OBJECTIVE: To review the first 8-month outcome of the Common Mental Disorder Clinic model in Hong Kong in terms of patient exit status and improvement in depressive and anxiety symptoms.
METHODS: During the first appointment, patients were interviewed by a multidisciplinary team comprising a psychiatrist, a psychiatric nurse, and an occupational therapist. A multidisciplinary case conference was conducted to discuss clinical observations, diagnosis, issues of concern, and the optimal individualised treatment plan. Low-intensity interventions by nurses and/or occupational therapists were provided, as were optional, time-limited, protocol-based interventions by clinical psychologists for those with mild to moderate depressive and anxiety symptoms. Pharmacological intervention may be used when indicated. Upon completion of the treatment plan, patients were reassessed by the treating psychiatrist. Discharge options included discharge without psychiatric follow-up, step-up to psychiatric outpatient clinics, and step-down services. The self-administered Patient Health Questionnaire-9 (PHQ-9) and Generalised Anxiety Disorder 7-item scale (GAD-7) were used to assess the past 2 weeks\' depressive and anxiety symptoms, respectively, at baseline and at each session.
RESULTS: From July 2015 to February 2016, 1325 Chinese patients received the new service. Of them, 170 men and 363 women (mean age, 52.6 years) completed the treatment plan. After treatment, their mean PHQ-9 score decreased from 11.06 to 7.55 (p < 0.001), and the mean GAD-7 score decreased from 9.94 to 6.54 (p < 0.001). After treatment, 42.4% and 48.2% of the patients were within the normal range of PHQ-9 and GAD-7 scores, respectively, compared with 16.9% and 20.8% before treatment. The mean time to implementation of the individualised treatment plan was 82.33 days. Of the patients, 54.4% were discharged without any need for medical or psychiatric follow-up; 28% were stepped up to psychiatric outpatient clinics; and 17.3% were stepped down. The predictors of exit status were whether psychiatric medication was prescribed during initial intake (p = 0.011), whether psychiatric medication was prescribed at last follow-up (p < 0.001), the service period (p = 0.010), and the GAD-7 final score (p = 0.005).
CONCLUSIONS: The first 8-month outcome of the new service model was encouraging, with shortened waiting time, reduced severity of symptoms, and better exit status (high recovery and step-down rates).

To perform a systematic review and meta-analysis of studies comparing coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), and medical treatment (MT) in patients with chronic total occlusions (CTOs).
We identified eligible observational studies published in the China National Knowledge Infrastructure database, PubMed, Excerpta Medica database, Google Scholar, Cochrane Library, Web of Science, and \"Clinical trials\" registration from 1999 to October 2018. Main outcome measures were all-cause mortality, cardiac death, major adverse cardiac events (MACEs), and myocardial infarction (MI).
There were eight observational studies including 6985 patients. Patients\' mean age was 64.4 years. Mean follow-up time was 4.3 years. Comparing with MT (2958 patients), PCI (3157 patients) presented decreased all-cause mortality (odd ratio [OR]: 0.46, 95% confidence interval [CI]: 0.36-0.60; P<0.001), cardiac death (OR: 0.40, 95% CI: 0.31-0.52; P<0.001), MACE (OR: 0.55, 95% CI: 0.43-0.71; P<0.001), and MI (OR: 0.40, 95% CI: 0.26-0.62; P<0.001). Comparing with MT, CABG (613 patients) presented lower all-cause mortality (OR: 0.50, 95% CI: 0.36-0.69; P<0.001) and MACE (OR: 0.50, 95% CI: 0.26-0.96; P=0.04), but not lower MI (OR: 0.23, 95% CI: 0.03-1.54; P=0.13) and cardiac death (OR: 0.83, 95% CI: 0.51-1.35). Comparing with CABG, PCI did not present decreased risk for those outcomes.
PCI or CABG was associated with better clinical outcome in patients with CTO than MT. PCI is not better than CABG in decreasing mortality, MI, cardiac death, and MACE in coronary CTO patients.

