Determinants influencing health-promoting behaviors in individuals at high risks of stroke: a cross-sectional study.

Background: Quit smoking, moderate drinking, exercise, and healthy eating habits are all known to decrease the risk of stroke. As a result, understanding the health behaviors of high risk groups for stroke is crucial. Health behavior is influenced by knowledge, social environment, and health beliefs. However, little research has been done on these relationships. For a better grasp of the relationships mentioned above, consider using the COM-B model (capability, opportunity, motivation, and behavior). The purpose of this study was to investigate the variables related to health behavior and to test the mediating effect of health beliefs. Methods: The cross-sectional study was carried out at a physical examination center of a tertiary hospital in Shanghai, China. 986 high-risk populations of stroke have been tested using the Health Behavior Scale (HBS-SP), Stroke Knowledge Questionnaire (SKQ), Health Beliefs Questionnaire (HBS), and Multidimensional Scale of Perceived Social Support (MSPSS). The structural equation modeling was used in this study. Results: The scores for MSPSS, SKQ, HBS, and HBS-SP were 60.64 ± 13.72, 26.60 ± 9.77, 157.71 ± 34.34, and 2.46 ± 0.41, respectively. The revised model fits well (approximate root mean square error = 0.042; comparative fit index = 0.946). The health behavior was obviously and positively correlated to social Support, stroke knowledge, and health beliefs. Moreover, health belief has a mediating effect on the relation of social support, stroke knowledge, and health behavior. Conclusion: Chinese high risk groups for stroke have a mediate level of health behaviors. Factors associated with health behaviors are knowledge of stroke, health beliefs, and social support. The COM-B-based model can be used to explain the health behavior of individuals at risk of stroke and to guide the formulation of effective health management programs.

Feasibility of an oral health promotion program among older people in geriatric care facilities, Shanghai, China: a pre/post-implementation study.

BACKGROUND: The oral health of older people is closely related to their overall health. Timely and effective intervention in oral issues is necessary to maintain their overall health. This study aimed to evaluate the feasibility and effectiveness of an Oral Health Promotion Program (OHPP) in Geriatric Care Facilities (GCFs). METHODS: The OHPP was implemented in two GCFs and evaluated using a pre/post-design. Questionnaires on self-efficacy and attitude for providing oral care were sent to 42 nurse participants before and three months after the implementation of the OHPP. Outcomes of 295 patient participants were assessed at four time points (T1-baseline, T2-one month, T3-two months, and T4-three months post-implementation) including Activities of Daily Living (ADL), Mini-Mental State Examination (MMSE), and Oral Health Assessment Tool (OHAT). RESULTS: The oral health and daily activity ability of patient participants showed an improving trend at four time points pre/post-implementation of the OHPP. The proportion of patients with healthy mouths (OHAT: 0-3 points) increased from 29.8 to 67.8% and their scores of OHAT and ADL were significantly better at T4 compared to T1, T2, and T3 (p < 0.001). Self-efficacy (SE-PMC: T1 = 18.93 ± 3.18, T4 = 28.83 ± 6.56, p < 0.001) and attitude (A-PMC: T1 = 18.78 ± 3.09, T4 = 28.20 ± 6.03, p < 0.001) for oral care among nurse participants improved after the implementation of the OHPP. CONCLUSIONS: This study highlights the feasibility of implementing OHPP within GCFs, potentially enhancing the oral health and daily living activities of older individuals. Integrating the OHPP into routine care in geriatric settings is not only practical but also widely acceptable, offering a proactive approach to address oral health disparities among older residents. Stakeholders can maximize the impact of the OHPP by fostering collaboration among healthcare professionals, administrators, and residents, ultimately improving oral health outcomes and overall quality of life of older residents. TRIAL REGISTRATION: ChiCTR2000035236 (registration date: 04/08/2020).

Factors associated with nurses' attitudes for providing oral care in geriatric care facilities: a cross-sectional study.

