499 research outputs found
Conceptualising the spirituality of Chinese older adults: a Delphi study
Free Paper Session II : Mental Health / End-Of-Life CareINTRODUCTION: Service provision in geriatric health and social care is increasingly guided by holistic principles, in which many aspects, including physical, psychological, social, and spiritual aspects, are equally emphasized to enhance well-being and enrich life. However, little is known about the degree of consensus among multidisciplinary professionals in the Chinese context on the central components of spirituality that most promote spiritual well-being among Chinese older adults. This study is intended to identify the core components of ...published_or_final_versio
A three-miRNA signature as promising non-invasive diagnostic marker for gastric cancer
published_or_final_versio
Effects of Promotional Materials on Attitudes and Fear towards Colorectal Cancer Screening among Chinese Older Adults: An Experimental Study
published_or_final_versio
Risk of selection bias in randomised trials
Background: Selection bias occurs when recruiters selectively enrol patients into the trial based on what the next treatment allocation is likely to be. This can occur even if appropriate allocation concealment is used if recruiters can guess the next treatment assignment with some degree of accuracy. This typically occurs in unblinded trials when restricted randomisation is implemented to force the number of patients in each arm or within each centre to be the same. Several methods to reduce the risk of selection bias have been suggested; however, it is unclear how often these techniques are used in practice. Methods: We performed a review of published trials which were not blinded to assess whether they utilised methods for reducing the risk of selection bias. We assessed the following techniques: (a) blinding of recruiters; (b) use of simple randomisation; (c) avoidance of stratification by site when restricted randomisation is used; (d) avoidance of permuted blocks if stratification by site is used; and (e) incorporation of prognostic covariates into the randomisation procedure when restricted randomisation is used. We included parallel group, individually randomised phase III trials published in four general medical journals (BMJ, Journal of the American Medical Association, The Lancet, and New England Journal of Medicine) in 2010. Results: We identified 152 eligible trials. Most trials (98%) provided no information on whether recruiters were blind to previous treatment allocations. Only 3% of trials used simple randomisation; 63% used some form of restricted randomisation, and 35% did not state the method of randomisation. Overall, 44% of trials were stratified by site of recruitment; 27% were not, and 29% did not report this information. Most trials that did stratify by site of recruitment used permuted blocks (58%), and only 15% reported using random block sizes. Many trials that used restricted randomisation also included prognostic covariates in the randomisation procedure (56%). Conclusions: The risk of selection bias could not be ascertained for most trials due to poor reporting. Many trials which did provide details on the randomisation procedure were at risk of selection bias due to a poorly chosen randomisation methods. Techniques to reduce the risk of selection bias should be more widely implemented
Development and validation of a spirituality scale for Chinese elders: a mixed approach
Free Paper Presentation 5 â Geriatric Assessment: no. F5-4æè°äž»éĄ:ă ćè¶ćș·éœĄæć - ćĄè°ăćéČèææ ăConference Theme: 3As in Aged Care- Advocacy, Advancement and AchievementpostprintThe 8th World Congress on Long Term Care in Chinese Communities and Asian Ageing Development Conference, Hong Kong, 24-26 November 2011
A community study on burden and depressive symptoms among carers of demented relatives
Background: Most mild to moderate demented patients
are cared at home. Studies have shown that carers face
increased stress and are prone to depression. In order to
understand their needs, a collaboration study between
District Board, Community Rehabilitation Network and
local hospitals was done. Objective: (1) To understand
care needs of demented patients and their carers in the
family. (2) To assess difficulties faced by carers and evaluate
their stress. (3) To find out which factors may aggravate
or relieve carer stress. Method: The study was performed
by interviewing 100 carers by questionnaire. Three main
themes were studied: (1) presence of depression by Center
for Epidemiological Studies Depression Scale (CES-D), (2)
caregiver burden by Zarit Burden Interview (ZBI), patientsâ
memory and behavioural problems by Revised Memory
and Behaviour Problems Checklist (RMBPC), patient ADL
performance, and (3) carer coping abilities by Brief COPE
and perceived social support by Multidimensional Scale
of Perceived Social Support (MSPSS). Results: 49% of
patients are in moderate to severe stage, with moderate to
high ADL dependency level (mean ADL score: 62.4, with
40% of patients scoring 60 or below). On average carers
spent 13.8 hours per day on their relative. 24% of carers
have rated self-perceived health status as poor or very
poor. 36% have little or no knowledge about the dementia
illness. Regarding carer depression, 49% had CES-D score
in the moderately and severely depressed range. Caregiver burden was high with ZBI score of 38.2 (>24 being highly
associated with depression). Memory and behavioural
symptoms were common with mean RMBPC 38.2. Carer
coping abilities as measured by Brief COPE was 24.6.
Perceived social support as measured by MSPSS was
56.2. Carer depression was found to be correlated with
cognitive and behaviour problems as well as carer burden;
whereas it was negatively correlated with social support.