OBJECTIVE: The aim of this systematic review was to compare patient-reported outcomes measures (PROMs) of implant-supported fixed complete dentures (IFCDs) and overdentures (IODs).
METHODS: PubMed, Cochrane Library, EMBASE, Scopus and Web of Science were searched, complemented by manual search. Studies published in English up to November 2016 comparing removable with fixed implant-supported prosthesis on fully edentulous patients were included. The review focused on impact on patients\' oral health-related quality of life (OHRQoL), satisfaction or other patient-reported outcomes measures.
RESULTS: Of 1,563 initially screened articles, 13 studies including 8 prospective and 5 retrospective studies fulfilled the inclusion criteria. OHRQoL and patient satisfaction were the most common PROMs. When evaluating the levels of evidence, five of thirteen studies were graded as level III and seven reached level II. The only randomized control trial was rated as Ib. The methods used to evaluate PROMs were heterogeneous among studies, and there was a lack of standardization in the measurements employed. In general, IFCD and IOD showed no significant differences when compared for PROMs, with a slight trend of IFCD being superior to IOD in most included studies. However, conflicting results were observed in many aspects such as chewing function, phonetics-related function, overall satisfaction and aesthetics.
CONCLUSIONS: Inconsistent results were observed in PROMs when comparing IFCD and IOD for fully edentulous patients. A guideline for standardizing the assessment of PROMs in clinical research is needed in order to produce more meaningful evidence-based information.

Objective: To assess the impact of Chinese Cervical Cancer Screening Program for Rural Area (NACCSPRA) on population-based screening rates. Methods: The subjects were selected from 2013-2014 Chinese Chronic Diseases and Risk Factors Surveillance (CDRFS2013), which adopting multi-stage stratified cluster sampling from 31 provinces. A total of 169 632 participants aged 18 years and older in 297 surveillance points were interviewed, of whom 65 476 women aged 35-64 years were included in the analysis. The surveillance points in CDRFS 2013 were divided into the screening areas and the control areas by matching points in CDRFS2014 with counties in NACCSPRA. The difference in socioeconomic status between areas was compared. The screening rates and 95% confidence interval (95%CI) were estimated by Tylar series variance method. The Propensity Score was evaluated for individuals by multivariate logistic regression and the greedy matching method based on propensity score value was used to conduct 1∶1 matching sample for the screening areas and the control areas. After matching, multivariate conditional logistic regression model was fitted to assess the impact of national cervical cancer screening intervention on the likelihood of undergoing cervical cancer screening at population level. Results: Among 65 476 subjects, 48.6% (n=31 794) was in the screening areas. Before matching, in the rural area the screening rate in the screening areas (24.0% (4 763/19 838), 95%CI: 21.8%-26.3%) was higher than that in the control areas (15.6% (2 331/14 942), 95%CI: 13.4%-17.8%); whereas in the urban area the screening rate in the screening areas (28.5% (3 413/11 956), 95%CI: 26.1%-31.0%) was similar to that in the control areas (26.3% (4 923/18 740), 95%CI: 24.1%-28.4%). After matching, in rural area the screening rate in the screening areas (23.2% (3 454/14 875), 95% CI: 20.9%-25.5%) was higher than that in the control areas (15.6% (2 315/14 875), 95% CI: 13.3%-17.8%); in urban area the screening rate in the screening areas (28.7% (3 202/11 146), 95% CI: 26.2%-31.2%) was higher than that in the control areas (23.1% (2 571/11 146), 95%CI: 20.9%-25.3%). Multivariate conditional logistic regression model showed that the cervical cancer screening rates in intervention areas significantly increased among women aged 35-64 years both in urban areas (OR=1.44, 95%CI: 1.34-1.54) and rural areas (OR=1.78, 95%CI: 1.67-1.90) as compared with those in control areas. Conclusion: The implementation of Chinese cervical cancer screening program during the five years substantially increased the population-based screening rates both in urban and rural areas.
目的： 评价中国农村地区子宫颈癌筛查项目实施5年对城乡子宫颈癌筛查率（以下简称\"筛查率\"）的影响。 方法： 对象来源于2013—2014年中国慢性病与危险因素监测，采用多阶段分层整群抽样，在中国内地31个省份调查了297个监测点的169 632名18岁及以上研究对象，本研究将其中的65 476名35~64岁女性纳入分析。依据2014年中国农村地区子宫颈癌筛查项目名单将监测点分为筛查地区与对照地区。比较不同地区社会经济水平差异；采用泰勒级数方差法估计筛查率的95%CI值；采用多因素logistic回归模型估计个体倾向评分值；采用贪婪匹配算法，根据个体的倾向评分值分别对筛查地区与对照地区调查对象进行1:1配对；采用多因素条件logistic回归模型分析子宫颈癌筛查对人群筛查率的影响。 结果： 65 476名研究对象中，筛查地区占48.6%（31 794名）。匹配前，筛查地区的农村筛查率为24.0%（4 763/19 838，95% CI：21.8%~26.3%），高于对照地区[15.6%（2 331/14 942，95%CI：13.4%~17.8%）]；筛查地区的城市筛查率为28.5%（3 413/11 956，95%CI：26.1%~31.0%），与对照地区相近[26.3%（4 923/18 740，95%CI：24.1%~28.4%）]。匹配后，筛查地区的农村筛查率为23.2%(3 454/14 875，95%CI：20.9%~25.5%），高于对照地区[15.6%(2 315/14 875，95%CI：13.3%~17.8%）]；筛查地区的城市筛查率为28.7%(3 202/11 146，95%CI：26.2%~31.2%），高于对照地区[23.1%(2 571/11 146，95%CI：20.9%~25.3%）]。多因素条件logistic回归模型分析显示，与对照地区相比，筛查地区城市（OR=1.44, 95%CI：1.34~1.54）和农村（OR=1.78, 95%CI：1.67~1.90）35~64岁人群子宫颈癌筛查率提高均有统计学意义。 结论： 中国子宫颈癌筛查项目实施5年对农村和城市地区人群筛查率均有提高作用。.

