Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-05-14 Cooperative journals: 《中国全科医学》
Abstract： Day care service is an important component of the community care service system for elderly people with dementia. However，the concept of dementia day care has not been unified，and its connotation and implementation framework have not been clarified，which greatly affects the continuous construction and high-quality service supply of dementia day care service. The Walker classic concept analysis method was used and five attributes of the concept was introduced including（1） daytime intensive，non-residential care；（2）professional coordination and integrated care focused on families with dementia； （3）public respite care support for families with dementia；（4）a crucial complement to high-quality care for dementia；（5） a driving force in promoting a dementia-friendly community. The preconditions of dementia day care include high care needs， weakened family functions and the dominant role of public care，and the consequences involve dementia，family caregivers and social welfare. The implementation factors identification，implementation strategy design，implementation and effect evaluation were carried out respectively using the consolidated framework for implementation research，the replicating effective programs implementation framework and the RE-AIM evaluation framework in the field of implementation science. The specialization， high quality，integrated care，and the philosophy of the friendly community should be highlighted in the future development of dementia day care. The service content，facilities and implementation process need to be improved to promote the quality of dementia day care service.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-03-11 Cooperative journals: 《中国全科医学》
Abstract： Background Cardiotoxicity is a leading cause of mortality among breast cancer survivors and patients，making early risk assessment vital for the clinical prevention and treatment of cardiac toxicity. However，there is currently a lack of recognized tools for assessing the risk of cardiotoxicity in breast cancer chemotherapy patients in China. Objective To develop a cardiotoxic risk assessment scale for breast cancer patients undergoing chemotherapy and test its reliability and validity. Methods To develop a risk assessment scale for cardiotoxicity in breast cancer chemotherapy patients and to test its reliability and validity. Results Twenty medical staff experts were included in the semi-structured interviews. After two rounds of expert consultations，a 19-item risk assessment scale for cardiotoxicity in breast cancer chemotherapy patients was developed. In this study，there were 79 patients in the low-score group and 83 in the high-score group. Comparisons of endocrine treatment history and immunotherapy history showed no statistically significant differences between the two groups（P>0.05）. Correlation analysis showed that smoking history and immunotherapy history were not significantly correlated with total scores（P>0.05）. Eventually，three items-"smoking history，"endocrine treatment history" and "immunotherapy history"-were removed，resulting in a 16-item scale. The scale's Cronbach's alpha coefficient was 0.739; test-retest reliability was 0.983; inter-rater reliability was 0.984. The content validity results showed: I-CVI ranged from 0.83 to 1.00; S-CVI was 0.98. Predictive validity results showed: the scale's AUC was 0.887（95%CI=0.827-0.947，P<0.001），with a cut-off value of 32.50 points，Youden's index was 0.649，specificity was 89.1%，and sensitivity was 75.9%. Exploratory factor analysis results showed a KMO value of 0.700，and Bartlett's test of sphericity χ2value was 1037.898（df=120，P<0.001）. The study extracted five common factors with a cumulative variance contribution rate of 61.991%. Risk stratification results indicated scores of 32-38 points as low risk，39-56 points as medium risk，and ≥ 57 points as high risk. Conclusion The cardiotoxicity risk assessment scale for breast cancer patients undergoing chemotherapy has good reliability and validity，which can better predict the high-risk population of cardiotoxicity and provide an effective assessment tool for clinicians and nurses to effectively identify the high-risk population of breast cancer patients undergoing chemotherapy.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-02-19 Cooperative journals: 《中国全科医学》
JIANG Xiaoman
XU Xinyi
DING Lingyu
GUO Yinning
MIAO Xueyi
JIANG Xiaoman, XU Xinyi, DING Lingyu, GUO Yinning, MIAO Xueyi, CHEN Li, XU Qin
JIANG Xiaoman, XU Xinyi, DING Lingyu, GUO Yinning, MIAO Xueyi, CHEN Li, XU Qin
Abstract： Background Frailty and metabolic syndrome（MetS）are both common geriatric conditions and may have potentially important links in terms of risk factors，body composition，and metabolic mechanisms，which could jointly affect the prognosis of older patients with gastric cancer. Clearly distinguishing the characteristics of the two syndromes and elucidating their intrinsic relationship can help to develop precise and targeted preoperative management strategies. Objective To compare the characteristics of preoperative frailty and MetS in older patients with gastric cancer，focusing on general information，blood indicators，and body compositions，and analyze their correlation. Methods A total of 286 patients aged 60 to 80 years who were admitted to the gastrosurgery department of the First Affiliated Hospital of Nanjing Medical University for gastric malignancy from August 2021 to August 2022 were included and divided into the four groups：the frailty group（n=45），the MetS group（n=58），the frailty+MetS group（n=12），and the normal group（n=171）based on the presence of frailty and MetS，and the clinical indicators of these groups were compared. With frailty as the dependent variable，Logistic regression analysis was conducted to investigate the correlation of MetS and its diagnostic indicators with preoperative frailty. Results Statistically significant differences were observed among the four groups in terms of age，comorbidities，Nutritional Risk Screening 2002（NRS2002）scores>3，fasting blood glucose，triglyceride，high-density lipoprotein cholesterol（HDL-C），C-reactive protein，hemoglobin，albumin，height，body mass，waist circumference，BMI，fat content，fat mass index，body fat percentage，visceral fat area，skeletal muscle content，skeletal muscle mass index，limb skeletal muscle mass index，muscle percentage，fat to muscle ratio，and muscle to fat ratio（P<0.05）. Multivariate Logistic regression analysis showed that age（OR=1.115，95%CI=1.046-1.190），history of smoking（OR=2.156，95%CI=1.134-4.096），NRS2002 score>3（OR=2.359，95%CI=1.159-4.802），CRP（OR=1.038，95%CI=1.003-1.073），and central obesity（OR=0.405，95%CI=0.183-0.896） were the risk factors for frailty in older patients with gastric cancer（P<0.05）. Conclusion The frailty group showed advanced age，elevated levels of inflammation，and increased nutritional risk，along with an overall decline in fat and muscle composition. The MetS group showed increased comorbidities，elevated inflammation and albumin levels，abnormal markers of glycolipid metabolism，and overall increased fat and muscle composition. The frailty+MetS group had increased comorbidities，abnormal fasting blood glucose and HDL-C levels，with increases only in fat-related components but no significant changes in muscle components. Thus，frailty was not significantly associated with MetS in this study.