After multiple linear regression analysis, caregiver burden
was the most significant factor contributing to caregiver
depression (ÎČ=0.55, T=5.43, p<0.001). Conclusions: This
cohort of carers, having spent long hours caring for their
demented relatives had limited knowledge, poor perceived
health and emotional problems. They had high burden
and showed signs of depression. Caregiver depression
was found to be associated with a higher level of burden.published_or_final_versio
Plasma high sensitivity troponin T levels in adult survivors of childhood leukaemias: determinants and associations with cardiac function
published_or_final_versio
Comparing etoricoxib and celecoxib for preemptive analgesia for acute postoperative pain in patients undergoing arthroscopic anterior cruciate ligament reconstruction: a randomized controlled trial
<p>Abstract</p> <p>Background</p> <p>The efficacy of selective cox-2 inhibitors in postoperative pain reduction were usually compared with conventional non-selective conventional NSAIDs or other types of medicine. Previous studies also used selective cox-2 inhibitors as single postoperative dose, in continued mode, or in combination with other modalities. The purpose of this study was to compare analgesic efficacy of single preoperative administration of etoricoxib versus celecoxib for post-operative pain relief after arthroscopic anterior cruciate ligament reconstruction.</p> <p>Methods</p> <p>One hundred and two patients diagnosed as anterior cruciate ligament injury were randomized into 3 groups using opaque envelope. Both patients and surgeon were blinded to the allocation. All of the patients were operated by one orthopaedic surgeon under regional anesthesia. Each group was given either etoricoxib 120 mg., celecoxib 400 mg., or placebo 1 hour prior to operative incision. Post-operative pain intensity, time to first dose of analgesic requirement and numbers of analgesic used for pain control and adverse events were recorded periodically to 48 hours after surgery. We analyzed the data according to intention to treat principle.</p> <p>Results</p> <p>Among 102 patients, 35 were in etoricoxib, 35 in celecoxib and 32 in placebo group. The mean age of the patients was 30 years and most of the injury came from sports injury. There were no significant differences in all demographic characteristics among groups. The etoricoxib group had significantly less pain intensity than the other two groups at recovery room and up to 8 hours period but no significance difference in all other evaluation point, while celecoxib showed no significantly difference from placebo at any time points. The time to first dose of analgesic medication, amount of analgesic used, patient's satisfaction with pain control and incidence of adverse events were also no significantly difference among three groups.</p> <p>Conclusions</p> <p>Etoricoxib is more effective than celecoxib and placebo for using as preemptive analgesia for acute postoperative pain control in patients underwent arthroscopic anterior cruciate ligament reconstruction.</p> <p>Trial registration number</p> <p>NCT01017380</p
FibroScan-AST (FAST) score for the non-invasive identification of patients with non-alcoholic steatohepatitis with significant activity and fibrosis: a prospective derivation and global validation study
BACKGROUND
The burden of non-alcoholic fatty liver disease (NAFLD) is increasing globally, and a major priority is to identify patients with non-alcoholic steatohepatitis (NASH) who are at greater risk of progression to cirrhosis, and who will be candidates for clinical trials and emerging new pharmacotherapies. We aimed to develop a score to identify patients with NASH, elevated NAFLD activity score (NASâ„4), and advanced fibrosis (stage 2 or higher [Fâ„2]).
METHODS
This prospective study included a derivation cohort before validation in multiple international cohorts. The derivation cohort was a cross-sectional, multicentre study of patients aged 18 years or older, scheduled to have a liver biopsy for suspicion of NAFLD at seven tertiary care liver centres in England. This was a prespecified secondary outcome of a study for which the primary endpoints have already been reported. Liver stiffness measurement (LSM) by vibration-controlled transient elastography and controlled attenuation parameter (CAP) measured by FibroScan device were combined with aspartate aminotransferase (AST), alanine aminotransferase (ALT), or AST:ALT ratio. To identify those patients with NASH, an elevated NAS, and significant fibrosis, the best fitting multivariable logistic regression model was identified and internally validated using boot-strapping. Score calibration and discrimination performance were determined in both the derivation dataset in England, and seven independent international (France, USA, China, Malaysia, Turkey) histologically confirmed cohorts of patients with NAFLD (external validation cohorts). This study is registered with ClinicalTrials.gov, number NCT01985009.
FINDINGS
Between March 20, 2014, and Jan 17, 2017, 350 patients with suspected NAFLD attending liver clinics in England were prospectively enrolled in the derivation cohort. The most predictive model combined LSM, CAP, and AST, and was designated FAST (FibroScan-AST). Performance was satisfactory in the derivation dataset (C-statistic 0·80, 95% CI 0·76â0·85) and was well calibrated. In external validation cohorts, calibration of the score was satisfactory and discrimination was good across the full range of validation cohorts (C-statistic range 0·74â0·95, 0·85; 95% CI 0·83â0·87 in the pooled external validation patients' cohort; n=1026). Cutoff was 0·35 for sensitivity of 0·90 or greater and 0·67 for specificity of 0·90 or greater in the derivation cohort, leading to a positive predictive value (PPV) of 0·83 (84/101) and a negative predictive value (NPV) of 0·85 (93/110). In the external validation cohorts, PPV ranged from 0·33 to 0·81 and NPV from 0·73 to 1·0.
INTERPRETATION
The FAST score provides an efficient way to non-invasively identify patients at risk of progressive NASH for clinical trials or treatments when they become available, and thereby reduce unnecessary liver biopsy in patients unlikely to have significant disease
- âŠ