Efficacy and safety of enteral supplementation with high-dose vitamin D in critically ill patients with vitamin D deficiency.

BACKGROUND: Vitamin D deficiency is associated with mortality and morbidity in critically ill patients. This study investigated the safety and effectiveness of enteral high-dose vitamin D supplementation in intensive care unit (ICU) patients in Asia. METHODS: This was a multicenter, prospective, randomized-controlled study. Eligible participants with vitamin D deficiency were randomly assigned to the control or vitamin D supplementation group. In the vitamin D supplementation group, the patients received 569,600 IU vitamin D. The primary outcome was the serum 25(OH)D level on day 7. RESULTS: 41 and 20 patients were included in the vitamin D supplementation and control groups, respectively. On day 7, the serum 25(OH)D level was significantly higher in the vitamin D supplementation group compared to the control group (28.5 [IQR: 20.2-52.6] ng/mL and 13.9 [IQR: 11.6-18.8] ng/mL, p < 0.001). Only 41.5% of the patients achieved serum 25(OH)D levels higher than 30 ng/mL in the supplementation group. This increased level was sustained in the supplementation group on both day 14 and day 28. There were no significant adverse effects noted in the supplementation group. Patients who reached a serum 25(OH)D level of >30 ng/mL on day 7 had a significantly lower 30-day mortality rate than did those who did not (5.9% vs 37.5%, p < 0.05). CONCLUSIONS: In our study, less than half of the patients reached adequate vitamin D levels after the enteral administration of high-dose vitamin D. A reduction in 30-day mortality was noted in the patients who achieved adequate vitamin D levels. TRIAL REGISTRATION CLINICALTRIALS. GOV ID: NCT04292873, Registered, March 1, 2020.

[Prediction of Ozone Pollution in Sichuan Basin Based on Random Forest Model].

To study the long-term variation in ozone (O3) pollution in Sichuan Basin,the spatiaotemporal distribution of O3 concentrations during 2017 to 2020 was analyzed using ground-level O3 concentration data and meteorological observation data from 18 cities in the basin. The dominant meteorological factors affecting the variation in O3 concentration were screened out,and a prediction model between meteorological factors and O3 concentration was constructed based on a random forest model. Finally,a prediction analysis of O3 pollution in the Sichuan Basin urban agglomeration during 2020 was carried out. The results showed that:① O3 concentrations displayed a fluctuating trend during the period from 2017 to 2020,with a downward trend in 2019 and a rebound in 2020. ② The fluctuating trend of O3 concentration was significantly influenced by relative humidity,daily maximum temperature,and sunshine hours,whereas wind speed,air pressure,and precipitation had less impact. The linear relationships between meteorological factors were different. Air pressure was negatively correlated with other meteorological factors,whereas the remaining meteorological factors had a positive correlation. ③ The goodness of fit statistics (R2) between the predicted and actual values of the O3 prediction model constructed based on random forest demonstrated a strong predictive performance and ability to accurately forecast the long-term daily variations in O3 concentration. The random forest O3 prediction model exhibited excellent stability and generalization capability. ④ The prediction analysis of O3 concentrations in 18 cities in the basin showed that the explanation rate of variables in the prediction model reached over 80% in all cities (except Ya'an),indicating that the random forest model predicted the trend of O3 concentration accurately.

Structures and interactions forming stable shellac-casein nanocomplexes with a pH-cycle.

Casein forms diverse structures with functionalities tunable by complexation with surfactants, and shellac is an emerging surfactant. In the present work, molecular and mesoscopic structures of shellac and micellar casein and the underlying interactions after treatment with a pH-cycle were investigated. Dispersions with 0.5 % w/v shellac and various shellac:casein mass ratios were prepared at pH 12.0 to dissolve shellac and dissociate casein micelles, followed by neutralization to pH 7.0 to form complexes. Both covalent and non-covalent (hydrogen bonding, electrostatic, and hydrophobic) interactions contributed to the complex formation. The formed complexes had an average diameter of ~80 nm. The complexation of shellac and casein prevented the precipitation of protonated shellac during neutralization, and dispersions with casein:shellac mass ratios of 2:1 and above were absent of precipitates at pH 7.0. The formed nanocomplexes may have applications for preparing novel colloidal systems and loading lipophilic bioactive compounds.

