Background Evidence on the effects of different exercise interventions on cognitive function is insufficient.Aims To evaluate the feasibility and effects of remotely supervised aerobic exercise(AE)and resistance exerc...Background Evidence on the effects of different exercise interventions on cognitive function is insufficient.Aims To evaluate the feasibility and effects of remotely supervised aerobic exercise(AE)and resistance exercise(RE)interventions in older adults with mild cognitive impairment(MCI).Methods This study is a 6-month pilot three-arm randomised controlled trial.Eligible participants(n=108)were recruited and randomised to the AE group,RE group or control(CON)group with a 1:1:1 ratio.Interventions were delivered at home with remote supervision.We evaluated participants’global cognition,memory,executive function,attention,physical activity levels,physical performance and muscle strength of limbs at baseline,3 months(T1)and 6 months(T2)after randomisation.A linear mixed-effects model was adopted for data analyses after controlling for covariates.Tukey’s method was used for adjusting for multiple comparisons.Sensitivity analyses were performed after excluding individuals with low compliance rates.Results 15(13.89%)participants dropped out.The median compliance rates in the AE group and RE group were 67.31%and 93.27%,respectively.After adjusting for covariates,the scores of the Alzheimer’s Disease Assessment Scale-Cognitive subscale in the AE group decreased by 2.04(95%confidence interval(CI)−3.41 to−0.67,t=−2.94,p=0.004)and 1.53(95%CI−2.88 to−0.17,t=−2.22,p=0.028)points more than those in the CON group at T1 and T2,respectively.The effects of AE were still significant at T1(estimate=−1.70,95%CI−3.20 to−0.21,t=−2.69,p=0.021),but lost statistical significance at T2 after adjusting for multiple comparisons.As for executive function,the Stroop time interference in the RE group decreased by 11.76 s(95%CI−21.62 to−1.90,t=−2.81,p=0.015)more than that in the AE group at T2 after Tukey’s adjustment.No other significant effects on cognitive functions were found.Conclusions Both remotely supervised AE and RE programmes are feasible in older adults with MCI.AE has positive effects on global cognition,and RE improves executive function.展开更多
AIM:To systematically evaluate and update evidence on the efficacy and safety of probiotic supplementation for the treatment of constipation. METHODS:The MEDLINE,EMBASE,CINAHL,and Cochrane Library databases were searc...AIM:To systematically evaluate and update evidence on the efficacy and safety of probiotic supplementation for the treatment of constipation. METHODS:The MEDLINE,EMBASE,CINAHL,and Cochrane Library databases were searched in May 2009 for randomised controlled trials(RCTs)performed in paediatric or adult populations related to the study aim. RESULTS:We included five RCTs with a total of 377 subjects(194 in the experimental group and 183 in the control group).The participants were adults (three RCTs,n=266)and children(two RCTs,n= 111)with constipation.In adults,data suggests a favourable effect of treatment with Bifidobacterium lactis DN-173 010,Lactobacillus casei Shirota,and Escherichia coli Nissle 1917 on defecation frequency and stool consistency.In children,L.casei rhamnosusLcr35,but not L.rhamnosus GG,showed a beneficial effect. CONCLUSION:Until more data are available,we believe the use of probiotics for the treatment of constipation condition should be considered investigational.展开更多
AIM To compare the outcomes of displaced distal radius fractures treated with volar locking plates and with immediate postoperative mobilisation with the outcomes of these fractures treated with modalities that necess...AIM To compare the outcomes of displaced distal radius fractures treated with volar locking plates and with immediate postoperative mobilisation with the outcomes of these fractures treated with modalities that necessitate 6 wk wrist immobilisation.METHODS A prospective,randomised controlled single-centre trial was conducted with 56 patients who had a displaced radius fracture were randomised to treatment either with a volar locking plate(n=29),or another treatment modality(n=27;cast immobilisation with or without wires or external fixator).Outcomes were measured at 12 wk.Functional outcome scores measured were the Patient-Rated Wrist Evaluation(PRWE)Score;Disabilities of the Arm,Shoulder and Hand and activities of daily living(ADLs).Clinical outcomes were wrist range of motion and grip strength.Radiographic parameters were volar inclination and ulnar variance.RESULTS Patients in the volar locking plate group had significantly better PRWE scores,ADL scores,grip strength and range of extension at three months compared with the control group.All radiological parameters were significantly better in the volar locking plate group at 3 mo.CONCLUSION The present study suggests that volar locking plates produced significantly better functional and clinical outcomes at 3 mo compared with other treatment modalities.Anatomical reduction was significantly more likely to be preserved in the plating group.Level of evidence:Ⅱ.展开更多
AIM To compare high definition white light endoscopy and bright narrow band imaging for colon polyps' detection rates. METHODS Patients were randomised to high definition white light endoscopy(HD-WLE) or the brigh...AIM To compare high definition white light endoscopy and bright narrow band imaging for colon polyps' detection rates. METHODS Patients were randomised to high definition white light endoscopy(HD-WLE) or the bright narrow band imaging(b NBI) during withdrawal of the colonoscope. Polyps identified in either mode were characterised using b NBI with dual focus(b NBI-DF) according to the Sano's classification. The primary outcome was to compare adenoma detection rates(ADRs) between the two arms. The secondary outcome was to assess the negative predictive value(NPV) in differentiating adenomas from hyperplastic polyps for diminutive rectosigmoid lesions.RESULTS A total of 1006 patients were randomised to HD-WLE(n = 511) or b NBI(n = 495). The mean of adenoma per patient was 1.62 and 1.84, respectively. The ADRs in b NBI and HD-WLE group were 37.4% and 39.3%, respectively. When adjusted for withdrawal time(OR = 1.19, 95%CI: 1.15-1.24, P < 0.001), the use of b NBI was associated with a reduced ADR(OR = 0.69, 95%CI: 0.52-0.92). Nine hundred and thirty three polyps(86%) in both arms were predicted with high confidence. The sensitivity(Sn), specificity(Sp), positive predictive value and NPV in differentiating adenomatous from non-adenomatous polyps of all sizes were 95.9%, 87.2%, 94.0% and 91.1% respectively. The NPV in differentiating an adenoma from hyperplastic polyp using b NBI-DF for diminutive rectal polyps was 91.0%.CONCLUSION ADRs did not differ between b NBI and HD-WLE, however HD-WLE had higher ADR after adjustment of withdrawal time. b NBI surpassed the PIVI threshold for diminutive polyps.展开更多