BACKGROUND: The world's population is getting older. This issue is accompanied by a rise in the number of older people suffering from dementia and disability, for whom oral hygiene care is challenging. Nurses' attitudes toward providing oral care (POC) are critical for the elderly, while few studies have investigated the determinant factors of nurses' attitudes by identifying the current work pressure, resilience and self-efficacy in geriatric care facilities (GCFs). It is of great significance to explore the nurses' attitudes toward POC and associated influencing factors related to psychological aspects including resilience, self-efficacy, and stress from the workplace. METHODS: Attitudes for Providing Mouth Care (A-PMC) in Chinese version were used in this cross-sectional study with 160 nurses in 2 GCFs. Data were collected using online questionnaires and analyzed by multiple linear regression analysis. Statistically significant values were considered at p < 0.05. RESULTS: A total of 160 nurses participated in this study, with an average age of 32.86 ± 7.43. The mean score for the A-PMC was 2.81 ± 0.47. The score of A-PMC was negatively correlated with work pressure (r=-0.332, p < 0.01), and positively correlated with resilience (r = 0.735, p < 0.01) and self-efficacy (r = 0.425, p < 0.01) respectively. Multiple linear regression analyses identified that the potential influencing factors of A-PMC were education background, work hours every shift, self-efficacy, work pressure and resilience. CONCLUSIONS: The study results indicate nurses' attitudes regarding PMC were at a low level, which is influenced by many factors. To improve nurses' attitudes toward PMC and the oral hygiene (OH) of the elderly in GCFs, it is necessary to increase nurses' education and training, establish a reasonable and effective incentive mechanism to improve nurses' work motivation and other intervention measures to reduce work pressure.

Research status, hotspots and trends on oral care research in the elderly published from 2002 to 2022: A bibliometric analysis - A review article.

AIMS: The aim of this study was to analyse the status, hotspots and trends of research on oral care for the elderly in mainland China in the past 20 years through bibliometrics, which aims to provide new ideas and targets for future clinical work and research. DESIGN: Bibliometric analysis. METHODS: Relevant literature was retrieved from China National Knowledge Infrastructure, Wanfang, China Science and Technology Journal Database, Web of Science and PubMed. NoteExpress, Co-Occurrence and CiteSpace were used to analyse bibliometric features in terms of year of publication, journal of publication, authors, institution and keywords. RESULTS: A total of 716 related articles were obtained. The number of publications shows an increasing trend over time, only 2017-2021; 309 papers were published, accounting for 43.2% of the total number of publications. A total of 238 articles were published in Science Citation Index journals or Chinese core journals, accounting for 33.2% of the total number of articles. The study of oral health-related quality of life in the elderly is a hot research topic. There is a lack of research on the elderly living in elderly care facilities.

Effect of Iron-Erythrocyte Metabolism-Related Indexes on Posttraumatic Growth in Patients on Maintenance Hemodialysis (MHD).

Purpose: To investigate the effect of iron-erythrocyte metabolism-related indexes on posttraumatic growth in MHD patients and their caregivers. Patients and Methods: A total of 170 pairs of MHD patients and their caregivers in Shanghai Changhai Hospital were enrolled in this research, which used sociodemographic characteristics, the Posttraumatic Growth Inventory (PTGI), the Perceived Social Support Scale (PSSS), and the Medical Coping Modes Questionnaire (MCMQ). The test data of 141 patients were retrieved from the hospital database. Results: Single-factor analysis showed that the PTGI score of patients with a mean corpuscular erythrocyte volume ≥ 100 fL was 85.4 ± 19.8 and those with a mean corpuscular erythrocyte volume lower than 100 fL were 70.6 ± 24.7; the PTGI scores of patients with reticulocytes >1.5% were 68.8 ± 25.8, and those with reticulocytes <1.5% were 78.4 ± 21.1; the PTGI scores of the caregivers whose serum iron was >10.6 µmol /L were 78.2 ± 21.6, and those with serum iron <10.6 µmol /L were 67.9 ± 22.8. The difference in MCMQ scores between the caregivers with transferrin saturation>50% and with transferrin saturation<20% was 18.9 ± 8.4. For the correlation test of serum iron, reticulocyte and PTGI scores for patients, the Pearson correlation coefficients were 0.239 and -0.193, respectively, and the correlation test between erythrocyte distribution width SD and the score of caregivers MCMQ scale, the Pearson correlation coefficient was 0.225; p for all was< 0.05, with significant differences. There was no significant difference in the scores of different scales for total iron binding capacity (TIBC) at different levels. Conclusion: The indexes related to iron erythrocyte metabolism in MHD patients are correlated with ruminant meditation of patients and their caregivers and promotion of posttraumatic growth. Good nutritional status, adequate hematopoietic material, and normal erythrocyte count and function are also important for them.