Associations between cardiometabolic multimorbidity and cerebrospinal fluid biomarkers of Alzheimer's disease pathology in cognitively intact adults: the CABLE study.

BACKGROUND: Cardiometabolic multimorbidity is associated with an increased risk of dementia, but the pathogenic mechanisms linking them remain largely undefined. We aimed to assess the associations of cardiometabolic multimorbidity with cerebrospinal fluid (CSF) biomarkers of Alzheimer's disease (AD) pathology to enhance our understanding of the underlying mechanisms linking cardiometabolic multimorbidity and AD. METHODS: This study included 1464 cognitively intact participants from the Chinese Alzheimer's Biomarker and LifestylE (CABLE) database. Cardiometabolic diseases (CMD) are a group of interrelated disorders such as hypertension, diabetes, heart diseases (HD), and stroke. Based on the CMD status, participants were categorized as CMD-free, single CMD, or CMD multimorbidity. CMD multimorbidity is defined as the coexistence of two or more CMDs. The associations of cardiometabolic multimorbidity and CSF biomarkers were examined using multivariable linear regression models with demographic characteristics, the APOE ε4 allele, and lifestyle factors as covariates. Subgroup analyses stratified by age, sex, and APOE ε4 status were also performed. RESULTS: A total of 1464 individuals (mean age, 61.80 years; age range, 40-89 years) were included. The markers of phosphorylated tau-related processes (CSF P-tau181: ß = 0.165, P = 0.037) and neuronal injury (CSF T-tau: ß = 0.065, P = 0.033) were significantly increased in subjects with CMD multimorbidity (versus CMD-free), but not in those with single CMD. The association between CMD multimorbidity with CSF T-tau levels remained significant after controlling for Aß42 levels. Additionally, significantly elevated tau-related biomarkers were observed in patients with specific CMD combinations (i.e., hypertension and diabetes, hypertension and HD), especially in long disease courses. CONCLUSIONS: The presence of cardiometabolic multimorbidity was associated with tau phosphorylation and neuronal injury in cognitively normal populations. CMD multimorbidity might be a potential independent target to alleviate tau-related pathologies that can cause cognitive impairment.

Drying of probiotics to enhance the viability during preparation, storage, food application, and digestion: A review.

Functional food products containing viable probiotics have become increasingly popular and demand for probiotic ingredients that maintain viability and stability during processing, storage, and gastrointestinal digestions. This has resulted in heightened research and development of powdered probiotic ingredients. The aim of this review is to overview the development of dried probiotics from upstream identification to downstream applications in food. Free probiotic bacteria are susceptible to various environmental stresses during food processing, storage, and after ingestion, necessitating additional materials and processes to preserve their activity for delivery to the colon. Various classic and emerging thermal and nonthermal drying technologies are discussed for their efficiency in preparing dehydrated probiotics, and strategies for enhancing probiotic survival after dehydration are highlighted. Both the formulation and drying technology can influence the microbiological and physical properties of powdered probiotics that are to be characterized comprehensively with various techniques. Furthermore, quality control during probiotic manufacturing and strategies of incorporating powdered probiotics into liquid and solid food products are discussed. As emerging technologies, structure-design principles to encapsulate probiotics in engineered structures and protective materials with improved survivability are highlighted. Overall, this review provides insights into formulations and drying technologies required to supplement viable and stable probiotics into functional foods, ensuring the retention of their health benefits upon consumption.

