The Clinical Efficacy and Safety of 11 Commonly Used Treatment Strategies Improving Arrhythmia of CHD in China: A Network Meta-Analysis

Purpose: Arrhythmia which as a common complication of CHD, has a high incidence. At present, more and more anti-arrhythmic drugs are used in clinical practice. However, which drug has the best efficacy and high safety is still unknown. Therefore, we decided to use NMA to solve this problem.Method: We searched CNKI, Wanfang database, VIP database, Pubmed, Embase and Cochrane libraries, and collected all RCTs of arrhythmia of CHD, and used RevMan (5.3) and Stata (13.0) to carry out this NMA. The primary outcome indicator of this study is efficiency; the secondary outcome indicator is the incidence of adverse reactions.Result: A total of 134 RCTs, 13,951 patients, and 11 treatment strategies were included in this NMA. The results show that all treatment strategies can effectively improve the arrhythmia of patients. Among them, PMA+AM, AM+AT, AM+WG have higher effective rates, and PMA+AM, WG+ME, SC+ME have better safety. The effectiveness and safety of the treatment strategies which combined TCM and chemical drugs, are significantly better than that of using chemical drugs alone.Conclusion: The treatment strategy of combination of multiple drugs usually has higher efficiency and safety. PMA+AM seems to be the most recommended treatment strategy. In addition, the rational combination of TCM and chemical drugs may provide potential benefit.Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42021229693.

The association between serum CD4 T lymphocyte counts and surgical outcomes in HIV/AIDS patients in Guangxi, China: a retrospective cohort study

Background HIV/AIDS is a chronic disease leading to complications in infected individuals that often require surgical intervention. These patients’ serum CD4 T lymphocyte (CD4) counts represent one of the most important indicators of their ability to tolerate surgical treatment. Previous studies have demonstrated that CD4 cell count (CD4-CC) < 200 cells/μl may increase the risk of surgical complications in these patients, limiting their ability to undergo surgery, which may negatively affect their quality of life. Further investigation into the surgical outcomes of patients with CD4-CC < 200 cells/μl should provide guidance in making appropriate clinical decisions for the optimal healthcare of this patient demographic. Methods All enrolled patients were selected from 14 prefecture-level general hospitals in Guangxi, China, and were referred to AIDS outpost hospitals for inpatient surgical therapy. A total cohort of 168 adult patients was retrospectively analyzed. Multifactorial and stratified analyses were performed to evaluate the in surgical outcome differences for patients with CD4-CC < 200 cells/μl (N = 43), using those with CD4-CC ≥ 200 cells/μl (N = 125) as controls. Results Poor incisional healing was used as the primary outcome indicator, and postoperative complications were used as the secondary outcome indicator. In the patient group with CD4-CC < 200 cells/μl, the risk of surgical complications was significantly increased (OR 2.379; 95% CI [1.049–5.394]) after adjustment. Adjusted stratified analysis of the CD4-CC < 200 cells/μl group revealed that individuals over 60 years (OR 27.504; 95% CI [2.297–329.317]) with erythrocyte counts below 4.00/ml for males or 3.50/ml for females (OR 3.353; 95% CI [1.079–10.419]) had a significantly higher risk of postoperative complications; this finding was statistically different from the control (CD4 ≥ 200 cells/μl) group. However, there was no significant difference between the two groups regarding the risk of poorly healed incision outcomes. Conclusions Preliminary findings suggest that a serum CD4-CC < 200 cells/μl is not a definitive contraindication for surgical therapy and that baseline and surgical characteristics may help predict surgical outcomes in these patients. Further studies are needed to confirm these findings.

Structured Evaluation of Rehabilitation Programs Outcomes in Psychiatry: Application of a Recovery-Centered Model

