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1.
Background
Many studies have examined the relationship between hospital volume and outcomes for inpatients with acute myocardial infraction (AMI) in developed countries. However, very few studies of this relationship have been conducted for inpatients with AMI in China. This study aimed to assess the relationship between hospital volume and clinical outcomes for inpatients with AMI in Shanxi, China.Methods
Data from a total of 15?747 patients with AMI who were treated in 56 hospitals in Shanxi, China, were analysed. Hospital volume was defined as the number of inpatients with AMI in 2015 at each hospital, and hospitals were sorted into three groups by volume (low volume [<385 inpatients], medium volume [385–637 inpatients], and high volume [>637 inpatients]). Patient and hospital characteristics were adjusted using multivariable logistic regression and linear regression, and the relationships between hospital volume and in-hospital mortality, length of stay, and total hospitalization costs were assessed for inpatients with AMI.Findings
The crude in-hospital mortality rate was 1.93% among the 15?747 patients with AMI. Adjusted in-hospital mortality among AMI patients was significantly lower for medium-volume hospitals (odds ratio [OR] 0·605, 95% CI 0·411–0·900) compared to low-volume hospitals, whereas no significant difference was found between low-volume hospitals and high-volume hospitals (0·783, 0·525–1·178). Lengths of stay in medium-volume hospitals and high-volume hospitals were 0·915 days (95% CI 0·880–0·951) and 1.047 days (1·007–1·088) days longer, respectively, than in low-volume hospitals. The hospitalization costs per inpatient with AMI in medium-volume hospitals (OR 1·087, 95% CI 1·051–1·125) and high-volume hospitals (1·230, 1·188–1·274) were higher than in low-volume hospitals.Interpretation
Given that in-hospital mortality was lower in medium-volume hospitals than in low-volume and high-volume hospitals, it is important to recognise that pursuit of high patient volumes and volume-based referral may not improve overall outcomes for inpatients with AMI, particularly in countries in which medical resources are strained.Funding
National Natural Science Foundation of China (number 71473099). 相似文献2.
Kenneth Mangion David Carrick Jaclyn Carberry Ahmed Mahrous Christie McComb Hao Gao Xiayou Luo Keith Oldroyd Hany Eteiba Margaret McEntegart Mitchell Lindsay Mark Petrie Xiaodong Zhong Caroline Haig Colin Berry 《Lancet》2017
Background
Infarct size assessed early after acute ST-segment elevation myocardial infarction (STEMI) can overestimate the true extent of infarction, limiting its usefulness as a prognostic biomarker. Myocardial strain derived from displacement encoding with stimulated echoes (DENSE) cardiovascular magnetic resonance (CMR) provides information on myocardial contractility with high precision and accuracy. We hypothesised that the prognostic value of peak circumferential strain is higher than infarct size.Methods
In a prospective, single centre study, participants underwent 1·5T CMR 2 days and 6 months after myocardial infarction. The 5-SD technique was used to quantify late gadolinium enhancement (LGE) as proportion of left ventricular mass. Mid-left ventricular DENSE acquisitions were analysed using postprocessing software. During longer-term follow-up, major adverse cardiac events (MACE) were independently assessed by masked cardiologists. Participants provided written informed consent and ethics approval was given (reference 10/S0703/28). This study is registered with ClinicalTrials.gov, number NCT02072850.Findings
300 patients underwent CMR (mean age 58·6 years [SD 13·2], 237 men [79%], 118 anterior myocardial infarction [39%], 30 with diabetes [10%], 284 with normal flow [Thrombolysis in Myocardial Infarction grade 3] after percutaneous coronary intervention [95%]). 259 of these patients had DENSE acquired, of whom 21 (8%) experienced a MACE at 3 years' follow-up. DENSE and baseline LGE had reasonable power for prediction of adverse events (area under the curve [AUC] DENSE 0·712, p=0·001; AUC LGE 0·644, p=0·028). For MACE (receiver operating characteristic analysis), optimal cut-offs for peak circumferential strain using DENSE was ?10·51%, and LGE 24·05 g. Cox-regression analysis showed that DENSE (hazard ratio 1·175, 95% CI 0·036–1·334; p=0·012) offered an incremental prognostic benefit over LGE (1·040, 1·010–1·070; p=0·008) to predict MACE.Interpretation
DENSE-derived peak circumferential strain offers an incremental prognostic benefit over infarct size revealed by LGE to predict MACE; a cut-off of ?10·51% can identify STEMI patients at higher risk of events. This is the first time, to our knowledge, that CMR-derived strain has been shown to provide prognostic utility in patients with STEMI.Funding
This research was supported by project grants from the Chief Scientist Office (SC01), Medical Research Scotland (343 FRG), and the British Heart Foundation (BHF-PG/14/64/31043). 相似文献3.