Vaccination against coronavirus disease 2019 in patients with pulmonary hypertension: A national prospective cohort study.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has potential risks for both clinically worsening pulmonary hypertension (PH) and increasing mortality. However, the data regarding the protective role of vaccination in this population are still lacking. This study aimed to assess the safety of approved vaccination for patients with PH. METHODS: In this national prospective cohort study, patients diagnosed with PH (World Health Organization [WHO] groups 1 and 4) were enrolled from October 2021 to April 2022. The primary outcome was the composite of PH-related major adverse events. We used an inverse probability weighting (IPW) approach to control for possible confounding factors in the baseline characteristics of patients. RESULTS: In total, 706 patients with PH participated in this study (mean age, 40.3 years; mean duration after diagnosis of PH, 8.2 years). All patients received standardized treatment for PH in accordance with guidelines for the diagnosis and treatment of PH in China. Among them, 278 patients did not receive vaccination, whereas 428 patients completed the vaccination series. None of the participants were infected with COVID-19 during our study period. Overall, 398 patients received inactivated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine, whereas 30 received recombinant protein subunit vaccine. After adjusting for baseline covariates using the IPW approach, the odds of any adverse events due to PH in the vaccinated group did not statistically significantly increase (27/428 [6.3%] vs. 24/278 [8.6%], odds ratio = 0.72, P = 0.302). Approximately half of the vaccinated patients reported at least one post-vaccination side effects, most of which were mild, including pain at the injection site (159/428, 37.1%), fever (11/428, 2.6%), and fatigue (26/428, 6.1%). CONCLUSIONS: COVID-19 vaccination did not significantly augment the PH-related major adverse events for patients with WHO groups 1 and 4 PH, although there were some tolerable side effects. A large-scale randomized controlled trial is warranted to confirm this finding. The final approval of the COVID-19 vaccination for patients with PH as a public health strategy is promising.

Deep learning based channel estimation method for mine OFDM system.

In this paper, we present a channel estimation approach based on deep learning to solve the problem that the orthogonal frequency division multiplexing (OFDM) system channel estimation algorithm cannot accurately obtain the channel state information in the complex environment of the mine, resulting in system performance degradation. First, LS channel estimation matrix is considered as a low-resolution image and the actual channel state information is considered as a high-resolution image. Then the optimization of the LS channel estimation matrix is achieved by the FSRCNN image super-resolution algorithm. We validate the effectiveness of the proposed algorithm by conducting experiments in different channel environments, different number of pilots, and mismatched signal-to-noise ratio scenarios. The simulation results show that the proposed scheme is much better than the traditional LS channel estimation method and the DFT-LS channel estimation method, and the accuracy of the proposed scheme approaches that of the MMSE channel estimation method when the number of pilots is low.

Association between antihyperlipidemic agents and the risk of chronic periodontitis in patients with hyperlipidemia: A population-based retrospective cohort study in Taiwan.

BACKGROUND: The lipid-lowering and anti-inflammatory effects of statins and fibrates may ameliorate periodontitis. Patients with hyperlipidemia tend to have a worse periodontal status. This study assessed the association between the use of statins/fibrates and the incidence of chronic periodontitis in patients with hyperlipidemia in Taiwan. METHODS: This retrospective cohort study enrolled patients newly diagnosed with hyperlipidemia between 2001 and 2012 from the 2000 Longitudinal Generation Tracking Database and followed them for 5 years. The study population was divided into four groups: statin monotherapy, fibrate monotherapy, combination therapy (both statins and fibrates), and control (neither statins nor fibrates). Each patient in the treatment group was matched at a ratio of 1:1 with a control. Chronic periodontitis risk was compared in the three study arms by using a Cox proportional hazard model. RESULTS: Chronic periodontitis risk was reduced by 25.7% in the combination therapy group compared with the control group (adjusted hazard ratio [aHR], 0.743; 95% confidence interval (CI), 0.678-0.815). Low dose (<360 cumulative defined daily dose [cDDD]) and shorter duration (<2 years) of statin monotherapy seem to be associated with an increased risk of chronic periodontitis; high dose (≥720 cDDD/≥1080 cDDD) and longer duration (≥3 years) of statin/fibrate monotherapy may be correlated with a lower risk of periodontitis. Hydrophobic statin users had a lower chronic periodontitis risk than hydrophilic statin users. CONCLUSION: Chronic periodontitis risk was lower in patients with hyperlipidemia on combination treatment with statins and fibrates, and the risk decreased when patients used statins or fibrates for >3 years.

