Mild traumatic brain injury has a large number of patients in China. In recent years, studies have pointed out that the return to work is a key goal for rehabilitation, indicating that patients can start integrating into society again and resume normal work and life as soon as possible, which has a positive impact on their rehabilitation. This article summarizes the relevant factors that affect the return to work from four aspects: individual, disease, occupation, and social support, and introduces intervention measures such as follow-up and health education, neuromodulatory technology, symptom management, social support, cognitive and occupational rehabilitation, and multidisciplinary occupational rehabilitation, aiming to provide a reference for promoting the research and development of patients with mild traumatic brain injury returning to work in China.
Objective To explore the impact of COVID-19 positive donors on the prognosis of heart transplant recipients. MethodsThe Medline, EMbase, CENTRAL, CNKI, Wanfang Data, VIP and Chinese Biomedical Abstracts Database from inception to May 2023 were searched by computer for studies about impact of COVID-19 positive donors on the prognosis of heart transplant recipients. The data was extracted from all the relevant literatures, and the quality of the data was assessed using the Newcastle-Ottawa score (NOS). All statistical analysis was conducted by the STATA 11.0 software. Results A total of 10 studies (NOS score ranging from 5 to 9 points) involving 643 patients were enrolled. The pooled results demonstrated that the pooled mortality of heart transplant recipients from COVID-19 positive donors was 4% (95%CI 2%–5%). And the incidence of composite outcome, regarding graft failure, rejection and death as poor prognosis, was 7% (95%CI 5%–9%). Besides, compared with recipients from COVID-19 negative donors, the pooled odds ratio (OR) value of death in which from COVID-19 positive donors was 0.68 (95%CI 0.38–1.22, Z=1.28, P=0.200). The pooled OR value of rejection rate was 0.41 (95%CI 0.27–0.64, Z=3.97, P<0.005). For the composite outcome, the pooled OR value was 0.50 (95%CI 0.37-0.69, Z=4.30, P<0.005). In addition, there was no statistical difference in the length of hospital stay between heart transplant recipients from COVID-19 positive donors and negative donors (SMD=–0.03, 95%CI –0.22–0.15, Z=0.36, P=0.720). Conclusion The application of heart from COVID-19-positive donor for transplantation are safe and feasible. However, further prospective studies with longer follow-up times are still needed to verify its impact on long-term outcomes.
Objective To evaluate the effect of exogenous melatonin and its analogues on the prevention of delirium in critically ill patients by meta-analysis. Methods Randomized controlled trials of exogenous melatonin and its analogues in the prevention of delirium in critically ill patients were searched by computer from the Cochrane Library, PubMed, Web of Science, Embase, China National Knowledge Infrastructure, Chongqing VIP, Wanfang, and SinoMed databases. The trial group was treated with melatonin or its analogues, while the control group was treated with placebo. The retrieval period was from the establishment of database to January 14th, 2021. Two researchers independently evaluated the literature quality, and meta-analysis was performed using RevMan 5.4 software. Results A total of 11 randomized controlled trials containing 1177 patients were enrolled, including 588 patients in the trial group and 589 patients in the control group. The results showed that exogenous melatonin and its analogues could reduce the occurrence of delirium in critically ill patients [odds ratio (OR)=0.45, 95% confidence interval (CI) (0.22, 0.91), P=0.03] and shorten the time of mechanical ventilation [standard mean difference (SMD)=−0.49, 95%CI (−0.94, −0.03), P=0.04], while might not affect the mortality rate [OR=0.73, 95%CI (0.46, 1.17), P=0.19] or length of intensive care unit stay [SMD=−0.05, 95%CI (−0.26, 0.15), P=0.61]. Conclusions The current evidence shows that exogenous melatonin and its analogues have some effect on reducing the occurrence of delirium and shortening the duration of mechanical ventilation in critically ill patients, and have no significant effect on reducing the mortality or length of intensive care unit stay. The above conclusions need to be confirmed by more high-quality studies.