Hui Chen Lizheng Shi Ming Xue Xiao Dong Ni Wang Jieqing Chen Weiguo Zhu Yue Cai Hua Xu Qun Meng 《Lancet》2017
Background
The prevalence of acute myocardial infarction (AMI) has increased in China within the past few decades and is now a major cause of mortality. Percutaneous coronary intervention (PCI) is an effective treatment for AMI. We aimed to investigate how geographical and hospital characteristics affect in-hospital mortality and PCI use for AMI admissions in tertiary hospitals.Methods
We extracted data from the Nationwide Hospital Discharge Database from China's National Center for Health Statistics. Adjusted odds ratios (aORs) with 95% CI from multivariable logistic regressions were reported as associations between geographical variation or hospital characteristics and in-hospital mortality or PCI use, controlling for demographics and comorbidity scores.Findings
We identified 242866 adult admissions with AMI as primary diagnosis in 2015 from 1055 tertiary hospitals. The nationwide in-hospital mortality rate of AMI was 4·7% and differed significantly by geographic regions: 6·44% in northeast China; 5·84% in west China, 4·50% in south China, 3·77% in east China, and 3·60% in north China. Compared with eastern China, a high risk of in-hospital mortality was found in northeast China (aOR 1·86; 95%CI 1·75–1·98), west China (1·74; 1·62–1·86), south China (1·32; 1·24–1·40), and north China (1·14; 1·06–1·22). Hospital characteristics associated with the highest mortality were non-teaching hospitals (1·18; 1·12–1·24) and tertiary B hospitals (1·06; 1·01–1·11). The nationwide rate of PCI use was 45·3%. Compared with eastern China, PCI use was low in northeast China (0·49; 0·47–0·50), west China (0·63; 0·62–0·65), north China (0·83; 0·81–0·85), and south China (0·88; 0·86–0·91). Other factors that contributed to lowering the rate of PCI use were non-teaching hospitals (0·84; 0·81–0·865) and tertiary B hospitals (0·55; 0·53–0·56).Interpretation
Among China's tertiary hospitals, substantial disparities of in-hospital mortality and PCI use be attributable to geographical and hospital characteristics. More efforts are needed to reduce disparities and improve access to effective health technology.Funding
National Natural Science Foundation of China Grant (81671786). The funder had no role in the conduct of the study; in the collection, management, analysis, and interpretation of the data; or in the preparation or approval of the Abstract. 相似文献4.
Background
Infections can trigger acute vascular events but the differential effect of specific respiratory pathogens is unknown. We aimed to quantify the association between laboratory-confirmed respiratory bacterial or viral infections and first myocardial infarction or stroke to inform intervention development and targeting.Methods
Scottish Morbidity Record data on first myocardial infarction or stroke (International Classification of Diseases, 10th revision, codes) were linked to records of Streptococcus pneumoniae, influenza, rhinovirus, parainfluenza, respiratory syncytial virus, or human metapneumovirus from the Electronic Communication of Surveillance in Scotland (National Services Scotland) dataset on individuals aged 40 years or older from Jan 1, 2004, to Dec 31, 2014. We analysed incidence ratios for myocardial infarction or stroke in the 28 days after infection compared with baseline using self-controlled case series.Findings
There were 1227 individuals with myocardial infarction (751 men [61%]) and 762 with stroke (392 men [51%]). Median age was 68 years (IQR 59–77). The relative incidence of myocardial infarction was markedly raised in the first 1–3 days after both bacterial and viral infections (incidence ratio 5·98, 95% CI 2·47–14·4 [p<0·0001] and 5·59, 1·77–17·6 [p=0·003], respectively) and persisted for about 1 week. For stroke, the respective relative incidence after respiratory infection was even higher for days 1–3 (12·3, 5·48–27·7 [p<0·0001] and 6·79, 1·67–27·50 [p=0·007]). Elevated stroke risks after both bacterial and viral infections persisted to 28 days (p<0·0001).Interpretation
Our findings suggest that respiratory bacterial and viral infections act as vascular triggers. For stroke, the incidence ratio remained elevated a month after the date of respiratory sampling but for myocardial infarction the raised incidence ratio appeared to be more transient, suggesting potentially different mechanisms. This study highlights the need to ensure adequate uptake of influenza and pneumococcal vaccines as well as appropriate treatment during infections to reduce vascular risk.Funding
Academy of Medical Sciences. 相似文献5.
