Circadian aspects of mortality in hospitalized patients: A retrospective observation from a large cohort.

AIM: This study aimed to describe the circadian characteristics of hospitalized mortality in order to provide nursing guidance for preventing in-hospital mortality. DESIGN: A retrospective analysis on inpatient information was implemented. METHODS: Harmonic Analysis of Time Series was applied to quantify the periodic structure of the frequency of the occurrence of death. RESULTS: A total of 3300 cases were included in the present study (male, 63.4% and median age 73 years), including 1540 (46.7%) ICU patients. Incidence of overall hospitalized death exhibited a circadian pattern, presenting peaks from 07:00 to 12:00 and 15:00 to 20:00 P.M., with 21.5% and 13.1% increase above the average at those peak points, respectively. Similarly, the incidence of sudden cardiac death (SCD) showed peaks between 06:00-12:00 and 15:00-20:00, with a 34.7% and 28.0% increase above the average at peak time, respectively. The distribution of death incidence revealed no statistical difference between SCD and non-SCD (p = 0.525).

Depression in patients with epilepsy during the COVID-19 pandemic based on longitudinal self-reporting.

The current study screened major depression in people with epilepsy (PWE) during the epidemic of the novel coronavirus-related disease COVID-19, in order to identify whether the outbreak generated negative psychological impact on PWE. A Chinese version of the Neurological Disorders Depression Inventory for Epilepsy (C-NDDI-E), a self-reporting depression inventory, was applied for rapid detection of major depression. Assessment was carried out online during three different periods (prior to, during, and after the outbreak of COVID-19), with the aim of identifying changes in prevalence of depression and associated risk factors. A total of 158 PWE were recruited into the study (48.7% female). The questionnaire completion rates were 94.3% and 70.9% during and after the outbreak, respectively. The prevalence of depression prior to the epidemic, as the baseline, was 34.8% and increased to 42.3% during the period of the epidemic. Towards the end of the outbreak, the prevalence declined towards the baseline (36.6%). Factors such as living alone (OR = 4.022, 95% CI: 1.158-13.971, P = 0.028) and active seizures before the epidemic (OR = 2.993, 95% CI: 1.197-7.486, P = 0.019) were associated with depression during the epidemic. Monotherapy appeared to be protective against depression (OR = 0. 105, 95% CI: 0.047-0.235, P <0.001). Our results suggest that the pandemic exerts negative influence on PWE's mental health. Depression is one of the common psychological disorders that needs greater attention during this extraordinary period.

Epilepsy management during epidemic: A preliminary observation from western China.

OBJECTIVE: This study aimed to investigate whether the proposed model could manage patients with epilepsy (PWEs) during the coronavirus disease 2019 (COVID-19) outbreak. METHODS: We used a model to manage the PWEs during the outbreak. Questionnaire survey and hospital data were used to explore whether PWEs under our management were affected by the virus. RESULTS: A total of 118 (78.7%) PWEs completed the survey. During the "model period," 22.9% (27/118) of the respondents reported antiepileptic drug (AEDs) discontinuity, including six (22.2%) PWEs who failed to purchase AEDs. Of the patients, 40.7% (22/54) failed to attend ordinary clinic, which was higher than that during the "period before model" (7.9%, 5/63). The common causes were movement limits (77.3%) and appointment failure (54.5%). A shift from ordinary clinic toward remote consultation was observed. Of the PWEs, 15.7% (13/83) referred to online pharmacy. 87.5% (14/16) of emergencies related to epilepsy were timely treated. 48.3%of PWEs thought that the epidemic had an impact on accessing medical services. Hospital data indicated that a decline in ordinary clinic visit, inpatient, surgery, and emergency attendance was observed in January and February 2020 and an increase in March 2020, as the epidemic mitigated. By contrast, online clinic visit soared in February, when the outbreak hit hard. In addition, we found no cross-infection of COVID-19 in our hospital and respondents. CONCLUSION: We demonstrated a much-needed model to manage the PWEs during the outbreak. We believed that the core architecture of this model was suitable for the management of other chronic diseases.

The efficacy and safety of moxibustion for chemotherapy-induced gastrointestinal adverse reaction: A protocol for systematic review and meta-analysis.

BACKGROUND: Many cancer patients experience gastrointestinal adverse reaction during chemotherapy. Pharmacological interventions are commonly used to treat chemotherapy-induced gastrointestinal side effects but have various limitations. Clinical trials have indicated that moxibustion may alleviate gastrointestinal dysfunction and improve quality of life (QoL) after chemotherapy. This study aims to assess the efficacy and safety of moxibustion for chemotherapy-induced gastrointestinal adverse reaction through a systematic review and meta-analysis. METHODS: All randomized controlled trials (RCTs) related to moxibution targeting chemotherapy-induced gastrointestinal adverse reaction will be searched in online databases, such as PubMed, EMBASE, the Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), the Chinese Scientific Journal Database (VIP Database) and WanFang Database from their inception to May 1, 2020. The primary outcome is the incidence and severity of chemotherapy-related gastrointestinal toxicities (nausea and vomiting, diarrhea and constipation). The secondary outcomes include the quality of life, biological parameters' alteration, and adverse events. Study selection, data extraction, and assessment of risk of bias will be performed independently by 2 researchers. The Cochrane Collaboration's Review Manager (RevMan 5.3) software will be used to conduct the direct meta-analysis. RESULTS: This study will provide a comprehensive review of the available evidence for the treatment of chemotherapy-induced gastrointestinal adverse reaction with moxibustion. CONCLUSION: The conclusion of this study will provide evidence to judge whether moxibustion is an effective and safety therapeutic intervention for chemotherapy-induced gastrointestinal adverse reaction. PROSPERO REGISTRATION NUMBER: CRD42020182990.

