A Methodological Quality Evaluation of Meta-Analyses on Nursing Home Research: Overview and Suggestions for Future Directions.

(1) Background: The nursing home (NH) research field lacks quality reporting about meta-analyses (MAs), and most gradings of MA evidence are biased on analyzing the effectiveness of independent variables in randomized control trials. (2) Objectives: This study aimed to perform a critical methodological review of MAs in the NH research field. (3) Methods: We searched the articles from four databases (PubMed, MEDLINE, CINAHL, and PsycINFO) until 15th January 2021. We reviewed a total of 41 published review articles in the NH research field. (4) Results: The studies primarily fell into the following categories: medicine (17/41), nursing (7/41), and psychiatry or psychology (6/41); 36.6% of the reviewed studies did not use any validated MA guidelines. The lowest correctly reported PRISMA 2000 guideline item was protocol and registration (14.6%), and more than 50% of articles did not report risk of bias. Moreover, 78.0% of studies did not describe missing reports of effect size formula. (5) Discussion: NH researchers must follow appropriate and updated guidelines for their MAs in order to provide validated reviews, as well as consider statistical issues such as the complexity of interventions, proper grouping, and scientific effect-size calculations to improve the quality of their study. Future quality review studies should investigate more diverse studies.

Self-Management Model fails to Predict Quality of Life for People Living with Dual Diagnosis of HIV and Diabetes.

The objective of this study was to test a self-management model for self-management in people living with HIV and type 2 diabetes (PLWH + T2DM). We conducted a predictive, longitudinal study of data from a national research cohort of PLWH using lag analysis to test short- and long-term health outcomes for PLWH + T2DM. We used a dataset from the Center for AIDS Research (CFAR) Network of Integrated Clinic Systems (CNICS), a nation-wide research network of 8 clinics that serves PLWH. Patient-reported outcomes, collected at clinic visit, included depression, adherence, CD4 cell count, and health-related quality of life (HRQoL). We computed summary statistics to describe the sample. Using lag analysis, we then modeled the three variables of adherence, CD4 count, and HRQoL as a function of their predecessors in our conceptual model. In the final model, an increase of in medication adherence corresponded to a small increase in HRQoL. An increase in CD4 count corresponded to a small increase in HRQoL. An increase in lagged depression was associated with a small decrease in HRQoL. The model was not sufficient to predict short- or long-term outcomes in PLWH + T2DM. Although depression had a moderate impact, the final model was not clinically significant. For people with a dual diagnosis of HIV and T2DM, variables other than those traditionally addressed in self-management interventions may be more important.

RESUMEN: El objetivo de este estudio era evaluar un modelo de autocontrol para el autocontrol en aquellas personas que viven con VIH y diabetes de tipo 2 (PLWH + T2DM). Llevamos a cabo un estudio predictivo y longitudinal de la información proveniente de un estudio nacional de una población base de PLWH usando un análisis de retraso para evaluar los resultados en la salud a corto y largo plazo para PLWH + T2DM. Utilizamos un conjunto de datos del Center for AIDS Research [Instituto para la Investigación del SIDA] (CFAR) Network of Integrated Clinic Systems [Red de Sistemas de Clínicas Integradas] (CNICS), una red de investigación nacional que cuenta con ocho clínicas al servicio de PLWH. Los resultados que los pacientes reportaron, recolectados en una visita médica, incluyen depresión, adherencia, conteo de células CD4 y la calidad de vida relacionado con la salud (HRQoL). Calculamos el resumen estadístico para describir la muestra. Utilizando análisis de retraso, modelamos luego las tres variables de adherencia, conteo de células CD4 y el HRQoL como función de su antecesor en nuestro modelo conceptual. En el modelo final, un aumento en la adherencia al medicamento correspondió a un aumento en el HRQoL. Un aumento en el conteo de células CD4 correspondió a un aumento en el HRQoL. Se asoció un aumento de depresión retardada con una disminución en el HRQoL. El modelo no fue suficiente como para predecir resultados a corto o largo plazo en PLWH + T2DM. A pesar de que la depresión tenía un impacto moderado, el modelo final no fue clínicamente significativo. Para aquellas personas con un diagnóstico doble de VIH y T2DM, otras variables, además de las que se abordan tradicionalmente en las intervenciones de autocontrol, podrían ser más importantes.

