Aims and objectives. The main aim of this study was to identify the coping strategies of stroke caregivers, to identify the factors associated with caregivers’ depression and to identify predictors of caregivers’ depression. Background. Stroke has a high incidence in China. Most stroke survivors are accompanied by family caregivers during hospitalisation. However, little is known about these informal caregivers’ coping strategies to the consequences brought on by stroke and their depressive symptoms. Method. A correlation and cross‐sectional design was used and a purposive sample of 92 stroke survivors and their caregivers completed the questionnaires, which were used to describe the demographic of both the caregiver and stroke survivor, coping strategies (the Brief COPE Inventory) and depression of caregivers (the Center for Epidemiologic Studies Depression Scale). Spearman's correlation and multiple stepwise regression analysis were used in data analyses. Results. Several coping strategies (planning, positive reframing, acceptance, active coping, use of instrumental support and humour) were most commonly used by stroke caregivers. The length of hospital stay, stroke survivor's cognitive status and functional status, family income and coping strategies such as (i) denial, (ii) self‐blame, (iii) planning and (iv) religion had significant correlations with caregiver's depression. The best predictors of caregiver's depression were denial, planning and stroke survivor's functional status. Conclusions. This study contributes to our knowledge about the coping strategies and depression level of stroke caregivers on the Chinese mainland. The depression rate is very high during hospitalisation, although these caregivers often had positive coping responses to the stroke event. Many factors were associated with caregivers’ depression. Relevance to clinical practice. Nurses should not only pay attention to stroke survivors but also to their caregivers. To help them adjust well from the stroke consequences and avoid depression, nurses should implement effective interventions.
Background Programmed cell death protein-1/programmed cell death ligand-1 (PD-1/PD-L1) inhibitors works by reactivating immune cells. Considering the accessibility of noninvasive liquid biopsies, it is advisable to employ peripheral blood lymphocyte subsets to predict immunotherapy outcomes. Methods We retrospectively enrolled 87 patients with available baseline circulating lymphocyte subset data who received first-line PD-1/PD-L1 inhibitors at Peking Union Medical College Hospital between May 2018 and April 2022. Immune cell counts were determined by flow cytometry. Results Patients who responded to PD-1/PD-L1 inhibitors had significantly higher circulating CD8+CD28+ T-cell counts (median [range] count: 236 [30-536] versus 138 [36-460]/μL, p < 0.001). Using 190/μL as the cutoff value, the sensitivity and specificity of CD8+CD28+ T cells for predicting immunotherapy response were 0.689 and 0.714, respectively. Furthermore, the median progression-free survival (PFS, not reached versus 8.7 months, p < 0.001) and overall survival (OS, not reached versus 16.2 months, p < 0.001) were significantly longer in the patients with higher CD8+CD28+ T-cell counts. However, the CD8+CD28+ T-cell level was also associated with the incidence of grade 3-4 immune-related adverse events (irAEs). The sensitivity and specificity of CD8+CD28+ T cells for predicting irAEs of grade 3-4 were 0.846 and 0.667, respectively, at the threshold of CD8+CD28+ T cells ≥ 309/μL. Conclusions High circulating CD8+CD28+ T-cell levels is a potential biomarker for immunotherapy response and better prognosis, while excessive CD8+CD28+ T cells (≥ 309/μL) may also indicate the emergence of severe irAEs.
Objective: The aims of the study were to investigate predictors and outcomes of psychiatric disorders among survivors postearthquake. Design: Cross-sectional design survey. Setting: Government-aided communities with temporary shelters. Subjects: A multistage stratified and cluster sampling strategy was employed to select participants via face-to-face interviews, and a total of 1,297 survivors participated in the research. Main outcome measure: Psychiatric disorders were measured with self-reporting questionnaire-20 (SRQ-20), and quality of life was measured with medical outcomes study 36-item short form health survey (SF-36) and a series of problems were made to evaluate the demographic characteristics of survivors. Results: The findings of the present study show that psychiatric morbidity was very prevalent among survivors (76.6%). Negative correlation was found between the total score of SRQ and PCS (rs= -0.525, p<0.001), and MCS(rs= -0.679, p<0.001) by Pearson correlation analysis. The multivariate logistic regression analysis demonstrated that female, aged 60 or older, having financial burden and having >2 chronic diseases were significant risk factors for psychiatric disorder. While married, monthly income > ¥1,500, and with medical insurance were significant protection factors against psychiatric disorders. Conclusions: The psychiatric morbidity was very prevalent among survivors two years after the earthquake. The survivors with psychiatric disorders tend to have poor quality of life. Appropriate public health and medical interventions should put an emphasis on survivors who are female, aged 60 or older, having financial burden and having >2 chronic diseases because they are at heightened risk for psychiatric disorders.