Development and psychometric testing of burn inpatient nursing dependency assessment scale.

AIMS: The aim was to develop and psychometrically test the burn inpatient nursing dependency assessment scale (BINDAS). DESIGN: This was a scale development study. METHODS: This study was conducted in four phases from November 2019 to November 2021. Items were generated and the initial scale was constructed in phase 1. The preliminary evaluation of items was conducted through expert reviews and a pilot study in phase 2. The scale, including item quality, reliability and validity, was validated with 420 individuals in phase 3. The translation of the scale from Chinese to English was performed in phase 4. RESULTS: Content validity was satisfactory. Thirteen items were retained after item analysis, and three factors accounting for 73% of the total item variance were extracted through exploratory and confirmatory factor analyses. Predictive validity with nursing time spent with patients during 24 h was also estimated, with r = .66 (p < .01). Receiver operating characteristic analysis was conducted, and an area under the curve of the scale of 0.94 was obtained. Concurrent validity with Barthel index was estimated, with r = -.71 (p < .01). Cronbach's alpha coefficient for scale was .93, and the correlation between raters for total scores was .95. CONCLUSION: Burn inpatient nursing dependency assessment scale is a psychometrically valid and reliable measurement instrument as well as objective other-rating scale with 12 items for scoring on a four-point scale (0, 1, 2 or 3) and 1 item for scoring on a two-point scale (0 or 2). BINDAS with 13 items was developed in this study. Nurses can give each patient a total score of 0-38. A high score indicates high nursing dependency. The 13-item scale consists of three factors: basic care need, physiological index, and psychology and adaptation. IMPACT: This scale demonstrated satisfactory psychometric properties and can be used to evaluate patient dependency on nurses in burn units and optimize an individual's care plan to achieve efficient staff allocation.

Grading of cytokine release syndrome associated with the CAR T cell therapy tisagenlecleucel.

BACKGROUND: Anti-CD19 CAR T cell therapy has demonstrated high response rates in patients with relapsed or refractory (r/r) B cell malignancies but is associated with significant toxicity. Cytokine release syndrome (CRS) is the most significant complication associated with CAR T cell therapy, and it is critical to have a reproducible and easy method to grade CRS after CAR T cell infusions. DISCUSSION: The Common Terminology Criteria for Adverse Events scale is inadequate for grading CRS associated with cellular therapy. Clinical experience with the anti-CD19 CAR T cell therapy tisagenlecleucel at the University of Pennsylvania (Penn) was used to develop the Penn grading scale for CRS. The Penn grading scale depends on easily accessible clinical features; does not rely on location of care or quantitation of supportive care; assigns grades to guide CRS management; distinguishes between mild, moderate, severe, and life-threatening CRS; and applies to both early-onset and delayed-onset CRS associated with T cell therapies. Clinical data from 55 pediatric patients with r/r B cell acute lymphoblastic leukemia and 42 patients with r/r chronic lymphocytic lymphoma treated with tisagenlecleucel were used to demonstrate the current application of the Penn grading scale. CONCLUSION: We show that the Penn grading scale provides reproducible CRS grading that can be useful to guide therapy and that can be applied across clinical trials and treatment platforms.

Assessing the impact of safety monitoring on the efficacy analysis in large Phase III group sequential trials with non-trivial safety event rate.

In Phase III clinical trials for life-threatening conditions, some serious but expected adverse events, such as early deaths or congestive heart failure, are often treated as the secondary or co-primary endpoint, and are closely monitored by the Data and Safety Monitoring Committee (DSMC). A naïve group sequential design (GSD) for such a study is to specify univariate statistical boundaries for the efficacy and safety endpoints separately, and then implement the two boundaries during the study, even though the two endpoints are typically correlated. One problem with this naïve design, which has been noted in the statistical literature, is the potential loss of power. In this article, we develop an analytical tool to evaluate this negative impact for trials with non-trivial safety event rates, particularly when the safety monitoring is informal. Using a bivariate binary power function for the GSD with a random-effect component to account for subjective decision-making in safety monitoring, we demonstrate how, under common conditions, the power loss in the naïve design can be substantial. This tool may be helpful to entities such as the DSMCs when they wish to deviate from the prespecified stopping boundaries based on safety measures.

