MATERIALS AND METHODS: During the period from 16 to 21 March 2007, outbreak investigations and active case finding were carried out among residents and nursing staff at the welfare home. Interviews and medical notes review were conducted to obtain epidemiological and clinical data. Hospitalised patients were tested for respiratory pathogens. Further genetic studies were also carried out on positive respiratory samples.
RESULTS: The overall clinical attack rate was 9.4% (17/180) in residents and 6.7% (2/30) in staff. All infected residents and staff had received influenza immunisation. Fifteen residents were hospitalised, with 2 developing severe complications. Genetic sequencing revealed that the outbreak strain had an 8.2% amino acid difference from B/Malaysia/2506/2004, the 2006 southern hemisphere influenza vaccine strain, which the residents and staff had earlier received.
CONCLUSIONS: A mismatch between the vaccine and circulating influenza virus strains can result in an outbreak in a highly immunised LTCF resident population. Active surveillance for acute respiratory illness in LTCFs could be implemented for rapid detection of antigenic drift. Enhanced infection control and other preventive measures can then be deployed in a timely manner to mitigate the effect of any outbreaks.
METHODS: PubMed, Embase, Web of Science, Cochrane Library, CBM, CNKI, Wan fang, and VIP databases were searched for studies published from inception to 2023, without language restrictions. Observational studies were included in this systematic review that analyzed risk factors for accidental falls in pre-frail older adults. The NOS scale was used to evaluate the quality of cohort studies and case-control studies, while the AHRQ scale was used to evaluate the quality of the cross-sectional study. We utilized odds ratios (OR) and their corresponding 95 % confidence intervals (CI) to describe the statistical indicators. OR and 95 % CI values were directly extracted and organized in Excel. In cases where OR and CI values were not directly available, we extracted β and p values, calculated Exp using functions, and subsequently derived OR and 95 % CI using formulas. Finally, data pertaining to each risk factor were incorporated into RevMan 5.4 software for statistical analysis and effect size synthesis. We performed tests for heterogeneity and evaluated publication bias.
RESULTS: A total of 14,370 studies were initially identified, and 26 studies were included in the systematic review. Among these studies, 14 were of high quality, while the remaining 12 were of moderate quality. A total of 16 risk factors were identified as potential risk factors for falls in pre-frail older adults. Significant risk factors were peripheral neuropathy(OR = 3.18, 95 %CI:3.02-3.35), decreased gait speed(OR = 1.90, 95 %CI:1.60-2.27), decreased ability to perform activities of daily living(OR = 1.57, 95 % CI:1.42-1.75), grip strength decreases(OR = 1.53, 95 % CI:1.17-2.00), gender (female)(OR = 1.51, 95 % CI:1.39-1.64), pain(OR = 1.47, 95 %CI:1.41-1.54), history of falls(OR = 1.20, 95 %CI:1.13-1.28) and age(OR = 1.10, 95 %CI:1.07-1.14).
CONCLUSIONS: The occurrence of falls in pre-frail older adults is associated with multiple risk factors. These risk factors can provide clinical nursing staff with specific focal points for monitoring this population and devising targeted fall prevention measures, with the aim of reducing the incidence of falls in pre-frail older adults.
REGISTRATION: The systematic review was registered on the International Prospective Register of Systematic Review (CRD42023450670).
DESIGN: In this phase III, double-blind, multicentre study, patients with endoscopically confirmed EO were randomised 1:1 to receive vonoprazan 20 mg or lansoprazole 30 mg, once daily for up to 8 weeks. The primary endpoint was EO healing rate at 8 weeks. The secondary endpoints were EO healing rates at 2 and 4 weeks. Safety endpoints included treatment-emergent adverse events (TEAEs).
RESULTS: In the vonoprazan (n=238) and lansoprazole (n=230) arms, 8-week EO healing rates were 92.4% and 91.3%, respectively (difference 1.1% (95% CI -3.822% to 6.087%)). The respective 2-week EO healing rates were 75.0% and 67.8% (difference 7.2% (95% CI -1.054% to 15.371%)), and the respective 4-week EO healing rates were 85.3% and 83.5% (difference 1.8% (95% CI -4.763% to 8.395%)). In patients with baseline Los Angeles classification grade C/D, 2-week, 4-week and 8-week EO healing rates were higher with vonoprazan versus lansoprazole (2 weeks: 62.2% vs 51.5%, difference 10.6% (95% CI -5.708% to 27.002%); 4 weeks: 73.3% vs 67.2%, difference 6.2% (95% CI -8.884 to 21.223); and 8 weeks: 84.0% vs 80.6%, difference 3.4% (95% CI -9.187% to 15.993%)). Overall, EO healing rates appeared higher with vonoprazan versus lansoprazole. TEAE rates were 38.1% and 36.6% in the vonoprazan and lansoprazole group, respectively.
CONCLUSION: Our findings demonstrate the non-inferior efficacy of vonoprazan versus lansoprazole in terms of EO healing rate at 8 weeks in this population. Safety outcomes were similar in the two treatment arms.
TRIAL REGISTRATION NUMBER: NCT02388724.
METHODS: We performed a double-blind, double-dummy, multicenter, phase 3 clinical trial among non-Japanese Asian adults with endoscopically confirmed healed EE from April 2015 to February 2019. Patients from China, South Korea, and Malaysia were randomized to vonoprazan 10 mg or 20 mg once daily or lansoprazole 15 mg once daily for 24 weeks. The primary endpoint was endoscopically confirmed EE recurrence rate over 24 weeks with a noninferiority margin of 10% using a two-sided 95% confidence interval (CI). Treatment-emergent adverse events (TEAEs) were recorded.
RESULTS: Among 703 patients, EE recurrence was observed in 24/181 (13.3%) and 21/171 (12.3%) patients receiving vonoprazan 10 mg or 20 mg, respectively, and 47/184 (25.5%) patients receiving lansoprazole (differences: -12.3% [95% CI, -20.3% to -4.3%] and -13.3% [95% CI, -21.3% to -5.3%], respectively), meeting the primary endpoint of noninferiority to lansoprazole in preventing EE recurrence at 24 weeks. Evidence of superiority (upper bound of 95% CI <0%) was also observed. At 12 weeks, endoscopically confirmed EE recurrence was observed in 5/18, 2/20, and 7/20 of patients receiving vonoprazan 10 mg, vonoprazan 20 mg, and lansoprazole, respectively. TEAEs were experienced by 66.8% (157/235), 69.0% (156/226), and 65.3% (158/242) of patients receiving vonoprazan 10 mg, vonoprazan 20 mg, and lansoprazole, respectively. The most common TEAE was upper respiratory tract infection in 12.8% (30/235) and 12.8% (29/226) patients in vonoprazan 10 mg and 20 mg groups, respectively and 8.7% (21/242) patients in lansoprazole group.
CONCLUSION: Vonoprazan maintenance therapy was well-tolerated and noninferior to lansoprazole for preventing EE recurrence in Asian patients with healed EE.
TRIAL REGISTRATION: https://clinicaltrials.gov; NCT02388737.