Zhenggang Bai

The traditional Chinese medicine evaluation indicator system can effectively identify and recognize deficiencies in the implementation of standards and provide a rationale for improving the technical content, enhancing the effectiveness of implementation and promoting the dissemination of traditional Chinese medicine culture and technology globally. Evidence-based principles can be an important method to guide the development of traditional Chinese medicine indicators and to promote the application of standards. This paper introduces the development status of NICE indicators and provides reference ideas for constructing evaluation indicators for traditional Chinese medicine standards application based on evidence-based principles. The specific steps for constructing an evaluation indicator system for traditional Chinese medicine standard application include identifying indicator domains, evidence synthesis, developing indicators, constructing an indicator system, cost-effectiveness and resource impact analyses, and finalizing indicators for training and promotion. To promote the further development of traditional Chinese medicine, it is necessary to strengthen the integrated construction of “guidelines-standards-indicators,” accelerate the establishment of a coordination mechanism between domestic and international organizations, and pay attention to the characteristics of traditional Chinese medicine and focus on implications for practice and policy.

Objective: To systematically analyze the effectiveness of technology-based interventions for reducing loneliness in older adults.Methods: We searched relevant electronic databases from inception to April 2021, which included Cochrane Library, PubMed, Web of Science, SpringerLink, EMBASE, CNKI, and Wanfang. The following criteria were used: (i) study design—randomized controlled trial (RCT) designs, (ii) people—older adults (aged ≥ 60 years), (iii) intervention—technology-based interventions in which a core component involved the use of technology to reduce loneliness in older adults; and (iv) outcome—reduction of loneliness level in terms of rating scale scores. Two reviewers independently identified eligible studies, extracted data, and assessed the risk of bias in the included studies. A third reviewer resolved any conflicts. The Cochrane Collaboration's bias assessment tool was used to evaluate the risk of bias for the included studies, and Review Manager 5.4 software was used for the meta-analysis. A random effects model was adopted to measure estimates of loneliness reduction, and standard mean differences (SMD) with a 95% confidence interval (CI) were calculated for each intervention-control contrast, and the I² statistic was applied to examine heterogeneity.Results: A total of 391 participants from six RCTs were included in the review. Of these, three studies were rated as low-quality, and the remaining three were rated as moderate-quality studies. The meta-analysis showed that the evidence regarding the effects on loneliness of technology-based interventions compared with control groups was uncertain, and suggested that technology-based interventions resulted in little to no difference in loneliness reduction compared to control groups (SMD = −0.08, 95% CI −0.33 to 0.17, p = 0.53). Two types of technology-based interventions were identified: smartphone-based video calls and computer-based training with Internet usage. The subgroup analysis found low-quality evidence to support the effectiveness of both intervention types (SMD = −0.01, 95% CI −0.25 to 0.24, p = 0.95, and SMD = −0.38, 95% CI −0.19, 0.64, p = 0.47, respectively).Conclusions: We found no current evidence to support that technology-based interventions were effective compared to different control conditions in reducing loneliness in older adults. This suggests that more research is needed to investigate the effects of technology-based interventions on loneliness in older adults.

