Objective To use direct adherent method to induce human embryonic stem cells （hESCs） to become cardiomyocytes in vitro and examine their differentiation rate. Methods Undifferentiated hESCs were seeded onto Matrigel-coated plates at a density of 1×105 cells/cm2 and cultured in MEF-conditioned medium （MEF-CM） with 8 ng/ml basic fibroblast growth factor （bFGF） for 6 days. Then MEF-CM was replaced with RPMI 1640/B27 medium supplemented with 100 ng/ml human recombinant activin A for 24 hours in hESCs culture，followed by supplementation of 10 ng/ml human recombinant bone morphogenetic protein 4 （BMP4） for 4 days in hESCs culture. The medium was then replaced with RPMI 1640/B27 medium without supplementary cytokines，and hESCs were refed every 2-3 days for 2-3 additional weeks. Self-beating cardiomyocytes and the beating frequency were observed under the microscope，and the percentage of colonies showing beating cardiomyocytes was calculated. Cardiac troponin T （cTnT），a specific marker of cardiomyocytes，was examined by immunofluorescence. Spontaneous action potentials of cardiomyocytes were measured with patch clamp technique.Apoptotic rate of cardiomyocytes was detected with apoptosis-hoechst staining kit after beating cardiomyocytes were culturedunder hypoxia for 24 hours. Results A large number of spontaneous beating cardiomyocytes were observed 13 days after induction. The average time to show beating cardiomyocytes was 13.0±1.1 days after induction，the percentage of colonies showing beating cardiomyocytes was 66.7%，and the beating frequency of cardiomyocytes was 63.0±7.0 times/minutes. Beating cardiomyocytes were cTnT-positive. Spontaneous action potentials were detected in beating cardiomyocytes.Apoptotic rate of cardiomyocytes was 8.0%±0.5% after beating cardiomyocytes were cultured under hypoxia for 24 hours. Conclusion It’s the first time to use direct adherent method to induce hESCs to become cardiomyocytes in vitro in China with the differentiation rate of 66.7% and differentiation time of 13 days.
ObjectiveTo systematically review the effects of adherence therapy in improving medication adherence and clinical outcomes in psychosis patients. MethodsWe searched databases including PubMed, EMbase, The Cochrane Library (Issue 10, 2015), EBSCO, CBM, CNKI, VIP, and WanFang Data from inception to Oct. 2015, to collect randomized controlled trials (RCTs) about adherence therapy for patients with psychosis. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.2 software. ResultsA total of 13 RCTs involving 1 244 patients were included. The results of metaanalysis showed that adherence therapy could improve attitude towards medication adherence (MD=3.12, 95%CI 1.26 to 4.98, P=0.001), behavioral adherence (SMD=0.54, 95%CI 0.21 to 0.88, P=0.001), function (SMD=0.42, 95%CI 0.28 to 0.56, P=0.000 01) and insight of diseases (SMD=0.34, 95%CI 0.15 to 0.54, P=0.000 7) in patients with psychosis. But regarding psychotic symptoms, hospital stay, medical costs and adverse drug reactions, adherence therapy did not show benefit (all P values >0.05). ConclusionCurrent evidence shows that adherence therapy could improve medication adherence, function and insight towards diseases in patients with psychosis. Due to the limited quantity and quality of included studies, more large-scale, multi-center, and high quality RCTs are needed to verify the above conclusion.
Colorectal cancer (CRC) screening is effective in reducing the burden of the disease. Participation rate is an important determinant of the magnitude of the effectiveness in population-based CRC screening. We summarize the current status of participation rate across the different organized CRC screening programs in China. The results indicate that the overall participation rates are low, and the acceptance of the screening protocols is poor in Chinese population. We conclude that the associated factors may include the poor health consciousness, low willingness-to-pay for screening, lack of personalized screening strategy and inadequate organization. Studies on the inventions to improve the willingness of screening and participation rate are of high demand and will provide important references in implementing large-scale CRC screening programs in China in the future.