Impact of safety monitoring on error probabilities of binary efficacy outcome analyses in large phase III group sequential trials.

In phase III clinical trials, some adverse events may not be rare or unexpected and can be considered as a primary measure for safety, particularly in trials of life-threatening conditions, such as stroke or traumatic brain injury. In some clinical areas, efficacy endpoints may be highly correlated with safety endpoints, yet the interim efficacy analyses under group sequential designs usually do not consider safety measures formally in the analyses. Furthermore, safety is often statistically monitored more frequently than efficacy measures. Because early termination of a trial in this situation can be triggered by either efficacy or safety, the impact of safety monitoring on the error probabilities of efficacy analyses may be nontrivial if the original design does not take the multiplicity effect into account. We estimate the actual error probabilities for a bivariate binary efficacy-safety response in large confirmatory group sequential trials. The estimated probabilities are verified by Monte Carlo simulation. Our findings suggest that type I error for efficacy analyses decreases as efficacy-safety correlation or between-group difference in the safety event rate increases. In addition, although power for efficacy is robust to misspecification of the efficacy-safety correlation, it decreases dramatically as between-group difference in the safety event rate increases.

Quantitative comparison of randomization designs in sequential clinical trials based on treatment balance and allocation randomness.

To evaluate the performance of randomization designs under various parameter settings and trial sample sizes, and identify optimal designs with respect to both treatment imbalance and allocation randomness, we evaluate 260 design scenarios from 14 randomization designs under 15 sample sizes range from 10 to 300, using three measures for imbalance and three measures for randomness. The maximum absolute imbalance and the correct guess (CG) probability are selected to assess the trade-off performance of each randomization design. As measured by the maximum absolute imbalance and the CG probability, we found that performances of the 14 randomization designs are located in a closed region with the upper boundary (worst case) given by Efron's biased coin design (BCD) and the lower boundary (best case) from the Soares and Wu's big stick design (BSD). Designs close to the lower boundary provide a smaller imbalance and a higher randomness than designs close to the upper boundary. Our research suggested that optimization of randomization design is possible based on quantified evaluation of imbalance and randomness. Based on the maximum imbalance and CG probability, the BSD, Chen's biased coin design with imbalance tolerance method, and Chen's Ehrenfest urn design perform better than popularly used permuted block design, EBCD, and Wei's urn design.

Racial disparities in being recommended to surgery for oral and oropharyngeal cancer in the United States.

OBJECTIVES: To investigate the impact of race on the likelihood of patients being recommended for surgery after a diagnosis of oral and oropharyngeal cancer. METHODS: A total of 68,445 cases of oral and oropharyngeal cancer were extracted from the 1988 to 2005 Surveillance, Epidemiology, and End Results (SEER) database. County-level rurality data and income data were merged using the US Department of Agriculture Rural-Urban Continuum Codes dataset and US Census Bureau Small Area Income & Poverty Estimates dataset. We used logistic regression analyses to investigate the impact of race on being recommended to surgery for oral and oropharyngeal cancer, adjusting for demographic, socioeconomic, and clinical factors. Stratified analyses were further conducted by tumor site and rural/urban status. RESULTS: Recommendation to surgery varied significantly by race, with black patients less likely than white patients to be recommended to surgery for their oral and oropharyngeal cancer. The racial difference in recommendation to surgery varied significantly by age, geography, and tumor subsite. Racial disparities are most evident in lip and buccal cancer from rural areas (OR, 4.4; 95% CI, 2.6-7.5); and least evident in oropharyngeal cancer from urban areas (OR, 1.2; 95% CI, 1.1-1.3). The magnitude of the racial disparity is attenuated with increasing age. CONCLUSIONS: We observed substantial racial disparities in surgery recommendation for oral and oropharyngeal cancer in the United States. Our results suggest the need to improve accessibility to better health care in racial minority groups, particularly in rural areas, and call for individual and institutional efforts to avoid physician bias related to the patient's sociodemographic characteristics in healthcare service.

Block urn design - a new randomization algorithm for sequential trials with two or more treatments and balanced or unbalanced allocation.

