Investigating influencing factors of physical restraint use in China intensive care units: A prospective, cross-sectional, observational study.

OBJECTIVE: In this study, we characterised the use of physical restraints in three intensive care units (ICUs) in a general hospital in Nantong, China. Additionally, we explored risk factors potentially related to physical restraint use. BACKGROUND: Despite their numerous harmful effects, physical restraints are frequently used in ICUs worldwide. Few studies have investigated the factors that contribute to physical restraint use in Chinese hospitals. METHODS: We conducted a prospective, cross-sectional, observational study of 312 patients in three ICUs at a general hospital in China. The quantitative data were collected during a 5-month period using a physical restraint observation form and patient records. The data obtained were analysed using descriptive statistics. The independent risk factors for physical restraint use were assessed using a logistic regression model. RESULTS: Of the 312 patients in the three ICUs, 191 (61.2%) were restrained, and physical restraints were used more than once for 46 (24.1%) patients during their ICU stay. The median length of physical restrain use was 20 shifts (interquartile range = 10-36 shifts). Physical restraints were applied in 6664 of 12374 (53.9%) nurse shifts. The most common time at which physical restraints were applied was the beginning of the evening shift. According to the forward stepwise logistic regression analysis, delirium (P < 0.001), mechanical ventilation (P < 0.001), and age (P < 0.001) were independent risk factors for physical restraint use. The use of analgesics (P = 0.001) exerted an independent protective effect against physical restraint use. CONCLUSIONS: The overall prevalence of physical restraint use in Chinese ICUs was higher than that reported in previous investigations. The patients' nursing notes lacked complete physical restraint records, reflecting a need for standard guidelines and policies for physical restraint use in hospital ICUs in China. In addition, in this study, we explored the risk factors related to physical restraint use and found that age, delirium, mechanical ventilation, and analgesic use are associated with physical restraint use.

High Prevalence of Erectile Dysfunction in Diabetic Men With Depressive Symptoms: A Meta-Analysis.

BACKGROUND: Erectile dysfunction (ED) may be common among diabetic men with depressive symptoms (DS), but its prevalence is still debated. AIM: To conduct a meta-analysis of the prevalence of ED in diabetic men with DS compared to those without DS, calculating the relative odds ratios (ORs) and 95% CIs. METHODS: PubMed, MEDLINE, Embase, and Web of Science were searched up to January 2018. All the studies assessing the risk of ED among diabetic men having DS were reviewed. 2 Authors independently assessed literature and extracted information eligibility. Any disagreement was resolved by a third reviewer. Newcastle-Ottawa quality assessment scale was used to evaluate study quality in meta-analyses. We calculated the ORs with 95% CIs using software Stata, Version 12.0; StataCorp, College Station, TX). Data were pooled using a fixed or random effects model according to heterogeneity. Sensitivity analyses were conducted to assess potential bias. This study was conducted according to the guidelines for Meta-Analyses and Systematic Reviews of Observational Studies. OUTCOMES: The strength of the association between DS and the prevalence of ED was evaluated using ORs and 95% CIs. RESULTS: 5 Studies were eligible for the present analysis, reporting on a total of 2525 diabetic men. Mean age of patients ranged from 42.37-61.65 years in the included studies. The overall prevalence of ED in diabetic men with DS was 74.2% (95% CI 59.0-89.4). The overall prevalence of ED in diabetic men without DS was 37.4% (95% CI 16.2-58.6). The pooled crude OR for these 5 studies was 6.40 (95% CI 2.11-19.38, P < .05, I2 = 94.6%). The pooled OR of 4 multi-variate analyses was 3.08 (95% CI 1.32-4.85, P < .001, I2 = 83.5%). CLINICAL IMPLICATIONS: Diabetic men with DS had a significantly increased prevalence of ED, suggesting that ED should be of concern to clinicians when managing diabetic men with DS. STRENGTHS & LIMITATIONS: A strength of this study is that it is the first meta-analysis to assess the prevalence of ED in diabetic men with DS and quantitatively analyze the association between DS and ED risk among diabetic men. A limitation is that all included studies were cross-sectional studies, which may generate bias. CONCLUSION: The present meta-analysis of 5 cross-sectional studies suggests that diabetic men showing DS, compared to the diabetic men without DS, have more risk of ED. Further larger prospective cohorts with more power or meta-analysis based on individual patient data need to be conducted to confirm this association. Wang X, Yang X, Cai Y, et al. High Prevalence of Erectile Dysfunction in Diabetic Men With Depressive Symptoms: A Meta-Analysis. J Sex Med 2018;15:935-941.

Investigating Factors Associated with Depressive Symptoms of Chronic Kidney Diseases in China with Type 2 Diabetes.

Aim. To assess the depressive symptoms status of chronic kidney diseases in Nantong, China, with type 2 diabetes and to identify factors associated with depressive symptoms. Methods. In this cross-sectional analytic study, 210 type 2 diabetic patients were recruited from the Second Affiliated Hospital of Nantong University. Depressive symptoms were assessed with the depression subscale of the Hospital Anxiety and Depression Scale (HAD-D). The quality of life was measured with the RAND 36-Item Health Survey (SF-36). And the independent risk factors of depressive symptoms were assessed by using a stepwise forward model of logistic regression analysis. Results. The mean age of the study subjects was 57.66 years (SD: 11.68). Approximately 21.4% of subjects reported depressive symptoms (n = 45). Forward stepwise logistic regression analysis showed that female gender (P = 0.010), hypertension (P = 0.022), Stage IV (P = 0.003), and Stage V (P < 0.001) were significant risk factors for depressive symptoms. The quality of life of individuals with HAD-D score <11 was significantly better compared with individuals with HAD-D score ≥ 11. Conclusions. These results indicate that clinicians should be aware that female patients with chronic kidney diseases with T2DM in their late stage with hypertension are at a marked increased risk of depressive symptoms. Providing optimal care for the psychological health of this population is vital.