ObjectivesTo evaluate the effects of short message service (SMS) intervention for improving antiretroviral treatment adherence in HIV patients by meta-analysis.MethodsDatabases including PubMed, EMbase, CINAHL, Web of Science, ScienceDirect, The Cochrane Library, CNKI, WanFang Data, VIP and CBM were searched electronically from January 2000 to December 2018 to collect randomized controlled trials (RCTs) on the efficacy of SMS intervention on HIV patients. Two reviewers independently screened literature, extracted data, and assessed risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software.ResultsA total of 10 RCTs with 2 411 patients were included. The meta-analysis showed that SMS intervention could improve significantly treatment adherence of HIV patients (RR=1.11, 95%CI 1.03 to 1.20, P<0.01). The subgroup analysis showed that weekly texting had an effect on treatment adherence (RR=1.15, 95%CI 1.00 to 1.33, P<0.05); personal sending (RR=1.17, 95%CI 0.99 to 1.38, P=0.06) and daily sending (RR=1.02, 95%CI 0.83 to 1.26, P=0.84) of SMS had no statistical significance on treatment adherence; the intervention duration of 6 months (RR=1.11, 95%CI 1.00 to 1.23, P=0.05) could improve the treatment adherence, while the intervention duration of 12 months (RR=1.07, 95%CI 0.98 to 1.17, P=0.13) had no statistical difference on treatment adherence; there was no statistical difference in CD4+ cell count before and after treatment (WMD=4.18, 95%CI −39.33 to 47.69, P=0.85).ConclusionsBy comparing SMS intervention with routine nursing, sending SMS weekly for 6 months to remind HIV patients to take medicine can improve treatment adherence. Due to the limitation of quantity and quality of the included studies, the above conclusions are required to be assessed by more high-quality studies.
ObjectiveTo systematically review the medication adherence in children with tic disorder to assist in the selection of clinical treatment options and enhance the efficacy of medications for tic disorder.MethodsDatabases including Medline (Ovid), EMbase (Ovid), The Cochrane Library, PsycINFO (EBSCOhost), CINAHL Plus (EBSCOhost), CNKI, WanFang Data and VIP were searched from inception to August 2020, and original studies on medication adherence in children with tic disorder were included. Two researchers independently screened literature, extracted data on the definition of compliance, compliance rate, and factors affecting compliance, and evaluated risk bias of included studies. Systematic review was performed to analyze the status of medication adherence in children with tic disorder.ResultsA total of 12 studies were included, involving seven randomized controlled trials, two case series studies, and three cross-sectional studies. Most studies failed to specify the definition of compliance. The results of cross-sectional studies showed that the proportion of children with good medication compliance was 29.3% to 47.1%. The first-line treatment drugs, tiapride, risperidone, aripiprazole, and clonidine, had relatively good adherence. Medication adherence was affected by drug factors, patient and family factors, and environmental factors.ConclusionsThe adherence rate of medications for tic disorder varies between studies. Few studies have analyzed the factors that affect medication adherence for tic disorder, and some influencing factors are controversial. The first-line treatment drugs, tiapride, risperidone, aripiprazole, and clonidine, have high medication adherence and are recommended for clinical use.