Background
China has made remarkable efforts and achievements since its health reform in 2009, yet there are substantial knowledge gaps in the quality of primary health care (PHC) in China. We aimed to assess the quality of PHC in China by analysing hospital admission rates among diabetics, a frequently used quality indicator for PHC.Methods
We obtained data from a nationwide longitudinal survey for 1006, 1472, and 1771 participants with diabetes who were surveyed as part of China Health and Retirement Longitudinal Study in 2011, 2013, and 2015, respectively. We described and analysed primary care coverage and hospital admission rates (proportion of patients with diabetes who were admitted to hospital) to assess the quality of PHC in eastern, central, and western China. Primary care coverage included proportion of patients who received diabetes-related health education, examinations, and treatments. We used logistic regressions to model the changes of primary care coverage and hospital admission rates in 2011–15 by adjusting for sociodemographic variables. Ethical approval is not applicable in this study as we use anonymised secondary data.Findings
Health education coverage decreased significantly in 2011–15 (76·17% in 2011, 73·15% in 2013, and 70·15% in 2015; OR 0·747 [95% CI 0·62–0·90]) whereas the proportion of patients who received diabetic-related examinations and medical treatments remained largely unchanged (78·88% in 2011, 78·35% in 2013, and 81·45% in 2015; OR 1·18 [95% CI 0·95–1·45]). Moreover, the proportion of patients who received diabetic-related examinations in the west was lower than that in the east (OR 0·52 [0·35–0·76]). Diabetes-related hospital admission rates increased from 4·01% in 2011 to 6·08% in 2013 (OR 1·47 [0·97–2·22]), and recurrent hospital admission rates increased from 18·87% in 2011 to 28·45% in 2015 (OR 1·78 [1·44–2·20]). Both diabetes-related admission rates (OR 1·80 [1·13–2·87]) and recurrent hospital admission rates (OR 1·92 [1·50–2·45]) were higher in the west than in the east.Interpretation
Judging by the patient-reported process and outcome indicators studied, quality of PHC has not improved in China between 2011–2015. Continuous evidence-based monitoring, evaluation and reporting of PHC quality are crucial for accomplishing the goals of health-care system reform in China.6.
7.
Background
Globally, antimicrobial resistance has become one of the most complex public health challenges. Accurate estimates of health and economic burden of antimicrobial resistance has not been available in China because of the absence of representative empirical data. We therefore aimed to estimate the effect of antimicrobial resistance attributable to Staphylococcus aureus bloodstream infections in Chinese hospitals, and to compare the effect of resistant strains with susceptible strains.Methods
We did a multicentre, retrospective cohort study of 11 tertiary hospitals in China. The cohort consisted of all inpatients with S aureus bloodstream infections from the sample hospitals, and we randomly included individuals free of S aureus bloodstream infections. We stratified the patients into two categories of S aureus bloodstream infections: meticillin-susceptible S aureus (MSSA) or meticillin-resistant S aureus (MRSA). The primary outcome was the effect of antimicrobial resistance on excess length of stay in the hospital, hospital mortality, and cost of treatment. We adopted a multistate model to estimate the expected length of stay. Multi-level Cox proportional hazards models were adopted to compare the hazard of reaching hospital death, discharge alive, and the combined end-of-stay endpoint. Two bed-day values were adopted when estimating the cost of treatment. This study was approved by Peking University Health Science Center Ethics Committee, with a waiver for individual informed consent.Findings
From Jan 1, 2010, to June 31, 2017, we assessed 861 inpatients with S aureus bloodstream infections and 10?000 individuals free of S aureus bloodstream infections. Of the 861 admissions with an S aureus blood stream infection detected, 324 (38%) were due to MRSA and 537 (62%) were due to MSSA. Bloodstream infections caused by MRSA prolonged the length of stay in the hospital by 13·4 days (95% CI 11·1–16·3), and MSSA bloodstream infections prolonged the length of stay by 11·9 days (95% CI 9·7–14·1). However, bloodstream infections caused by MRSA did not increase the hazard of death (adjusted hazard ratio [aHR] 0·31, 95% CI 0·09–1·10). MSSA bloodstream infections also did not increase the hazard of death (aHR 0·59, 95% CI 0·14–2·54). Compared with MSSA, MRSA did not significantly increase the hazard of death (aHR 0·44, 95% CI 0·19–1·03), excess length of stay (1·5 days, 95% CI ?0·4 to 2·8), and cost of treatment. Although the cost of MRSA treatment was higher per infection than MSSA treatment, the annual cost of MSSA was higher overall.Interpretation
By accounting for time-dependent bias and important confounders, this study added to the existing literature about the effect of antimicrobial resistance in China. Current results of the study implicate the importance of surveillance and infection control policies that target infections rather than resistance.Funding
China Medical Board (17-270). 相似文献8.
