Life situations and the care burden for stroke patients and their informal caregivers in a prospective cohort study

Abstract

Background. The purpose of this study was to analyse whether the parallel life situation between stroke patients and their informal caregivers (dyads) shown in cross-sectional studies prevails also in a longitudinal perspective.

Methods. A total of 377 Swedish stroke patients, aged ≥65 years, and their 268 informal caregivers were followed from hospital admission and one year on. Analyses were based on patient interviews, functional ability (MMSE) score, Nottingham Health Profile (NHP) score, Hospital Anxiety and Depression (HAD) score, self-rated health score, and the Gothenburg Quality of Life (GQL) activity score. Similar information was obtained by postal questionnaires from informal caregivers, also including information on the nature and amount of assistance provided and on Caregiver Burden (CB) score.

Results. Before index admission informal caregivers provided care on average 5 h per week and after discharge 11 h per week (P < 0.0001). Support volume was associated with patient sex (more for men), low patient’s functional ability, low received municipal social service support, closeness of patient–caregiver relation, and short distance to patient’s home. Significant positive associations within the dyads were found for HAD anxiety score (P < 0.0001), total NHP score (P < 0.0001), and GQL activity score (P < 0.0001) after adjustment for patient’s age, sex, functional ability, and patient–caregiver relationship. CB score increased with amount of informal caregiver support, patient’s age, and with low functional ability and low amount of municipal social service support. All these associations were constant across time.

Conclusions. There was an association within the dyads regarding anxiety score, NHP score, and activity score. CB score was generally high.     

The impact of caregiving on caregivers of older persons and its associated factors: a cross-sectional study

INTRODUCTION:Many older people rely on caregivers for support. Caring for older people can pose significant burdens for caregivers yet may also have positive effects. This study aimed to assess the impact on the caregivers and to determine factors associated with caregivers who were burdened.METHODS:This was a cross-sectional study of 385 caregivers of older people who attended a community clinic in Malaysia. Convenience sampling was employed during the study period on caregivers who were aged ≥ 21 years and provided ≥ 4 hours of unpaid support per week. Participants were asked to complete a self-administered questionnaire, which included the Carers of Older People in Europe (COPE) index and the EASYCare Standard 2010 independence score. The COPE index was used to assess the impact of caregiving. A highly burdened caregiver was defined as one whose scores for all three COPE subscales were positive for burden. Care recipients’ independence was assessed using the independence score of the EASYCare Standard 2010 questionnaire. Multiple logistic regression was used to determine the factors associated with caregiver burden.RESULTS:73 (19.0%) caregivers were burdened, of whom two were highly burdened. Caregivers’ median scores on the positive value, negative impact and quality of support scales were 13.0, 9.0 and 12.0, respectively. Care recipients’ median independence score was 18.0. Ethnicity and education levels were found to be associated with caregiver burden.CONCLUSION:Most caregivers gained satisfaction and felt supported in caregiving. Ethnicity and education level were associated with a caregiver being burdened.     

Human-centered development of an electronic health record-embedded,interactive information visualization in the emergency department using fast healthcare interoperability resources

ObjectiveDevelop and evaluate an interactive information visualization embedded within the electronic health record (EHR) by following human-centered design (HCD) processes and leveraging modern health information exchange standards.Materials and MethodsWe applied an HCD process to develop a Fast Healthcare Interoperability Resources (FHIR) application that displays a patient’s asthma history to clinicians in a pediatric emergency department. We performed a preimplementation comparative system evaluation to measure time on task, number of screens, information retrieval accuracy, cognitive load, user satisfaction, and perceived utility and usefulness. Application usage and system functionality were assessed using application logs and a postimplementation survey of end users.ResultsUsability testing of the Asthma Timeline Application demonstrated a statistically significant reduction in time on task (P < .001), number of screens (P < .001), and cognitive load (P < .001) for clinicians when compared to base EHR functionality. Postimplementation evaluation demonstrated reliable functionality and high user satisfaction.DiscussionFollowing HCD processes to develop an application in the context of clinical operations/quality improvement is feasible. Our work also highlights the potential benefits and challenges associated with using internationally recognized data exchange standards as currently implemented.ConclusionCompared to standard EHR functionality, our visualization increased clinician efficiency when reviewing the charts of pediatric asthma patients. Application development efforts in an operational context should leverage existing health information exchange standards, such as FHIR, and evidence-based mixed methods approaches.     

