Objective?To systematically evaluate the effects of thoracic epidural anesthesia on outcome after coronary artery bypass surgery. Methods?We searched PubMed, EBSCO, Springer, Ovid, and CNKI databases from 1990 through Oct. 2009 to identify randomized controlled trials (RCTs) about thoracic epidural anesthesia combined with general anesthesia versus general anesthesia alone on outcome after coronary artery bypass surgery. The methodological quality of the included RCTs was assessed and the data was extracted according to the Cochrane Reviewer’s Handbook. The homogeneous RCTs were pooled using RavMan 4.2.10 software. Results?Sixteen RCTs involving 1 316 patients met the inclusion criteria. The results of meta-analyses showed that thoracic epidural anesthesia significantly reduced time to tracheal extubation (MD= –332.43, 95%CI –640.19 to –24.68, P=0.03), visual analog scale (VAS) scores at rest on postoperation day 1 (MD= –1.23, 95%CI –2.19 to –0.27, P=0.01), VAS scores with movement on postoperation day 1 (MD= –2.52, 95%CI –4.65 to –0.39, P=0.02) and day 2 (MD= –1.5, 95%CI –2.56 to –0.43, P=0.006), and incidences of myocardial ischemia (RR=0.53, 95%CI 0.29 to 0.97, P=0.04). There were no significant differences between the two groups in postoperative pulmonary function, incidences of myocardial infarction, atrial fibrillation, and mortality. Conclusions?Thoracic epidural anesthesia could reduce postoperative time to tracheal extubation, VAS score, and incidences of myocardial ischemia, but it does not affect postoperative pulmonary function, incidences of myocardial infarction, atrial fibrillation, and mortality. More high-quality RCTs are required.
Avoidable mortality (AM) is an important indicator of health system performance. It is also an effective tool for evaluating the effectiveness of health measures and allocation of health resources. The concept development, analytical methods, and research contents of avoidable mortality are introduced in this study. This study investigated the applicability of avoidable mortality analysis in determining priority health-service intervention areas, determining priority health-service intervention populations and evaluating the quality of those services. This paper also discussed the significance and limitations of avoidable mortality analysis. The investigation provided references for further research and application of avoidable mortality analysis.
ObjectivesTo systematically review the association between pubertal development progression and emotional and behavioral problems.MethodsVIP, CNKI, CBM, WanFang Data, PubMed, Web of Science and EBSCO databases were electronically searched to collect studies on the relationship between pubertal tempo or trajectory and emotional and behavioral problems from inception to December 31st, 2019. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Qualitative methods were then used to analyze the data.ResultsA total of 14 cohort studies were included. The results showed that depression was the most studied emotional problem, and 2 of the 3 studies found a significant association between faster pubertal tempo and more depressive symptoms in juvenile males. However, no association was found in 3 of the 4 studies on juvenile females. The content of behavioral problems of included studies was broad, including internalizing and externalizing problems, substance abuse, attention problem, self-control, first-sexual experience, delinquency, conduct disorder, peer relationship, etc. However, few studies on the same behaviors, and the relationship between behavioral problems was unclear.ConclusionsThe faster pubertal tempo may be associated with depression in juvenile males. The association between pubertal tempo and behavioral problems in males and females remain to be determined by more studies.
ObjectiveTo identify the effects of transition to siblinghood (TTS) on the firstborn children’s emotions and behaviors, and to define the time of TTS.MethodsCBM, VIP, CNKI, WanFang Data, PubMed, Web of Science and EBSCO were electronically searched to collect studies on the emotional and behavioral characteristics of firstborn children in TTS from inception to December 31st, 2019. Two reviewers independently screened literature, extracted data and assessed the risk bias of included studies. Then, qualitative methods were used to analyze the studies.ResultsA total of 13 studies involving 980 children were included. 12 behavioral related studies explored self-behavior of the firstborn children during TTS, 3 studies focused on the interaction behavior between the firstborn children and their parents, the firstborn children and the second children. The systematic reviews found that TTS showed both positive and negative effects on the behavioral characteristics of firstborn children, primarily the negative effects. Firstborn children’s anxiety, confrontation and attachment showed 3 different patterns over time, respectively. Two studies showed the increase of negative emotions of firstborn children during TTS. The time range of TTS was mainly concentrated in the third trimester to 12 months after the birth of the second child.ConclusionsThe current evidence shows that TTS primarily increases the negative emotions and behaviors of firstborn children, and the behaviors of firstborn children changes over time. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.