Healthcare relief teams dispatched to rural areas often face difficulties due to limited initial and ongoing health information in the affected community. The present study investigated patterns of healthcare service demand for a rural displaced population in a post-disaster situation. Three weeks after the 2014 Ludian County earthquake, the Institute for Disaster Management and Reconstruction (IDMR) at Sichuan University and Hong Kong Polytechnic University organized a disaster nursing team to support the rural community in Longtoushan, at the epicenter of the earthquake. A cross-sectional, records-based study of 2484 records obtained from a temporary hospital in Longtoushan (for the period of 14 September–1 October 2014) was conducted. The daily number of records by patients' sociodemographic characteristics and medical diagnoses were plotted on a time series graph to explore the temporal change during the study period. Findings indicate that healthcare service demand from younger age groups was higher than that of the older adult group. Three major health problems were observed: respiratory disease, skin problems, and ear, eye, and throat (EET) problems. All of these very real health problems are chronic issues that require long-term care. They are not health issues directly related to the disaster emergency itself. Yet disaster relief nursing teams were selected on the basis of their ability to cope primarily with traumatic disaster-related injuries. The existing practice of teaming up disaster relief professions might not be optimal. To better understand the healthcare needs of a displaced population, short- and long-term planning is needed. Planning will allow disaster response professionals to better organize and deploy healthcare personnel to manage the above-listed problems in a post-disaster situation.
Abstract Background: Although China has a large population and increasing incidence of ulcerative colitis (UC), data on pregnancy outcomes in women with UC are insufficient and the relationship between simple clinical colitis activity index (SCCAI) and pregnancy outcomes has rarely been studied. This retrospective study aimed to assess the relationship between SCCAI and pregnancy outcomes of Chinese women with UC and explore factors affecting pregnancy outcomes. Methods: Overall, 23 pregnancies of 18 patients with UC were included. The following factors were analyzed: SCCAI before and during pregnancy; basic conditions, comorbidities, and treatment before and during pregnancy; frequency and details of pregnancy-related complications; and mode of delivery. Clinical characteristics, disease condition, and treatment details were compared between patients with and without adverse pregnancy outcomes. Results: The SCCAI was significantly lower in the remission group than in the active group (P < 0.001), except in the second trimester, but no significant difference in recurrence/exacerbation rate was found. There were 18 live births (remission group, 15; active group 3; P > 0.05). No significant difference in the frequency and characteristics of pregnancy-related complications was noted between the two groups. Outcomes of 15 pregnancies were satisfactory, but the other eight cases had adverse pregnancy outcomes. Patients with adverse pregnancy outcomes had higher SCCAI in the second trimester than the patients without adverse outcomes (P = 0.034). Multivariate analysis showed no statistically significant risk factor for adverse pregnancy outcomes. Conclusion: Chinese women with UC can usually achieve favorable pregnancy outcomes under multidisciplinary management, and a higher SCCAI in the second trimester has a positive correlation with adverse pregnancy outcomes.
Abstract Background Ovarian endometrioma is a common gynecologic disease among reproductive-aged women. Pregnancy-related hormonal status may lead to changes of decidualization, which may resemble ovarian malignancies in sonographic appearance. Here we present a case of decidualized ovarian endometrioma clinically mimicking malignant transformation. Case presentation A 37-year-old pregnant woman presented to our hospital at 25 + 5 weeks of gestation with a persistent left adnexal mass that was first detected on routine ultrasound in the first trimester. Transvaginal and transabdominal ultrasound showed a cystic mass of size 8.4 × 5.8 cm in the left ovary with abundant blood flow signals in the papillary medium echo of the capsule wall and inner wall, raising concern for malignant ovarian tumor. After a multidisciplinary discussion, the patient underwent laparoscopic left salpingo-oophorectomy. The results of the frozen section revealed decidualized endometrioma and the final histopathology confirmed endometrioma with extensive decidualization. The patient’s postoperative recovery was uneventful and she was discharged on the 4th postoperative day. Conclusions Decidualized ovarian endometrioma is rare. Sonography and magnetic resonance imaging are helpful for differential diagnosis. Conservative management of expectant management and serial monitoring should be adopted if decidualized endometriosis is suspected.
This study examined the relationships between demographic characteristics, sources of nursing stress and coping strategies, and psychological well-being within graduate nurses. Moving from the student role to the staff nurse role can be an uneasy journey, transition is recognized as a stressful experience, and many graduate nurses find it difficult to cope with their new roles in their first few months. Four self-report questionnaires were administered to a sample of 96 new graduate nurses in central China. Death and dying, workload, and inadequate preparation were the most common sources of nursing stress, whereas the most frequently used coping strategies were planning, acceptance, and positive reframing. A number of significant correlations were found among demographic characteristics, sources of nursing stress, coping strategies, and psychological well-being. Negative predictors of psychological well-being were denial (coping strategies) and death and dying (workplace stressor). Role transition is often difficult when an individual comes to a new environment and is given new responsibilities and expectations. Although this transition is stressful and they feel inadequately prepared, with assistance, the new graduate nurses can develop effective coping strategies to adjust to the new role.