There is a paucity of data from large cohort studies examining the prognostic significance of obstructive sleep apnea (OSA) in patients with coronary artery disease. We hypothesized that OSA predicts subsequent major adverse cardiac and cerebrovascular events (MACCEs) in patients undergoing percutaneous coronary intervention.
The Sleep and Stent Study was a prospective, multicenter registry of patients successfully treated with percutaneous coronary intervention in 5 countries. Between December 2011 and April 2014, 1748 eligible patients were prospectively enrolled. The 1311 patients who completed a sleep study within 7 days of percutaneous coronary intervention formed the cohort for this analysis. Drug-eluting stents were used in 80.1% and bioresorbable vascular scaffolds in 6.3% of the patients, and OSA, defined as an apnea-hypopnea index of ≥15 events per hour, was found in 45.3%. MACCEs, a composite of cardiovascular mortality, nonfatal myocardial infarction, nonfatal stroke, and unplanned revascularization, occurred in 141 patients during the median follow-up of 1.9 years (interquartile range, 0.8 years). The crude incidence of an MACCEs was higher in the OSA than the non-OSA group (3-year estimate, 18.9% versus 14.0%; p=0.001). Multivariate Cox regression analysis indicated that OSA was a predictor of MACCEs, with an adjusted hazard ratio of 1.57 (95% confidence interval, 1.10-2.24; P=0.013), independently of age, sex, ethnicity, body mass index, diabetes mellitus, and hypertension.
OSA is independently associated with subsequent MACCEs in patients undergoing percutaneous coronary intervention. Evaluation of therapeutic approaches to mitigate OSA-associated risk is warranted.
URL: http://www.clinicaltrials.gov. Unique identifier: NCT01306526.

OBJECTIVE: Mechanisms, acute management, and outcomes for patients who experience intracerebral hemorrhage may differ from patients with ischemic stroke. Studies of very early rehabilitation have been mainly undertaken in patients with ischemic stroke, and it is unknown if benefits apply to those with intracerebral hemorrhage. We hypothesized that early rehabilitation, within 48 hours of stroke, would improve survival and functional outcomes in patients with intracerebral hemorrhage.
METHODS: This was a multicenter, randomized controlled study, with blinded assessment of outcome at 3 and 6 months. Eligible patients were randomized to receive standard care or standard care plus early rehabilitation. Primary outcome includes survival. Secondary outcomes includes health-related quality of life using the 36-item Short Form Questionnaire, function measured with the modified Barthel Index, and anxiety measured with the Zung Self-Rated Anxiety Scale.
RESULTS: Two hundred forty-three of 326 patients were randomized (mean age, 59 years; 56% men). At 6 months, patients receiving standard care were more likely to have died (adjusted hazard ratio, 4.44; 95% confidence interval [CI], 1.24-15.87); for morbidity outcomes, a 6-point difference in the Physical Component Summary score of the 36-item Short Form Questionnaire (95% CI, 4.2-8.7), a 7-point difference for the Mental Component Summary score (95% CI, 4.5-9.5), a 13-point difference in Modified Barthel Index scores (95% CI, 6.8-18.3), and a 6-point difference in Self-Rating Anxiety Scale scores (95% CI, 4.4-8.3) was reported in favor of the intervention groups.
CONCLUSIONS: For the first time, we have shown that commencing rehabilitation within 48 hours of intracerebral hemorrhage improves survival and functional outcomes at 6 months after stroke in hospitalized patients in China.
BACKGROUND: http://www.chictr.org/en. Unique identifier: ChiCTR-TRC-13004039.