Background Hyperprolactinaemia is a common adverse effect of antipsychotics （APs）. The results of Peony-Glycyrrhiza decoction （PGD） as a potentially useful adjunctivetreatment for hyperprolactinaemia are inconsis...Background Hyperprolactinaemia is a common adverse effect of antipsychotics （APs）. The results of Peony-Glycyrrhiza decoction （PGD） as a potentially useful adjunctivetreatment for hyperprolactinaemia are inconsistent.Aim This meta-analysis of randomised controlled trials （RCTs） examined the effcacy and safety of adjunctive PGDtherapy for AP-induced hyperprolactinaemia.Methods English （PubMed, Embase, Cochrane Library, PsycINFO） and Chinese （Chinese National Knowledge Infrastructure, Wanfang Data） databases were systematicallysearched up to 10 June 2018. The inclusion criteria were based on PICOS-Participants： adult patients with schizophrenia; Intervention： PGD plus APs; Comparison： APs plus placebo or AP monotherapy; Outcomes： effcacy and safety; Study design： RCTs. The weighted mean difference （WMD） and risk ratio （RR） along with their 95% CIs were calculated using Review Manager （RevMan） V.5.3 software.Results Five RCTs （n=450） were included and analysed. Two RCTs （n=140） were double-blind and four RCTs （n=409） reported ‘random’ assignment with specifc description. The PGD group showed a signifcantly lower serum prolactin level at endpoint than the control group （n=380, WMD： ？32.69 ng/mL （95% CI -41.66 to 23.72）, p〈0.00001, I2=97%）. Similarly, the superiority of PGD over the control groups was also found in the improvement of hyperprolactinaemia-related symptoms. No difference was found in the improvement of psychiatric symptoms assessed by the Positive and Negative Syndrome Scale （n=403, WMD： -0.62 （95% CI -2.38 to 1.15）, p=0.49, I^2=0%）. There were similar rates of all-cause discontinuation （n=330, RR 0.93 （95% CI 0.63 to 1.37）, p=0.71, I^2=0%） and adverse drug reactions between the two groups. According to the Grading of Recommendations Assessment, Development and Evaluation approach, the level of evidence of primary and secondary outcomes ranged from ‘very low’ （14.3%）, ‘low’ （42.8%）, ‘moderate’ （14.3%）, to ‘high’ （28.6%）.Conclusions Current evidence supports the adjunctive use of PGD to suppress elevated prolactin and improve prolactin-induced symptoms without signifcant adverse events in adult patients with AP-induced hyperprolactinaemia. High-quality RCTs with longer duration are needed to confrm these fndings.展开更多
Objective: To report our experience of attempting a randomised controlled trial of an intensive lifestyle intervention for early type 2 diabetes delivered in a residential setting. Methods: We established a trial requ...Objective: To report our experience of attempting a randomised controlled trial of an intensive lifestyle intervention for early type 2 diabetes delivered in a residential setting. Methods: We established a trial requiring 84 participants (46 standard care and 38 intervention) to detect a 1% difference in HbA1c between intervention and control groups at 12 months, allowing for attrition. Ethics approval was obtained from Monash University. Results: The study was abandoned after five months of consistent promotion due to recruitment failure (four subjects recruited). Conclusion: It appears to be difficult for patients with diabetes to commit to a live-in period of education regarding lifestyle modification as a means of treating the illness. We recommend better education of patients and their doctors about the potential health benefits of lifestyle change to manage type 2 diabetes, and further research into novel methods of delivering lifestyle advice which are both effective and sustainable.展开更多
AIM To assess the utility of modified Sano′s(MS) vs thenarrow band imaging international colorectal endoscopic(NICE) classification in differentiating colorectal polyps.METHODS Patients undergoing colonoscopy between...AIM To assess the utility of modified Sano′s(MS) vs thenarrow band imaging international colorectal endoscopic(NICE) classification in differentiating colorectal polyps.METHODS Patients undergoing colonoscopy between 2013 and 2015 were enrolled in this trial.Based on the MS or the NICE classifications,patients were randomised for real-time endoscopic diagnosis.This was followed by biopsies,endoscopic or surgical resection.The endoscopic diagnosis was then compared to the final(blinded) histopathology.The primary endpoint was the sensitivity(Sn),specificity(Sp),positive predictive value(PPV) and negative predictive value(NPV) of differentiating neoplastic and non-neoplastic polyps(MSⅡ/Ⅱo/Ⅲa/Ⅲb vs I or NICE 1 vs 2/3).The secondary endpoints were "endoscopic resectability"(MSⅡ/Ⅱo/Ⅲa vs Ⅰ/Ⅲb or NICE 2 vs 1/3),NPV for diminutive distal adenomas and prediction of post-polypectomy surveillance intervals.RESULTS A total of 348 patients were evaluated.The Sn,Sp,PPV and NPV in differentiating neoplastic polyps from non-neoplastic polyps were,98.9%,85.7%,98.2% and 90.9% for MS;and 99.1%,57.7%,95.4% and 88.2% for NICE,respectively.The area under the receiver operating characteristic curve(AUC) for MS was 0.92(95%CI:0.86-0.98);and AUC for NICE was 0.78(95%CI:0.69,0.88).The Sn,Sp,PPV and NPV in predicting "endoscopic resectability" were 98.9%,86.1%,97.8% and 92.5% for MS;and 98.6%,66.7%,94.7% and 88.9% for NICE,respectively.The AUC for MS was 0.92(95%CI:0.87-0.98);and the AUC for NICE was 0.83(95%CI:0.75-0.90).The AUC values were statistically different for both comparisons(P = 0.0165 and P = 0.0420,respectively).The accuracy for diagnosis of sessile serrated adenoma/polyp(SSA/P) with high confidence utilizing MS classification was 93.2%.The differentiation of SSA/P from other lesions achieved Sp,Sn,PPV and NPV of 87.2%,91.5%,89.6% and 98.6%,respectively.The NPV for predicting adenomas in diminutive rectosigmoid polyps(n = 150) was 96.6% and 95% with MS and NICE respectively.The calculated accuracy of post-polypectomy surveillance for MS group was 98.2%(167 out of 170) and for NICE group was 92.1%(139 out of 151).CONCLUSION The MS classification outperformed the NICE classification in differentiating neoplastic polyps and predicting endoscopic resectability.Both classifications met ASGE PIVI thresholds.展开更多
Objective:To observe the difference in clinical efficacy of acupuncture with strong and weak stimulation in treating neck type cervical spondylosis.Methods:64 patients with neck type cervical spondylosis were randomly...Objective:To observe the difference in clinical efficacy of acupuncture with strong and weak stimulation in treating neck type cervical spondylosis.Methods:64 patients with neck type cervical spondylosis were randomly divided into strong stimulation group and weak stimulation group,with 32 cases in each group.The acupoints selected are Jingjiaji 5-7(cervical acupoints EX-B2 C5-C7),Tianzhu(BL10)on both sides,Houxi(SI3)on both sides,Hegu(LI4)on both sides,Geshu(BL17)on both sides,and Ashi.In the strong stimulation group,deep needling with 0.25 mm×40 mm milli-needle was performed,with a mild reinforcing-reducing method.The twisting angle was 90°-180°,the frequency was 60-90 times/min,and the needles were applied for 1 min at each point.Keep the needle for 30 minutes,twisting was performed every 10 min during the retention period.Change hands once.In the weak stimulation group,shallow acupuncture with a 0.18 mm×40 mm milli-needle was performed,with a mild reinforcing-reducing method,with a twisting angle of 60°-90°,a frequency of 30-60 times/min,and acupuncture for 10 seconds at each acupoint.Keep the needle for 30 minutes,and no needle during the retention period.Patients in both groups were treated once every 1 to 2 days,3 times a week for 2 weeks,and followed up for 1 month after all treatments.The two groups of patients were compared before and after treatment and during follow-up.The McGill pain questionnaire score and the cervical spine dysfunction index score were compared to determine the clinical efficacy.Statistical analysis was performed using SPSS 22.0 statistical software.Results:1 case drop-out in the strong stimulation group and 1 case in the weak stimulation group.The total effective rate of the strong stimulation group was 90.32%,the total effective rate of the weak stimulation group was 83.87%,and the total effective rate of the strong stimulation group was higher than that of the weak stimulation group(P<0.05).The total scores of the short-form McGill pain questionnaire,the VAS score,and the cervical spine dysfunction index scores of the two groups of patients were significantly lower than those of this group before treatment,and the difference was statistically significant(P<0.05).The total scores of the short-form McGill pain questionnaire,visual analogue scale score,and cervical spine dysfunction index scores of the strong stimulation group after treatment and follow-up were significantly lower than those of the weak stimulation group(P<0.05).Conclusion:Acupuncture with strong and weak stimulation can effectively treat patients with cervical spondylosis,and deep acupuncture with filiform needles and strong stimulation have better effect.展开更多