Hui Chen Lizheng Shi Ni Wang Yangtong Han Yilu Lin Xiao Dong Yue Cai Honglei Liu Ming Xue Hua Xu 《Lancet》2018
Background
Stroke is now the leading cause of death in China, following a rise in the incidence of the disease over the past few decades. For certain types of ischaemic stroke, endovascular treatment improves functional outcomes and reduces mortality. However, there is very limited information about nationwide geographical variations in hospital mortality and the adoption of endovascular therapy after stroke, particularly ischemic stroke.Methods
The Nationwide Hospital Discharge Database operated by the National Health Commission of China was used to obtain de-identified data for 1?788?020 adult inpatients (aged 18 and over) with a primary diagnosis of stroke in 2015 from 1267 tertiary hospitals across all provinces of China except for Tibet. The overall hospital mortalities for each type of stroke were reported and compared among five geographical regions. For patients with ischaemic stroke, multivariable logistic regression analyses were conducted to explore the associations between geographical variation and both hospital mortality and endovascular therapy use, controlling for demographics, medical insurance, comorbidity, and admission status.Findings
The nationwide hospital mortalities of intracerebral haemorrhage, subarachnoid haemorrhage and ischaemic stroke were 5·15%, 4·34% and 0·88%, respectively, and differed significantly by geographical region (p<0·0001 in all cases). After controlling for multiple confounding factors, the risk of hospital mortality from ischaemic stroke was found to be significantly higher in Northeast (1·24%, odds ratio 2·37), Western (1·02%, 1·65), North (0·78%, 1·29), and South Central China (0·73%, 1·25), than in East China (0·56%, p<0·0001 in all cases). The use of endovascular therapy also differed significantly by geographical region (p<0·0001 in all cases except between East China and South Central China [p=0.012]), with the lowest use in Northeast China (0·14%) and the highest use in North China (0·81%).Interpretation
Substantial geographical variations in both hospital mortality and endovascular therapy use for patients with ischaemic stroke among tertiary hospitals may be attributable to the variations in climate, economic development, and the quality and level of medical care across geographical regions in China. More efforts are needed to reduce the disparities and to improve access to effective health technology.Funding
The National Natural Science Foundation of China (number 81671786). 相似文献9.
Background
In areas of rural China inhabited by minority groups, local village doctors often use traditional Chinese folk medicines to treat primary epilepsy in children. However, such folk medicines have been implicated in heavy metal poisoning in children. This study determined the heavy metal concentrations of samples of folk medicines, and examined the attitudes of local doctors regarding their use.Methods
Inductively coupled plasma-optical emission spectrometry (ICP-OES) was used to identify toxic heavy metals from 33 samples of folk medicines (28 mixtures and five monomers) from eight counties in western Hunan Province, China, from March 1, 2018 to March 30, 2018. Village doctors in western Hunan Province, China, participated in face-to-face interviews based on a questionnaire focused on knowledge about the heavy metal toxicity of folk medicines.Findings
Four toxic heavy metals—cadmium (Cd), lead (Pb), mercury (Hg), and arsenic (As)—were identified in the samples. The mean (SD) concentrations of Cd, Pb, Hg, and As, were 0·513 (0·237), 5·145 (2·404), 0·298 (0·179), and 0·321 (0·106)?mg/kg, respectively. Furthermore, Cd was found in 76%, Pb in 68%, Hg in 38%, and As in 24% of the samples. These levels exceeded the Chinese legal limits of 0·3, 5·0, and 0·2 mg/kg, respectively. The highest concentration of lead found in a sample was 65·42 mg/kg. The questionnaire was completed by 112 village doctors, of whom 68% considered folk medicine to be safe for treating epilepsy and 77% believed that some heavy metals, especially lead, were efficacious for treating epilepsy.Interpretation
Some folk medicines contain heavy metal concentrations exceeding safe limits. The use of folk medicines by rural village doctors to treat epilepsy might lead to increased heavy metal exposure in children in these rural areas. It is important to focus on this issue given the potential harmful effects on children's health. There is a clear need for multifaceted interventions that target village doctors to improve their knowledge of heavy metal poisoning in children.Funding
This study was supported by the Yale-China Association. 相似文献10.
Tess Harris Elizabeth Limb Fay Hosking Iain Carey Steve DeWilde Cheryl Furness Charlotte Wahlich Shaleen Ahmad Sally Kerry Peter Whincup Christina Victor Michael Ussher Steve Iliffe Ulf Ekelund Julia Fox-Rushby Judith Ibison Derek Cook 《Lancet》2018
Background
Data are lacking from physical activity (PA) trials with long-term follow-up of both objectively measured PA levels and robust health outcomes. Two primary care 12-week pedometer-based walking interventions in adults and older adults (PACE-UP and PACE-Lift) found sustained objectively measured PA increases at 3 and 4 years, respectively. Using routine primary care data, we aimed to evaluate intervention effects on long-term health outcomes relevant to walking interventions.Methods
We downloaded primary care data for trial participants who gave written informed consent, for 4-year periods after their randomisation from the 7 general practices in the PACE-UP trial and 3 general practices in the PACE-Lift trial (PACE-UP from Oct 23, 2012, to Nov 11, 2017; PACE-Lift from Oct 12, 2011, to Oct 11, 2016). The following new events were counted masked to intervention status for all participants, including those with pre-existing diseases (apart from diabetes, where existing cases were excluded): cardiovascular (myocardial infarction, coronary artery bypass graft, angioplasty, and stroke or transient ischaemic attack), diabetes cases, depression episodes, fractures, and falls. We modelled the effect of the interventions on outcomes using Cox and Poisson regression models, adjusting for age, sex, and practice.Findings
Data were downloaded for 1297 (98%) of 1321 trial participants. Event rates were low (<20 per group) for outcomes, apart from fractures and falls. Cox hazard ratios for time-to-first event after randomisation for interventions versus controls were: cardiovascular 0·24 (95% CI 0·07–0·77), diabetes 0·77 (0·43–1·38), depression 0·98 (0·46–2·07), and fractures 0·56 (0·35–0·90). Poisson incident rate ratio for falls was 1.09 (95% CI 0·83–1·43).Interpretation
Short-term primary care PA interventions led to long-term PA increases in the intervention groups, associated with significant decreases in new cardiovascular events and fractures at 4 years. Though no significant differences between intervention and control groups were demonstrated for other events, direction of effect for diabetes was protective, but our trials were underpowered to find differences in low frequency outcomes. Our study also demonstrates the potential for using routine data to evaluate the outcome of large-scale primary care walking interventions, avoiding expensive objective accelerometry assessment or inaccurate self-report PA data.Funding
Supported by the National Institute for Health Research (NIHR). 相似文献11.