Identifying the Risk Factors Associated with Nursing Home Residents' Pressure Ulcers Using Machine Learning Methods.

BACKGROUND: Machine learning (ML) can keep improving predictions and generating automated knowledge via data-driven predictors or decisions. OBJECTIVE: The purpose of this study was to compare different ML methods including random forest, logistics regression, linear support vector machine (SVM), polynomial SVM, radial SVM, and sigmoid SVM in terms of their accuracy, sensitivity, specificity, negative predictor values, and positive predictive values by validating real datasets to predict factors for pressure ulcers (PUs). METHODS: We applied representative ML algorithms (random forest, logistic regression, linear SVM, polynomial SVM, radial SVM, and sigmoid SVM) to develop a prediction model (N = 60). RESULTS: The random forest model showed the greatest accuracy (0.814), followed by logistic regression (0.782), polynomial SVM (0.779), radial SVM (0.770), linear SVM (0.767), and sigmoid SVM (0.674). CONCLUSIONS: The random forest model showed the greatest accuracy for predicting PUs in nursing homes (NHs). Diverse factors that predict PUs in NHs including NH characteristics and residents' characteristics were identified according to diverse ML methods. These factors should be considered to decrease PUs in NH residents.

A systematic review and meta-analysis of patient activation in people living with chronic conditions.

OBJECTIVE: The objectives of this review are to (1) describe the state of the science of patient activation interventions for the self-management of chronic conditions; (2) identify effective intervention elements for improving patient activation; and (3) compare intervention effectiveness across chronic conditions. METHODS: This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA). PubMed, CINAHL, and Web of Science databases were searched. RESULTS: Thirty-two articles published between 2005 and 2019 were identified with intervention elements of self-management, disease management, and education. Meta-analysis of a subset of seven randomized controlled trials (n = 7) that used the 13-item version of the Patient Activation Measure with data collection points at 6 months demonstrated that patient activation did not change significantly in comparison with controls (MD = 0.25, 95 % CI = 0.02-0.47). CONCLUSION: Most interventions reported significant improvement in patient activation and were linked to tasks such as regular exercise and monitoring glucose. However, the meta-analysis of RCTs did not confirm these findings. PRACTICE IMPLICATIONS: Patient activation can be assessed and addressed uniformly across all chronic conditions to improve patient engagement in care.

Factors associated with medication persistence among ischemic stroke patients: a systematic review.

OBJECTIVE: An investigation of the prevalence of medication persistence and associated factors in order to inform effective strategies for improving medication persistence. METHODS: A systematic review of the literature from 2010 to the present was performed, using the PRISMA protocol. Primary and empirical observational studies of adult ischemic stroke or transient ischemic attack patients were included. PubMed, CINAHL, Web of Science, Cochrane Library, and PsycInfo databases were searched using the key terms stroke, ischemic stroke, medication persistence, medication adherence, and patient compliance. RESULTS: Of four hundred twenty-eight journal articles retrieved, a final 18 articles were included. Short-term medication persistence was 46.2-96.7%, and long-term medication persistence was 41.7-93.0%. Identified hospital-related factors for medication persistence were stroke unit care, in-hospital medical complications, and early follow-up visit. Demographic factors for medication persistence were older age, and high/adequate financial status; disease-related factors were disease history, stroke subtype, and symptom severity. Age less than 75, female sex, comorbidity, antiplatelet medication switch, and polypharmacy were identified as factors of medication nonpersistence. CONCLUSIONS: Stroke patients' medication persistence decreases over time, and persistence on antiplatelets, anticoagulants, and statin was poor. Several factors were associated with medication persistence, and these factors should be considered in future secondary preventative strategies.

Differences in Health-Related Quality of Life Predictors in People Living With HIV With and Without Diabetes.

