Background: Adverse outcomes after unilateral vs bilateral breast reconstruction involve an unknown level of risk that warrants thorough investigation. Methods: To address this research need, PubMed, Ovid, Medline, EMBASE, and Scopus databases were searched through systematically from January 1, 1990, to January 1, 2019 to retrieve the relevant studies on the risk of postoperative complications after unilateral vs bilateral abdominal flap breast reconstruction. According to the pre-designed inclusion criteria, available data were extracted from the relevant studies, and then analyzed comparatively in order to identify the relative risk (RR) and 95% confidence intervals (CI) applying either a random or a fixed effects model. Results: Eventually, 20 studies involving 8122 female subjects met the inclusion criteria. It was found that unilateral reconstruction involved a significantly higher risk of flap loss (RR: 1.56, 95% CI: 1.21–2.00; P < .05) and fat necrosis (RR: 1.60, 95% CI: 1.23–2.09; P < .05) compared to bilateral reconstruction, while bilateral reconstruction involved a greater risk of abdominal hernia/bulge (RR: 1.67, 95% CI: 1.25–2.24; P < .05). The risk was found to be higher following bilateral free transverse rectus abdominis myocutaneous (fTRAM) flaps in comparison with deep inferior epigastric perforator (DIEP) flaps (RR: 2.62, 95% CI: 1.33–5.15; P < .05). Conclusion: The risk of postoperative flap complications in unilateral breast reconstruction is significantly higher than that in bilateral reconstruction. Contrarily, the abdominal complications were significantly higher in the bilateral group vs the unilateral group. Meanwhile, the risk of abdominal hernia/bulge complication after bilateral breast reconstruction was significantly higher with fTRAM vs DIEP. Therefore, DIEP flaps are recommended in priority for bilateral breast reconstruction, unless specifically contraindicated.
BackgroundTo understand the occurrence of post-traumatic stress disorder (PTSD) and the current status of sleep quality among community-dwelling elderly adults in Hunan Province of China, to explore the correlation between the two, and to analyze the trend of sleep disorders in PTSD elderly adults.MethodsA simple random sample containing 1,173 community-dwelling elderly adults in Hunan Province was established between March and May 2022, and an on-site face-to-face survey was administered using the PTSD Checklist–Civilian Version (PCL-C) with good reliability and validity, the Pittsburgh Sleep Quality Index (PSQI) scale, and a self-designed general condition questionnaire.ResultsThe incidence of PTSD in the 1,173 participants was 14.3% (168/1,173). The total incidence of sleep disorders was 40.9% (480/1,173); more specifically, the incidence of sleep disorders in participants with no PTSD symptom, in participants with mild-to-moderate PTSD symptoms, and in participants with severe PTSD symptoms was 36.3, 69.8, and 66.7%, respectively. The Spearman's rank correlation analysis showed that the total PTSD score and the scores of each dimension (i.e., re-experiencing symptom cluster, avoidance symptom cluster and hypervigilance symptom cluster) were positively correlated with the total PSQI score and its dimension scores (i.e., sleep quality, time to fall asleep, sleep duration, sleep efficiency, sleep disturbance, hypnotic medication, and daytime function) (P < 0.05). The correlation coefficients ranged from 0.013 to 0.495. For all PSQI dimensions, the differences across participants with different degrees of PTSD were statistically significant (P < 0.05).ConclusionsThe overall status of PTSD and sleep quality in community-dwelling elderly adults in Hunan Province was not optimistic. The elderly with PTSD were more prone to sleep disorders, and the more severe the symptoms of PTSD, the poorer the sleep quality was. However, differences were observed in the scores of each dimension of sleep across participants with different degrees of PTSD. Regardless of the degree of PTSD symptoms, the sleep quality of the elderly is severely affected, and the occurrence rate is not unlimited.
Background: The elderly grow as age, sleep quality becomes worse, and psychogenic insomnia occupies a large proportion, which can lead to cognitive impairment and an increased risk of cardiovascular disease, even leading to suicide. It also places a psychological and financial burden on families. It is because of the characteristics of psychogenic insomnia: the two-way effect of negative emotions and insomnia, coupled with the aging of the elderly themselves, that psychogenic insomnia in the elderly is more difficult to treat. Considering the side effects of medication in the elderly, therefore, identifying non-pharmacological interventions for the elderly with psychogenic insomnia is a matter of urgent research for a solution that will help health professionals and stakeholders (nursing staff, patients, and community). Methods and analysis: We will undertake the review using the Joanna Briggs Institute (JBI) methodology. We develop search strategies and will search 6 databases without a date limit, and select articles published in Chinese and English. Retrieve and store all the records in Endnote 20 and NoteExpress, followed by the title and abstract screening as well as a full-text review. Results will be reported using PRISMA flow charts. Use standardized data extraction tables to extract data. All screening and extraction will be performed independently by two authors. We will present the final results in the form of descriptive summaries and charts. Discussion We anticipate that the scoping review will highlight the available resources and evidence on interventions that improve the sleep quality of the elderly. This may contribute to informed empirical evidence for professionals to enhance the functional recovery of the elderly. It may also reveal what interventions nurses could do. Scoping review registration The protocol has been registered prospectively on the Open Science Framework: http://osf.io/urdhy/
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