Thromboembolic Presentations among Patients Hospitalized to the Intensive Care Unit for Coronavirus Disease 2019 (COVID-19) - A Northern Taiwan Single Center Experience.

Coronavirus Disease 2019 (COVID-19) has been associated with a high thromboembolic risk among patients in intensive care units. Asian populations may share a similar thromboembolic risk, but with a higher prevalence of arterial thromboembolism than venous thromboembolism. To clarify this risk in Taiwan, this single-center retrospective study collected 27 consecutive intensive care unit patients with COVID-19 confirmed by polymerase chain reaction, with a median age of 67.6 years (male 81.5%). Twenty-three patients received prophylactic anticoagulation (85.2%), and there were four bleeding events (14.8%). Nine patients had thromboembolism (33.3%), including three with deep vein thrombosis, two with peripheral artery thromboembolism, and four with ischemic stroke. There were no significant clinical differences between the patients with or without thromboembolism. Initial serum ferritin [adjusted odds ratio (OR): 13.19, 95% confidence interval (CI): 1.01-172.07] and peak serum procalcitonin (adjusted OR: 18.93, 95% CI: 1.08-330.91) were associated with a higher risk of thromboembolism. Furthermore, prophylactic anticoagulation (adjusted OR: 0.01, 95% CI: < 0.001-0.55) was associated with a lower risk of thromboembolism. All cases of deep vein thrombosis and one peripheral artery thromboembolism occurred at intravascular catheter locations. No association between thromboembolism and survival was found (age-adjusted hazard ratio: 0.55, 95% CI: 0.10-2.95). In conclusion, the prevalence of COVID-19 thromboembolism among Taiwanese patients in intensive care units was high, even with prophylactic anticoagulation. Serum ferritin and procalcitonin may identify high-risk populations. Prophylactic anticoagulation may reduce the risk of thromboembolism with a manageable bleeding risk. Larger prospective studies are needed to clarify the risk of COVID-19 thromboembolism and its risk factors in the post-Omicron era.

Spectrum Sensing Method Based on Residual Dense Network and Attention.

To address the problems of gradient vanishing and limited feature extraction capability of traditional CNN spectrum sensing methods in deep network structures and to effectively avoid network degradation issues under deep network structures, this paper proposes a collaborative spectrum sensing method based on Residual Dense Network and attention mechanisms. This method involves stacking and normalizing the time-domain information of the signal, constructing a two-dimensional matrix, and mapping it to a grayscale image. The grayscale images are divided into training and testing sets, and the training set is used to train the neural network to extract deep features. Finally, the test set is fed into the well-trained neural network for spectrum sensing. Experimental results show that, under low signal-to-noise ratios, the proposed method demonstrates superior spectral sensing performance compared to traditional collaborative spectrum sensing methods.

Fabrication of glass-based analytical devices by immobilizing nanomaterials on glass substrate with a fluorescent glue for the highly sensitive determination of mercury ions.

A facile method is reported to develop glass-based analytical devices (GADs) based on immobilizing nanomaterials on a glass substrate with fluorescent glue. The fluorescent glue was first prepared by coupling bovine serum albumin (BSA)-protected Au nanoclusters (NCs) and sugars (i.e., ascorbic acid, AA). The glue was then used to immobilize carbon dots (C-dots) on glass substrates to fabricate the portable GADs. The liquid glue-C-dots mixture and probable GADs were developed for Hg2+ detection. Under 365-nm excitation wavelength, the emission at 652 nm from the glue is gradually quenched with increasing concentrations of Hg2+. This quenching is explained in terms of the Stern-Volmer equation and is ascribed to static quenching. The fluorescent color of the glue and GADs gradually changes from pink to blue, with increasing concentrations of Hg2+. The limits of detection (LODs) for Hg2+ determination by bare eyes are 1 nM both for the glue and GADs, suggesting an uncompromised sensing capability even after immobilization. The detection sensitivity of GADs shows a significant improvement compared with the same material-based papers (5 µM). A linear relationship is observed between the total Euclidean distances (EDs) and Hg2+ concentration in the range 0-100 nM, providing the potential for Hg2+ quantification using GADs. The LOD is estimated to be 0.84 nM. To show a potentially practical application, the GADs were used to detect Hg2+ in certified reference material and lake water.