Optimising epilepsy management with a smartphone application: a randomised controlled trial.

OBJECTIVE: To assess whether a practical intervention based upon a smartphone application (app) would improve self-management and seizure control in adults with epilepsy. DESIGN, SETTING: Randomised, controlled trial in western China, December 2017 to August 2018. PARTICIPANTS: 380 eligible people with epilepsy were recruited; 327 completed the 6-month follow-up (176 in the app group, 151 in the control group). MAIN OUTCOME MEASURES: Self-management of epilepsy (measured with the validated Chinese Epilepsy Self-Management Scale, C-ESMS) and self-reported seizure frequency. RESULTS: In the intention-to-treat analysis, the mean C-ESMS score increased significantly in the app group between baseline and the 6-month evaluation (from 121.7 [SD, 12.1] to 144.4 [SD, 10.0]; P < 0.001); improvements on the information management, medication management, and safety management subscales were also statistically significant. At 6 months, the mean overall C-ESMS score for the app group was significantly higher than that for the control group (125.4 [SD, 1.5];  P < 0.001). The proportion of patients who were seizure-free at the 6-month follow-up was larger for the app than the control group (54 of 190, 28% v 22 of 190, 12%), as was the proportion with reductions in frequency of between 75 and 100% (22 of 190, 12% v 8 of 190, 4%). Changes in C-ESMS score were not statistically associated with seizure frequency. CONCLUSIONS: Using a smartphone app improved epilepsy self-management scores in people in western China. It should be further tested in larger populations in other areas. Our preliminary investigation of building digital communities for people with epilepsy should encourage similar approaches to managing other chronic diseases. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR1900026864, 24 October 2019.

Development and validation of the Chinese Version of the Adult Epilepsy Self-Management Scale (C-ESMS) in Western China.

PURPOSE: To develop and validate the Epilepsy Self-Management Scale (ESMS) for Chinese persons with epilepsy (PWE). METHODS: On the basis of ESMS, the standard translation procedure was used to set up the Chinese version of the ESMS (C-ESMS). A consecutive cohort of PWE admitted in Sichuan Provincial People's Hospital were recruited randomly from May 2017 to December 2017 and required to complete the C-ESMS. Project analysis was employed to test the homogeneity of each dimension. Content validity was evaluated by experts. Exploratory factor analysis and confirmatory factor analysis (CFA) were applied to assess the validity. Cronbach's alpha was used to evaluate the reliability. RESULTS: Of the 400 completed C-ESMS forms, only 394 (98.5%) were suitable for analysis. The C-ESMS included 34 items and five dimensions, after removing four and modifying three items. The correlation coefficient of all 34 items was greater than 0.4. Each item level (I-CVI) and scale level CVI (S-CVI) was equal to 1. Five factors were extracted and together they explained 51.24% of the data's variance. The factor load of each item was 0.446-0.843. The CFA showed that CMIN/DF was 1.325, goodness of fit was 0.835, comparative fit index was 0.921, and root mean square error of approximation was 0.041. The total Cronbach's alpha of the scale was 0.848, and Cronbach's alpha in each dimension was 0.784-0.845. CONCLUSION: The C-ESMS exhibited good reliability and validity for adult PWE in western China.

Risk assessment of in-hospital mortality of patients with epilepsy: A large cohort study.

PURPOSE: This study aimed to explore the mortality risks of hospitalized patients with epilepsy (PWE). METHODS: Our data source was extracted from discharge abstracts in a hospital medical database. Various clinical variables, including demographical characteristics, natural features of epilepsy, and comprehensive set of comorbidities, were screened to investigate the risk. Comorbidities were defined using a validated ICD-10-based classification. The distributions of comorbid conditions and demographics were presented. In-hospital mortality rates of groups with epilepsy and without epilepsy were compared. Logistic regression was applied to explore the important predictors of in-hospital mortality. RESULTS: A cohort of 11,422 PWE (male: 58.5%, mean age: 40.2 years) was recruited for the study. The most common comorbidities were cerebrovascular disease, hypertension, and peripheral vascular disease, which accounted for 23.5%, 18.8%, and 8.0% of the study cohort, respectively. In-hospital mortality rates were 2.9% and 1.1% in the epilepsy and nonepilepsy cohort, respectively. Male patients exhibited an increased risk of death (odds ratio (OR) = 1.2; 95% confidence interval (CI) = 1.0-1.6). Patients aged over 65 years were more likely to die than those below 18 years (OR = 18.2; 95% CI = 8.8-31.0). Patients with comorbidities, including central nervous system (CNS) infections, renal disease, traumatic brain and head injuries, anoxic brain injury, metastatic cancer, pulmonary circulation disorders, encephalopathy, solid tumor without metastasis, cardiac arrhythmias, and diabetes without complication, had a higher risk of in-hospital death than patients without comorbidities (OR = 6.1, 5.2, 5.1, 4.4, 3.7, 2.5, 2.4, 2.0, 1.5, 1.4, respectively; 95% CI = 4.1-9.1, 3.8-7.0, 2.8-9.5, 2.4-8.3, 2.2-6.3, 1.5-4.3, 1.4-4.2, 1.1-3.7, 1.1-2.1, 1.0-1.9, respectively). CONCLUSION: The in-hospital mortality of PWE increased remarkably with age, and this parameter was predominant in male patients. Central nervous system infection, renal disease, traumatic brain and head injuries, anoxic brain injury, metastatic cancer, pulmonary circulation disorders, encephalopathy, solid tumor without metastasis, cardiac arrhythmias, and diabetes without complication were the most important comorbidities associated with in-hospital death.