Permuted block design is the most popular randomization method used in clinical trials, especially for trials with more than two treatments and unbalanced allocation, because of its consistent imbalance control and simplicity in implementation. However, the risk of selection biases caused by high proportion of deterministic assignments is a cause of concern. Efron's biased coin design and Wei's urn design provide better allocation randomness without deterministic assignments, but they do not consistently control treatment imbalances. Alternative randomization designs with improved performances have been proposed over the past few decades, including Soares and Wu's big stick design, which has high allocation randomness, but is limited to two-treatment balanced allocation scenarios only, and Berger's maximal procedure design which has a high allocation randomness and a potential for more general trial scenarios, but lacks the explicit function for the conditional allocation probability and is more complex to implement than most other designs. The block urn design proposed in this paper combines the advantages of existing randomization designs while overcoming their limitations. Statistical properties of the new algorithm are assessed and compared to currently available designs via analytical and computer simulation approaches. The results suggest that the block urn design simultaneously provides consistent imbalance control and high allocation randomness. It can be easily implemented for sequential clinical trials with two or more treatments and balanced or unbalanced allocation.

Effect of a multi-faceted intervention on gingival health among adults with systemic sclerosis.

OBJECTIVES: To evaluate the effect of adaptive oral hygiene devices and orofacial exercise to improve gingival health among adults with systemic sclerosis (SSc). METHODS: Forty-eight patients with SSc were assigned randomly to the multifaceted oral health intervention or usual dental care control group. Participants in the intervention group received a rechargeable, powered Oral-B® oscillating-rotating-pulsating toothbrush and a Reach® Access™ Flosser that has a toothbrush-like handle. For those with an oral aperture of less than 40 mm, orofacial exercises were taught. Participants in the control group were each given a manual toothbrush and dental floss. Participants in both groups received instructions and demonstration on the use of the devices, and were requested to perform the respective intervention twice a day for 6 months. Evaluations were at baseline, 3-, and 6-months. The main outcome was gingival index (GI), an indicator of gingival inflammation. RESULTS: Both groups showed significant reduction in GI scores at 6 months (ps<0.005). Reduction in GI scores of the intervention group at 6 months was 20.8% which is considered to be clinically significant. Compared to the control group, the intervention group showed a significant and larger reduction in GI score by 8% at 6 months (p=0.0007). CONCLUSIONS: Results support the use of adaptive devices and orofacial exercise to improve gingival health in adults with SSc when compared to use of manual toothbrushing and finger-held flossing. Recommending and educating patients with SSc to use adaptive devices to clean the tooth surfaces looks promising for long-term oral health improvement.

A simplified formula for quantification of the probability of deterministic assignments in permuted block randomization.

Open label and single blinded randomized controlled clinical trials are vulnerable to selection bias when the next treatment assignment is predictable based on the randomization algorithm and the preceding assignment history. While treatment predictability is an issue for all constrained randomization algorithms, deterministic assignments are unique to permuted block randomization. Deterministic assignments may lead to treatment predictability with certainty and selection bias, which could inflate the type I error and hurts the validity of trial results. It is important to accurately evaluate the probability of deterministic assignments in permuted block randomization, so proper protection measures can be implemented. For trials with number of treatment arms T = 2 and a balance block size B = 2m, Matts and Lachin indicated that the probability of deterministic assignment is 1m+1. For more general situations, with T ≥ 2 and a block size B=∑j=1Tmj, Dupin-Spriet provided a formula, which can be written as 1B∑j=1T∑i=1mj∏k=1imj-k+1B-k+1. This formula involves extensive calculation in evaluation. In this paper, we simplified this formula to 1B∑j=1TmjB-mj+1 for general scenarios and 1B-m+1 for trials with a balanced allocation. Through mathematical induction we show the equivalence of the formulas. While the new formula is numerically equivalent to Dupin-Spriet's formula, the simple format not only is easier for evaluation, but also is clearer in describing the impact of parameters T and m(i) on the probability of deterministic assignments.

Lateral lip-splitting approach for total and subtotal maxillectomy.