Background： Rhythmical massage therapy（RMT） is a massage technique used in anthroposophic medicine.Objective： The authors aimed to investigate the physiological action of RMT on the cardiovascular system by analys...Background： Rhythmical massage therapy（RMT） is a massage technique used in anthroposophic medicine.Objective： The authors aimed to investigate the physiological action of RMT on the cardiovascular system by analysing heart rate variability（HRV）.Design, setting, participants and intervention： This study was a randomised, controlled and single-blinded trial, involving 44 healthy women（mean age：（26.20 ± 4.71） years）. The subjects were randomised to one of three arms： RMT with aromatic oil（RA）, RMT without aromatic oil（RM） or standardised sham massage（SM）. In the study the subjects were exposed to a standardised stress situation followed by one of the study techniques and Holter electrocardiograms（ECGs） were recorded for 24 h.Main outcome measures： HRV parameters were calculated from linear（time and frequency domain） and nonlinear dynamics（symbolic dynamics, Poincare plot analysis） of the 24-h Holter ECG records.Results： Short-and long-term effects of massage on autonomic regulation differed significantly among the three groups. Immediately after an RMT session, stimulation of HRV was found in the groups RA and RM. The use of an aromatic oil produced greater short-term measurable changes in HRV compared with rhythmic massage alone, but after 24 h the effect was no longer distinguishable from the RM group.The lowest stimulation of HRV parameters was measured in the SM group.Conclusion： RMT causes specific and marked stimulation of the autonomic nervous system. Use of a medicinal aromatic oil had only a temporary effect on HRV, indicating that the RM causes the most relevant long-term effect. The effect is relatively specific, as the physiological effects seen in the group of subjects who received only SM were considerably less pronounced.展开更多
OBJECTIVE:To detect the impact of moderate-intensity aerobic exercise combined with acupuncture on the attention function of mentally-retarded adolescents from the three dimensions of attention concentration,attention...OBJECTIVE:To detect the impact of moderate-intensity aerobic exercise combined with acupuncture on the attention function of mentally-retarded adolescents from the three dimensions of attention concentration,attention transfer and attention span.METHODS:A total of 48 adolescents with mild to moderate mental disabilities were recruited.The participants were randomly divided into four groups:control group(C),Traditional Chinese Medicine acupuncture group(M),moderate-intensity aerobic exercise group(E)and exercise and acupuncture combined intervention group(J).Before and after the experimental intervention,the participant’s height,weight and attention ability were measured.RESULTS:The improved range of attention total duration of the J group after the intervention was significantly higher than that of the E and M groups(P<0.05),whereas that of the latter groups was significantly higher compared to that of the C group(P<0.05).The J group showed significantly higher(P<0.05)attention span values after the intervention compared to the E,M and C groups.The C group did not show a significant difference in attention transfer at 12 weeks compared to before intervention(P>0.05),whereas the E,M and J groups increased significantly(P<0.05)after intervention than the C group.CONCLUSIONS:Moderate-intensity aerobic exercise combined with acupuncture can more effectively improve the attention concentration and attention span of mentally-retarded adolescents than aerobic exercise or acupuncture alone.展开更多
Background: Ginkgo biloba extract EGb 761<sup>®</sup> is widely used to treat various types of vertigo. Aims: An exploratory trial was conducted to evaluate the efficacy of EGb 761<sup>&...Background: Ginkgo biloba extract EGb 761<sup>®</sup> is widely used to treat various types of vertigo. Aims: An exploratory trial was conducted to evaluate the efficacy of EGb 761<sup>®</sup> in addition to vestibular exercises in central vestibular vertigo caused by vertebro-basilar ischaemia. Subjects and Methods: In this randomised, placebo-controlled, double-blind trial, 40 patients were enrolled in the vertigo clinic of a neurological university hospital and treated with daily doses of 240 mg EGb 761<sup>®</sup> or placebo for a period of 180 days. All patients regularly performed vestibular exercises in addition. Efficacy was assessed using: a visual analogue scale for the patients to rate the overall intensity of vertigo;a numeric scale for physician-rated change;a vertigo score based on intensity, duration, and frequency of vertigo;and electronystagmography. Results: Until day 180, the mean patient-rated intensity of vertigo decreased by 46% during EGb 761<sup>®</sup> treatment and by 19% with placebo (p <sup>®</sup> group compared to the placebo group. Nystagmus or other eye movement disorders were present only in small subgroups of patients without sufficient statistical power to detect differences between treatment groups. Conclusions: EGb 761<sup>®</sup> alleviated vertigo caused by ischaemic lesions in the brainstem or cerebellum in patients undergoing vestibular exercises.展开更多
Background:Using a pilot randomised controlled trial(RCT),to assess the short-term effectiveness of a structured diabetic retinopathy(DR)-specific,intensive,and personalised care planning(DR-IPCP)intervention on diabe...Background:Using a pilot randomised controlled trial(RCT),to assess the short-term effectiveness of a structured diabetic retinopathy(DR)-specific,intensive,and personalised care planning(DR-IPCP)intervention on diabetes control outcomes in Singaporeans with poorly controlled type 2 diabetes.Methods:Eighteen individuals with mild-moderate DR and poor glycemic control[HbA1c≥64 mmol/mol(≥8.0%)over two consecutive 6-month readings]were randomized to DR-IPCP(n=9)or usual care(UC,n=9).The intervention included a physician consultation,an initial personalised eye consultation with a experienced diabetes nurse educator,and three behaviour change follow-up calls.HbA1c(primary outcome),lipids and blood pressure were assessed at baseline and three months post-intervention.Participant feedback regarding the DR-IPCP program was collected at three months via a semi-structured telephone interview.Results:While no significant between-group differences were observed,DR-IPCP participants experienced significant within-group reductions in HbA1c,total cholesterol,and low density lipoprotein at follow-up compared to baseline[7 mmol/mol(−0.8%),−0.64 mmol/L,and−0.66 mmol/L,respectively].No significant within-group changes in these parameters were observed in the UC group.Following the DR-IPCP intervention,participants reported a clearer understanding of the link between diabetes management;the development and progression of DR.Conclusions:DR-IPCP provides an effective short-term improvement in diabetes control parameters in DR patients with poor diabetes control.An adequately powered and longitudinal RCT is warranted to assess the clinical,patient-centred and economic potential of this programme in this population.展开更多
The aim of this study was to compare the scores of maternal self-efficacy for child diarrhoea prevention, between intervention and control groups, according to sanitary, social and demographic characteristics. A rando...The aim of this study was to compare the scores of maternal self-efficacy for child diarrhoea prevention, between intervention and control groups, according to sanitary, social and demographic characteristics. A randomised clinical trial was carried out on 163 mothers of children under 5 years old. Data collection was conducted during two months, at two different moments (M0 and M1);at the moment M0 only the intervention group watched the educational video to promote self-efficacy for child diarrhoea prevention;at M1 (two months later) the scale was applied to both groups. In the intervention group, greater mean self-efficacy scores were obtained compared with the control group. The following variables showed statistically significant associations (p < 0.05) with maternal self-efficacy: age 35 or over;high school education;working outside the home;residence with 4 to 5 people;house not of brick or mortar;public refuse collection;piped water supply;consumption of mineral water;and public sewerage network. After use of the video “Diarrhoea: you can prevent it”, the maternal self-efficacy increased, proving that this strategy is able to assist the nursing staff in educational practices.展开更多