Validation of the Thai QOL-AD version in Alzheimer’s patients and caregivers

Background

Quality of life (QOL) plays an important role in determining the improvement of patient care in Alzheimer’s disease (AD). The simple and easily used Thai instrument for measuring QOL is still limited.

Aims

This study aimed to translate the Quality of Life–Alzheimer’s Disease (QOL-AD) scale original version into a Thai version and test its psychometric properties.

Method

A Thai version of QOL-AD was translated following the sequential method. The validation was tested in 136 pairs of patients and their caregivers. Mild to moderate Alzheimer’s patients were recruited from outpatient clinics at Chiang Mai Neurological Hospital and Chiang Mai Psychiatry Hospital from April to September 2012. Internal consistency, factor analysis, and construct validity were evaluated.

Results

Internal consistency of Thai QOL-AD version was good for both patients (0.82) and caregivers (0.82). The results of factor analysis indicated three factors (physical and psychological well-being, social well-being, and close interpersonal relationships) in the patient group, while four factors were found (social well-being, functional ability, psychological well-being, and physical well-being) in the caregiver group. The scaling success in the patient group was around 80–83 per cent for convergent validity, and 70–83 per cent for discriminant validity. The caregiver group showed higher scaling success in convergent validity except for the psychological well-being domain. The scaling success of discriminant validity was around 44–83 per cent for caregivers.

Conclusion

The findings of the study demonstrate a good reliability of a Thai QOL-AD version for both patient and caregiver groups. Validity, especially in the caregiver group, might need to be re-examined.     

Efficacy and Safety of OnabotulinumtoxinA in Treating Neurogenic Detrusor Overactivity: A Systematic Review and Meta-analysis

Background:

OnabotulinumtoxinA is widely used in treating neurogenic detrusor overactivity (NDO). We carried out a systematic review and meta-analysis to assess the efficacy and safety of the drug for treating NDO.

Methods:

We searched the following databases: Medline, EMBASE, and the Cochrane Controlled Trials Register. All published randomized double-blind, placebo-controlled trials of onabotulinumtoxinA for the treatment of NDO were identified in the analysis. The reference lists of the retrieved studies were also investigated.

Results:

Four publications involving a total of 807 patients were identified in the analysis, which compared onabotulinumtoxinA with placebo. The changes of the mean number of urinary incontinence per week (the standardized mean difference [SMD] = −10.91, 95% confidence intervals [CIs] = −14.18–−7.63, P < 0.0001); maximum cystometric capacity (SMD = 146.09, 95% CI = 126.19–165.99, P < 0.0001) and maximum detrusor pressure (SMD = −32.65, 95% CI = −37.83–−27.48, P < 0.0001) indicated that onabotulinumtoxinA was more effective than the placebo, despite the doses of onabotulinumtoxinA. Safety assessments primarily localized to the urinary tract indicated onabotulinumtoxinA were often associated with more complications. Urinary tract infections (relative risk [RR] =1.48, 95% CI = 1.20–1.81, P = 0.0002); hematuria (RR = 1.81, 95% CI = 1.00–3.24, P = 0.05) and urinary retention (RR = 5.87, 95% CI = 3.61–9.56, P < 0.0001).

Conclusions:

This meta-analysis indicates that onabotulinumtoxinA to be an effective treatment for NDO with side effects primarily localized to urinary tract.     

