Objectives: The co-occurring flood and coronavirus disease (COVID-19) increase the consequences for health and life. This study examined the strategies to manage the health consequences of the co-occurring flood and COVID-19, with a specific focus on these 2 challenges. Methods: This review included all the studies published in peer-reviewed journals between January 1980 and June 2021. Several electronic databases were searched, including Scopus, Web of Science, and PubMed. Mixed Methods Appraisal Tools (MMT), version 2018, assessed the articles retrieved through a comprehensive and systematic literature search. Descriptive and thematic analyses were carried out to derive strategies for managing the health consequences of the simultaneous flood and COVID-19. Results: Among 4271 identified articles, 10 were eligible for inclusion. In total, 199 strategies were identified in this review for managing the multi-hazard health consequences of flooding and COVID-19, which were classified into 9 categories and 25 subcategories. The categories included policy making and decision making, coordination, risk communication, logistics, planning, preparedness measures, response measures, social and humanitarian support, and actions of local communities and non-governmental organizations. Conclusions: Managing a multi-hazard and reducing its health consequences requires various actions. Flood management must be needed, and flood-affected people and their health should be protected.

Background:Deep vein thrombosis (DVT) is a condition in which a clot forms in the deep veins, most commonly of the leg. It occurs in approximately one in 1000 people. If left untreated, the clot can travel up to the lungs and cause a potentially life-threatening pulmonary embolism (PE). Previously, a DVT was treated with the anticoagulants heparin and vitamin K antagonists. However, two forms of direct oral anticoagulants (DOACs) have been developed: oral direct thrombin inhibitors (DTIs) and oral factor Xa inhibitors, which have characteristics that may be favourable compared to conventional treatment, including oral administration, a predictable effect, lack of frequent monitoring or dose adjustment and few known drug interactions. DOACs are now commonly being used for treating DVT: recent guidelines recommended DOACs over conventional anticoagulants for both DVT and PE treatment. This Cochrane Review was first published in 2015. It was the first systematic review to measure the effectiveness and safety of these drugs in the treatment of DVT. This is an update of the 2015 review. OBJECTIVES: To assess the effectiveness and safety of oral DTIs and oral factor Xa inhibitors versus conventional anticoagulants for the long-term treatment of DVT. Search methods:The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase and CINAHL databases and the World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers to 1 March 2022. Selection criteria:We included randomised controlled trials (RCTs) in which people with a DVT, confirmed by standard imaging techniques, were allocated to receive an oral DTI or an oral factor Xa inhibitor compared with conventional anticoagulation or compared with each other for the treatment of DVT. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. Our primary outcomes were recurrent venous thromboembolism (VTE), recurrent DVT and PE. Secondary outcomes included all-cause mortality, major bleeding, post-thrombotic syndrome (PTS) and quality of life (QoL). We used GRADE to assess the certainty of evidence for each outcome. Main results:We identified 10 new studies with 2950 participants for this update. In total, we included 21 RCTs involving 30,895 participants. Three studies investigated oral DTIs (two dabigatran and one ximelagatran), 17 investigated oral factor Xa inhibitors (eight rivaroxaban, five apixaban and four edoxaban) and one three-arm trial investigated both a DTI (dabigatran) and factor Xa inhibitor (rivaroxaban). Overall, the studies were of good methodological quality. Meta-analysis comparing DTIs to conventional anticoagulation showed no clear difference in the rate of recurrent VTE (odds ratio (OR) 1.17, 95% confidence interval (CI) 0.83 to 1.65; 3 studies, 5994 participants; moderate-certainty evidence), recurrent DVT (OR 1.11, 95% CI 0.74 to 1.66; 3 studies, 5994 participants; moderate-certainty evidence), fatal PE (OR 1.32, 95% CI 0.29 to 6.02; 3 studies, 5994 participants; moderate-certainty evidence), non-fatal PE (OR 1.29, 95% CI 0.64 to 2.59; 3 studies, 5994 participants; moderate-certainty evidence) or all-cause mortality (OR 0.66, 95% CI 0.41 to 1.08; 1 study, 2489 participants; moderate-certainty evidence). DTIs reduced the rate of major bleeding (OR 0.58, 95% CI 0.38 to 0.89; 3 studies, 5994 participants; high-certainty evidence). For oral factor Xa inhibitors compared with conventional anticoagulation, meta-analysis demonstrated no clear difference in recurrent VTE (OR 0.85, 95% CI 0.71 to 1.01; 13 studies, 17,505 participants; moderate-certainty evidence), recurrent DVT (OR 0.70, 95% CI 0.49 to 1.01; 9 studies, 16,439 participants; moderate-certainty evidence), fatal PE (OR 1.18, 95% CI 0.69 to 2.02; 6 studies, 15,082 participants; moderate-certainty evidence), non-fatal PE (OR 0.93, 95% CI 0.68 to 1.27; 7 studies, 15,166 participants; moderate-certainty evidence) or all-cause mortality (OR 0.87, 95% CI 0.67 to 1.14; 9 studies, 10,770 participants; moderate-certainty evidence). Meta-analysis showed a reduced rate of major bleeding with oral factor Xa inhibitors compared with conventional anticoagulation (OR 0.63, 95% CI 0.45 to 0.89; 17 studies, 18,066 participants; high-certainty evidence). AUTHORS' CONCLUSIONS: The current review suggests that DOACs may be superior to conventional therapy in terms of safety (major bleeding), and are probably equivalent in terms of efficacy. There is probably little or no difference between DOACs and conventional anticoagulation in the prevention of recurrent VTE, recurrent DVT, pulmonary embolism and all-cause mortality. DOACs reduced the rate of major bleeding compared to conventional anticoagulation. The certainty of evidence was moderate or high.

