Study protocol: a core outcome set for perioperative exercise clinical effectiveness trials for lung cancer patients.

BACKGROUND: Outcome assessment in perioperative exercise trials for lung cancer is heterogeneous, often omitting those that are important and patient-relevant. This heterogeneity hinders the synthesis of evidence. To address this issue, a core outcome set, an agreed-upon standardized set of outcomes to be measured and reported, is required to reduce heterogeneity among outcome measurements. This study protocol describes the methodology, aiming to develop a core outcome set for perioperative exercise intervention trials for lung cancer in clinical practice. METHODS: The project will follow the standard methodology recommended by the Core Outcome Measures in Effectiveness Trials (COMET) initiative, which is divided into four steps. Stage I: Conducting a scoping review of outcomes reported in clinical trials and protocols to develop a list of potential outcome domains. Stage II: Conducting semi-structured interviews to obtain important outcomes for patients. Stage III: Choosing the most important outcomes by conducting two rounds of the Delphi exercise. Stage IV: Achieving a consensus in a face-to-face meeting to discuss the final core outcome set. DISCUSSION: This is the first project identified for the core outcome set of perioperative exercise trials in lung cancer, which will enhance the quality, comparability, and usability of future trials and positively impact perioperative exercise and the care of patients with lung cancer. TRIALS REGISTRATION: Core Outcome Measurement in Effectiveness Trials (COMET) Initiative database registration: https://www.comet-initiative.org/Studies/Details/2091.

Prevalence of impaired awareness of hypoglycaemia in people with diabetes mellitus: A systematic review and meta-analysis from 21 countries and regions.

AIMS: Impaired awareness of hypoglycaemia (IAH) is a complication of glucose-lowering therapies for diabetes. The purpose of this review was to estimate the pooled prevalence of IAH and unawareness of hypoglycaemia (UAH). METHODS: We searched the major databases from inception to 8 August 2022 and included all cross-sectional and cohort studies reporting IAH prevalence in people with diabetes. A random-effects model was used to pool effect values. Subgroup analysis and meta-regression were used to identify study-level characteristics affecting prevalence. RESULTS: Sixty-two studies from 21 countries published between 2000 and 2022 were included, with 39,180 participants (type 1 diabetes: 19,304 vs. Type 2 diabetes: 14,650). The pooled prevalence was 23.2% (95% CI: 18.4%-29.3%) via the Clarke questionnaire, 26.2% (95% CI: 22.9%-29.9%) via the Gold score, and 58.5% (95% CI: 53.0%-64.6%) via the Pedersen-Bjergaard method, all from studies classified as presenting a moderate and low risk of bias. The prevalence of IAH was generally higher in people with type 1 diabetes than in those with type 2 diabetes and lowest in Europe. Meta-regression results show that the duration of diabetes was a factor influencing the prevalence of IAH. The prevalence of UAH by the Pedersen-Bjergaard method was 17.6 (95% CI: 14.9%-20.3%). CONCLUSIONS: IAH is a prevalent risk event among people with type 1 and type 2 diabetes, showing clinical heterogeneity and regional variability. UAH, an adverse progression of IAH, is also a serious burden. More primary research on the prevalence of IAH is needed in areas with a high diabetes burden.

Validation of a Chinese version of the short-form Cataldo lung cancer stigma scale.

BACKGROUND: Lung cancer stigma is a widespread psychosocial problem. We developed a short form of the Cataldo lung cancer stigma scale for Chinese people with lung cancer (CLCSS-C-SF) and compared its psychometric properties with those of the full and short versions. METHODS: This was a secondary analysis using data from the full CLCSS-C, distress thermometer and perceived social support of Chinese people with lung cancer (N = 394). Exploratory and confirmatory factor analysis (CFA) were used to identify factor structure and assess construct validity. The internal consistency and concurrent and known-group validity were evaluated. RESULTS: The 22-item CLCSS-C-SF comprised four factors. The convergent validity evaluated using average variance extracted and discriminant validity were acceptable. Cronbach's alphas, concurrent and known-group validity were satisfactory for three versions. Only the four-factor model proposed was validated by CFA. CONCLUSION: The CLCSS-C-SF is reliable and valid and can be used in Chinese lung cancer populations.

Self-efficacy, Hope as Mediators Between Positive Coping and Resilience Among Patients With Gastric Cancer Before the First Chemotherapy.