Functional mitral regurgitation combined with increased early diastolic transmitral velocity to early mitral annulus diastolic velocity ratio is associated with a poor prognosis in patients with shock

Background:Functional mitral regurgitation (FMR) is common in critically ill patients and may cause left atrial (LA) pressure elevation. This study aims to explore the prognostic impact of synergistic LA pressure elevation and FMR in patients with shock.Methods:We retrospectively screened 130 consecutive patients of 175 patients with shock from April 2016 to June 2017. The incidence and impact of FMR and early diastolic transmitral velocity to early mitral annulus diastolic velocity ratio (E/e’) ≥ 4 within 6 h of shock on the prognosis of patients were evaluated. Finally, the synergistic effect of FMR and E/e’ were assessed by combination, grouping, and trend analyses.Results:Forty-four patients (33.8%) had FMR, and 15 patients (11.5%) had E/e’ elevation. A multivariate analysis revealed FMR and E/e’ as independent correlated factors for 28-day mortality (P = 0.043 and 0.028, respectively). The Kaplan-Meier survival analysis revealed a significant difference in survival between patients with and without FMR (χ² = 7.672, P = 0.006) and between the E/e’ ≥ 14 and E/e’ < 14 groups (χ² = 19.351, P < 0.010). Twenty-eight-day mortality was significantly different among the four groups (χ² = 30.141, P < 0.010). The risk of 28-day mortality was significantly higher in group 4 (E/e’ ≥ 14 with FMR) compared with groups 1 (E/e’ < 14 without FMR) and 2 (E/e’ < 14 with FMR) (P = 0.001 and 0.046, respectively).Conclusions:Patients with shock can be identified by the presence of FMR. FMR and E/e’ are independent risk factors for a poor prognosis in these patients, and prognosis is worst when FMR and E/e’ ≥ 14 are present. It may be possible to improve prognosis by reducing LA pressure and E/e’.Trial Registration:ClinicalTrials.gov, {"type":"clinical-trial","attrs":{"text":"NCT03082326","term_id":"NCT03082326"}}NCT03082326.     

A risk score system for stratifying the risk of relapse in B cell acute lymphocytic leukemia patients after allogenic stem cell transplantation

BackgroundFor patients with B cell acute lymphocytic leukemia (B-ALL) who underwent allogeneic stem cell transplantation (allo-SCT), many variables have been demonstrated to be associated with leukemia relapse. In this study, we attempted to establish a risk score system to predict transplant outcomes more precisely in patients with B-ALL after allo-SCT.MethodsA total of 477 patients with B-ALL who underwent allo-SCT at Peking University People''s Hospital from December 2010 to December 2015 were enrolled in this retrospective study. We aimed to evaluate the factors associated with transplant outcomes after allo-SCT, and establish a risk score to identify patients with different probabilities of relapse. The univariate and multivariate analyses were performed with the Cox proportional hazards model with time-dependent variables.ResultsAll patients achieved neutrophil engraftment, and 95.4% of patients achieved platelet engraftment. The 5-year cumulative incidence of relapse (CIR), overall survival (OS), leukemia-free survival (LFS), and non-relapse mortality were 20.7%, 70.4%, 65.6%, and 13.9%, respectively. Multivariate analysis showed that patients with positive post-transplantation minimal residual disease (MRD), transplanted beyond the first complete remission (≥CR2), and without chronic graft-versus-host disease (cGVHD) had higher CIR (P < 0.001, P = 0.004, and P < 0.001, respectively) and worse LFS (P < 0.001, P = 0.017, and P < 0.001, respectively), and OS (P < 0.001, P = 0.009, and P < 0.001, respectively) than patients without MRD after transplantation, transplanted in CR1, and with cGVHD. A risk score for predicting relapse was formulated with the three above variables. The 5-year relapse rates were 6.3%, 16.6%, 55.9%, and 81.8% for patients with scores of 0, 1, 2, and 3 (P < 0.001), respectively, while the 5-year LFS and OS values decreased with increasing risk score.ConclusionThis new risk score system might stratify patients with different risks of relapse, which could guide treatment.     