Background
We have previously described outcomes in severe alcoholic hepatitis, identifying abstinence after hospital discharge as the only independent predictor of long-term survival. The outcome of patients presenting with other forms of decompensated alcohol-related liver disease is unknown. Our aim was to assess predictors of inpatient and long-term survival in patients admitted with decompensated alcohol-related cirrhosis compared with those with severe alcoholic hepatitis.Methods
A retrospective case-note review was performed for all index hospital admissions with alcoholic-related liver disease between April 1, 2005, and Dec 31, 2011. Patients with decompensated alcohol-related cirrhosis (Child-Pugh score ≥7 and bilirubin <80 mmol/L) were compared with a previously studied cohort with severe alcoholic hepatitis admitted over the same time period (discriminant function ≥32, corroborated by biopsy results where available). Predictors of inpatient survival were determined using binary logistic regression, and the Kaplan-Meier method was used to estimate long-term survival.Findings
177 patients were studied (73 decompensated alcohol-related cirrhosis, 104 severe alcoholic hepatitis). In decompensated alcohol-related cirrhosis, the independent determinants of inpatient mortality were hospital-acquired infection (odds ratio 20·2, 95% CI 3·5–118; p=0·001) and hepatic encephalopathy (9·3, 1·8–47; p=0·007). Overall median survival was similar in both groups (26 months [IQR 12·8–39·2] in decompensated alcohol-related cirrhosis vs 23 [10·6–35·4] in severe alcoholic hepatitis, p=0·872) with similar abstinence rates at last follow-up (41·1% vs 34·6%, p=0·431). In severe alcoholic hepatitis, abstinence at last follow-up was the only predictor of survival (3 year survival 75·2% in abstainers vs 33·2% in continued drinkers, p=0·012). However, in decompensated alcohol-related cirrhosis, abstinence did not predict long-term survival (median survival 36 months [IQR 22·3–49·7] in abstainers vs 38 [9·9–66·1] in continued drinkers, p=0·949).Interpretation
Inpatient mortality in decompensated alcohol-related liver disease was predicted by hospital-acquired infection and hepatic encephalopathy. Long-term survival in decompensated alcohol-related cirrhosis did not significantly improve with abstinence, which is in contrast to severe alcoholic hepatitis, and this suggests a reduced scope for disease reversibility thereby mandating earlier assessment for liver transplantation.Funding
None. 相似文献12.
Background
Secondary hospitals in Shanghai received less support for conducting medical residency programmes than tertiary hospitals, until the programmes became standardised in 2010. If standardisation succeeds, it may reduce the disparities in the quality of the physician workforce and health care among different hospitals. This study examined whether residents at secondary hospitals had the same perception of the magnitude of their improvement in competence as those at tertiary hospitals after standardised residency training.Methods
We recruited all 2283 residents who started their residency in 2013 at 47 hospitals in Shanghai. One week before graduation, residents reported their perceived improvement in competence as the primary outcome. Hospital of residency, awareness of the program requirements, and demographic information were treated as explanatory variables. We ran linear regressions to examine whether hospital type and the university to which the hospital is affiliated were associated with the extent of perceived improvement. Fudan University Institutional Review Board approved the study. All participants who submitted responses provided informed consent.Findings
Of the 2283 residents recruited, 2208 (96·71%) completed the survey. The mean score of perceived improvement in competence was 3·418 on a scale of 1–5 (SD 0·690). Although the adjusted multilevel analysis showed that scores at tertiary specialty hospitals (β=?0·044, SE 0·098, p=0·653) and tertiary general hospitals (β=?0·041, SE 0·081, p=0·612) were lower than at secondary general hospitals, the association was not statistically significant. No variance in improvement scores could be explained by hospital type or university affiliation.Interpretation
The Shanghai standardised residency training has achieved standardisation of training and of professional competence across different hospitals for the residents who started residency in 2013. Continual evaluation with objective data will be necessary as the programme proceeds, to determine whether these findings are reliable, and whether Shanghai's model remains an exemplar for standardised residency training programmes in the rest of China.Funding
No funding. 相似文献13.