BACKGROUND: Patients with gastric cancer experience severe psychological distress as a result of their cancer diagnosis and chemotherapy. Resilience is a defense mechanism that enables one to thrive amid distress. However, little research has been done to explore the formation and development mechanism of resilience among patients with gastric cancer before their first chemotherapy treatment. OBJECTIVE: The mediating roles of self-efficacy and hope on the relationship between positive coping and resilience among patients with gastric cancer before their first chemotherapy treatment were examined to inform the future resilience intervention. METHODS: A total of 253 patients with gastric cancer before their first chemotherapy treatment were investigated using the Simplified Coping Style Questionnaire, the General Self-efficacy Scale, the Herth Hope Index, and the 14-Item Resilience Scale. Structural equation modeling was conducted using Mplus version 7.03 to test the hypothesized mediational model. RESULTS: Structural equation modeling analysis showed self-efficacy and hope completely mediated the relationship between positive coping and resilience; the indirect effects were 0.242 (P < .01) and 0.258 (P < .01), respectively; indirect effects accounted for 81% of the total effect. CONCLUSIONS: Positive coping is not the independent predictor that may contribute to resilience among patients with gastric cancer before their first chemotherapy treatment, but it can indirectly affect resilience through self-efficacy and hope. IMPLICATIONS: Self-efficacy and hope may increase the positive influence of positive coping on resilience among patients with gastric cancer before their first chemotherapy treatment. Resilience intervention might be enhanced by addressing the impact of positive coping on self-efficacy and hope.

A Cognitive-Behavioral Intervention for the Symptom Clusters of Chinese Patients With Gastrointestinal Tract Cancer Undergoing Chemotherapy: A Pilot Study.

BACKGROUND: Patients with gastrointestinal tract (GIT) cancer undergoing chemotherapy often experience several symptoms that constitute symptom clusters and can cause patients to suffer. Effective interventions are lacking for this kind of patients. OBJECTIVE: The aims of this study were to test the feasibility and acceptability of a cognitive-behavioral (CB) intervention developed for Chinese patients with GIT cancer undergoing chemotherapy and to estimate the efficacy of the intervention for symptom clusters. METHODS: In this pilot, quasi-randomized controlled trial, 40 patients were assigned to the CB intervention or control group. The CB intervention, considering characteristics of patients and Chinese culture, contained 4 sections including cognitive reframing, cancer-diet education, relaxation, and exercise techniques. Symptom clusters, illness perception, anxiety, and depression were measured. RESULTS: Thirty-nine patients (97.5%) completed the study program and expressed willingness to follow the intervention. Compared with the control group, all outcomes were improved (all P < .05) in the CB group after the intervention, except for the gastrointestinal symptom cluster (t = 0.25, P = .802). In the CB group, the scores of all outcomes (all P < .05) decreased except for depression (t = 1.76, P = .095). CONCLUSION: The CB intervention is partially feasible and acceptable. It may also help to improve part of the symptom clusters of Chinese patients with GIT cancer undergoing chemotherapy. However, some modifications are needed in future studies to better test effectiveness. IMPLICATIONS FOR PRACTICE: Symptom management remains a major problem in clinical nursing. Such a CB intervention can be beneficial to the clinical management of symptom clusters.

Folic Acid Promotes Wound Healing in Diabetic Mice by Suppression of Oxidative Stress.

The aim of this study was to investigate the effects of folic acid on impaired wound healing in diabetic mice. Male mice were divided into three groups: group 1, the non-diabetic mice (control); group 2, the streptozotocin (STZ)-induced type 1 diabetic mice; and group 3, the diabetic mice that received a daily dose of 3 mg/kg folic acid via oral gavage. Full-thickness excision wounds were created with 8-mm skin biopsy punches. Each wound closure was continuously evaluated until the wound healed up. Wound healing was delayed in diabetic mice compared with the non-diabetic mice. There were significantly reduced levels of hydroxyproline content (indicator of collagen deposition) and glutathione in diabetic wounds, whereas levels of lipid peroxidation and protein nitrotyrosination were increased. Daily supplementation with folic acid restored diabetes-induced healing delay. Histopathology showed that folic acid supplementation accelerated granulation tissue formation, proliferation of fibroblasts, and tissue regeneration in diabetic mice. Interestingly, folic acid alleviated diabetes-induced impaired collagen deposition in wounds. Moreover, folic acid significantly decreased levels of lipid peroxidation, protein nitrotyrosination and glutathione depletion in diabetic wounds. In conclusion, our results indicate that folic acid supplementation may improve impaired wound healing via suppressing oxidative stress in diabetic mice.