Evaluation of factors influencing intention to quit smokeless and cigarette tobacco use among Nigerian adolescents

Background:

Smokeless and cigarette tobacco use is becoming increasingly popular among Nigerian adolescents. This study aimed to evaluate predictors of intention to quit tobacco use among adolescents that currently use tobacco products in Nigeria.

Materials and Methods:

A total of 536 male and female high school students in senior classes in Benue State, Nigeria were enrolled into the cross-sectional study. The survey instrument was adapted from the Global Youth Tobacco Survey (GYTS) questionnaire.

Results:

Among adolescents with tobacco habits, 80.5% of smokeless tobacco users and 82.8% of cigarette smokers intended to quit tobacco use within 12 months. After adjustment, significant predictors of intention to quit cigarette smoking were parents’ smoking status (P<0.01), peers’ smokeless use status (P<0.01) and perception that smoking made one comfortable at social events (P<0.01). For intention to quit smokeless tobacco use, significant predictors after adjustment were parents’ smokeless use status, (P=0.03) perception that smokeless tobacco use made one more comfortable at social events (P=0.04) and perception of harm from smokeless use (P=0.02).

Conclusion:

This study demonstrates that the intention to quit smokeless and cigarette tobacco use is significantly predicted by perception about the societal acceptance of tobacco use at social events, parents and peers’ tobacco use status as well as the perception of harm from use of tobacco products. Providing social support may increase quit attempts among youth smokers.     

Implementation of the pre-operative rehabilitation recovery protocol and its effect on the quality of recovery after colorectal surgeries

Background:Patients’ recovery after surgery is the major concern for all perioperative clinicians. This study aims to minimize the side effects of peri-operative surgical stress and accelerate patients’ recovery of gastrointestinal (GI) function and quality of life after colorectal surgeries, an enhanced recovery protocol based on pre-operative rehabilitation was implemented and its effect was explored.Methods:A prospective randomized controlled clinical trial was conducted, patients were recruited from January 2018 to September 2019 in this study. Patients scheduled for elective colorectal surgeries were randomly allocated to receive either standardized enhanced recovery after surgery (S-ERAS) group or enhanced recovery after surgery based on pre-operative rehabilitation (group PR-ERAS). In the group PR-ERAS, on top of recommended peri-operative strategies for enhanced recovery, formatted rehabilitation exercises pre-operatively were carried out. The primary outcome was the quality of GI recovery measured with I-FEED scoring. Secondary outcomes were quality of life scores and strength of handgrip; the incidence of adverse events till 30 days post-operatively was also analyzed.Results:A total of 240 patients were scrutinized and 213 eligible patients were enrolled, who were randomly allocated to the group S-ERAS (n = 104) and group PR-ERAS (n = 109). The percentage of normal recovery graded by I-FEED scoring was higher in group PR-ERAS (79.0% vs. 64.3%, P < 0.050). The subscores of life ability and physical well-being at post-operative 72 h were significantly improved in the group PR-ERAS using quality of recovery score (QOR-40) questionnaire (P < 0.050). The strength of hand grip post-operatively was also improved in the group PR-ERAS (P < 0.050). The incidence of bowel-related and other adverse events was similar in both groups till 30 days post-operatively (P > 0.050).Conclusions:Peri-operative rehabilitation exercise might be another benevolent factor for early recovery of GI function and life of quality after colorectal surgery. Newer, more surgery-specific rehabilitation recovery protocol merits further exploration for these patients.Trial Registration:ChiCTR.org.cn, ChiCTR-ONRC-14005096     

Efficacy and Safety Investigation of Kuntai Capsule for the Add-back Therapy of Gonadotropin Releasing Hormone Agonist Administration to Endometriosis Patients: A Randomized,Double-blind,Blank- and Tibolone-controlled Study

Background:

As a Chinese Traditional Medicine product, Kuntai capsule could improve the peri-menopausal symptoms in postmenopausal women. But it is still not clear whether Kuntai capsule has a good effect on alleviating peri-menopausal symptoms induced by gonadotropin releasing hormone agonist (GnRH-a) treatment. The purpose of this study was to investigate the clinical effectiveness and safety of Kuntai capsule, on peri-menopausal symptoms in endometriosis (EMS) patients, with postoperative GnRH-a treatment.