PURPOSE: This study reviewed our patients who underwent maxillectomy by the lateral lip-splitting approach and evaluated postoperative outcomes. PATIENTS AND METHODS: Thirty-six patients with diseases in the maxilla, maxillary gingiva, and hard palate who underwent total or subtotal maxillectomy by the lateral lip-splitting approach. The marginal mandibular branch of facial nerves were dissected and preserved before and after the procedure to split the lateral lower lip in all patients. Seventeen patients were reconstructed with free vascularized flaps. Postoperative radiotherapy was administered in 26 patients. The patient's self-assessment and examiner's evaluation were included in the postoperative assessment. The patient's self-assessment included answering a questionnaire, that included evaluation of buccal scar, symmetry of cheilion, lower lip movement, oral incontinence, and lower lip sensation. The examiner's evaluation included assessment of the functions of the facial nerve. RESULTS: All tumors were removed en bloc with sufficient safety margins except 1 adenoid cystic carcinoma in maxilla. The average mouth opening was 3.81 cm. According to the results classified as good, fair, and poor by questionnaires, most of the 36 patients thought their results were good or fair. Most of the patients were high scores, according to the examiner's evaluation. The overall 5-year survival and local control rates for patients with malignant tumors were 76.7% and 85.8%, respectively. The local and regional recurrent and distant metastasis rate was 12.9%, 6.5%, and 19.4%, respectively. CONCLUSIONS: The lateral lip-splitting approach is an acceptable and optional approach for maxillectomy because of wide exposure, satisfied function, inconspicuous scar, and preservation of facial nerve.

Analysis of determinants on speech function after glossectomy.

PURPOSE: To determine which of the following factors-type of reconstruction, size of tumor, and site of excision-may influence speech intelligibility after glossectomy. MATERIALS AND METHODS: The speech intelligibilities of 27 tongue cancer patients who underwent glossectomy within the range of the hemitongue were investigated within 6 months after operation with a speech intelligibility test formed by 100 sensitive Chinese sounds. They were compared according to the following factors: type of reconstruction (forearm flap or adjacent flap); size of tumor (T1, T2, T3); and site of excision (anterior, middle, posterior, or hemi part). RESULTS: There was no significant difference in speech intelligibility between the forearm flap reconstructed group and adjacent flap reconstructed group (P > .05). There was a significant difference in the result between the T1 and T3 groups (P < .05). The speech intelligibilities of the patients with tumors in anterior tongue or hemitongue were significantly lower than those with tumor in the middle or posterior tongue (P < .05). Patients with preservation of the tip of the tongue or floor of the mouth had higher intelligibilities (P < .05). CONCLUSION: For the patients after glossectomy within the range of hemitongue, except for the type of reconstruction, the tumor site or excision extent of the tongue followed by the tumor size may be key factors in determining the postoperative articulation intelligibility.

[Axial split osteotomy of free fibular flap for mandibular angle reconstruction: a clinical study].

PURPOSE: To introduce an axial split osteotomy of free fibular flap for mandible angle reconstruction and discuss its indications and surgical technique. METHODS: 16 patients underwent axial split osteotomy of free fibular flap(12 males and 4 females, aged from 23 to 62). 11 patients with benign tumors (8 ameloblastomas and 3 odontogenic keratocyst), 3 patients with osteoradionecrosis, and 2 patients with secondary mandibular deformity were included. The length of free fibular flap ranged from 10-17 cm (mean 14.6 cm). The length of the vascular pedicel ranged from 5-11 cm (mean 8.2 cm). The fibular flap harvested was performed in routine manner. After elevating the periosteum and performing minimal dissection at osteotomy site only, axial splitting was performed using an oscillating saw. The first osteotomy was made on the external surface of the fibula, perpendicular to the main axis of the bone down to the level of the medullary canal. The second osteotomy was made along the main axis of the bone. The length of this osteotomy was between 2 and 3 cm. The last osteotomy was made perpendicular to the internal surface at one junction of the anterolateral and posteromedial surfaces down to the medullary canal, as was done for the first osteotomy. Then the harvested flap was contoured, which was achieved by raising the two bone segments and fitting them together. The angulation was 120 degrees. RESULTS: 16 flaps were monitored by Doppler ultrasound postoperatively and examined by colored ultrasound 3 months, 6 months after operation. The results revealed that the recipient sites healed primarily without complications. CONCLUSIONS: Axial split osteotomy is a reliable technique with maximum contact surface for bone union, and less bone loss, which can lengthen the transplanted bone to a certain extent. It is suitable especially for reconstruction of the defect of the angle of the mandible.