Diabetes is one of the most common comorbid conditions in people living with HIV (PLWH). Diabetes may affect health-related quality of life (HRQoL) for PLWH because they experience more symptoms, are prescribed more medications, and are required to do self-care activities. The purpose of our study was to compare predictors of the HRQoL for PLWH with and without diabetes. The study was a secondary analysis of data from the Center for AIDS Research Network of Integrated Clinical Systems cohort using multiple regression. Significant differences were found between PLWH with and without diabetes. The significant predictors of HRQoL for PLWH-alone were depression, anxiety, medication adherence, physical activity, smoking, and age. For PLWH with diabetes, the only significant predictors of HRQoL were anxiety and depression.

Self-Care Performance of Middle-Aged Stroke Patients in Korea.

The incidence rate of middle-aged ischemic stroke patients has been increasing. Because of their high risk of recurrence, it is important for them to adhere to their self-care performance. The purpose of this study was to investigate predictors of self-care performance among middle-aged ischemic stroke patients. A descriptive correlational and cross-sectional survey design was used. About 140 participants who had been diagnosed with ischemic stroke within a year and visited neurological outpatients were investigated. Participants answered self-report questionnaires, the Secondary Stroke Prevention Knowledge Scale, the Health-Related Hardiness Scale, and the Subjective Self-Care Performance Scale. Hardiness, secondary-stroke-prevention knowledge, age, and stroke-diagnosis duration had statistically significant influences on self-care performance; hardiness had the largest effect. This study highlighted hardiness as the major predictor of self-care performance. To improve middle-aged ischemic stroke patients' self-care performance, nurses need an integrated approach that considers a patient's age, diagnosis duration, secondary-stroke-prevention knowledge, and, especially, hardiness.

Chemopreventive mechanisms of methionine on inhibition of benzo(a)pyrene-DNA adducts formation in human hepatocellular carcinoma HepG2 cells.

This study was designed to investigate the molecular mechanism underlying the chemopreventive effects of methionine on benzo[a]pyrene (B[a]P)-DNA adducts formation in HepG2 cells. Methionine significantly inhibited B[a]P-DNA adduct formation in HepG2 cells. Methionine significantly decreased the cellular uptake of [(3)H] B[a]P, but increased the cellular discharge of [(3)H] B[a]P from HepG2 cells into the media. B[a]P significantly lowered total cellular glutathione (GSH) level, but co-cultured with B[a]P and methionine, gradually attenuated intracellular GSH levels in a concentration-dependent manner, which was markedly higher at 20-500µM methionine. The cellular proteins of treated cells were resolved by 2D-polyacrylamide gel electrophoresis. Proteomic profiles showed that phase II enzymes such as glutathione S-transferase (GST) omega-1, GSTM3, glyoxalase I (GLO1) and superoxide dismutase (SOD) were down-regulated by B[a]P treatment, whereas cathepsin B (CTSB), Rho GDP-dissociation inhibitor alpha (Rho-GDP-DIA), histamine N-methyltransferase (HNMT), spermidine synthase (SRM) and arginase-1 (ARG1) were up-regulated by B[a]P. B[a]P and methionine treatments, GST omega-1, GSTM3, GLO1 and SOD were significantly enhanced compared to B[a]P alone. Similarly, methionine was effective in diminishing the B[a]P-induced up-regulation of CTSB, Rho-GDP-DIA, HNMT, SRM and ARG1. Our data suggests that methionine might exert a chemoprotective effect on B[a]P-DNA adduct formation by attenuating intracellular GSH levels, blocking the uptake of B[a]P into cells, or by altering expression of proteins involved in DNA adduct formation.

Comparative nephrotoxicitiy induced by melamine, cyanuric acid, or a mixture of both chemicals in either Sprague-Dawley rats or renal cell lines.