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-02-05 Cooperative journals: 《中国全科医学》
Abstract： Background Nowadays，cardiac rehabilitation is mostly transferred from the hospital to a home environment. Mobile health applications assist patients in bridging the support gap from hospital to home environment，which encourages home-based recovery processes. Unfortunately，numerous quality difficulties accompany its promise，and the service quality of cardiac rehabilitation applications must be 〝confirmed〞 as soon as possible. Objective To develop a quality assessment indicator system for home-based rehabilitation APP services for heart failure patients，and to provide a model for standardizing and increasing the quality of mobile health APP. Methods This study was conducted from July 2022 to February 2023，using semi-structured interviews，literature review，the expert consultation method and analytic hierarchy process（AHP） to determine the content of indicator system and the weight for each index. Results 2 rounds of expert consultations resulted in the effective response rates of 100%，with the authority coefficients of 0.867，and the coordination coefficients of 0.128- 0.154 and 0.151-0.197 respectively（P<0.001）. As a result，an assessment indicator system for home-based rehabilitation APP services for heart failure patients was developed from three dimensions：software usability，medical professionalism，and behavioral science，with 7 primary indicators，24 secondary indicators，and 51 tertiary indicators. Conclusion The developedquality assessment indicator system for home-based rehabilitation APP services for heart failure patients is comprehensive and scientific，and can be useful for assessing and measuring the quality of heart rehabilitation APP services，as well as facilitating the benign development of similar APP services.
Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2023-09-27 Cooperative journals: 《中国全科医学》
Abstract： Food intake disorders are costly to treat，with an increasing prevalence over the years，and a higher risk of mortality compared to other psychiatric disorders. Avoidant/restrictive food intake disorder（ARFID），as a relatively new type of food intake disorder，is more prevalent in children and adolescents than in other age groups，affecting their normal growth and development，as well as psychosocial functioning. Currently，there are more foreign studies，while domestic studies are still in the initial stage. Therefore，this paper reviews the diagnostic criteria，assessment tools，influencing factors and treatment approaches for ARFID in children and adolescents，with the aim of providing a reference for related research in China.
Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2023-06-16 Cooperative journals: 《中国全科医学》
Abstract： Background Previous studies have shown that self-rated health would be used as a simple assessment indicator for frailty，and individuals with poor self-rated health status are at higher risk of frailty. However，the association between self-rated health and frailty may be different and the effectiveness of self-rated health in frailty assessment may vary in apathetic older adults. Objective To explore the moderating role of apathy in the association between self-rated health and frailty among community-dwelling older adults，so as to provide theoretical guidance for the application of the self-rated health in the assessment of frailty in apathetic older adults. Methods From November 2021 to March 2022，a total of 384 community dwelling older adults were selected as respondents by convenience sampling method，including 179 cases in Nanjing communities and 205 cases in Donghai Communities. Questionnaire surveys were conducted using the General Information Questionnaire，Fried Frailty Phenotyp（FFP），Geriatric Depression Scale（GDS-3），and the self-reported health（SRH）. Generalized linear model was used to analyze the association between self-rated health and frailty of community-dwelling older adults. The model 1 of the SPSS macro program process compiled by Hayes was used to analyze the moderating role of apathy on the association between the self-rated health and frailty，with simple slope analyze performed and simple slope graphs plotted. Results The median FFP and SRH item scores of 384 community-dwelling older adults were 1.00（2.00）and 4.00（1.00），respectively， with the detection rate of apathy of 55.5%（213/384）. The results of the generalized linear model showed that the relationship between the self-rated health and frailty of community-dwelling older adults was significant（b=0.310，P<0.001）. The results of the moderating effect test showed that apathy played a moderating role in the relationship between self-rated health status and frailty in community-dwelling older adults（b=0.355，t=3.074，P=0.002），and the results of simple slope analysis showed that the simple slope of the non-apathy group and apathy group was 0.100（t=1.209，P=0.228）and 0.455（t=5.206，P<0.001），respectively. Conclusion There is an association between self-rated health and frailty in community-dwelling older adults，and the application of the self-rated health can help community health workers assess frailty in older adults. Apathy plays a moderating role in the relationship between self-rated health and frailty. Compared with the non-apathetic older adults，the association between self-rated health and frailty was significant in apathetic older adults. Strengthening the self-rated health assessment of older adults is beneficial to the identification of their frailty.
Hits
Hits
Downloads
Comment