This systematic review and meta-analysis evaluated the impact of a restrictive episiotomy protocol on the incidence of severe perineal tears in first vaginal deliveries. A comprehensive search was conducted in Pub Med...This systematic review and meta-analysis evaluated the impact of a restrictive episiotomy protocol on the incidence of severe perineal tears in first vaginal deliveries. A comprehensive search was conducted in Pub Med, CENTRAL, Embase, Latin American and Caribbean Health Sciences Literature and Clinical Trials. gov until June 2024. The study followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was registered in PROSPERO(CRD42024550295). Randomised controlled trials comparing restrictive episiotomy(for foetal indications only) with selective episiotomy in first-time vaginal deliveries were included. Two reviewers independently extracted data, assessed bias using the Cochrane Risk of Bias tool and conducted assessment according to Grading of Recommendations Assessment, Development and Evaluation(GRADE). Statistical analyses were performed using R(v.4.4.0) and Rev Man(v.8.6.1). Two trials with a total of 785 participants met the inclusion criteria. The restrictive episiotomy group showed a 51.8% reduction in severe perineal tears(risk ratio(RR)=0.50, 95% CI 0.21 to 1.21), though this result was not statistically significant. Episiotomy rates were lower in the restrictive group(RR=0.61, 95% CI 0.49 to 0.76). There were no significant differences in minor perineal tears, intact perineum rates or neonatal outcomes between the two groups. Despite the lack of statistical significance in the reduction of severe perineal tear occurrence, the findings suggest a trend towards improved perineal outcomes with restrictive episiotomy. Additionally, given the potential physical and psychological consequences of episiotomies, limiting their use to foetal indications may be beneficial. Further research is needed to confirm these findings and guide clinical practice.展开更多
Background Tele-cognitive behavioural therapy(t-CBT)is the most studied remote therapy,and evidence supports its efficacy in treating depression and anxiety symptoms.Aims To compare the effectiveness of tele-interpers...Background Tele-cognitive behavioural therapy(t-CBT)is the most studied remote therapy,and evidence supports its efficacy in treating depression and anxiety symptoms.Aims To compare the effectiveness of tele-interpersonal psychotherapy(t-IPT)to that of t-CBT.We hypothesise that t-IPT is as effective as t-CBT.Methods We conducted a randomised clinical trial with two parallel arms and equal randomisation.The allocation was on a 1∶1 ratio based on a computerised randomisation sequence of permuted blocks of 50.Interventions and assessments were done via a website designed specifically for the trial.Participants were community-based adults with symptoms of anxiety,depression or irritability who received four sessions of t-CBT or t-IPT.The main outcome measures were the Patient Health Questionnaire-9 for depressive symptoms,Generalised Anxiety Disorder-7 for anxiety symptoms and Affective Reactivity Index for irritability.Results 149 individuals with a mean(standard deviation)age of 32.51(10.73)years were randomised to receive t-CBT(n=73)or t-IPT(n=76).Seven participants withdrew from the interventions(t-CBT,n=4;t-IPT,n=3),and 20 participants completed the interventions but did not complete the follow-up questionnaires(t-CBT,n=9;t-IPT,n=11).Analysis was conducted by intention-to-treat.There was a significant overall reduction in symptoms of depression,anxiety and irritability(p<0.001)in both treatment arms;neither modality was superior to the other.Effectiveness analysis showed that the two interventions were equivalent.Conclusions In community adults,t-IPT is as effective as t-CBT in treating symptoms of anxiety,depression or irritability.展开更多
Background Although endovascular stenting is considered an effective and safe therapeutic option for symptomatic intracranial atherosclerotic disease(sICAD),an elevated rate of restenosis remains an important issue fo...Background Although endovascular stenting is considered an effective and safe therapeutic option for symptomatic intracranial atherosclerotic disease(sICAD),an elevated rate of restenosis remains an important issue for the conventional bare-metal stent(BMS).Recent evidence from observational studies suggests that applying drug-coated balloons(DCB)in sICAD may decrease restenosis occurrence.Additional large randomised studies are warranted to provide firmer evidence and to determine which patients would benefit most from DCB.Aim To design a randomised trial to examine DCB angioplasty(Taijieweiye intracranial paclitaxel-coated balloon catheter)versus BMS stenting(Wingspan intracranial stent system)in patients with sICAD.Design This is a multicentre,prospective,randomised,open-label,blinded end-point study to assess whether DCB angioplasty reduces the risk of restenosis compared with BMS stenting in sICAD patients with high-grade stenosis(≥70%-99%).Our goal is to randomly assign 198 eligible individuals at a 1:1 ratio to undergo DCB angioplasty(intervention group)or BMS stenting(control group).Outcome The primary efficacy outcome is restenosis at 6 months post treatment,that is,>50%stenosis in or within 5 mm of the treated segment and>20%absolute luminal loss.The primary safety outcome is stroke or death within 30 days post treatment.Discussion The DRug-coated Balloon for Endovascular treatment of sYmptOmatic intracraNial stenotic Disease trial aims to produce strong evidence on the efficacy and safety of DCB angioplasty as a promising therapeutic option for sICAD cases with high-grade stenosis.展开更多
Objective To measure the impact of each type of exercise on sleep quality and identify the exercise that enhances sleep quality the most.Study selection Eligible randomised controlled trials that compare physical exer...Objective To measure the impact of each type of exercise on sleep quality and identify the exercise that enhances sleep quality the most.Study selection Eligible randomised controlled trials that compare physical exercise to routine activities,usual care,non-physical activity,or health education to measure the Pittsburgh Sleep Quality Index.Data source Studies retrieved from Medline,Embase,CINAHL,Scopus,ClinicalTrial.gov and ThaiJo from the database’s inception to October 2022.Data extraction and synthesis Two reviewers independently identified studies,collected data and assessed bias.In the absence of heterogeneity,a fixed effect model was used for pairwise meta-analysis.Alternatively,a random effect model was used.A two-stage network meta-analysis used the surface under the cumulative ranking curve(SUCRA)to compare exercise efficacy.Main outcome Global Pittsburgh Sleep Quality Index(GPSQI)and subdomain score.Results This review comprised 2170 people from 25 trials.Direct meta-analysis revealed significant improvement in GPSQI with combined exercise(unstandardised mean difference(USMD)−2.35,95%CI−3.13 to-1.57,p<0.001,I^(2)=69.13%).GPSQI decreased considerably with aerobic activity(USMD−4.36,95%CI−7.86 to-0.86,p=0.01,I^(2)=97.83%).For the network meta-analysis,strengthening,aerobic and combination exercise significantly lowered GPSQI(USMD−5.75,-3.76 and−2.54,respectively).Strength training improved GPSQI scores most effectively(SUCRA 94.6%).Conclusion Exercise that strengthens muscles,rather than aerobic or combination exercises,is the most effective way to enhance sleep quality.展开更多
基金funded by the National Natural Science Foundation of China(81871854,72374014)the National Key R&D Program of China(2020YFC2008804)+1 种基金the Shanghai Jiao Tong University Young Talent Cultivation Program in Liberal Arts(2024QN041)the Shanghai Jiao Tong University School of Medicine:Nursing Development Program(SJTUHLXK2024).