Methods:

Ninety EMS ovarian cyst women with postoperative GnRH-a administration were enrolled in the study, and were randomly divided into Kuntai group, Tibolone group, or blank Control group. The therapeutic strategy in Kuntai group was 4 Kuntai capsules tid,po for 12 weeks after the first GnRH-a injection, while Tibolone 2.5 mg qd, po for 12 weeks in Tibolone group. There was no drug addition in Control group. Climacteric complaints were evaluated by Kupperman menopausal index (KMI) and hot flash/sweating score. Liver and renal functions, lipid profile, serum sex hormone levels and endometrial thickness were measured, and the frequency of adverse events in Kuntai and Tibolone groups was recorded.

Results:

(1) Before GnRH-a therapy, the baseline parameter results were comparable in the three groups (P > 0.05). (2) After GnRH-a therapy, KMI and hot flash/sweating scores in all the three groups increased significantly (P < 0.05). At the 4^th week after GnRH-a therapy, KMI and hot flash/sweating score results were as follows: Control group > Kuntai group > Tibolone group (P < 0.05); at the 8^th and 12^th week after GnRH-a therapy, KMI and hot flash/sweating score in Control group were significantly higher than the other two groups (P < 0.05), and no significant difference was identified between Kuntai and Tibolone group (P > 0.05). (3) No statistical change took place in the liver and renal functions and lipid profile in all the three groups after the treatment (P > 0.05). (4) The posttherapeutic serum follicle-stimulating hormone (FSH), luteinizing hormone (LH) and estradiol (E2) level and endometrial thickness decreased significantly in all the three groups (P < 0.05). After therapy, serum E2 level in Tibolone group was obviously higher than the other two groups (P < 0.05), while FSH and LH levels were obviously lower (P < 0.05). (5) The incidence of vaginal bleeding, breast distending pain in Tibolne group was obviously higher than Kuntai group (P < 0. 05).

Conclusions:

Kuntai capsule is effective on the peri-menopausal symptoms induced by postoperative GnRH-a administration to EMS patients, although its clinical effect might be a few weeks later than Tibolone. Kuntai capsule might be a little safer than Tibolone tablet.     

Validation and inter-rater reliability testing of the Arabic version of speech intelligibility rating among children with cochlear implant

Objectives:To validate and assess the reliability of the new version of an Arabic speech intelligibility rating among different raters.Methods:This cross-sectional analysis was carried out between December 2018 and January 2019. Thirty cochlear-implant (CI) children (study group) and 30 subjects (control group) were enrolled. Study candidates’ speech skills were evaluated using the translated Arabic SIR by parents and original SIR by professions such as speech-language pathologists (SLPs). Inter-rater agreement, test–retest reliability, pre- and post-intervention score (responsiveness test), patient versus control score comparison (discriminant validity), and cross-validation of Arabic SIR have all been assessed.Results:There was a good sense of agreement between the post-operative SIR parents’ assessments and the professional SLPs’ assessments (r=0.920, p<0.001). The mean of study subjects pre- and post-implantation score of Arabic SIR showed a statistically significant difference (p<0.001).Conclusion:The Arabic SIR demonstrated excellent reliability with strong consistency. It showed its clinical ability in distinguishing healthy subjects from patients along with follow up of speech development skills over time. The Arabic SIR can be used by parents to evaluate post-CI progress of their children.     

Calculation of Coronary Angiographic Total Blush in Patients with Coronary Artery Disease and its Prognostic Implication

Background:

Myocardial perfusion grade (MPG) is an accepted method of evaluating myocardial perfusion. However, it does not take into the account, the extent of the perfusion. We hypothesized that myocardial blush area times MPG (total blush) would be more accurate than simple MPG, and yield better prognostic information.