Acute nephrotoxicities of melamine (MEL), cyanuric acid (CA), and a mixture of both melamine and cyanuric acid (MC) were comparatively investigated in male Sprague-Dawley rats at 5 doses each with 10-fold dose interval as follows: MEL at 0.0315, 0.315, 3.15, 31.5, and 315 mg/kg; CA at 0.025, 0.25, 2.5, 25, and 250 mg/kg, and MC: [1×: (0.0315 + 0.025), 10×: (0.315 + 0.25), 100×: (3.15 + 2.5), 1000×: (31.5 + 25), and (315 + 250) mg/kg]. No marked adverse effects in renal function were observed in animals treated with MEL alone or CA alone, but evidence related to nephrotoxicity was noted in rats administered MC. Renal calculi and increased kidney weights were found in rats 7 d after daily oral administration of MC. Blood urea nitrogen (BUN) and creatinine were significantly elevated in the high dose MC groups at 100× or 1000×. In addition, elevated numbers of white blood cells (WBC), neutrophils, and lymphocytes in vivo and increased levels of prostaglandin E(2) (PGE(2)) in vitro were found in the MC group. Based on these data, the NOAEL (no-observed-adverse-effect level) for nephrotoxicity for MC was estimated to be 3.15 mg/kg body weight (bw)/d (MEL) plus 2.5 mg/kg bw/d (CA). If a safety factor of 1000 or more were applied to NOAEL, tolerable daily intake (TDI) would be 0.00315 and 0.0025 mg/kg/d or less for MEL and CA, respectively, which is far below the TDI of 0.2 mg/kg/d set by World Health Organization (WHO). In addition, in vitro cytotoxicity assays showed that the ACHN human renal adenocarcinoma cell line was more sensitive to MEL, CA, and MC than the MDCK canine kidney epithelial cell line. The 24-h half maximal inhibitory concentration (IC(50)) values for MEL (4792, 2792 µg/ml) were less than those of CA (9890, 6725 µg/ml, respectively) in MDCK and ACHN cell lines, suggesting that MEL may be more cytotoxic than CA. Furthermore, the 24-h IC(50) value for MC was found to be 208 µg/ml in ACHN cells. Data suggest that NOAELs based upon acute nephrotoxic parameters for MC were low, which might require further reassessment of the current TDI.

Comparison of the short term toxicity of phthalate diesters and monoesters in sprague-dawley male rats.

This study was carried out to investigate the short term toxicity of nine phthalate diesters including di-2 (ethylhexyl) phthalate (DEHP) , di (n-butyl) phthalate (DBP) , di-n-octyl phthalate (DnOP) , diethyl phthalate (DEP) , butylbenzyl phthalate (BBP) , dimethyl phthalate (DMP) , di-isodecyl phthalate (DIDP) , diundecyl phthalate (DUP) , and di-isononyl phthalate (DINP) and five phthalate monoesters including mono- (2-ethylhexyl) phthalate (MEHP) , monobutyl phthalate (MBuP) , monobenzyl phthalate (MBeP) , monoethyl phthalate (MEP) , monomethyl phthalate (MMP) and phthalic acid (PA) in Sprague-Dawley male rats. Animals were administered 250 mg/kg/day (monoesters and PA) or 500 mg/kg/day (diesters) of phthalate for two weeks. All animals were examined for body and organ weights, blood hematology, serum biochemistry, and urine analysis. The body weight gain was significantly lower in rats treated with BBP, DBP, DINP, MEHP, MBuP, and PA than that of control. Liver weights were significantly increased in the DEHP,DBP, DnOP, DIDP, and MEHP groups as compared to the control group. Testes weights were significantly decreased only in the DEHP-, DnOP-, and DIDP-treated groups as compared to the control. Significant differences in hematological changes were not observed in any treatment groups. Significant increases in blood glucose levels were observed in the DEHP, MEHP, and MBeP groups. Aspartate aminotransferase (AST) levels were significantly increased in the DBP, DUP, DINP, MBuP, and MBeP groups, whereas alanine aminotransferase (ALT) levels were significantly increased only in the DEHP and MEHP groups. Serum ALP levels were significantly higher in phthalate diester (500 mg/kg/day) -treated rats as compared to control. However, the total cholesterol level was significantly reduced in the DEHP- and DIDP-treated groups, whereas serum triglyceride (TG) levels were higher in the DINP-, MEHP-, and MBuP-treated groups. These results suggest that short term toxicity of phthalate monoesters produces adverse effects as similar to phthalate diesters in Sprague-Dawley rats.