Background
Coronary artery bypass graft (CABG) surgery is one of the major surgeries requiring long-term stay in hospital. This generally leads to the detrimental effects of bed-rest, including dependency in self-care, transfer, and locomotion. Our aim was to compare the effect of high-frequency and low-frequency exercise therapy in patients who had undergone CABG.Methods
Patients who had undergone CABG were recruited from PSG Medical College and Hospital, Coimbatore, India, between Jan 1 and March 31, 2006. Functional Independence Measure (FIM) and modified Borg Rating of Perceived Exertion (RPE) were used to assess functional outcome. In a quasi-experimental design, patients received either high-frequency exercise therapy (exercise three times a day for 10 days, group 1), or low-frequency exercise therapy (once a day for 10 days, group 2). Data were analysed with paired t tests.Findings
30 patients were recruited (15 in each group). Mean FIM was 75 (SD 1·77) in group 1 and 64 (1·65) in group 2. There was a significant difference between the pretest and post-test FIM values in group 1 patients (49·07 [2·43] vs 124·07 [1·75], p<0·0001) but not in group 2 patients. The RPE in group 1 and group 2 was 6·3 (0·62) and 4·2 (0·7), respectively.Interpretation
Patients given high-frequency exercise thearpy had a significant improvement in their physical activity, but low-frequency exercise did not lead to significantly improved changes. In conclusion, the high-frequency exercise therapy improves the functional ability of patients with CABG.Funding
None. 相似文献14.
Samah W Al-Jabi Rayah Yahya Ru&#x;a Salameh Haya Jabi Warde Msaime Mohammad Daraghmeh Ala&#x; Barakat Sa&#x;ed H Zyoud Waleed M Sweileh 《Lancet》2018
Background
The negative effect of breast cancer on survivors highlights the importance of increased knowledge about patients' health-related quality of life (HRQOL). The aim of this study was to assess HRQOL in women with breast cancer and to examine the effect of patient characteristics on HRQOL.Methods
This cross-sectional study took place in four oncology centres in the West Bank, occupied Palestinian territory, during a 6 month period in 2014. We used a convenient sampling method to recruit participants and the EuroQol-5 Dimension (EuroQoL EQ-5D) scale to assess their HRQOL. All analyses were done in SPSS version 16.0. The study was approved by the Institutional Review Board at An-Najah National University. Informed verbal consent was obtained from the participants before the start of the study.Findings
244 women with breast cancer were interviewed. Their mean age was 52·7 years (SD 12·2), and the mean number of years of breast cancer was 3·38 years (SD 3.6). 136 (56%) women had stage 2 breast cancer, and 54 (22%) women had stage 3 breast cancer. 233 (96%) participants received chemotherapy, and 206 (84%) participants had surgery. The median EQ-5D index was 0·72 (IQR 0·51–0·84), and the median of EQ-visual analogue scale (EQ-VAS) was 70 (IQR 55–80). We found a positive correlation between the EQ-5D index and EQ-VAS scores (R=0·51; p<0·001). The highest EQ-5D index scores were found in elderly patients (p=0·006), employed women (p=0·002), women with high income (p=0·012), women with higher education (p=0·001), and women who exercised regularly (p=0·006). Additionally, patients with advanced disease stage had the lowest median EQ-5D index (p=0.002).Interpretation
Palestinian women who had survived breast cancer reported favourable overall HRQOL. Increased educational attainments, monthly income, and physical activity was associated with improved overall HRQOL. Thus, improved overall HRQOL should be considered a very important goal in treatment of breast cancer.Funding
None. 相似文献15.
