Objective To construct a nomogram model for predicting delayed encephalopathy after acute carbon monoxide poisoning (DEACMP) in emergency departments. Methods All patients with acute carbon monoxide poisoning who visited the Department of Emergency of Zigong Fourth People’s Hospital between June 1st, 2011 and May 31st, 2023 were retrospectively enrolled and randomly divided into a training set and a testing set in a 6∶4 ratio. LASSO regression was used to screen variables in the training set to establish a nomogram model for predicting DEACMP. The discrimination, calibration, and clinical practicality were compared between the nomogram and Glasgow Coma Scale (GCS) in the training and testing sets. Results A total of 475 patients with acute carbon monoxide poisoning were included, of whom 41 patients had DEACMP. Age, GCS and aspartate aminotransferase were selected as risk factors through LASSO regression, and a nomogram model was constructed based on these factors. The areas under the receiver operating characteristic curves for nomogram and GCS to predict DEACMP in the training set were 0.897 [95% confidence interval (CI) (0.829, 0.966)] and 0.877 [95%CI (0.797, 0.957)], respectively; and those for nomogram and GCS to predict DEACMP in the testing set were 0.925 [95%CI (0.865, 0.985)] and 0.858 [95%CI (0.752, 0.965)], respectively. Compared with GCS, the performance of nomogram in the training set (net reclassification index=0.495, P=0.014; integrated discrimination improvement=0.070, P=0.011) and testing set (net reclassification index=0.721, P=0.004; integrated discrimination improvement=0.138, P=0.009) were both positively improved. The calibration of nomogram in the training set and testing set was higher than that of GCS. The decision curves in the training set and testing set showed that the nomogram had better clinical net benefits than GCS. Conclusion The age, GCS and aspartate aminotransferase are risk factors for DEACMP, and the nomogram model established based on these factors has better discrimination, calibration, and clinical practicality compared to GCS.
ObjectiveTo systematically review the research on pediatric treatment satisfaction of medication (TS-M). MethodsThe PubMed, Embase, Cochrane Library, CBM, WanFang Data, VIP, CNKI databases and medical scale websites were electronically searched to collect studies on pediatric TS-M from inception to November 2022. Two reviewers independently screened literature, and extracted data. Using descriptive analysis, we comprehensively reviewed the TS-M assessment tool selected for the studies of children. We evaluated the methodological quality and measurement properties of existing TS-M scales for children using the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) assessment criteria. ResultsA total of 157 studies were included, including 150 pediatric studies using TS-M evaluation tools and 7 studies on the development and validation of TS-M scales for children, covering 7 specific TS-M scales for children. Our review revealed that 67.3% of the pediatric studies used unvalidated self-administered TS-M questionnaires or interviews, 24.7% used adult TS-M scales, and only 6.0% used two pediatric-specific TS-M scales. The results of the quality assessment indicated that the development quality of existing TS-M pediatric scales was considered "doubtful" or "inadequate", and the internal consistency was "sufficient" but the structural validity was probably "uncertain". High-quality research on the content validity, test-retest reliability and construct validity of the pediatric TS-M scale was still lacking. ConclusionCurrently, the use of TS-M evaluation tools in pediatric studies has irrationalities: over 90% of pediatric studies use self-made questionnaires or adult scales to evaluate children's TS-M; and the existing pediatric TS-M scales globally have narrow applications, questionable development quality, and lack some measurement performance studies. Pediatric TS-M scales with a wide range of applications are lacking.
Objective To investigate the current situation of randomized controlled trials (RCTs) on compound salvia pellet (CSP) for angina pectoris and assess whether there is adequate evidence for clinical practice. Methods We collected all the published clinical studies on CSP for angina pectoris from 1994 to December 2005, and assessed each included report using the Jadad scale, the revised CONSORT statement and other self-edited items. Results We finally identified 115 RCTs. Among which, 1 scored 3 points, 6 scored 2 points, 106 scored 1 points and 2 socred 0 points. No RCT performed allocation concealment according to the CONSORT criteria, only 4 RCTs (3.5%) described the generation of the randomization sequence, among which 2 were quasi-randomized. No RCT provided randomization implementation,1 RCT (0.9%) carried out placebo control, 1 RCT (0.9%) reported endpoint, 9 RCTs (7.8%) adopted single blinding, 4 RCTs (3.5%) reported double blinding, 11 RCTs (9.6%) calculated statistical values, 2 RCTs (1.7%) provided the record of follow-up, 1 RCT (0.9%) reported negative outcome, 25 RCTs (21.8%) described adverse events, no RCT described how the sample size was estimated, and how an intent-to-treat (ITT) analysis and correlation analysis were reported, 1 RCT (0.9%) was multi-center, no RCT completed ethical approval and informed consent, 27 RCTs (23.5%) described syndrome type of TCM. Conclusion Currently, the methodology and reporting of studies on CSP for angina pectoris are not good enough to provide reliable evidence for clinical practice.
