Qualitative and quantitative evaluation of a standardized training model for improving patients' ability to use inhalers

ObjectiveTraining contributes to the effectiveness of aerosol inhalation therapy. However, qualitative and quantitative evaluation of effective training methods is rarely reported. This study aimed to evaluate the effectiveness of a standardized training model by pharmacists based on verbal instruction and physical demonstration in improving patients' ability to use inhalers using qualitative and quantitative methods. Risk or protective factors affecting correct inhaler use were also explored.Methods431 Outpatients with asthma or COPD were recruited and randomly divided into a standardized training group (n = 280) and a usual training group (control group, n = 151). A framework of qualitative (e.g., multi-criteria analysis) and quantitative comparisons [percentage of correct use (CU%), percentage of complete error (CE%), and percentage of partial error (PE%)] was established to evaluate the two training models. In addition, the changes of key factors (age, education level, adherence, device type, etc.) influencing patients' ability to use inhalers of two models were observed.ResultsThe multi-criteria analysis showed that the standardized training model had comprehensive advantages in qualitative indicators. The average correct use percentage (CU%) of the standardized training group was significantly higher than that of the usual training group (77.6% vs. 35.5%). A stratified analysis further demonstrated that the ORs (95%CI) in the usual training group of age and educational level was 2.263 (1.165–4.398) and 0.556 (0.379–0.815), while in the standardized training group, age and educational level were not the key factors influencing the ability to use inhaler devices (P > 0.05). Logistic regression analysis demonstrated that standardized training was a protective factor for inhalation ability.ConclusionThese findings indicate that the framework of qualitative and quantitative comparisons could be used to evaluate training models, and the standardized training model by pharmacists can significantly improve patients' ability to use inhalers correctly and address the influence of older age and lower education because of its methodological advantages. Further studies with more extended follow-up are needed to validate the role of the standardized training model by pharmacists in the correct use of inhalers.Clinical trial registrationchictr.org.cn, ChiCTR2100043592 (23-02-2021)

Association of Geriatric Nutritional Risk Index with Mortality in Hemodialysis Patients: A Meta-Analysis of Cohort Studies

Background/Aims: Geriatric nutritional risk index (GNRI) was developed as a “nutrition-related” risk index and was reported in different populations as associated with the risk of all-cause and cardiovascular morbidity and mortality. Therefore, GNRI can be used to classify patients according to a risk of complications in relation to conditions associated with protein-energy wasting (PEW). However, not all reports pointed to the prognostic ability of the GNRI. The purpose of this study was to assess the associations of GNRI with mortality in chronic hemodialysis patients. Methods: We electronically searched original articles published in peer-reviewed journals from their inception to September 2018 in The PubMed, Embase, and the Cochrane Library databases. The primary outcome was all-cause and cardiovascular mortality. We pooled unadjusted and adjusted odds ratios (ORs) with 95% confidence intervals (95% CIs) using Review Manager 5.3 software. Results: A total of 10,739 patients from 19 cohort studies published from 2010 to 2018 were included. A significant negative association was found between the GNRI and all-cause mortality in patients with chronic hemodialysis (OR, 0.90; 95% CI, 0.84-0.97, p=0.004) (per unit increase) and (OR, 2.15; 95% CI, 1.88-2.46, p＜0.00001) (low vs. high GNRI). Moreover, there was also a significant negative association between the GNRI (per unit increase) and cardiovascular events (OR, 0.98; 95% CI, 0.97-1.00, p=0.01), as well as cardiovascular mortality (OR, 0.89; 95% CI, 0.80-0.99, p=0.03). Conclusion: Our findings supported the hypothesis that the low GNRI is associated with an increased risk of all-cause and cardiovascular mortality in chronic hemodialysis patients. Based on our literature review, GNRI has been found to be an effective tool for identifying patients with nutrition-related risk of all-cause and cardiovascular disease

Causative agent distribution and antibiotic therapy assessment among adult patients with community acquired pneumonia in Chinese urban population