Effects of an interactive handgrip game on surgical patients requiring intensive care: An assessor-blinded randomized controlled trial.

OBJECTIVE: To explore the effect of an interactive handgrip game on psychological distress and handgrip strength among critically ill surgical patients. DESIGN: A randomised controlled trial. SETTING: A surgical intensive care unit. INTERVENTION: Participants were enrolled in the program within 48 hours of admission to the intensive care unit. Patients in the intervention group played a 20-minute interactive handgrip game twice daily for a maximum of three days in the intensive care unit in addition to routinely passive physical rehabilitation. Patients in the routine care group had a daily target of 20 min of passive physical rehabilitation as needed. MEASUREMENT: The primary outcomes included depression, anxiety, and stress measured using the shortened version of the Depression Anxiety Stress Score scale. The secondary outcomes were perceived sleep evaluated using the Richards-Campbell Sleep Questionnaire, delirium assessed using the Intensive Care Delirium Screening Checklist, and handgrip strength measured using handgrip dynamometry within a handgrip device. RESULTS: Two hundred and twenty-seven patients were eligible and 70 patients were recruited in the intervention (n = 35) and routine care groups (n = 35). The patients in the intervention group had lower scores (median = 6.0, 4.0, and 12.0) for depression, anxiety, and stress compared with those in the routine care group (12.0, 12.0, and 20.0; all p < 0.05). The interactive handgrip game did not significantly improve sleep quality and prevent the occurrence of delirium (both p > 0.05). The patients who received the interactive handgrip game intervention exhibited significantly enhanced handgrip strength in both hands over time (both p < 0.001). CONCLUSION: An interactive handgrip game may benefit the psychological well-being and handgrip strength of critically ill patients. IMPLICATIONS FOR CLINICAL PRACTICE: Interactive handgrip games is effective active exercise which should be integrated into routine nursing practice.

Transmit-Receive Sparse Synthesis of Linear Frequency Diverse Array in Range-Angle Space Using Genetic Algorithm.

Unlike conventional phased array (PA), frequency diversity array (FDA) can perform the beampattern synthesis not only in an angle dimension but also in a range dimension by introducing an additional frequency offset (FO) across the array aperture, thus greatly enhancing the beamforming flexibility of an array antenna. Nevertheless, an FDA with uniform inter-element spacing that consists of a huge number of elements is required when a high resolution is needed, which results in a high cost. To substantially reduce the cost while almost maintaining the antenna resolution, it is important to conduct a sparse synthesis of FDA. Under these circumstances, this paper investigated the transmit-receive beamforming of a sparse-fda in range and angle dimensions. In particular, the joint transmit-receive signal formula was first derived and analyzed to resolve the inherent time-varying characteristics of FDA based on a cost-effective signal processing diagram. In the sequel, the GA-based low sidelobe level (SLL) transmit-receive beamforming of the sparse-fda was proposed to generate a focused main lobe in a range-angle space, where the array element positions were incorporated into the optimization problem. Numerical results showed that 50% of the elements can be saved for the two linear FDAs with sinusoidally and logarithmically varying frequency offsets, respectively termed as sin-FO linear-FDA and log-FO linear-FDA, with only a less than 1 dB increment in SLL. The resultant SLLs are below -9.6 dB, and -12.9 dB for these two linear FDAs, respectively.

A Fast Design Method of Anisotropic Dielectric Lens for Vortex Electromagnetic Wave Based on Deep Learning.