Background: Workplace violence is a serious threat to healthcare workers worldwide. Aim: We aimed to determine the prevalence of physical and verbal violence against healthcare workers in the WHO Eastern Mediterranean Region and Türkiye. Methods: We searched the Medline (via PubMed), Cochrane Library, Scopus, Science Direct, Web of Science and ProQuest databases along with reference lists from selected articles. Studies of health workers exposed to verbal and/or physical violence by patients or their relatives conducted in the WHO Eastern Mediterranean Region and Türkiye among staff working in hospitals and primary health care services were included. Seventy-five of the 3513 articles identified of studies conducted during 1999-2021 were eligible. The data were analysed using MetaXL version 5.3 and STATA version 16. Results: This study covered 69 024 healthcare workers from 22 countries. Meta-analysis showed that 63.0% (95% CI: 46.7- 79.2) of them had experienced verbal violence and 17.0% (95.0% CI: 14.0-21.0) experienced physical violence. There was no significant difference for sample size, professional group, quality score, or response rate. The frequency of physical and verbal violence in the subgroup analysis was statistically significantly different for countries and years. Conclusion: Findings from this study provide useful information for policymaking regarding interventions to prevent or minimize violence against healthcare workers in the Eastern Mediterranean Region and Türkiye.

BACKGROUND: Nursing during the perioperative period of hepatobiliary surgery is essential in the treatment and rehabilitation of patients. Personalized nursing gives full consideration to the personal characteristics of patients and encourages patients to participate in making decisions. However, compared to traditional nursing, there is insufficient evidence of the effectiveness of personalized nursing. This review sought to evaluate the effects of personalized nursing during the perioperative period of hepatobiliary surgery. METHODS: A meta-analysis was conducted of articles published from 2010 to 2021. To identify the relevant electronic publications, the PubMed, Web of Science, Embase, CNKI, and Wanfang databases were searched for articles comparing the clinical efficacy of personalized nursing with that of traditional nursing. The standardized mean difference (SMD) and odds ratio (OR) with 95% confidence interval (CI) were used to calculate the aggregated effect index. RESULTS: Of the 286 records retrieved from the search of the databases, 12 studies, comprising 1,039 patients, met the screening criteria. The meta-analysis showed that personalized nursing improved patients' levels of satisfaction with nursing (OR =6.871; 95% CI: 3.708-12.734), and decreased the incidence of adverse reactions significantly (OR =0.234; 95% CI: 0.153-0.357). Compared to traditional nursing, personalized nursing reduced patients' average hospitalization time, the time it took to get out of bed for the first time after surgery, the time it took to first eat after surgery, and the time it took to first exhaust after surgery. Additionally, patients who received personalized nursing had significantly reduced Self-rating Anxiety Scale (SAS) scores and Self-rating Depression Scale (SDS) scores than patients who received traditional nursing. DISCUSSION: The application of personalized nursing to patients undergoing hepatobiliary surgery during the perioperative period improved patients' level of satisfaction with nursing, effectively reduced the incidence of adverse reactions, accelerated the recovery of hepatobiliary function after surgery, and relieved anxiety and depression; thus, personalized nursing is worthy of clinical application.