Methods:

About 34 patients were recruited after they had consented to both coronary angiography (CAG) and single photon emission computed tomography (SPECT), and divided into two groups. A special dedicated computer was employed to calculate the total blush. The CAG was performed as a conventional way. Scintigraphic technetium 99m methoxyisobutyl-isonitrile rest and stress images were evaluated quantitatively. The comparison was made between stenosis versus chronic total occlusion (CTO), MPG 1, 2 versus MPG 3, percutaneous intervention (PCI) successful versus failure. A correlation was made between ejection fraction (EF) and myocardial perfusion by MPG, total blush, SPECT, and syntax score.

Results:

The perfusion indices of total blush, summed difference score (SDS) and syntax score were insignificant between the two groups (P > 0.05). However, the left ventricular end diastolic volume was significantly larger in CTO (P < 0.05). The patients with stenosis had better MPG than with CTO (P < 0.05). The increased MPG was associated with increased total blush, higher syntax score, and EF (P < 0.05). Successful PCI resulted in better perfusion indicated by increased total blush, and MPG (P < 0.05) but successful PCI did not change syntax score, EF and SDS significantly. Multivariate linear analysis with EF as the dependent factor and syntax score, SDS, total blush, blush area, and MPG as the independent factors showed a significantly higher degree of correlation (R = 0.87, P < 0.05).

Conclusion:

After PCI the total blush and EF improved significantly indicating its potential application in the future.     

Comparison of five equations for estimating resting energy expenditure in Chinese young,normal weight healthy adults

Background

Most resting energy expenditure (REE) predictive equations for adults were derived from research conducted in western populations; whether they can also be used in Chinese young people is still unclear. Therefore, we conducted this study to determine the best REE predictive equation in Chinese normal weight young adults.

Methods

Forty-three (21 male, 22 female) healthy college students between the age of 18 and 25 years were recruited. REE was measured by the indirect calorimetry (IC) method. Harris-Benedict, World Health Organization (WHO), Owen, Mifflin and Liu’s equations were used to predictREE (REEe). REEe that was within 10% of measured REE (REEm) was defined as accurate. Student’s t test, Wilcoxon Signed Ranks Test, McNemar Test and the Bland-Altman method were used for data analysis.

Results

REEm was significantly lower (P < 0.05 or P < 0.01) than REEe from equations, except for Liu’s, Liu’s-s, Owen, Owen-s and Mifflin in men and Liu’s and Owen in women. REEe calculated by ideal body weight was significantly higher than REEe calculated by current body weight ( P < 0.01), the only exception being Harris-Benedict equation in men. Bland-Altman analysis showed that the Owen equation with current body weight generated the least bias. The biases of REEe from Owen with ideal body weight and Mifflin with both current and ideal weights were also lower.

Conclusions

Liu’s, Owen, and Mifflin equations are appropriate for the prediction of REE in young Chinese adults. However, the use of ideal body weight did not increase the accuracy of REEe.     

Effect of bariatric surgery on cardiac function in obese patients: An echocardiographic assessment

Objectives:To analyze the clinical and echocardiographic changes in individuals with morbid obesity who underwent bariatric surgery.Methods:In total, 59 obese patients with body mass index >35 kg/m ² were prospectively enrolled. We assessed baseline pre-operative and a 6-month post-operative lipid profile, hemoglobin A1c, echocardiography, lifetime, and a 10-year risks of atherosclerotic disease for all patients.Results:The mean patients’ age was 37±12 years, with 40 (67.8%) women. We found that the pre-operative total cholesterol (4.2±1.1 vs. 4.4±1.1, p=0.014) and triglyceride levels (1.4±0.7 vs. 1.8±0.8, p<0.0001) were significantly lower than post-operative levels, while post-operative high-density lipoprotein levels were significantly higher (1.5±0.5 vs. 1.2±0.3, p<0.0001). The calculated 10-year risk of atherosclerotic cardiovascular disease was significantly lower post-operatively (1.1±1.6% vs. 1.6±1.8%, p<0.0001). Echocardiography follow-up revealed that diastolic dysfunction was more prevalent pre-operatively than that post-operatively (41% vs. 10%, p<0.0001). Post-operative left ventricular (LV) mass was significantly lesser than the pre-operative mass (168±252 g vs. 187±255 g, p=0.019), whereas the post-operative LV diastolic (46.5±7 mm vs. 38.5±18 mm, p=0.002) and systolic dimensions (31±5 mm vs. 25±11 mm, p=0.001) were significantly smaller.Conclusion:Bariatric surgery resulted in a significant amelioration in lipid profile, reduction in LV mass, and LV cavity dimensions.     