ObjectiveTo explore whether education and management of medical care integration can improve asthma control. MethodsA prospective, 12-month, cohort study was undertaken in a real-world setting based on Australasian severe asthma network (ASAN). A total of 516 patients with stable asthma were consecutively recruited, who received education and management of medical care integration, and step-wise anti-asthma regimens determined by physicians’ standard practice. Furthermore, inhaled corticosteroid (ICS) adherence, lung function, asthma symptom control and exacerbation were assessed at 1, 3, 6, and 12 months. ResultsAt the end of 12 months, ICS adherence (47.7% vs. 81.5%, P<0.05), lung function, and asthma symptoms were assessed by asthma control text (ACT) [20 (16, 23) vs. 23 (21, 24), P<0.05], which were significantly improved in comparison to the status at baseline, and 86.0% of patients achieved total/well-controlled level of asthma. The exacerbation (14.2% vs. 36.2%, P<0.01) and hospitalizations (8.5% vs. 15.3%, P<0.01) because of asthma for the following year significantly decreased compared with those in the past year. The multivariate regression analysis indicated that poor ICS adherence (RR=1.52, 95%CI 1.02 to 2.25, P=0.039), depression symptoms (RR=1.19, 95%CI 1.05 to 1.34, P=0.007), and exacerbation during the past year (RR=2.81, 95%CI 1.49 to 5.27, P=0.001) were associated with an increased risk of future exacerbation. ConclusionIn a real-world setting, most of asthmatics achieve total/well-controlled asthma by education and management of medical care integration including shared decision-making between physicians and patients and step-wise anti-asthma regimens. ICS adherence and depression symptoms independently predict asthma exacerbations, and strengthening education and management of medical care integration, esp. psychological nursing, would improve asthma control levels.
ObjectiveTo systematically review the adjuvant endocrine therapy adherence among Chinese patients with breast cancer. MethodsThe Cochrane Library, Web of Science, PubMed, EMbase, CINAHL, CNKI, VIP, WanFang Data and CBM were electronically searched to collect studies on adjuvant endocrine therapy adherence among Chinese patients with breast cancer from inception to September 2022. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using Stata 16.0 software. ResultsA total of 24 studies were included. The results of meta-analysis showed that: the overall adherence rate of adjuvant endocrine therapy in Chinese breast cancer patients was 55.0% (95%CI 0.44 to 0.65), and a 5-year adherence rate was 54.4% (95%CI 0.46 to 0.63). Subgroup analysis showed that patients with good disease awareness, high education level, high monthly household income, living in cities, effective family support, no adverse drug reactions, high convenience of seeking medical treatment, regular review, health education, no comorbidities, and changes in medication type might have higher compliance. ConclusionThe adherence rate of adjuvant endocrine therapy in breast cancer patients in China is low. Adherence varies between sociodemographic characteristics, treatment, and social support for breast cancer patients.
Objective To review main obstacles to health care professionals' adherence to clinical practice guidelines (CPGs) by employing the scoping review method and a determinants framework, and to explore the effect of implementation strategies in intervention researches on guideline adherence. Methods The articles published from January 1, 2011 to June 10, 2023 were retrieved from the PubMed, CINAHL, MEDLINE, Embase, Scopus, Cochrane Library, SinoMed, CNKI, WanFang Data and VIP databases. The original literature on the CPGs implementation obstacles and strategies was included, and the primary and secondary screening of the literature were completed by four researchers according to the inclusion and exclusion criteria. The basic characteristics of the literature, the factors affecting the implementation of the CPGs, and the strategies used were extracted. The results were analyzed and summarized using qualitative and quantitative methods. Results A total of 61 articles were included in the scoping review. The factors affecting the implementation of CPGs could be divided into five categories: guidelines themselves, external factors, internal factors, individual factors, and implementation process. The most common implementation obstacles were insufficient knowledge or skills of professionals regarding guidelines (n=21, 34.4%), insufficient necessity of using guidelines according to doctors (n=17, 27.9%), and unreasonable factors within hospital (n=16, 26.2%). The factors that promoted the implementation of CPGs included guidelines based on high-quality evidence (n=5, 8.2%), good department or hospital culture (n=4, 6.6%), convenient accessibility of guideline knowledge and information (n=4, 6.6%), and doctors’ excellent professional ability (n=4, 6.6%). The overall effectiveness of the guideline implementation strategy was 50%. Clinical decision support system (CDSS) could improve the adherence of CPGs. Guideline education or training was one of the most commonly used methods, but the effect of improving guideline compliance was unstable. Conclusion The primary challenges in implementing guidelines include inadequate professional capacity and demand, suboptimal hospital infrastructure and limited resources. However, the obstacles are not absolute. It is recommended to use implementation strategies to improve the absorption and implementation of guidelines, among which CDSS is an effective measure for promoting guideline adherence.