Background: Hybrid emergency room (ER) systems, consisting of an angiography-computed tomography (CT) machine in a trauma resuscitation room, are reported to be effective for reducing death from exsanguination in trauma patients. We aimed to investigate the cost-effectiveness of a hybrid ER system in severe trauma patients without severe traumatic brain injury (TBI). Methods: We conducted a cost-utility analysis comparing the hybrid ER system to the conventional ER system from the perspective of the third-party healthcare payer in Japan. A short-term decision tree and a long-term Markov model using a lifetime time horizon were constructed to estimate quality-adjusted life years (QALYs) and associated lifetime healthcare costs. Short-term mortality and healthcare costs were derived from medical records and claims data in a tertiary care hospital with a hybrid ER. Long-term mortality and utilities were extrapolated from the literature. The willingness-to-pay threshold was set at $47,619 per QALY gained and the discount rate was 2%. Deterministic and probabilistic sensitivity analyses were conducted. Results: The hybrid ER system was associated with a gain of 1.03 QALYs and an increment of $33,591 lifetime costs compared to the conventional ER system, resulting in an ICER of $32,522 per QALY gained. The ICER was lower than the willingness-to-pay threshold if the odds ratio of 28-day mortality was < 0.66. Probabilistic sensitivity analysis indicated that the hybrid ER system was cost-effective with a 79.3% probability. Conclusion: The present study suggested that the hybrid ER system is a likely cost-effective strategy for treating severe trauma patients without severe TBI.

Importance: Knowing the underlying etiology of intellectual disability in genetic disorders holds great promise for developing targeted treatments. Although successful preclinical studies and many positive clinical studies have been reported, it is unclear how many purported therapies have become established treatments. The quality of the clinical trials may be an important determinant for achieving clinical impact. Objective: To evaluate clinical impact, strengths, and weaknesses of clinical trials of diet or drug treatments to improve cognitive function in patients with a genetic disorder. Evidence Review: MEDLINE, EMBASE, PsycINFO, and Cochrane databases were searched from inception date to January 26, 2014, for clinical trials with cognitive outcomes in patients with genetic disorders. Outcome measures of randomized clinical trials (RCTs) were compared between trial registries and reports, and trials were evaluated for the quality of design using the Jadad score and Consolidated Standards of Reporting Trials (CONSORT) criteria. Findings: We identified 169 trial reports of 80 treatments for 32 genetic disorders. Seventy-five trials (44.4%) reported potential efficacy, of which only 2 therapies are now established treatments, namely, dietary restriction for phenylketonuria and miglustat for Niemann-Pick disease type C. The median sample size for RCTs was 25 (range, 2-537). Only 30 of 107 RCTs (28.0%) had acceptable Jadad scores exceeding 3. Reporting of key CONSORT items was poor. Reported outcome measures matched preregistered outcome measures in trial registries in only 5 of 107 RCTs (4.7%). Conclusions and Relevance: The number of trials in the field of cognitive genetic disorders is rapidly growing, but clinical impact has been limited because few drugs have become established treatments and the benefit of most drugs remains unclear. Most trials have small sample sizes and low quality of design. Predefinition of outcome measures, improved trial reporting and design, and international collaboration to increase recruitment are needed to unequivocally determine efficacy of drugs identified in preclinical research

BACKGROUND: There is evidence that several intervention types, including psychotherapy, reduce repeat suicide attempts. However, these interventions are less applicable to the heterogeneous patients admitted to emergency departments (EDs). The risk of a repeat suicide attempt is especially high in the first 6 months after the initial attempt. Therefore, it is particularly important to develop effective ED interventions to prevent repeat suicide attempts during this 6-month period. METHODS: We systematically reviewed randomized controlled trials of ED-initiated interventions for suicidal patients admitted to EDs using the databases MEDLINE, PsychoINFO, CINAHL, and EMBASE up to January 2015 in accordance with an a priori published protocol (PROSPERO: CRD42013005463). Interventions were categorized into four types, including active contact and follow-up interventions (intensive care plus outreach, brief interventions and contact, letter/postcard, telephone, and composite of letter/postcard and telephone), and a meta-analysis was conducted to determine pooled relative risks (RRs) and 95% confidence intervals (CIs) of a repeat suicide attempt within 6 months. RESULTS: Of the 28 selected trials, 14 were active contact and follow-up interventions. Two of these trials (n = 984) reported results at 6 months (pooled RR = 0.48; 95% CI: 0.31 to 0.76). There were not enough trials of other interventions to perform meta-analysis. Some trials included in the meta-analysis were judged as showing risk of bias. CONCLUSION: Active contact and follow-up interventions are recommended for suicidal patients admitted to an ED to prevent repeat suicide attempts during the highest-risk period of 6 months.