ObjectiveTo systematically review the accuracy of the mini-mental state examination scale (MMSE) in the screening of poststroke cognitive impairment (PSCI), and the diagnostic value of different cut-off values of the scale, so as to provide references for the selection of the threshold of the MMSE scale. MethodsDatabases including PubMed, EMbase, Cochrane Library, Web of Science, CINAHL, CBM, VIP, CNKI, and WanFang data were searched for diagnostic tests about MMSE for PSCI from inception to November 2022. Two researchers independently screened the literatures, extracted data and assessed the risk of bias of the included studies. Then, meta-analysis was performed by Stata 16.0 software. ResultsA total of 23 studies involving 1 525 patients were included. The results of meta-analysis showed that after the analysis of bivariate mixed effect model, the optimal cutoff value of MMSE scale was 23/24 (the pooled sensitivity=0.75, 95%CI 0.52 to 0.89; the pooled Specificity=0.90, 95%CI 0.81 to 0.95; DOR=28, 95%CI 12 to 65; AUC=0.92, 95%CI 0.89 to 0.94). The results of hierarchical summary receiver-operating characteristic (HSROC) curve model showed that the pooled sensitivity=0.77, 95%CI 0.70 to 0.83; the pooled specificity=0.76, 95%CI 0.69 to 0.83, Beta=0.1, 95%CI ?0.13 to 0.33, Z=0.82, P=0.41, Lambda=2.38, 95%CI 2.12 to 2.64, and the area under the SROC curve was 0.84. Fagan pre-test probability was 38%, positive likelihood ratio was 3.3, positive post-test probability was 67%, negative likelihood ratio was 0.3,negative post-test probability was 16%. ConclusionThe current evidence shows that MMSE has a certain diagnostic value as a screening tool for PSCI, the overall diagnostic efficacy is moderate, and the diagnostic value is highest when the cut-off value is 23/24. Due to the limited quality and quantity of the included studies, more high quality studies are required to verify the above conclusion.
Objective To assess the psychological status of patients with lung cancer in ward preliminarily for providing the theoretical support for further clinical treatment. Methods Lung cancer patients were enrolled in this study during the period from January 2016 to January 2017, when they were being treated in the respiratory ward of Nanjing General Hospital. Their psychological status was assessed by using Symptom Check List 90, and the results with their demographic information and somatic symptoms were combined. Data were analyzed by using SPSS 18.0 software. Results This study included 239 inpatients, out of them 161 patients were male (67.4%), and the average age was 60.7±9.9 years. Sixty patients had a positive psychological status. The incidence of depression was 11.3% (27/239), of anxiety 4.2% (10/239), and of the total psychological disorder 25.1%. The patients had more serious psychological problems, when they had a longer course, more autonomic symptoms, or a lower score of Karnofsky performance scale, etc. Conclusion More serious psychological problems exist in patients with lung cancer, so it has the clinical significance for their timely psychological assessment.
ObjectiveTo investigate prevalence of anxiety and depression in chronic obstructive pulmonary disease (COPD) in order to increase the awareness of physicians on this comorbidity.MethodsPatients were from a multicenter prospective cohort study and 13 institutions or hospitals participated in the study. Four hundred and ten patients with a prior diagnosis of COPD were prospectively recruited from January 2017 to January 2019, and baseline date were analyzed. Hospital Anxiety and Depression Scale was used to identify anxiety and depression.ResultsThe cohort had a mean age of (60.7±10.0) years with 76.8% males and 74.3% smokers. Seventy-nine patients (19.3%) had anxiety or depression. Among them, 36 subjects (8.8%) had anxiety, and 64 patients (15.6%) were with depression, and 21 patients (5.1%) with anxiety and depression. The prevalence of severe anxiety (2.7%) and severe depression (2.4%) was low. Compared to patients without anxiety or depression, patients with anxiety or depression had significantly higher CAT scores (17.8±9.3 with anxiety, 17.4±8.4 with depression, 12.5±7.3 without anxiety or depression, P 0.002 and 0.000 respectively). The risk of acute exacerbations was higher in patients with depression (37.5% vs. 22.7%, P=0.016). Proportion of patients categorized into GOLD group D was higher in patients with depression (P=0.001).ConclusionsAbout 20% COPD patients has anxiety or depression. Prevalence of depression is two times that of anxiety. The prevalence of severe anxiety or severe depression is low. Patients with depression have lower quality of life, higher risk of acute exacerbations, and higher proportion of patients categorized into GOLD group D.
