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Objective: To evaluate the effectiveness of psychosocial interventions on depressive symptoms, anxiety symptoms, quality of life, self-efficacy, coping, carer strain and carer satisfaction among stroke survivors, carers and survivor-carer dyads. Data sources: MEDLINE, CINAHL, PsycINFO, SocINDEX, Cochrane Library, Web of Science and Scopus databases and the grey literature were searched up to September 2018. Methods: A systematic review and meta-analysis of randomized controlled trials of psychosocial interventions for stroke survivors, carers and survivor-carer dyads, compared to usual care. Outcomes measured were depressive symptoms, anxiety symptoms, quality of life, coping, self-efficacy, carer strain, and carer satisfaction. Results: Thirty-one randomized controlled trials (n = 5715) were included in the systematic review which found improvements in depressive symptoms, anxiety symptoms, quality of life and coping, though the number of trials assessing each outcome varied. A meta-analysis (11 trials; n = 1280) on depressive symptoms found that in seven trials psychosocial interventions reduced depressive symptoms in stroke survivors (SMD: −0.36, 95% CI −0.73 to 0.00; p =.05) and in six trials reduced depressive symptoms in carers (SMD: −0.20, 95% CI −.40 to 0.00; p =.05). Conclusion: Psychosocial interventions reduced depressive symptoms in stroke survivors and their carers. There was limited evidence that such interventions reduced anxiety symptoms, or improved quality of life and coping for stroke survivors and carers and no evidence that they improved self-efficacy, carer strain or carer satisfaction. [ABSTRACT FROM AUTHOR]

Background Integrative diabetes care, which combines conventional diabetes therapy with traditional Chinese medicine (TCM)-based interventions, has gained popularity worldwide. Numerous TCM-based lifestyle modification approaches have been proposed for individuals with type 2 diabetes (T2DM). Objectives To synthesize and present the best available evidence on the effectiveness of TCM-based lifestyle interventions in individuals with T2DM. Design We undertook a systematic review of randomized controlled trials or controlled clinical trials. Data sources Six English and four Chinese electronic databases were searched from their inceptions to December 2016. Review methods Trials investigating the effectiveness of various TCM-based lifestyle interventions among adults with T2DM were reviewed. Studies were excluded if TCM-based lifestyle interventions were only part of the intervention regimen. Two reviewers independently selected studies according to pre-specified inclusion and exclusion criteria and appraised the risk of bias of the included studies. One reviewer extracted details of the included studies and the second reviewer checked the extracted data critically. When feasible, data were statistically pooled for meta-analysis. Otherwise, narrative summaries were used. Results Twenty-four studies were included. The pooled analysis of the eight studies on tai chi showed tai chi practice for at least 150 min per week was beneficial in lowering glycosylated hemoglobin (mean difference, −1.48%; 95%CI, −2.58% to −0.39%; p < 0.001). Tai chi was effective in reducing fasting blood glucose (mean difference, −1.14 mmol/L; 95%CI, −1.78 to −0.50 mmol/L; p < 0.001) and body mass index (mean difference, −0.62; 95%CI, −1.14 to −0.11; p = 0.02), and improving quality of life. The effects of tai chi on blood pressure and waist circumference were inconclusive due to the limited number of studies. The meta-analysis of the 12 studies on ba duan jin demonstrated beneficial effects on glycosylated hemoglobin (mean difference, −0.77%; 95%CI, −0.97% to −0.56%; p < 0.001), fasting blood glucose (mean difference, −0.82 mmol/L; 95%CI, −1.05 to −0.59 mmol/L; p < 0.001), body mass index (mean difference, −2.77; 95%CI, −4.11 to −1.43; p < 0.001), and depression (mean difference, −4.53; 95%CI, −7.12 to −1.94; p < 0.001). Conclusions on the effects of ba duan jin on quality of life cannot be drawn because only two studies measured the outcome. Evidence regarding the effectiveness of other TCM-based lifestyle interventions is limited. Conclusions Tai chi and ba duan jin are potentially effective options for individuals with T2DM to improve biomedical and psychosocial well-being. Further well-designed studies are needed to explore the optimal intervention dose and to investigate the effectiveness of other TCM-based lifestyle interventions. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To review the diagnostic accuracy of end-tidal carbon dioxide detection in detecting inadvertent airway intubation and verifying correct placement of nasogastric tubes. Design: We undertook a meta-analysis of diagnostic studies. Study selection: All clinical trials that evaluated the diagnostic accuracy of the colorimetric capnometry or capnography in detecting inadvertent airway intubation and differentiating between respiratory and gastrointestinal tube placement in adults were included. Electronic databases including MEDLINE, CINAHL, EMBASE, All EBM Reviews, WanFang Data, China Journal Net, Chinese Medical Current Contents, and Index to Chinese Periodical Literature were searched from inception to July 2009. Data extraction and quality assessment: Data were extracted using a form piloted prior to use. Two reviewers independently extracted data relating to purpose of the trial, sample, measurements used, index test results and reference standard. Methodological quality of eligible trials was assessed independently by two reviewers using a modified version of the Quality Assessment of Diagnostic Accuracy Studies for assessing studies of diagnostic accuracy. The accuracy of diagnostic tests is presented in terms of sensitivity, specificity, predictive values, and likelihood ratios. Data synthesis: Nine clinical trials were eligible for inclusion in the meta-analysis. Eight trials were undertaken in intubated and mechanically ventilated patients and two trials also involved participants who were alert or awake. Eight involving a total of 456 nasogastric feeding tube placements investigated the diagnostic accuracy of either colorimetric capnometry or capnography to detect feeding tube placement. One trial involving 195 gastric tube insertions compared the diagnostic accuracy of simultaneous use of a colorimetric carbon dioxide detector and capnography to detect feeding tube placement. The use of colorimetric capnometry or capnography had a sensitivity ranging from 0.88 to 1.00, specificity 0.95 to 1.00, positive likelihood ratio 15.22 to 283.35, negative likelihood ratio 0.01 to 0.25. A summary receiver operator characteristics (SROC) curve was constructed and showed an area under the curve was 0.9959. Three trials reported significant cost savings using end-tidal carbon dioxide detectors. Conclusions: There is evidence to support the use of capnography or colorimetric capnometry for the identification of nasogastric feeding tube placement in mechanically ventilated patients. [Copyright &y& Elsevier]