BACKGROUND Cognitive frailty and depression are prevalent among the elderly,significantly impairing physical and cognitive functions,psychological well-being,and quality of life.Effective interventions are essential t...BACKGROUND Cognitive frailty and depression are prevalent among the elderly,significantly impairing physical and cognitive functions,psychological well-being,and quality of life.Effective interventions are essential to mitigate these adverse effects and enhance overall health outcomes in this population.AIM To evaluate the effects of exercise-cognitive dual-task training on frailty,cognitive function,psychological status,and quality of life in elderly patients with cognitive frailty and depression.METHODS A retrospective study was conducted on 130 patients with cognitive frailty and depression admitted between December 2021 and December 2023.Patients were divided into a control group receiving routine intervention and an observation group undergoing exercise-cognitive dual-task training in addition to routine care.Frailty,cognitive function,balance and gait,psychological status,and quality of life were assessed before and after the intervention.RESULTS After the intervention,the frailty score of the observation group was(5.32±0.69),lower than that of the control group(5.71±0.55).The Montreal cognitive assessment basic scale score in the observation group was(24.06±0.99),higher than the control group(23.43±1.40).The performance oriented mobility assessment score in the observation group was(21.81±1.24),higher than the control group(21.15±1.26).The self-efficacy in the observation group was(28.27±2.66),higher than the control group(30.05±2.66).The anxiety score in the hospital anxiety and depression scale(HADS)for the observation group was(5.86±0.68),lower than the control group(6.21±0.64).The depression score in the HADS for the observation group was(5.67±0.75),lower than the control group(6.27±0.92).Additionally,the scores for each dimension of the 36-item short form survey in the observation group were higher than those in the control group,with statistically significant differences(P<0.05).CONCLUSION Exercise-cognitive dual-task training is beneficial for improving frailty,enhancing cognitive function,and improving psychological status and quality of life in elderly patients with cognitive frailty and depression.展开更多
In daily functional activities,the body needs the ability to perform two or more tasks at the same time(such as talking while walking).However,the gait disorder of patients with Parkinson's disease is aggravated w...In daily functional activities,the body needs the ability to perform two or more tasks at the same time(such as talking while walking).However,the gait disorder of patients with Parkinson's disease is aggravated when performing dual tasks,which seriously affects their quality of life.Therefore,the medical management plan should offer effective exercise training programming to improve Parkinson's disease patients'ability to perform dual tasks.Most traditional exercise intervention methods only focus on the perspective of exercise or cognition,ignoring their interaction,and fail to adequately resolve the dual task obstacles associated with Parkinson's disease.Some scholars put forward the concept of dual-task training and have applied dual-task training to pa-tients with neurological disorders and have achieved good therapeutic effects.Therefore,this article summarizes the research literature concerning dual-task training to improve cognitive impairment and walking function of Parkinson's disease patients,to evaluate and discuss possible mechanisms of action,and provide a basis for adjuvant treatment and rehabilitation of Parkinson's disease patients.展开更多
Background Although previous studies have examined the effects of exercise training on other International Classification of Functioning,Disability and Health(ICF)component levels in persons with multiple sclerosis(MS...Background Although previous studies have examined the effects of exercise training on other International Classification of Functioning,Disability and Health(ICF)component levels in persons with multiple sclerosis(MS),the effects of exercise training on participation remain unclear.The objectives of this review were to:(1)characterize systematically the use of outcome measures that capture participation in exercise training studies;(2)quantify the effect of exercise training on participation in persons with MS.Methods A search of 6 electronic databases(CINAHL,SPORTDiscuss,Embase,MEDLINE,Cochrane Central,and Scopus)was conducted to identify controlled and noncontrolled trials involving exercise training and participation in persons with MS.Search strings were built from Medical Subject Headings and CINAHL headings.ICF linking rules were used to identify participation chapters and categories captured.Meta-analysis was used to quantify the effect of exercise training on participation in randomized controlled trials comparing exercise effects to no intervention/usual care.Results We included 49 articles involving controlled and noncontrolled exercise trials in the systematic review of outcome measures.We captured 16 different outcome measures that captured all 9 participation chapters and identified 89 unique participation categories.Across these 16 outcome measures,mobility was the most commonly represented participation chapter,with 108 items.A subsample of 23 randomized controlled trials was included in the meta-analysis.An overall effect of 0.60(standard error=0.12,95%confidence interval:0.36-0.84,z=4.9,p<0.001)was calculated,indicating a moderate,positive effect of exercise training on participation.Conclusion The current review provides information that can be used to guide the selection of outcome measures that capture participation in studies of exercise training in persons with MS.Exercise training has a positive effect on outcomes that capture participation,providing further evidence for the role of exercise training in promoting and maintaining engagement in everyday life.展开更多