文摘Background Evidence on the effects of different exercise interventions on cognitive function is insufficient.Aims To evaluate the feasibility and effects of remotely supervised aerobic exercise(AE)and resistance exercise(RE)interventions in older adults with mild cognitive impairment(MCI).Methods This study is a 6-month pilot three-arm randomised controlled trial.Eligible participants(n=108)were recruited and randomised to the AE group,RE group or control(CON)group with a 1:1:1 ratio.Interventions were delivered at home with remote supervision.We evaluated participants’global cognition,memory,executive function,attention,physical activity levels,physical performance and muscle strength of limbs at baseline,3 months(T1)and 6 months(T2)after randomisation.A linear mixed-effects model was adopted for data analyses after controlling for covariates.Tukey’s method was used for adjusting for multiple comparisons.Sensitivity analyses were performed after excluding individuals with low compliance rates.Results 15(13.89%)participants dropped out.The median compliance rates in the AE group and RE group were 67.31%and 93.27%,respectively.After adjusting for covariates,the scores of the Alzheimer’s Disease Assessment Scale-Cognitive subscale in the AE group decreased by 2.04(95%confidence interval(CI)−3.41 to−0.67,t=−2.94,p=0.004)and 1.53(95%CI−2.88 to−0.17,t=−2.22,p=0.028)points more than those in the CON group at T1 and T2,respectively.The effects of AE were still significant at T1(estimate=−1.70,95%CI−3.20 to−0.21,t=−2.69,p=0.021),but lost statistical significance at T2 after adjusting for multiple comparisons.As for executive function,the Stroop time interference in the RE group decreased by 11.76 s(95%CI−21.62 to−1.90,t=−2.81,p=0.015)more than that in the AE group at T2 after Tukey’s adjustment.No other significant effects on cognitive functions were found.Conclusions Both remotely supervised AE and RE programmes are feasible in older adults with MCI.AE has positive effects on global cognition,and RE improves executive function.
基金Supported by The Medical University of Warsaw,Poland
文摘AIM:To systematically evaluate and update evidence on the efficacy and safety of probiotic supplementation for the treatment of constipation. METHODS:The MEDLINE,EMBASE,CINAHL,and Cochrane Library databases were searched in May 2009 for randomised controlled trials(RCTs)performed in paediatric or adult populations related to the study aim. RESULTS:We included five RCTs with a total of 377 subjects(194 in the experimental group and 183 in the control group).The participants were adults (three RCTs,n=266)and children(two RCTs,n= 111)with constipation.In adults,data suggests a favourable effect of treatment with Bifidobacterium lactis DN-173 010,Lactobacillus casei Shirota,and Escherichia coli Nissle 1917 on defecation frequency and stool consistency.In children,L.casei rhamnosusLcr35,but not L.rhamnosus GG,showed a beneficial effect. CONCLUSION:Until more data are available,we believe the use of probiotics for the treatment of constipation condition should be considered investigational.
文摘AIM To compare the outcomes of displaced distal radius fractures treated with volar locking plates and with immediate postoperative mobilisation with the outcomes of these fractures treated with modalities that necessitate 6 wk wrist immobilisation.METHODS A prospective,randomised controlled single-centre trial was conducted with 56 patients who had a displaced radius fracture were randomised to treatment either with a volar locking plate(n=29),or another treatment modality(n=27;cast immobilisation with or without wires or external fixator).Outcomes were measured at 12 wk.Functional outcome scores measured were the Patient-Rated Wrist Evaluation(PRWE)Score;Disabilities of the Arm,Shoulder and Hand and activities of daily living(ADLs).Clinical outcomes were wrist range of motion and grip strength.Radiographic parameters were volar inclination and ulnar variance.RESULTS Patients in the volar locking plate group had significantly better PRWE scores,ADL scores,grip strength and range of extension at three months compared with the control group.All radiological parameters were significantly better in the volar locking plate group at 3 mo.CONCLUSION The present study suggests that volar locking plates produced significantly better functional and clinical outcomes at 3 mo compared with other treatment modalities.Anatomical reduction was significantly more likely to be preserved in the plating group.Level of evidence:Ⅱ.
文摘AIM To compare high definition white light endoscopy and bright narrow band imaging for colon polyps' detection rates. METHODS Patients were randomised to high definition white light endoscopy(HD-WLE) or the bright narrow band imaging(b NBI) during withdrawal of the colonoscope. Polyps identified in either mode were characterised using b NBI with dual focus(b NBI-DF) according to the Sano's classification. The primary outcome was to compare adenoma detection rates(ADRs) between the two arms. The secondary outcome was to assess the negative predictive value(NPV) in differentiating adenomas from hyperplastic polyps for diminutive rectosigmoid lesions.RESULTS A total of 1006 patients were randomised to HD-WLE(n = 511) or b NBI(n = 495). The mean of adenoma per patient was 1.62 and 1.84, respectively. The ADRs in b NBI and HD-WLE group were 37.4% and 39.3%, respectively. When adjusted for withdrawal time(OR = 1.19, 95%CI: 1.15-1.24, P < 0.001), the use of b NBI was associated with a reduced ADR(OR = 0.69, 95%CI: 0.52-0.92). Nine hundred and thirty three polyps(86%) in both arms were predicted with high confidence. The sensitivity(Sn), specificity(Sp), positive predictive value and NPV in differentiating adenomatous from non-adenomatous polyps of all sizes were 95.9%, 87.2%, 94.0% and 91.1% respectively. The NPV in differentiating an adenoma from hyperplastic polyp using b NBI-DF for diminutive rectal polyps was 91.0%.CONCLUSION ADRs did not differ between b NBI and HD-WLE, however HD-WLE had higher ADR after adjustment of withdrawal time. b NBI surpassed the PIVI threshold for diminutive polyps.