<p>Abstract</p> <p>Background</p> <p>Knowledge of predominant microbial patterns in community-acquired pneumonia (CAP) constitutes the basis for initial decisions about empirical antimicrobial treatment, so a prospective study was performed during 2003–2004 among CAP of adult Chinese urban populations.</p> <p>Methods</p> <p>Qualified patients were enrolled and screened for bacterial, atypical, and viral pathogens by sputum and/or blood culturing, and by antibody seroconversion test. Antibiotic treatment and patient outcome were also assessed.</p> <p>Results</p> <p>Non-viral pathogens were found in 324/610 (53.1%) patients among whom <it>M. pneumoniae </it>was the most prevalent (126/610, 20.7%). Atypical pathogens were identified in 62/195 (31.8%) patients carrying bacterial pathogens. Respiratory viruses were identified in 35 (19%) of 184 randomly selected patients with adenovirus being the most common (16/184, 8.7%). The nonsusceptibility of <it>S. pneumoniae </it>to penicillin and azithromycin was 22.2% (Resistance (R): 3.2%, Intermediate (I): 19.0%) and 79.4% (R: 79.4%, I: 0%), respectively. Of patients (312) from whom causative pathogens were identified and antibiotic treatments were recorded, clinical cure rate with β-lactam antibiotics alone and with combination of a β-lactam plus a macrolide or with fluoroquinolones was 63.7% (79/124) and 67%(126/188), respectively. For patients having mixed <it>M. pneumoniae </it>and/or <it>C. pneumoniae </it>infections, a better cure rate was observed with regimens that are active against atypical pathogens (e.g. a β-lactam plus a macrolide, or a fluoroquinolone) than with β-lactam alone (75.8% vs. 42.9%, <it>p </it>= 0.045).</p> <p>Conclusion</p> <p>In Chinese adult CAP patients, <it>M. pneumoniae </it>was the most prevalent with mixed infections containing atypical pathogens being frequently observed. With <it>S. pneumoniae</it>, the prevalence of macrolide resistance was high and penicillin resistance low compared with data reported in other regions.</p

Health literacy and fatigue, anxiety, depression, and somatic symptoms in patients with differentiated thyroid carcinoma from West China: A cross‐sectional study

Abstract Background and Aims Differentiated thyroid carcinoma (DTC) patients are associated with excellent prognosis but impaired health‐related quality of life (HRQOL) by initial and subsequent therapy. Health literacy plays a pivotal role in public health and medical settings, but data on its relationship with DTC patients' HRQOL are insufficient and equivocal. This study was designed to explore the relationship between health literacy and HRQOL in patients with DTC from West China areas. Methods A cross‐sectional study with a descriptive correlational design was conducted. 126 patients with DTC were recruited between 2020 and 2021. Levels of health literacy and HRQOL (including fatigue level, anxiety/depression status, and somatoform symptoms) were assessed by questionnaires. Pearson product–moment correlation and Stepwise multiple regression were used to examined the adjusted association of health literacy with HRQOL. Results Health literacy and receiving DTC‐related education together explained 16.2% of the variance in fatigue level. Patients who had higher health literacy, received more DTC‐related education were currently employed and less fatigue. Health literacy, fatigue level and DTC‐related education together explained 31.0% of the variance in anxiety and depression of DTC patients. Patients who had higher health literacy, received more DTC‐related education and less fatigue level were less anxious and depressive. Age explained 8.3% of the variance in DTC patients' somatoform symptoms. Older patients complained more somatoform symptoms. Conclusion Health literacy was positively associated with HRQOL in DTC patients regarding to fatigue level and anxiety/depression status across the entire sample. Interventions to improve HRQOL should take the patients' health literacy into account

Clinical Observation of Erlotinib as the First-line Treatment for Patients with Advanced Non-small Cell Lung Cancer

Background and objective To evaluate the efficacy and toxicity of erlotinib as the first-line therapy for advanced non-small cell lung cancer (NSCLC). Methods A total of 28 pathologically-confirmed NSCLC patients who could not receive willingly or tolerate traditional cytotoxic drugs chemotherapy were enrolled. Erlotinib was orally administered 150 mg daily until disease progression or the occurrence of intolerable toxicity. Results Among a total of 28 patients, the objective response rate (ORR) of erlotinib was 28.6%. The disease control rate (DCR) was 60.7%. The rate of symptom relief was 53.6%. The median progression free survival (PFS) was 3.2 (95%CI: 0.851-5.585) months. The median overall survival (OS) was 9.6 (95%CI: 7.179-12.021) months. One-year survival rate was 32.1%. The therapeutic effect was better in patients with rash. Most of the toxicities were grade I and grade II toxicity. The most common adverse events were rash (46.4%), diarrhea (32.1%), skin dry (25.0%), anorexia(17.9%), fatigue (10.7%) and increased transaminase (7.1%). Conclusion Erlotinib provided another choice for the patients who could not willingly receive or tolerate chemotherapy

Relationships between Ecosystem Services and Urbanization in Jiangsu Province, Eastern China