Orbital angular momentum (OAM) has made it possible to regulate classical waves in novel ways, which is more energy- or information-efficient than conventional plane wave technology. This work aims to realize the transition of antenna radiation mode through the rapid design of an anisotropic dielectric lens. The deep learning neural network (DNN) is used to train the electromagnetic properties of dielectric cell structures. Nine variable parameters for changing the dielectric unit structure are present in the input layer of the DNN network. The trained network can predict the transmission phase of the unit cell structure with greater than 98% accuracy within a specific range. Then, to build the corresponding relationship between the phase and the parameters, the gray wolf optimization algorithm is applied. In less than 0.3 s, the trained network can predict the transmission coefficients of the 31 × 31 unit structure in the arrays with great accuracy. Finally, we provide two examples of neural network-based rapid anisotropic dielectric lens design. Dielectric lenses produce the OAM modes +1, -1, and -1, +2 under TE and TM wave irradiation, respectively. This approach resolves the difficult phase matching and time-consuming design issues associated with producing a dielectric lens.

Associations of Lung Function Decline with Risks of Cognitive Impairment and Dementia: A Meta-Analysis and Systematic Review.

BACKGROUND: There are controversies surrounding the effects of lung function decline on cognitive impairment and dementia. OBJECTIVE: We conducted a meta-analysis and systematic review to explore the associations of lung function decline with the risks of cognitive impairment and dementia. METHODS: The PubMed, EMBASE, and the Cochrane Library were searched to identify prospective studies published from database inception through January 10, 2023. We pooled relative risk (RR) and 95% confidence intervals (CI) using random-effects models. The Egger test, funnel plots, meta-regression, sensitivity, and subgroup analyses were conducted to detect publication bias and investigate the source of heterogeneity. RESULTS: Thirty-three articles with a total of 8,816,992 participants were subjected to meta-analysis. Poorer pulmonary function was associated with an increased risk of dementia (FEV: RR = 1.25 [95% CI, 1.17-1.33]; FVC: RR = 1.40 [95% CI, 1.16-1.69]; PEF: RR = 1.84 [95% CI, 1.37-2.46]). The results of the subgroup analyses were similar to the primary results. Individuals with lung diseases had a higher combined risk of dementia and cognitive impairment (RR = 1.39 [95% CI, 1.20-1.61]). Lung disease conferred an elevated risk of cognitive impairment (RR = 1.37 [95% CI, 1.14-1.65]). The relationship between lung disease and an increased risk of dementia was only shown in total study participants (RR = 1.32 [95% CI, 1.11-1.57]), but not in the participants with Alzheimer's disease (RR = 1.39 [95% CI, 1.00-1.93]) or vascular dementia (RR = 2.11 [95% CI, 0.57-7.83]). CONCLUSION: Lung function decline was significantly associated with higher risks of cognitive impairment and dementia. These findings might provide implications for the prevention of cognitive disorders and the promotion of brain health.

Dynamic prevalence of sleep disturbance among critically ill patients in intensive care units and after hospitalisation: A systematic review and meta-analysis.

BACKGROUND: Sleep disturbance is a common complaint among critically ill patients in intensive care units and after hospitalisation. However, the prevalence of sleep disturbance among critically ill patients varies widely. OBJECTIVE: To estimate the prevalence of sleep disturbance among critically ill patients in the intensive care unit and after hospitalisation. METHODS: Electronic databases were searched from their inception until 15 August 2022. Only observational studies with cross-sectional, prospective, and retrospective designs investigating sleep disturbance prevalence among critically ill adults (aged ≥ 18 years) during intensive care unit stay and after hospitalisation were included. RESULTS: We found 13 studies investigating sleep disturbance prevalence in intensive care units and 14 investigating sleep disturbance prevalence after hospitalisation, with 1,228 and 3,065 participants, respectively. The prevalence of sleep disturbance during an ICU stay was 66 %, and at two, three, six and ≥ 12 months after hospitalisation was 64 %, 49 %, 40 %, and 28 %, respectively. Studies using the Richards-Campbell Sleep Questionnaire detected a higher prevalence of sleep disturbance among patients in intensive care units than non-intensive care unit specific questionnaires; studies reported comparable sleep disturbance prevalence during intensive care stays for patients with and without mechanical ventilation. CONCLUSION: Sleep disturbance is prevalent in critically ill patients admitted to an intensive care unit and persists for up to one year after hospitalisation, with prevalence ranging from 28 % to 66 %. The study results highlight the importance of implementing effective interventions as early as possible to improve intensive care unit sleep quality.