Abstract Aim This study aimed to investigate personal preparedness among patients on haemodialysis (HD) and to examine the relationship among sociodemographic characteristics, attitudes toward disaster preparedness and personal preparedness behaviours during natural disaster incidents. Design A cross‐sectional survey was conducted. Methods A convenience sampling method was used. A total of 446 participants from six areas of Sichuan province completed the online questionnaire study from February 27 to March 13, 2022. Sociodemographic characteristics, attitudes toward disaster preparedness and personal preparedness behaviours were measured. Descriptive statistics were used to analyse sociodemographic characteristics and attitudes toward disaster preparedness. The relationship among sociodemographic characteristics, attitudes toward disaster preparedness and personal preparedness behaviours were assessed using ordinal regression. Statistical significance was defined as p < 0.05. Results A total of 446 participants completed the survey. Of these, 42.15% ( N = 188) were poorly prepared, 26.23% ( N = 117) were moderately prepared and 31.61% ( N = 141) were highly prepared. Ordinal regression showed that knowing about disaster preparedness (Odds Ratio (OR) = 1.691, 95% Confidence Interval (CI) = 1.081–2.644, p = 0.021), participating in disaster evacuation exercises (OR = 2.519, 95% CI = 1.595–3.977, p < 0.001) and learning about disaster preparedness (OR = 2.421, 95% CI = 1.542–3.802, p < 0.001) were associated with high preparedness. Compared to patients with a university degree or higher, patients with a junior high school education or lower (OR = 3.491, 95% CI = 1.760–6.925, p < 0.001) and senior high school degree (OR = 2.052, 95% CI = 1.038–4.057, p = 0.039) were associated with high preparedness. Patients who felt very confident and could deal with all their needs (OR = 3.878, 95% CI = 2.904–7.181, p < 0.001) or patients who felt confident and could meet some of their needs (OR = 1.949, 95% CI = 1.124–3.379, p = 0.017) had higher preparedness than those who felt less confident and were not well prepared to take care of their needs. Patient or Public Contribution After obtaining each participant's consent, they filled out the online questionnaire using their own or a relative's cell phone while undergoing HD. Implication for Practice It is essential that patients should be educated not only on medical specialty topics, but also on general disaster preparedness. Medical institutions should improve and reinforce preparation training among targeted populations. The low level of preparedness is partly due to the lack of participation of patients in disaster preparedness programs. Dialysis center managers should be urged to implement such programs at their centers.
The aim of the study was to evaluate the perioperative risks and outcomes of ultra-radical surgery in patients with extensive metastatic ovarian growing teratoma syndrome (GTS).We conducted a retrospective study of patients with extensive metastatic ovarian GTS treated in our hospital between 2000 and 2022. Patients' clinical characteristics, surgical treatment, and outcomes were evaluated.Overall, 13 patients were identified, and the median age at diagnosis of ovarian immature teratoma (IT) was 24 years (range: 5-37). The median interval between IT diagnosis and presenting GTS was 8 months (range: 2-60), with a median surgery delay of 5 months (range: 3-300). Peritoneum and liver were the most commonly affected sites (100%), followed by bowel (12 patients, 92.3%), diaphragm (12 patients, 92.3%), adnexa (9 patients, 69.2%), omentum (8 patients, 61.5%), uterus (7 patients, 53.8%), in the descending order. The mean operation time was 316 min (range: 180-625), and the mean blood loss volume was 992 mL (range: 200-5,000). Peritoneal metastasectomy (13 patients, 100%), diaphragmatic metastasectomy (12 patients, 92.3%), metastasis removal from the bowel (8 patients, 61.5%), partial hepatectomy (4 patients, 30.8%), bowel excision and anastomosis (1 patient, 7.7%) were also applied to achieve optimal debulking. R0 was achieved in 9 (69.2%) patients. A high rate of intraoperative blood transfusion (8 patients, 61.5%) and admission to the intensive care unit (9 patients, 69.2%) were observed, and the median postoperative hospitalization time was 8 days (range: 4-22). After a median follow-up of 3.3 years, 9 patients were free of disease, and 4 were alive with stable residual diseases.The survival outcomes in extensive metastatic ovarian GTS were satisfactory after ultra-radical surgery, while a proper therapeutic plan should be established due to the high perioperative risks.
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