Background
There is an increasing amount of data over the effect of folic acid and B vitamins (vitamin B6 and B12) on cardiovascular disease, but whether supplementation with folic acid and B vitamins can reduce the risk of cardiovascular disease among middle-aged and elderly patients remains unclear. We conducted this meta-analysis to assess the efficacy of folic acid supplementation in the prevention of cardiovascular disease.Methods
We searched PubMed and Web of Science for randomised controlled trials published between Jan 1, 1980, and Sept 1, 2015. We used relative risk (RR) with 95% CIs as a measure of effect of folic acid supplementation on the risk of cardiovascular disease. Data were independently extracted and sorted by two investigators to assess their quality. The results were pooled with a randomised-effects model using Stata 12.0 software. We used forest plots to analyse the effect of B vitamins as well as folic acid.Findings
We included 22 randomised controlled trials reporting data on 79?564 participants. All participants were aged 45 years or older (ie, middle-aged or elderly). Supplementation with both folic acid and B vitamins together was not associated with any significant reduction in the risk of cardiovascular events (RR 0·98, 95% CI 0·92 to 1·03, p=0·353), myocardial infarction (1·00, 0·93 to 1·08, p=0·940), or total mortality (1·00, 0·94 to 1·06, p=0·778). However, a beneficial effect was observed for stroke, with supplementation with folic acid and B vitamins reducing the risk by 12% (RR 0·88, 95% CI 0·80 to 0·97, p=0·001). Moreover, we found that folic acid only could reduce the risk of cardiovascular events by 11% (RR 0·89, 95% CI 0·80 to 0·98, p=0·016) and the risk of stroke by 20% (0·80, 0·69 to 0·93, p=0·003). The level of homocysteine was reduced by 0·72 μmol/L (95% CI ?1·00 to ?0·44, p<0·0001).Interpretation
Supplementation with folic acid with or without B vitamins is more beneficial for stroke than for other cardiovascular outcomes in middle-aged and elderly patients.Funding
2012 Chinese Nutrition Society Nutrition Research Foundation—DSM Research Fund (2014-014); the Research Program of Shaanxi Soft Science (2015KRM117); the National High-Level Talents Special Support Plan (“Thousands of People Plan”); Shaanxi Provincial Youth Star of Science and Technology in 2016; and the Basic Scientific Research Funding of Xi'an Jiaotong University (SK2015007). 相似文献16.
Background
The prevalence of metabolic syndrome is increasing in China and globally. Studies show that metabolic syndrome is associated with risk of cancer, but this association in Chinese populations remains unclear. We performed a systematic review and meta-analysis to evaluate the association between metabolic syndrome and cancer in Chinese populations.Methods
We searched Embase, MEDLINE, PubMed, and WanFang databases for studies up to April 5, 2018. We included research that met the following criteria: (1) they investigated the association between metabolic syndrome and risk of cancers; (2) they were case-control or cohort studies; (3) they were conducted in Chinese individuals aged 20 years and over; (4) they contained information on the numbers of cases and controls. We adopted random-effects models in the meta-analysis to estimate the relative risk (RR) and 95% CIs. We also performed subgroup analysis by sex and cancer types.Findings
We analysed 36 datasets from 22 articles, including 7273 cases of cancer (2429 with metabolic syndrome) and 49?987 controls (11?440 with metabolic syndrome). Overall, the presence of metabolic syndrome was associated with increased risk of cancer by almost two times (RR=1·96; 95% CI 1·63–2·35). The association was stronger in females (RR=2·18; 95% CI 1·67–2·86) than in males (RR=1·12; 95% CI 0·57–2·22). In females, the presence of metabolic syndrome was associated with ovarian (RR=3·42; 95% CI 2·84–4·11), endometrial (RR=2·53; 95% CI 1·56–4·08), cervical (RR=2·39; 95% CI 1·72–3·32), and breast cancers (RR=1·61; 95% CI 1·27–2·05). We did not identify an association with prostate cancer in males (RR=0·93; 95% CI 0·43–2·03).Interpretation
This is the first systematic review of the association between metabolic syndrome and risk of cancer among Chinese populations. Our results indicate an increased risk of cancer for individuals with metabolic syndrome, especially females. Our findings also highlight the urgent need for preventive measures and therapeutic interventions of metabolic syndrome in female individuals because of the rapidly growing disease burden.Funding
No funding. 相似文献17.
Fanfan Chan Niannian Chen Jianrong He Jinhua Lu Fanghua Liu Weidong Li Wanqing Xiao Songying Shen Mingyang Yuan Kar Keung Cheng Huimin Xia Ben Willem Mol Xiu Qiu 《Lancet》2017
Background
Gestational hypertension and pre-eclampsia are major causes of perinatal mortality. Prediction of gestational hypertension and pre-eclampsia is of great interest because it enables early intervention, thus improving prognosis. Most existing prediction models consist of biomarkers, which might be unavailable in low-resourced countries. We aimed to establish a prediction model of gestational hypertension and pre-eclampsia using data at early pregnancy.Methods
We studied women with singleton delivery from Born in Guangzhou Cohort Study (BIGCS), China. Predictors included maternal age, educational level, income level, prepregnancy weight, height, passive smoking, and blood pressure collected at the first antenatal-care visit (around 16 weeks' gestation). Information on diagnosis of gestational hypertension or pre-eclampsia was extracted from medical records using international classification of disease code (ICD-10). We used logistic regression to develop prediction models. Discrimination and calibration were assessed with receiver operation characteristics (ROC) and calibration plot, respectively.Findings
Between Feb 1, 2012, and Jan 1, 2016, we recruited 12?915 women, of which 326 (2·52%) women were diagnosed with gestational hypertension and 82 (0·66%) had pre-eclampsia. The prediction model for gestational hypertension with maternal characteristics alone had an area under the ROC-curve of 0·67 (95% CI 0·62–0·72). Maternal mean arterial pressure (MAP) had an area under the curve (AUC) of 0·74 (95% CI 0·70–0·79), whereas the AUC of the model with MAP and maternal characteristic combined was 0·76 (0·72–0·81), which was slightly better than for MAP alone (p=0·03). Results for prediction of pre-eclampsia were very similar to those of gestational hypertension. Calibration plots showed that the prediction model with MAP had good fit.Interpretation
Our findings show that MAP has acceptable predictive ability of gestational hypertension and pre-eclampsia and can be used to triage further care. Our relatively large sample size ensured stronger statistical power. Model validation need to be performed in a separate population.Funding
National Natural Science Foundation of China (81673181), Guangzhou Science and Technology Bureau, Guangzhou, China (2011Y2-00025, 201508030037) 相似文献18.
