simulation (CS) (MD=1.7, 95%CI 1.2 to 2.3, P=0.037), computerized cognitive training (CCT) (MD=1.6, 95%CI 0.42 to 2.8, P<0.001), and pharmacological therapies (PT) (MD=1.5, 95%CI 0.24 to 2.8, P=0.041).ConclusionsThe seven types of cognitive interventions are helpful in improving the cognitive ability of Alzheimer's patients, and nursing intervention is the most effective cognitive intervention. Moreover, non-pharmacological therapies may be better than pharmacological therapies.
ObjectiveTo observe the effect of bundle interventions on ventilator-associated pneumonia (VAP) in Intensive Care Unit (ICU). MethodsBaseline survey among the patients undergoing mechanical ventilation was conducted during June 2011 to August 2011. During September 2011 to May 2012, the rate of VAP was monitored every three months after taking bundle measures, which included oral care, elevation of the head of the bed, daily assessment of readiness to extubation, optimizing process of devices disinfection and hand hygiene. ResultsThrough carrying out the bundle interventions, the VAP rate decreased from 61.2‰ to 34.9‰ after six months and 22.7‰ after nine months, and the ventilator utilization ratio decreased from 26.5% to 24.6% after six months and 22.6% after nine months. The alcohol-based hand disinfectant dosage was increased from 32.6 mL to 58.8 mL and 54.4 mL for each patient bed in ICU. ConclusionThe bundle intervention has been proved to be effective. Measures such as staff education, bedside supervision and monitoring data feedback can help implement bundle interventions.
The application of complex interventions in the area of public health, clinical research and education is becoming increasingly widespread. The effectiveness of complex interventions may be affected by numerous factors due to the complexity of interventions, intervention pathways or the context of implementation. Therefore, it is significantly important to evaluate the process of complex interventions, which will provide information to understand the implementation of interventions. The British Medical Research Council’s process evaluation guidelines provide a framework for implementing and reporting on process evaluation research. This paper aims to interpret the guide in detail on complex intervention and process evaluation for the references of domestic researchers.