Sonographic assessment of the carotid intima-media thickness on B-mode ultrasonography in a Nigerian population

Background:

Hypertension is a common health problem and a major risk factor of cardiovascular disease. The most important mechanism by which hypertension acts as a cardiovascular risk factor is the induction of arteriosclerosis. The early phase of atherosclerosis before its clinical manifestation can be studied using B-mode ultrasonography.

Aims and Objectives:

This study evaluated the intima-media thickness of the common carotid artery (CCA), carotid intima-media thickness (CIMT) of subjects with essential hypertension as a way of detecting these early changes of atherosclerosis.

Subjects and Methods:

The study was performed on 200 subjects with newly diagnosed hypertension and 100 apparently normal controls that were consecutively recruited by a cardiologist. An ultrasound examination of both CCA were done to obtain the CIMT. Data were analyzed using the SPSS data analysis software.

Results:

The CIMT of males were greater in the hypertensive group compared to the controls (0.10 ± 0.02 cm vs. 0.077 ± 0.02 cm [P < 0.0001] and 0.10 ± 0.02 cm vs. 0.078 ± 0.02 cm [P < 0.0001] for the right and left sides, respectively). The female group showed a similar pattern of results (0.09 ± 0.02 cm vs. 0.072 ± 0.02 cm [P < 0.0001] and 0.1 ± 0.02 cm vs. 0.076 ± 0.02 cm [P < 0.0001] for the right and left sides respectively).

Conclusion:

A statistically significant increase in CIMT was noted in both male and female hypertensives in comparison to a normal population.     

Thoracic epidural anesthesia improves outcomes in patients undergoing cardiac surgery: meta-analysis of randomized controlled trials

To assess the efficacy of thoracic epidural anesthesia (TEA) with or without general anesthesia (GA) versus GA in patients who underwent cardiac surgery, PubMed, Embase, the Cochrane online database, and Web of Science were searched with the limit of randomized controlled trials (RCTs) relevant to ‘thoracic epidural anesthesia’ and ‘cardiac surgery’. Studies were identified and data were extracted by two reviewers independently. The quality of included studies was also assessed according to the Cochrane handbook. Outcomes of mortality, cardiac and respiratory functions, and treatment-associated complications were pooled and analyzed. The comprehensive search yielded 2,230 citations, and 25 of them enrolling 3,062 participants were included according to the inclusion criteria. Compared with GA alone, patients received TEA and GA showed reduced risks of death, myocardial infarction, and stroke, though there were no significant differences (P > 0.05). With regard to treatment-related complications, the pooled results for respiratory complications (risk ratio (RR), 0.69; 95% CI: 0.51, 0.91, P < 0.05), supraventricular arrhythmias (RR, 0.61; 95% CI: 0.42, 0.87, P < 0.05), and pain (mean difference (MD), −1.27; 95% CI: −2.20, −0.35, P < 0.05) were 0.69, 0.61, and −1.27, respectively. TEA was also associated with significant reduction of stays in intensive care unit (MD, −2.36; 95% CI: −4.20, −0.52, P < 0.05) and hospital (MD, −1.51; 95% CI: −3.03, 0.02, P > 0.05) and time to tracheal extubation (MD, −2.06; 95% CI:−2.68, −1.45, P < 0.05). TEA could reduce the risk of complications such as supraventricular arrhythmias, stays in hospital or intensive care unit, and time to tracheal extubation in patients who experienced cardiac surgery.

Electronic supplementary material

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