Junjie Huang Jason LW Huang Mellissa Withers Kuo-Liong Chien Indang Trihandini Edmar Elcarte Vincent Chung Martin CS Wong 《Lancet》2018
Background
The prevalence of metabolic syndrome is growing because of increasing rates of obesity and sedentary lifestyle. Metabolic syndrome is one of the most important risk factors associated with diabetes, cardiovascular disease, and all-cause mortality. Few studies have examined its sex-specific prevalence in China across time. We compared the prevalences and temporal trends of metabolic syndrome in Chinese women and men.Methods
We conducted a PRISMA-compliant search in MEDLINE and Embase from their inception to Feb 15, 2018, for epidemiological studies that reported metabolic syndrome prevalence in Chinese individuals. We included data from population-based studies for individuals aged 15 years and older and a random effect model was used to estimate prevalence and 95% CI. We modelled within-study variability by binomial distribution and Freeman-Tukey double arcsine transformation to stabilise the variances. We did subgroup analyses by sex, age, region, and screening period.Findings
We identified 80 eligible studies that included 734?511 individuals. The overall prevalence of metabolic syndrome in China was 22·0% (95% CI 19·9–24·1). Its prevalence was higher in women (23·6%, 21·0–26·3) than in men (21·0%, 18·8–23·3), in urban (23·5%, 20·7–26·) than in rural regions (20·3%, 16·4–24·6), and in people older than 40 years (27·6%, 23·9–31·6) than in those aged 15–40 years (8·3%, 6·5–10·3). From 1991–1995 to 2011–2015, prevalence of metabolic syndrome rose rapidly from 8·8% (2·8–17·7) to 29.3% (21·8–37·3), with a greater rise in women (from 7·9% to 30·7%) than in men (9·4% to 27·2%).Interpretation
We found a rapidly increasing prevalence of metabolic syndrome in Chinese women. These findings suggest that more targeted lifestyle intervention and early screening programmes should be implemented for women in China.Funding
None. 相似文献19.
Sa&#x;ed H Zyoud Dala N Daraghmeh Diana O Mezyed Razan L Khdeir Mayas N Sawafta Nora A Ayaseh Ghada H Tabeeb Waleed M Sweileh Rahmat Awang Samah W Al-Jabi 《Lancet》2018
Background
Haemodialysis is a life-saving but burdensome therapy for patients with end-stage renal disease, which can substantially impair health-related quality of life (HRQOL) and outcomes. The aim of this study was to determine the patterns of HRQOL and to identify the risk factors for reduced HRQOL in Palestinian patients receiving treatment by haemodialysis.Methods
This cross-sectional study was done between June 15, 2014, and Jan 15, 2015, using the EuroQOL-5 Dimensions instrument (EQ-5D-5L) for the assessment of HRQOL. We approached patients with end-stage renal disease undergoing haemodialysis at inpatient hospitals from ten different settings at a national level. The study protocol was approved by the Ethics Committee of An-Najah National University. Informed verbal consent was obtained from each participant before the start of the interview. Multiple linear regression was used to estimate which variables were significantly associated with reduced HRQOL.Findings
267 (96%) of 277 eligible patients consented to participate. 139 (52%) participants were men, and the mean age was 53·3 years (SD 16·2). 177 (66%) patients had been treated by haemodialysis for less than 4 years. The reported HRQOL, as measured by mean EQ-5D-5L index value, was 0·37 (SD 0·44). We found a moderate positive correlation between the EuroQol-visual analogue scales and the EQ-5D-5L index value (r=0·44; p<0·0001). The results of a multiple linear regression showed a significant association between HRQOL and age (p=0·0011), female sex (p=0·0167), education level (p=0·0057), number of chronic medications (p=0·0493), and number of comorbid diseases (p=0·0001).Interpretation
Our results provide insight into a number of associations between patient variables such as demographics, clinical factors, and their HRQOL. These findings should help raise health-care providers' awareness and improve the quality of life for patients receiving treatment by haemodialysis, especially those who have no formal education, are elderly, are female, are from refugee camps, or have multiple comorbid diseases or chronic medications.Funding
None. 相似文献20.
Kenneth Chan Riyaz Patel Xiangyuan Pu Iain A Simpson Robin N Poston Salim Hayek Shu Ye Arshed Quyyumi 《Lancet》2017