基金supported by the University of Macao(SRG2014-00019-FHSMYRG2015-00230 FHS+4 种基金MYRG2016-00005-FHS)the Affiliated Brain Hospital of Guangzhou Medical University(2016YFC0906302816713342014Y2-001052015BAI13B02)
文摘Background Hyperprolactinaemia is a common adverse effect of antipsychotics （APs）. The results of Peony-Glycyrrhiza decoction （PGD） as a potentially useful adjunctivetreatment for hyperprolactinaemia are inconsistent.Aim This meta-analysis of randomised controlled trials （RCTs） examined the effcacy and safety of adjunctive PGDtherapy for AP-induced hyperprolactinaemia.Methods English （PubMed, Embase, Cochrane Library, PsycINFO） and Chinese （Chinese National Knowledge Infrastructure, Wanfang Data） databases were systematicallysearched up to 10 June 2018. The inclusion criteria were based on PICOS-Participants： adult patients with schizophrenia; Intervention： PGD plus APs; Comparison： APs plus placebo or AP monotherapy; Outcomes： effcacy and safety; Study design： RCTs. The weighted mean difference （WMD） and risk ratio （RR） along with their 95% CIs were calculated using Review Manager （RevMan） V.5.3 software.Results Five RCTs （n=450） were included and analysed. Two RCTs （n=140） were double-blind and four RCTs （n=409） reported ‘random’ assignment with specifc description. The PGD group showed a signifcantly lower serum prolactin level at endpoint than the control group （n=380, WMD： ？32.69 ng/mL （95% CI -41.66 to 23.72）, p〈0.00001, I2=97%）. Similarly, the superiority of PGD over the control groups was also found in the improvement of hyperprolactinaemia-related symptoms. No difference was found in the improvement of psychiatric symptoms assessed by the Positive and Negative Syndrome Scale （n=403, WMD： -0.62 （95% CI -2.38 to 1.15）, p=0.49, I^2=0%）. There were similar rates of all-cause discontinuation （n=330, RR 0.93 （95% CI 0.63 to 1.37）, p=0.71, I^2=0%） and adverse drug reactions between the two groups. According to the Grading of Recommendations Assessment, Development and Evaluation approach, the level of evidence of primary and secondary outcomes ranged from ‘very low’ （14.3%）, ‘low’ （42.8%）, ‘moderate’ （14.3%）, to ‘high’ （28.6%）.Conclusions Current evidence supports the adjunctive use of PGD to suppress elevated prolactin and improve prolactin-induced symptoms without signifcant adverse events in adult patients with AP-induced hyperprolactinaemia. High-quality RCTs with longer duration are needed to confrm these fndings.
文摘Objective: To report our experience of attempting a randomised controlled trial of an intensive lifestyle intervention for early type 2 diabetes delivered in a residential setting. Methods: We established a trial requiring 84 participants (46 standard care and 38 intervention) to detect a 1% difference in HbA1c between intervention and control groups at 12 months, allowing for attrition. Ethics approval was obtained from Monash University. Results: The study was abandoned after five months of consistent promotion due to recruitment failure (four subjects recruited). Conclusion: It appears to be difficult for patients with diabetes to commit to a live-in period of education regarding lifestyle modification as a means of treating the illness. We recommend better education of patients and their doctors about the potential health benefits of lifestyle change to manage type 2 diabetes, and further research into novel methods of delivering lifestyle advice which are both effective and sustainable.
文摘AIM To assess the utility of modified Sano′s(MS) vs thenarrow band imaging international colorectal endoscopic(NICE) classification in differentiating colorectal polyps.METHODS Patients undergoing colonoscopy between 2013 and 2015 were enrolled in this trial.Based on the MS or the NICE classifications,patients were randomised for real-time endoscopic diagnosis.This was followed by biopsies,endoscopic or surgical resection.The endoscopic diagnosis was then compared to the final(blinded) histopathology.The primary endpoint was the sensitivity(Sn),specificity(Sp),positive predictive value(PPV) and negative predictive value(NPV) of differentiating neoplastic and non-neoplastic polyps(MSⅡ/Ⅱo/Ⅲa/Ⅲb vs I or NICE 1 vs 2/3).The secondary endpoints were "endoscopic resectability"(MSⅡ/Ⅱo/Ⅲa vs Ⅰ/Ⅲb or NICE 2 vs 1/3),NPV for diminutive distal adenomas and prediction of post-polypectomy surveillance intervals.RESULTS A total of 348 patients were evaluated.The Sn,Sp,PPV and NPV in differentiating neoplastic polyps from non-neoplastic polyps were,98.9%,85.7%,98.2% and 90.9% for MS;and 99.1%,57.7%,95.4% and 88.2% for NICE,respectively.The area under the receiver operating characteristic curve(AUC) for MS was 0.92(95%CI:0.86-0.98);and AUC for NICE was 0.78(95%CI:0.69,0.88).The Sn,Sp,PPV and NPV in predicting "endoscopic resectability" were 98.9%,86.1%,97.8% and 92.5% for MS;and 98.6%,66.7%,94.7% and 88.9% for NICE,respectively.The AUC for MS was 0.92(95%CI:0.87-0.98);and the AUC for NICE was 0.83(95%CI:0.75-0.90).The AUC values were statistically different for both comparisons(P = 0.0165 and P = 0.0420,respectively).The accuracy for diagnosis of sessile serrated adenoma/polyp(SSA/P) with high confidence utilizing MS classification was 93.2%.The differentiation of SSA/P from other lesions achieved Sp,Sn,PPV and NPV of 87.2%,91.5%,89.6% and 98.6%,respectively.The NPV for predicting adenomas in diminutive rectosigmoid polyps(n = 150) was 96.6% and 95% with MS and NICE respectively.The calculated accuracy of post-polypectomy surveillance for MS group was 98.2%(167 out of 170) and for NICE group was 92.1%(139 out of 151).CONCLUSION The MS classification outperformed the NICE classification in differentiating neoplastic polyps and predicting endoscopic resectability.Both classifications met ASGE PIVI thresholds.
文摘Objective:To observe the difference in clinical efficacy of acupuncture with strong and weak stimulation in treating neck type cervical spondylosis.Methods:64 patients with neck type cervical spondylosis were randomly divided into strong stimulation group and weak stimulation group,with 32 cases in each group.The acupoints selected are Jingjiaji 5-7(cervical acupoints EX-B2 C5-C7),Tianzhu(BL10)on both sides,Houxi(SI3)on both sides,Hegu(LI4)on both sides,Geshu(BL17)on both sides,and Ashi.In the strong stimulation group,deep needling with 0.25 mm×40 mm milli-needle was performed,with a mild reinforcing-reducing method.The twisting angle was 90°-180°,the frequency was 60-90 times/min,and the needles were applied for 1 min at each point.Keep the needle for 30 minutes,twisting was performed every 10 min during the retention period.Change hands once.In the weak stimulation group,shallow acupuncture with a 0.18 mm×40 mm milli-needle was performed,with a mild reinforcing-reducing method,with a twisting angle of 60°-90°,a frequency of 30-60 times/min,and acupuncture for 10 seconds at each acupoint.Keep the needle for 30 minutes,and no needle during the retention period.Patients in both groups were treated once every 1 to 2 days,3 times a week for 2 weeks,and followed up for 1 month after all treatments.The two groups of patients were compared before and after treatment and during follow-up.The McGill pain questionnaire score and the cervical spine dysfunction index score were compared to determine the clinical efficacy.Statistical analysis was performed using SPSS 22.0 statistical software.Results:1 case drop-out in the strong stimulation group and 1 case in the weak stimulation group.The total effective rate of the strong stimulation group was 90.32%,the total effective rate of the weak stimulation group was 83.87%,and the total effective rate of the strong stimulation group was higher than that of the weak stimulation group(P<0.05).The total scores of the short-form McGill pain questionnaire,the VAS score,and the cervical spine dysfunction index scores of the two groups of patients were significantly lower than those of this group before treatment,and the difference was statistically significant(P<0.05).The total scores of the short-form McGill pain questionnaire,visual analogue scale score,and cervical spine dysfunction index scores of the strong stimulation group after treatment and follow-up were significantly lower than those of the weak stimulation group(P<0.05).Conclusion:Acupuncture with strong and weak stimulation can effectively treat patients with cervical spondylosis,and deep acupuncture with filiform needles and strong stimulation have better effect.