Rehabilitation is oriented to psychiatric patients’ recovery through specific techniques and structured projects, not yet fully standardized, carried out in territorial services. This study aims to apply an operational structured outcome indicator model (hospitalizations, continuity of care, LAI treatment adherence, working support) through a recovery-centered model in a rehabilitation community in Milan. This observational-retrospective study included 111 patients from a University High Assistance Rehabilitation Community (C.R.A.) based in Milan. Psychopathological and psychosocial functioning was evaluated with Kennedy Axis V, Brief Psychiatric Rating Scale (BPRS), Life Skills Profile (LSP), AR module of the VADO scale. Statistical analyses were performed using SPSS software version 19. Student t test and Wilcoxon Test were used to analyze quantitative variables, while McNemar test for qualitative variables. The minimum level of significance was set at 0.05 (p <0.05). The results showed that CRA rehabilitation program led to significant improvement in global functioning in terms of hospitalization reduction; improved continuity of care; stable adherence to psychopharmacological treatment with Long Acting Injectable (LAI) antipsychotics; stable employment maintenance during the year following discharge from the CRA. This study confirmed the utility of a structured outcome indicator model and highlighted its feasibility in daily clinical context of a rehabilitative community. Our results supported the effectiveness of a community-based rehabilitation program to improve individual functioning and clinical stability. However, further studies are required to better achieve the development of a recovery-oriented rehabilitation model and rigorously define an outcomes evaluation model.

A composite neonatal adverse outcome indicator using population-based data: an update

Introduction Severe morbidity rates in neonates can be estimated using diagnosis and procedure coding in linked routinely collected data as a cost-effective way to monitor quality and safety of perinatal services. Coding changes necessitate an update to the previously published composite neonatal adverse outcome indicator for identifying infants with severe morbidity. Objectives To update the neonatal adverse outcome indicator for identifying neonates with severe morbidity, and to investigate the validity of the updated indicator. Methods We audited diagnosis and procedure codes and used expert clinician input to update the components of the indicator. We used linked birth, hospital and death data for neonates born alive at 24 weeks or more in New South Wales, Australia (2002–2014) to investigate the incidence of severe neonatal morbidity and assess the validity of the updated indicator. Results The updated indicator included 28 diagnostic and procedure components. In our population of 1,194,681 live births, 5.44% neonates had some form of morbidity. The relative risk of morbidity was greater for higher risk pregnancies and was lowest at 39–40 weeks’ gestation. Incidence increased over the study period for overall neonatal morbidity, and for individual components intravenous infusion, respiratory diagnoses, and non-invasive ventilation. Severe neonatal morbidity was associated with double the risk of hospital readmission and ten times the risk of death within the first year of life. Conclusions The updated composite indicator has maintained concurrent and predictive validity and is a standardised, economic way to measure neonatal morbidity when using population-based data. Changes within individual components should be considered when examining longitudinal data.

Logical goal-setting frameworks for leprosy projects

Background/aims Goal setting is a fundamental practice in the effective management of healthcare services worldwide. This study investigated the extent to which leprosy goal formulation in Nigeria is logical and SMART. Methods Document review of baseline problems, goal statements and goal attainments for 2016 in six leprosy projects using a customised logical framework matrix. Results A total of 15 main problems, 6 aims, 19 objectives and 42 indicators were found. The goals were problem-based and logically linked, with a pattern of a single aim per project, multiple objectives per aim, and multiple indicators per objective. Goal statements specified only impact in 5 out of 6 aims, and only outcome and terminal timeframe in 17 out of 19 (89.5%) objectives. Only one objective stated all four SMART components of outcome, indicator, target and timeframe. While three (7.1%) indicators and two (10.5%) objectives were measurable, no target was attainable. Conclusions Goal-setting frameworks for leprosy projects should be problem based and logical according to best practice. That most leprosy objectives were not completely SMART is similar to the reported structure of objectives published by other health organisations globally.

Outcome Indicator Matrix (OIM): a Tool to Assess National Action Plans

: The Outcome Indicator Matrix (OIM) (MIR in Spanish) is a tool that has been adapted by the Universidad de El Salvador (UES) to monitor commitments in national action plans (NAPs). It has been used to assess all commitments presented to the Open Government Partnership (OGP) by the Government of El Salvador that are in its NAP. The OIM-MIR is a result of integrating the logical framework method, used by many governments and public institutions and the focus of the Regulatory Impact Analysis (RIA) (OECD, 2018), which international organizations such as the OECD use to organize actions and procedures to produce a specific outcome.

WHETHER A “MEASUREMENT” OF HUMAN FEELINGS IS A MEASUREMENT IN AN OPERATIONAL SENSE?

The article points out that psychometric scaling based on self-assessment is not a measurement in the usual meaning and rank indicators should not be taken as numerical markers. Clarification of statistical procedures for different types of scaling is explained. The validity of the proposal to use death as a “solid” outcome indicator for universal evaluation of the effectiveness of antidepressants is questioned.