The design of diabetes inpatient educational preparation should be based on the needs of the nurses involved in terms of skills in this area. The objective of this qualitative study is to identify the preparatory need...The design of diabetes inpatient educational preparation should be based on the needs of the nurses involved in terms of skills in this area. The objective of this qualitative study is to identify the preparatory needs of nurses working in the medical and surgical units of a Lebanese hospital in terms of Survival Skills Education for Hospitalized Diabetic Patients (SSEHDP). Method: The focus group method is used for data collection using a semi-structured interview guide. The needs expressed by the thirty-two participating nurses were classified into categories of the competency framework for providing self-management education to diabetic patients proposed by the American Diabetes Association. Results: By focusing on the themes of an SSEHDP, a list of preparatory needs was drawn up. The needs identified and analyzed are then translated into general and specific learning objectives for educational preparation. Conclusion: The needs analysis is only the first step in a work that will ideally continue into the implementation and eventual evaluation of an educational program developed to help nurses acquire skills in the education of diabetic patients.展开更多
In recent years,reinforcement learning-based aerial combat strategy design has shown significant advantages in decision-making efficiency and flexibility.However,improper opponent strategy selection during training ma...In recent years,reinforcement learning-based aerial combat strategy design has shown significant advantages in decision-making efficiency and flexibility.However,improper opponent strategy selection during training may hinder the agent's ability to handle diverse and complex scenarios,reducing the generalization and performance of its strategies.To address this,this paper proposes"IOS-RAFS",a framework that dynamically adjusts opponent levels at different stages to provide a more diverse and adaptive environment.In the IOS-RAFS training framework,IOS refers to intelligent opponent selection,RA represents the"Rule-AI"dual strategy libraries,which are established to enhance the flexibility and diversity of opponent strategies,and FS represents a fuzzy logic-based method for switching between opponent strategy libraries,periodically selecting the strategy library for the next training phase based on training trends and model performance.Finally,the effectiveness of the proposed algorithm is validated through comparisons with the landmark methods in aerial combat,namely,the genetic fuzzy tree(GFT)algorithm and the expert-designed weapon engagement zones(WEZs)algorithm,demonstrating a significant improvement in rewards and achieving a win rate of at least 82.3%.展开更多
Background The Registrar Clinical Encounters in Training(ReCEnT)project is an Australian general practice vocational training programme with integrated and interdependent education and research functions.Trainees(regi...Background The Registrar Clinical Encounters in Training(ReCEnT)project is an Australian general practice vocational training programme with integrated and interdependent education and research functions.Trainees(registrars)contemporaneously document in-consultation clinical experience and actions.Objectives Using a realist lens,we elucidate the mechanisms underpinning project outcomes to answer questions around programme effectiveness,impacts,sustainability and the lessons and findings that are translatable to other primary care training programmes.Methods The context,input,process and product framework was used.As a means to understand the interactions between each of the interdependent components,it allows for inferences regarding causal mechanisms for specific outcomes.Results Context:ReCEnT occurs within an apprenticeship-like model of general practice vocational training entailing a central supervisor/apprentice relationship.ReCEnT has demystified the content and characteristics of registrar consultations.Input:multiple stakeholder involvement is both advantageous and a logistical challenge,with the programme’s success dependent on registrars,practices and training providers providing detailed and accurate data,with prompt subsequent processing.Process:contemporaneous consultation data collection in different stages of training constitutes a component of registrars’programmatic assessment.Product:individualised feedback provides educational benefit through reflection.Clinical and educational research questions can be addressed with resulting research translation feeding back into the programme model and government policy.Clinical behaviour change is also evaluated.Conclusion ReCEnT is unique,globally,in its scope and longevity(2010–present).Creation of meaningful,individualised feedback facilitates reflection and provides both immediate educational benefits and the substrate for further research,programme and policy design and targeted formal teaching and learning.展开更多