Objective To evaluate the subjective outcomes of sleepiness behavior and mood status applying continuous positive airway pressure（CPAP） in adults of elderly and middle-aged with obstructive sleep apnea syndrome（OSAS）. Methods Nine randomized controlled trails comparing nocturnal CPAP with inactive control appliances in adults with OSAS with the use of computerized search in related medical databases（MEDLINE，EMBASE，CBMdisk，etc） were included.The quality of literature was reviewed，and all data were extracted by two reviewers independently.Meta analysis was conducted used RevMan 4.2 software.Results 9 RCT involving 665 patients of elderly and middle-aged met the inclusion criteria.Meta analysis indicated that the score of Epworth sleepiness scale（ESS） and general health questionnaire-28（GHQ-28） declined significantly after CPAP treatment on effectiveness with WMD（random） －2.94，95 %CI －4.68 to －1.20，or WMD（fixed） －2.26，95 %CI －3.79 to －0.72，Plt;0.01.Nevertheless，hospital anxiety and depression scale（HADS） was not significantly different between CPAP and control with WMD（random） －0.89，95%CI －1.98 to 0.20，Pgt;0.05.Conclusion Current clinical evidence suggested that CPAP was effective in improving day-time subjective outcomes of sleepiness behavior and general mental health status in OSAS patients of elderly and middle-aged，although evidence of improving emotion disorder of anxiety and depression was not confirmed.
Objective
To investigate the early motor development and the risk factors affecting motor development in children with congenital muscular torticollis (CMT) aged 0–3 months.
Methods
CMT infants admitting to the Department of Rehabilitation Medicine, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine between January 1st, 2016 and April 30th, 2018 were enrolled as CMT group, and contemporaneous age-matched healthy infants were enrolled as the control group. Motor development was assessed with the Alberta Infant Motor scale (AIMS). We collected the birth weight, birth length, mode of birth, sleep position, and prone time when awake as dependent variables, and used multiple linear regression to find the variables that had significant effect on AIMS scores.
Results
There were 97 CMT infants (62 males and 35 females) with the mean age of (46.8±17.3) days, mean birth weight of (3.34±0.38) kg and mean birth length of (49.56±0.93) cm in the CMT group, while there were 97 healthy infants (60 males and 37 females) with the mean age of (45.1±19.4) days, mean birth weight of (3.38±0.35) kg and mean birth length of (49.84±1.03) cm in the control group, and the differences in sex, age, birth weight, birth length between the two groups were not statistically significant (P>0.05). AIMS centiles showed that 36 infants (37.1%) in CMT group had suspicious or abnormal motor development, while only 12 infants (12.4%) in the control group had; there was a significant statistical difference between the two groups (χ2=15.945, P<0.001). Multiple linear regression analysis showed that the time of prone position when awake and CMT had significant influence on the AIMS scores (F=64.851, P<0.001). Infants who had a long prone position when awake had significantly higher AIMS scores and CMT had a significantly lower AIMS scores (P<0.001).
Conclusions
The risk of early motor retardation in infants with CMT aged 0–3 months is higher than that in healthy infants of the same age. The decrease in prone position when awake and CMT may be the causes of delayed motor development. Clinical medical personnel and family caregivers should pay more attention to motor development and provide reasonable intervention to CMT infants.
Objective To investigate the relationship between systemic inflammation response index (SIRI) and early neurological deterioration (END) and 3-month prognosis in patients with acute ischemic stroke. Methods Patients with acute ischemic stroke treated at West China Hospital of Sichuan University and Deyang People’s Hospital between April 2020 and October 2020 were collected. Clinical data were collected using a unified case form and outcomes were followed up for 3 months. According to the poor prognosis, the patients were divided into END group and non-END group. The multivariate logistic regression analysis was used to explore the relationship of SIRI, END and 3-month prognosis. We drew receiver operating characteristic curve to evaluate the value of related factors in predicting the occurrence of END and poor prognosis after 3 months. Results A total of 242 patients were included, of which 47 (19.42%) were in the END group. There were statistically significant differences between the two groups in National Institutes of Health stroke Scale (NIHSS) score on admission, hypertension, creatinine, urea nitrogen, neutrophils count, lymphocyte count, neutrophil count/lymphocyte count ratio (NLR), lymphocyte count/monocyte count ratio, platelet count/lymphocyte count ratio, complications (besides cerebral edema) and SIRI (P<0.05). Logistic regression analysis showed that NIHSS score on admission, hypertension, SIRI and NLR were independent risk factors for END (P<0.05). SIRI had better predictive value for the occurrence of END than NLR (P<0.05). Compared with the non-END group, the patients in the END group had worse prognosis at 3-month [44.7%(21/47) vs. 17.4% (34/195), P<0.05]. NIHSS score on admission had predictive value for clinical prognosis of acute ischemic stroke patients at 3-month. Conclusion SIRI is an independent risk factor for END in patients with acute ischemic stroke, and there is no independent correlation with the 3-month prognosis.