Ecosystem services are comprehensive and quantitative indicators for describing ecosystem&#8211;human interactions. China has experienced rapid urbanization in the past 30 years, which has created a significant impact on regional ecosystem services. However, whether the impact is linear is not clear as yet. In this study, the Jiangsu province, a main body of the Chinese Yangtze River Delta city cluster, was chosen as a case study. Multi-source remotely-sensed geospatial data, including meteorological, land use, vegetation, and socio-economic data, were collected to estimate the total amount of ecosystem services (TESV) and urbanization levels. Subsequently, the relationships between TESV and urbanization indices (i.e., gross domestic product (GDP) per unit area, GPUA; population per unit area, PPUA; and built-up land proportion, BULP) were determined using the Pearson correlation analysis and piecewise linear regression. The primary findings of this study were as follows: (1) There was a distinct spatial pattern in TESV, which gradually increased from west to east with high-value areas located in eastern coastal areas of Jiangsu. Among different land use types, cropland and woodland contributed the most to TESV; (2) The three urbanization indices had spatial patterns, indicating higher urbanization in southern Jiangsu than in central or northern Jiangsu; and (3) Once GPUA and PPUA exceeded threshold values of 3719.55 &#215; 104 yuan/km2 and 744.37 person/km2, respectively, TESV sharply decreased with an increase in these indices. However, the BULP showed a linear and significantly negative relationship with TESV at all values, which indicated that the impacts of economic and population growth on TESV lagged behind that of built-up land expansion. These findings provide a potentially significant reference for decision-makers to rationally enhance regional ecosystem services during rapid urbanization processes

Recent Advances and Future Prospects on the Tailing Covering Technology for Oxidation Prevention of Sulfide Tailings

Acid mine drainage, produced from sulfur-containing mine waste exposed to air, water, and bacteria, is considered as a serious environmental pollutant because of its extremely low pH and excessive heavy metals. In order to solve the ecological environment problems caused by the acid mine drainage, treatment methods such as neutralization, adsorption, passivation, bio-inhibition, and physical coverage have been developed. Nevertheless, these methods are terminal treatment methods, which are unable to prevent the generation of acid mine drainage at the source. Recently, it is noteworthy that the tailing covering technology is particularly emphasized, owing to its superior source control capability. By reducing the contact with air, water, and bacteria, the oxidation of sulfide tailings is significantly reduced, thus avoiding the production of acid mine drainage. To date, massive research has been studied and parts of technologies have been applied, but the review on the principles, processes, and applications of these technologies are still lacking. Thus, the present review aims to increase the knowledge related to the most relevant application of tailing covering technology with the following aspects: (i) the background, concepts, and performance of tailing covering technology; (ii) the applicable conditions for each tailings coverage system and their advantages and limitations; and (iii) the future perspective of this technology

The mitochondrial genome of the giant panda tick Haemaphysalis flava (Acari, Ixodidae) from Southwest China

The tick Haemaphysalis flava (Acari, Ixodidae) is an obligatory blood-feeding ectoparasite of the giant panda and is also a vector for transmission of pathogenic microorganisms. In this study, the complete mitochondrial genome of this tick was sequenced through Illumina sequencing technology. The genome was 14,699 bp in length and encoded 37 genes including 13 protein-coding genes, 22 transfer RNAs and two ribosomal RNAs. Phylogeny revealed that three isolates of H. flava, regardless of host origins and locations, clustered together and formed a monophyletic relationship with Haemaphysalis japonica, supporting their species validity among the genus Haemaphysalis. These cumulative mitochondrial DNA data provides insights into phylogenetic studies among Haemaphysalis ticks

Effect of microstructure evolution induced by LP on hydrogen permeation behavior of 316L stainless steel

In order to investigate the hydrogen permeation behavior of 316L stainless steel during the microstructural evolution induced by laser peening (LP), an electrochemical hydrogen charging system for initial hydrogen charging of LPed and non-LPed specimen was developed. Afterward, the microhardness, residual stress, and microstructures of the samples were determined and analyzed. Finally, electrochemical hydrogen permeation experiments were undertaken to verify LP's influence on hydrogen permeation parameters of 316L. The results showed that LP reduced the hydrogen-induced hardening rate of the alloy and additionally invoked high magnitude compressive residual stress on its surface. At the layer close to the face of the specimen, the grain refinement rate was as high as 56.18%, which was accompanied by the appearance of high-density dislocations. Compared with the non-LPed sample, the hydrogen permeation time increased significantly, and the saturation current density in steady state hydrogen permeation also decreased gradually