Risk factors for medical adhesive-related skin injury at the site of peripherally inserted central venous catheter placement in patients with cancer: a single-centre prospective study from China.

OBJECTIVES: This study aims to explore the incidence of, and risk factors for medical adhesive-related skin injury (MARSI) at peripherally inserted central venous catheter (PICC) sites in patients with cancer. DESIGN: A prospective observational cohort study was conducted at a tertiary hospital in Shenzhen, China. SETTING: This was a single-centre study conducted in a tertiary hospital in Shenzhen, China. PARTICIPANTS: A total of 340 patients with cancer and PICC placement from January 2022 to June 2023 were selected using a convenience sampling method. METHODS: Factors potentially associated with PICC-related MARSI (PICC-MARSI) were recorded, including patient demographics, and catheter placement and maintenance. Patients were divided into MARSI and non-MARSI groups. Univariate analysis was performed to screen for associated variables, and logistic regression analysis was used to identify independent risk factors for PICC-MARSI. RESULTS: Of all 340 patients enrolled, 33 (9.7%) developed PICC-MARSI, including skin tear (8, 24.2%), tension injury (5, 15.2%), irritant contact dermatitis (10, 30.3%), allergic dermatitis (7, 21.2%) and maceration (3, 9.1%). Multivariable analysis showed that age (OR=1.058, p=0.001, 95% CI 1.023-1.094), wet skin (OR=4.873, p=0.003, 95% CI 1.728-13.742), dry skin (OR=6.247, p<0.0001, 95% CI 2.239-17.431), oedema (OR=3.302, p=0.008, 95% CI 1.365-7.985), allergy history (OR=6.044, p=0.001, 95% CI 2.040-17.906), dressing type (OR=3.827, p=0.003, 95% CI 1.595-9.185), body mass index (BMI) <18.5 (OR=4.271, p=0.015, 95% CI 1.327-13.742) and BMI 25-30 (OR=2.946, p=0.027, 95% CI 1.131-7.678) were independent risk factors for PICC-MARSI. CONCLUSIONS: Proper catheter maintenance and appropriate dressing selection are crucial for the prevention of this condition.

Successful postpyloric feeding tube insertion using prokinetic drugs for nasoenteric tube placement: A network meta-analysis.

OBJECTIVES: The objective was to compare the effects of prokinetic drugs on the success of postpyloric nasoenteric tube placement using network meta-analysis methods. MATERIALS AND METHODS: Articles from PubMed, Embase, and the Cochrane Library were retrieved up to April 18, 2021. Eligible studies were randomized controlled trials (RCTs) that investigated the effect of prokinetic drugs on postpyloric nasoenteric tube placement. Reviews, retrospective studies, observational studies, letters to the editors, and conference abstracts were excluded. Biases in each study were identified by using the tool recommended by the Cochrane Collaboration. Stata14.0 software were used to process the network meta-analysis. RESULTS: A total of 12 eligible RCTs with 777 patients receiving postpyloric nasoenteric tube placement were finally included for analysis. Patients receiving the following drugs appeared to have significant success with postpyloric feeding tube insertion compared with placebo: metoclopramide (odds ratio [OR] = 2.27; 95% CrI, 1.53-3.37), erythromycin (OR = 1.88; 95% CrI, 1.17-3.19), and domperidone (OR = 2.39; 95% CrI, 1.31-4.35). The surface under the cumulative ranking of placebo, erythromycin, metoclopramide, and domperidone were respectively 9.8%, 73.0%, 62.6%, and 54.6%. Erythromycin had an advantage over the other treatments in success postpyloric feeding tube insertion. CONCLUSIONS: Erythromycin may have the greatest possibility to improve success postpyloric feeding tube insertion.

Disaster Preparedness Among Populations in Shenzhen, China, With and Without Chronic Disease.

OBJECTIVE: This survey examined and compared the disaster perception and preparedness of 2421 residents with and without chronic disease in Shenzhen, China. METHODS: The participants were recruited and were asked to complete a survey in 2018. RESULTS: Three types of disasters considered most likely to happen in Shenzhen were: typhoons (73.5% vs 74.9%), major transport accidents (61.5% vs 64.7%), and major fires (60.8% vs 63.0%). Only 5.9% and 5% of them, respectively, considered infectious diseases pandemics to be likely. There were significant differences between those with and without chronic disease in disaster preparedness, only a small percentage could be considered to have prepared for disaster (20.7% vs 14.5%). Logistic regression analyses showed that those aged 65 or older (odds ratio [OR] = 2.76), who had attained a Master's degree or higher (OR = 2.0), and with chronic disease (OR = 1.38) were more prepared for disasters. CONCLUSIONS: Although participants with chronic disease were better prepared than those without, overall, Shenzhen residents were inadequately prepared for disasters and in need of public education.

Patent foramen ovale closure versus medical therapy for cryptogenic stroke: An updated meta-analysis.

BACKGROUND: The efficacy of patent foramen ovale (PFO) closure for secondary stroke prevention in cryptogenic stroke (CS) patients with PFO is uncertain. This meta-analysis aims to assess whether PFO closure is superior to medical therapy. METHODS: Pooled estimates were calculated using Revman 5.3. The two primary endpoints were stroke and transient ischemic attack (TIA). Secondary outcomes included all-cause mortality, new-onset atrial fibrillation or flutter, major bleeding and any adverse event. RESULTS: Five randomized controlled trials were included. A total of 3440 patients were randomized to either PFO closure (n = 1829) or medical therapy group (n = 1611) and followed for average 2.0-5.9 years. PFO closure reduced the incidence of recurrent stroke in CS patients with PFO compared to medical therapy (Risk ratio (RR) 0.42, 95% confidence intervals (CI) 0.20-0.91, P = 0.03; hazard ratio (HR) 0.34, 95% CI 0.15-0.78, p = 0.01). There were no significant differences between the two groups in TIA (RR 0.78, 95% CI 0.53-1.15, P = 0.21; HR 0.73, 95% CI 0.49-1.09, p = 0.12), all-cause mortality (RR 0.76, 95% CI 0.35-1.63, P = 0.48), major bleeding (RR 0.96, 95% CI 0.42-2.20, P = 0.93) and any adverse event (RR 1.06, 95% CI 0.95-1.18, P = 0.29). Higher risk of new-onset atrial fibrillation or flutter was found in closure group (RR 4.69, 95% CI 2.17-10.12, P < 0.0001). CONCLUSIONS: PFO closure combined with medical therapy showed superiority over medical therapy alone for stroke prevention in carefully selected CS patients with PFO, but increased the risk of atrial fibrillation or flutter.