基金supported financially by the Dr.Hauschka Stiftung Stuttgart(Germany)the SOFTWARE AG–Stiftung(Germany)the Christophorus Stiftung in der GLS Treuhand(Germany)
文摘Background： Rhythmical massage therapy（RMT） is a massage technique used in anthroposophic medicine.Objective： The authors aimed to investigate the physiological action of RMT on the cardiovascular system by analysing heart rate variability（HRV）.Design, setting, participants and intervention： This study was a randomised, controlled and single-blinded trial, involving 44 healthy women（mean age：（26.20 ± 4.71） years）. The subjects were randomised to one of three arms： RMT with aromatic oil（RA）, RMT without aromatic oil（RM） or standardised sham massage（SM）. In the study the subjects were exposed to a standardised stress situation followed by one of the study techniques and Holter electrocardiograms（ECGs） were recorded for 24 h.Main outcome measures： HRV parameters were calculated from linear（time and frequency domain） and nonlinear dynamics（symbolic dynamics, Poincare plot analysis） of the 24-h Holter ECG records.Results： Short-and long-term effects of massage on autonomic regulation differed significantly among the three groups. Immediately after an RMT session, stimulation of HRV was found in the groups RA and RM. The use of an aromatic oil produced greater short-term measurable changes in HRV compared with rhythmic massage alone, but after 24 h the effect was no longer distinguishable from the RM group.The lowest stimulation of HRV parameters was measured in the SM group.Conclusion： RMT causes specific and marked stimulation of the autonomic nervous system. Use of a medicinal aromatic oil had only a temporary effect on HRV, indicating that the RM causes the most relevant long-term effect. The effect is relatively specific, as the physiological effects seen in the group of subjects who received only SM were considerably less pronounced.
文摘OBJECTIVE:To detect the impact of moderate-intensity aerobic exercise combined with acupuncture on the attention function of mentally-retarded adolescents from the three dimensions of attention concentration,attention transfer and attention span.METHODS:A total of 48 adolescents with mild to moderate mental disabilities were recruited.The participants were randomly divided into four groups:control group(C),Traditional Chinese Medicine acupuncture group(M),moderate-intensity aerobic exercise group(E)and exercise and acupuncture combined intervention group(J).Before and after the experimental intervention,the participant’s height,weight and attention ability were measured.RESULTS:The improved range of attention total duration of the J group after the intervention was significantly higher than that of the E and M groups(P<0.05),whereas that of the latter groups was significantly higher compared to that of the C group(P<0.05).The J group showed significantly higher(P<0.05)attention span values after the intervention compared to the E,M and C groups.The C group did not show a significant difference in attention transfer at 12 weeks compared to before intervention(P>0.05),whereas the E,M and J groups increased significantly(P<0.05)after intervention than the C group.CONCLUSIONS:Moderate-intensity aerobic exercise combined with acupuncture can more effectively improve the attention concentration and attention span of mentally-retarded adolescents than aerobic exercise or acupuncture alone.
文摘Background: Ginkgo biloba extract EGb 761<sup>®</sup> is widely used to treat various types of vertigo. Aims: An exploratory trial was conducted to evaluate the efficacy of EGb 761<sup>®</sup> in addition to vestibular exercises in central vestibular vertigo caused by vertebro-basilar ischaemia. Subjects and Methods: In this randomised, placebo-controlled, double-blind trial, 40 patients were enrolled in the vertigo clinic of a neurological university hospital and treated with daily doses of 240 mg EGb 761<sup>®</sup> or placebo for a period of 180 days. All patients regularly performed vestibular exercises in addition. Efficacy was assessed using: a visual analogue scale for the patients to rate the overall intensity of vertigo;a numeric scale for physician-rated change;a vertigo score based on intensity, duration, and frequency of vertigo;and electronystagmography. Results: Until day 180, the mean patient-rated intensity of vertigo decreased by 46% during EGb 761<sup>®</sup> treatment and by 19% with placebo (p <sup>®</sup> group compared to the placebo group. Nystagmus or other eye movement disorders were present only in small subgroups of patients without sufficient statistical power to detect differences between treatment groups. Conclusions: EGb 761<sup>®</sup> alleviated vertigo caused by ischaemic lesions in the brainstem or cerebellum in patients undergoing vestibular exercises.
基金This study was supported by Singapore Health Services Pte Ltd.Prof Ecosse L.Lamoureux received the funding under the SingHealth Research Strategic Hires Scheme,STH-1202-SERI.The grant body had no roles in design,conduct or data analysis of the study.
文摘Background:Using a pilot randomised controlled trial(RCT),to assess the short-term effectiveness of a structured diabetic retinopathy(DR)-specific,intensive,and personalised care planning(DR-IPCP)intervention on diabetes control outcomes in Singaporeans with poorly controlled type 2 diabetes.Methods:Eighteen individuals with mild-moderate DR and poor glycemic control[HbA1c≥64 mmol/mol(≥8.0%)over two consecutive 6-month readings]were randomized to DR-IPCP(n=9)or usual care(UC,n=9).The intervention included a physician consultation,an initial personalised eye consultation with a experienced diabetes nurse educator,and three behaviour change follow-up calls.HbA1c(primary outcome),lipids and blood pressure were assessed at baseline and three months post-intervention.Participant feedback regarding the DR-IPCP program was collected at three months via a semi-structured telephone interview.Results:While no significant between-group differences were observed,DR-IPCP participants experienced significant within-group reductions in HbA1c,total cholesterol,and low density lipoprotein at follow-up compared to baseline[7 mmol/mol(−0.8%),−0.64 mmol/L,and−0.66 mmol/L,respectively].No significant within-group changes in these parameters were observed in the UC group.Following the DR-IPCP intervention,participants reported a clearer understanding of the link between diabetes management;the development and progression of DR.Conclusions:DR-IPCP provides an effective short-term improvement in diabetes control parameters in DR patients with poor diabetes control.An adequately powered and longitudinal RCT is warranted to assess the clinical,patient-centred and economic potential of this programme in this population.
文摘The aim of this study was to compare the scores of maternal self-efficacy for child diarrhoea prevention, between intervention and control groups, according to sanitary, social and demographic characteristics. A randomised clinical trial was carried out on 163 mothers of children under 5 years old. Data collection was conducted during two months, at two different moments (M0 and M1);at the moment M0 only the intervention group watched the educational video to promote self-efficacy for child diarrhoea prevention;at M1 (two months later) the scale was applied to both groups. In the intervention group, greater mean self-efficacy scores were obtained compared with the control group. The following variables showed statistically significant associations (p < 0.05) with maternal self-efficacy: age 35 or over;high school education;working outside the home;residence with 4 to 5 people;house not of brick or mortar;public refuse collection;piped water supply;consumption of mineral water;and public sewerage network. After use of the video “Diarrhoea: you can prevent it”, the maternal self-efficacy increased, proving that this strategy is able to assist the nursing staff in educational practices.