Background: Veterans who did not seek and complete treatment as intended have been shown to have an elevated risk of experiencing and being exposed to post-traumatic stress disorder (PTSD). Internet-based interventions (IBIs) provide more confidentiality and fewer treatment barriers, and they are regarded as potential treatments to reduce PTSD in veterans. However, the effects of IBI for veterans with PTSD are inconclusive.Objectives: IBI is defined as any internet-based series of psychosocial interventions, of which the internet works as a way of delivery. Psychosocial content and reduction of PTSD symptoms in veterans have been recognized as two core elements of this intervention. This study aimed to (1) examine the effects of IBI on veterans’ PTSD outcomes and (2) distinguish between the elements of IBI that play an important role for veterans with PTSD.Methods: Web of Science, PubMed, EMBASE, PsycINFO, Cochrane, Wanfang Data, CNKI, and CQVIP databases were searched for randomized controlled trials (RCT) in IBI programs for veterans with PTSD, covering all studies in English and Chinese published from January 1990 to November 2020. Also, related studies tracking citations were identified. Studies met the following inclusion criteria of (1) being RCTs; (2) containing IBI in the full text; (3) having IBI conducted on veterans as participants; and (4) being on PTSD. All processes followed PRISMA. The risk of bias of the studies was assessed by the Cochrane Systematic Review Handbook. The confidence of outcomes of this review was valued according to the GRADE (Grading of Recommendations Assessment, Development, and Evaluation). The meta-analysis was done by RevMan 5.13. Two teams of reviewers independently searched the literature, made the assessment, and extracted the data.Results: A total of 1,493 citations were identified after initial searching, of which the full texts of 66 studies were screened. Eventually, six RCT studies met the inclusion criteria. Beneficial effects of IBI were found on the overall PTSD outcome (−0.29; 95% CI–0.48 to −0.11, ppp=0.001). The intervention had a positive effect on the PTSD outcome on veterans with comorbid psychological disorders (−0.30; 95% CI –0.61 to −0.11, pConclusion: On the whole, IBIs have a positive effect on the overall PTSD outcome of veterans. The results encouraged us to focus on IBI with CBT with peer support for veterans, on specific instruments for veterans with PTSD, and on veterans with comorbid psychological disorders. This study, however, has limits. Only six studies with a Western population were included, which might result in cultural bias on IBI effects. In future, more high-qualified research and diverse cultural background of RCTs is needed to prove the effectiveness of IBI on veterans with PTSD.

RRH: Rural and Remote Health. Published article number: 4519 - Selective admission policy of medical undergraduates in western China: applicants' real attitudes to the choice of a rural medical career

Previous studies have demonstrated that elevated homocysteine (Hcy) level represents an independent risk factor for macrovascular disease. However, the relationship between hyperhomocysteinemia and the progression of diabetic retinopathy in patients remains controversial. Hence, the purpose of this systematic review and meta-analysis was to explore any potential association between Hcy and the risk of diabetic retinopathy. PubMed, Embase, and the Cochrane Library databases were searched to screen studies that fulfilled the inclusion criteria from date of database inception to November 2017. The summary odds ratio (OR) with 95% confidence intervals (CIs) was used to calculate the pooled effect estimate for the relationship between Hcy and diabetic retinopathy risk. Sensitivity, subgroup analyses, and publication bias were also assessed. Eleven studies involving a total of 2184 diabetic patients were included in the meta-analysis. The summary OR suggested that increased Hcy level in diabetic patients was associated with an increased risk of diabetic retinopathy (OR 1.62; 95% CI 1.29–2.03; p < 0.001). Although significant heterogeneity was detected among the included studies, the findings of sensitivity analysis remained statistically significant. Subgroup analyses found a significant association between Hcy and diabetic retinopathy in most subsets, but no significant association was found if the sample size was < 100, participants had type 1 diabetes mellitus, and the study quality was low. The findings of this study suggested that elevated Hcy level was associated with an increased risk of diabetic retinopathy, especially in type 2 diabetic patients. This finding may help diabetic patients to achieve effective management strategy to prevent the progression of diabetic retinopathy.

Objectives To determine the efficacy of music therapy in the management of depression in the elderly. Method We conducted a systematic review and meta-analysis of randomized controlled trials. Change in depressive symptoms was measured with various scales. Standardized mean differences were calculated for each therapy–control contrast. Results A comprehensive search yielded 2,692 citations; 19 articles met inclusion criteria. Meta-analysis suggests that music therapy plus standard treatment has statistical significance in reducing depressive symptoms among older adults (standardized mean differences = 1.02; 95% CI = 0.87, 1.17). Conclusions This systematic review and meta-analysis suggests that music therapy has an effect on reducing depressive symptoms to some extent. However, high-quality trials evaluating the effects of music therapy on depression are required.