Shellac Micelles Loaded with Curcumin Using a pH Cycle to Improve Dispersibility, Bioaccessibility, and Potential for Colon Delivery.

Delivery systems smaller than 50 nm are advantageous for cancer prevention. In this study, curcumin was dissolved in shellac micelles following co-dissolving at pH 13.0 and neutralization using glucono-delta-lactone. With 5% w/v shellac and 0.5-5 mg/mL curcumin, the loading capacity and encapsulation efficiency were up to 8.0 and 92.6%, respectively, and the nanocapsules had an average diameter of 20 nm. Differential scanning calorimetry, FTIR spectroscopy, and fluorescence spectroscopy results confirmed the encapsulation of curcumin in an amorphous state in shellac micelles. The neutral nanocapsule dispersions maintained the particle dimension and had less than 10% curcumin degradation during 4 week storage at 4 °C. Nanoencapsulating curcumin enhanced in vitro bioavailability and antiproliferation activity against colon cancer cells. After simulated digestions, ∼60% of the nanoencapsulated curcumin was not available for intestinal absorption, nanocapsules retained their structure, and nanoencapsulated curcumin remained active against colon cancer cells, indicating the potential delivery for colorectal cancer prevention.

Comparative effectiveness of non-pharmacological interventions for preventing delirium in critically ill adults: A systematic review and network meta-analysis.

BACKGROUND: Delirium presents a serious health problem in critically ill patients in intensive care units. However, knowledge regarding the selections of the optimal non-pharmacological interventions remains unclear. OBJECTIVES: To compare the effects of non-pharmacological interventions by combining direct and indirect evidence on the incidence and duration of delirium in intensive care units. DESIGN: A systematic review and network meta-analysis. DATA SOURCES: A comprehensive search of five electronic databases, including PubMed, EMBASE, CINAHL, Cochrane CENTRAL, and ProQuest Dissertations and Theses A&I were conducted. Only randomized control trials published from the inception to December 28, 2021 were included. REVIEW METHODS: Two reviewers independently screened the title and abstract for eligibility according to the inclusion and exclusion criteria. The random-effect network meta-analysis was used to estimate the comparative effects of non-pharmacological interventions in reducing delirium incidence and duration. RESULTS: A total of 29 studies with 7005 critically ill patients were enrolled. Twenty-six and eleven studies reported the delirium incidence and duration, respectively. Component-based intervention comparison revealed that multicomponent strategy was the most effective non-pharmacological intervention compared to usual care in reducing incidence of ICU delirium (Odd ratio [OR]=0.43, 95% CI= 0.22-0.84) but not ICU delirium duration. Treatment-based intervention comparisons indicated that specific multi-treatment interventions significantly reduced the ICU delirium incidence and duration, particularly the involvement of early mobilization and family participation (OR = 0.12 with 95% CI = 0.02 to 0.83; mean difference = -1.34 with 95% CI = -2.52 to -0.16, respectively). CONCLUSION: Our study suggests that the multicomponent strategy was the most effective non-pharmacological intervention in reducing the incidence of ICU delirium. Early mobilization and family participation involvement in non-pharmacological interventions seemed to be more effective in reducing the incidence of ICU delirium. These results of network-meta analysis could be an important evidence-based for clinical healthcare providers to optimize the critical care protocol. TWEETABLE ABSTRACT: Network meta-analysis of 29 randomised controlled trials with 7005 patients finds that multicomponent interventions, particularly those involving early mobilization, family participation, cognitive stimulation, reorientation, sensory stimulation, environment control and clinical adjustment, is the most effective non-pharmacological strategy to reduce the incidence of delirium in intensive care units.