文摘This systematic review and meta-analysis evaluated the impact of a restrictive episiotomy protocol on the incidence of severe perineal tears in first vaginal deliveries. A comprehensive search was conducted in Pub Med, CENTRAL, Embase, Latin American and Caribbean Health Sciences Literature and Clinical Trials. gov until June 2024. The study followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was registered in PROSPERO(CRD42024550295). Randomised controlled trials comparing restrictive episiotomy(for foetal indications only) with selective episiotomy in first-time vaginal deliveries were included. Two reviewers independently extracted data, assessed bias using the Cochrane Risk of Bias tool and conducted assessment according to Grading of Recommendations Assessment, Development and Evaluation(GRADE). Statistical analyses were performed using R(v.4.4.0) and Rev Man(v.8.6.1). Two trials with a total of 785 participants met the inclusion criteria. The restrictive episiotomy group showed a 51.8% reduction in severe perineal tears(risk ratio(RR)=0.50, 95% CI 0.21 to 1.21), though this result was not statistically significant. Episiotomy rates were lower in the restrictive group(RR=0.61, 95% CI 0.49 to 0.76). There were no significant differences in minor perineal tears, intact perineum rates or neonatal outcomes between the two groups. Despite the lack of statistical significance in the reduction of severe perineal tear occurrence, the findings suggest a trend towards improved perineal outcomes with restrictive episiotomy. Additionally, given the potential physical and psychological consequences of episiotomies, limiting their use to foetal indications may be beneficial. Further research is needed to confirm these findings and guide clinical practice.
基金funding from the Department for Innovation and Technology of the State of Rio Grande do Sul,Brazil,under Public Call Notice No.001/2020('Edital de Chamamento Público número 001/2020,vinculadoàs açöes do Programa INOVA-RS de apoio ao enfrentamento da Covid19)LSL received a master's scholarship('PROSUC Modalidade II')from Coordenação de Aperfeiçoamento de Pessoal de Nível Superior(CAPES),Brazil+1 种基金BMdA received a scholarship from Fundação de AmparoàPesquisa do Estado do Rio Grande do Sul(FAPERGS),BrazilACP receives a doctoral's scholarship from CAPES,Brazil,and a scholarship from Deutscher Akademischer Austauschdienst,Deutschland.FMS received a research grant from Fundação Vale do Taquari de Educação e Desenvolvimento Social(FUVATES),Brazil.
文摘Background Tele-cognitive behavioural therapy(t-CBT)is the most studied remote therapy,and evidence supports its efficacy in treating depression and anxiety symptoms.Aims To compare the effectiveness of tele-interpersonal psychotherapy(t-IPT)to that of t-CBT.We hypothesise that t-IPT is as effective as t-CBT.Methods We conducted a randomised clinical trial with two parallel arms and equal randomisation.The allocation was on a 1∶1 ratio based on a computerised randomisation sequence of permuted blocks of 50.Interventions and assessments were done via a website designed specifically for the trial.Participants were community-based adults with symptoms of anxiety,depression or irritability who received four sessions of t-CBT or t-IPT.The main outcome measures were the Patient Health Questionnaire-9 for depressive symptoms,Generalised Anxiety Disorder-7 for anxiety symptoms and Affective Reactivity Index for irritability.Results 149 individuals with a mean(standard deviation)age of 32.51(10.73)years were randomised to receive t-CBT(n=73)or t-IPT(n=76).Seven participants withdrew from the interventions(t-CBT,n=4;t-IPT,n=3),and 20 participants completed the interventions but did not complete the follow-up questionnaires(t-CBT,n=9;t-IPT,n=11).Analysis was conducted by intention-to-treat.There was a significant overall reduction in symptoms of depression,anxiety and irritability(p<0.001)in both treatment arms;neither modality was superior to the other.Effectiveness analysis showed that the two interventions were equivalent.Conclusions In community adults,t-IPT is as effective as t-CBT in treating symptoms of anxiety,depression or irritability.
文摘Background Although endovascular stenting is considered an effective and safe therapeutic option for symptomatic intracranial atherosclerotic disease(sICAD),an elevated rate of restenosis remains an important issue for the conventional bare-metal stent(BMS).Recent evidence from observational studies suggests that applying drug-coated balloons(DCB)in sICAD may decrease restenosis occurrence.Additional large randomised studies are warranted to provide firmer evidence and to determine which patients would benefit most from DCB.Aim To design a randomised trial to examine DCB angioplasty(Taijieweiye intracranial paclitaxel-coated balloon catheter)versus BMS stenting(Wingspan intracranial stent system)in patients with sICAD.Design This is a multicentre,prospective,randomised,open-label,blinded end-point study to assess whether DCB angioplasty reduces the risk of restenosis compared with BMS stenting in sICAD patients with high-grade stenosis(≥70%-99%).Our goal is to randomly assign 198 eligible individuals at a 1:1 ratio to undergo DCB angioplasty(intervention group)or BMS stenting(control group).Outcome The primary efficacy outcome is restenosis at 6 months post treatment,that is,>50%stenosis in or within 5 mm of the treated segment and>20%absolute luminal loss.The primary safety outcome is stroke or death within 30 days post treatment.Discussion The DRug-coated Balloon for Endovascular treatment of sYmptOmatic intracraNial stenotic Disease trial aims to produce strong evidence on the efficacy and safety of DCB angioplasty as a promising therapeutic option for sICAD cases with high-grade stenosis.
文摘Objective To measure the impact of each type of exercise on sleep quality and identify the exercise that enhances sleep quality the most.Study selection Eligible randomised controlled trials that compare physical exercise to routine activities,usual care,non-physical activity,or health education to measure the Pittsburgh Sleep Quality Index.Data source Studies retrieved from Medline,Embase,CINAHL,Scopus,ClinicalTrial.gov and ThaiJo from the database’s inception to October 2022.Data extraction and synthesis Two reviewers independently identified studies,collected data and assessed bias.In the absence of heterogeneity,a fixed effect model was used for pairwise meta-analysis.Alternatively,a random effect model was used.A two-stage network meta-analysis used the surface under the cumulative ranking curve(SUCRA)to compare exercise efficacy.Main outcome Global Pittsburgh Sleep Quality Index(GPSQI)and subdomain score.Results This review comprised 2170 people from 25 trials.Direct meta-analysis revealed significant improvement in GPSQI with combined exercise(unstandardised mean difference(USMD)−2.35,95%CI−3.13 to-1.57,p<0.001,I^(2)=69.13%).GPSQI decreased considerably with aerobic activity(USMD−4.36,95%CI−7.86 to-0.86,p=0.01,I^(2)=97.83%).For the network meta-analysis,strengthening,aerobic and combination exercise significantly lowered GPSQI(USMD−5.75,-3.76 and−2.54,respectively).Strength training improved GPSQI scores most effectively(SUCRA 94.6%).Conclusion Exercise that strengthens muscles,rather than aerobic or combination exercises,is the most effective way to enhance sleep quality.