Background: Mobility limitations and cognitive impairments which are common with ageing often coexist, causing a reduction in the levels of physical and mental activity and are prognostic of future adverse health even...Background: Mobility limitations and cognitive impairments which are common with ageing often coexist, causing a reduction in the levels of physical and mental activity and are prognostic of future adverse health events and falls. Consequently, multi-task training paradigms that simultaneously address both mobility and cognition benefit healthy ageing are important to consider in rehabilitation as well as primary prevention. Objectives: An exploratory RCT is being conducted to: a) describe the feasibility and acceptability of the study design and process, procedures, resources and management in two game-based dual-task training programs delivered in the community;b) to explore the lived experiences of the study participants who completed their respective exercise programs. A secondary objective is to obtain preliminary data on the therapeutic effectiveness of the two dual-task training programs. Methods: Thirty healthy older community dwelling participants aged 70 - 85 with previous history of falls will be recruited and randomized to either dual- task treadmill walking (experimental group) or dual-task recumbent bicycle (control group). Data analysis: The qualitative data will be analyzed by two investigators using a content analysis approach. For the quantitative data, outcome measures will be collected pre and post intervention and included measures to assess core balance, spatial-temporal gait variables, visual tracking and cognitive function, as well as, balance and gait analysis under dual-task conditions. Discussion: This research will demonstrate the feasibility of the dual-task training programs in the community, and demonstrate the system’s ability to improve targeted and integrated (dual-task) aspects of balance, mobility, gaze, and cognitive performance. A blended analysis of balance, mobility gaze and cognition will also contribute to a better understanding of the functional consequences of decline in physical and mental skills with age. Trial registration: This pilot clinical trial has been registered at ClinicalTrials.gov Protocol Registration System: NCT01940055.展开更多
文摘BACKGROUND Cognitive frailty and depression are prevalent among the elderly,significantly impairing physical and cognitive functions,psychological well-being,and quality of life.Effective interventions are essential to mitigate these adverse effects and enhance overall health outcomes in this population.AIM To evaluate the effects of exercise-cognitive dual-task training on frailty,cognitive function,psychological status,and quality of life in elderly patients with cognitive frailty and depression.METHODS A retrospective study was conducted on 130 patients with cognitive frailty and depression admitted between December 2021 and December 2023.Patients were divided into a control group receiving routine intervention and an observation group undergoing exercise-cognitive dual-task training in addition to routine care.Frailty,cognitive function,balance and gait,psychological status,and quality of life were assessed before and after the intervention.RESULTS After the intervention,the frailty score of the observation group was(5.32±0.69),lower than that of the control group(5.71±0.55).The Montreal cognitive assessment basic scale score in the observation group was(24.06±0.99),higher than the control group(23.43±1.40).The performance oriented mobility assessment score in the observation group was(21.81±1.24),higher than the control group(21.15±1.26).The self-efficacy in the observation group was(28.27±2.66),higher than the control group(30.05±2.66).The anxiety score in the hospital anxiety and depression scale(HADS)for the observation group was(5.86±0.68),lower than the control group(6.21±0.64).The depression score in the HADS for the observation group was(5.67±0.75),lower than the control group(6.27±0.92).Additionally,the scores for each dimension of the 36-item short form survey in the observation group were higher than those in the control group,with statistically significant differences(P<0.05).CONCLUSION Exercise-cognitive dual-task training is beneficial for improving frailty,enhancing cognitive function,and improving psychological status and quality of life in elderly patients with cognitive frailty and depression.
基金supported by National key R&D projects(2019YFF0301805)the Science and Technology Innovation Project of Dalian,China(ZX20180690).
文摘In daily functional activities,the body needs the ability to perform two or more tasks at the same time(such as talking while walking).However,the gait disorder of patients with Parkinson's disease is aggravated when performing dual tasks,which seriously affects their quality of life.Therefore,the medical management plan should offer effective exercise training programming to improve Parkinson's disease patients'ability to perform dual tasks.Most traditional exercise intervention methods only focus on the perspective of exercise or cognition,ignoring their interaction,and fail to adequately resolve the dual task obstacles associated with Parkinson's disease.Some scholars put forward the concept of dual-task training and have applied dual-task training to pa-tients with neurological disorders and have achieved good therapeutic effects.Therefore,this article summarizes the research literature concerning dual-task training to improve cognitive impairment and walking function of Parkinson's disease patients,to evaluate and discuss possible mechanisms of action,and provide a basis for adjuvant treatment and rehabilitation of Parkinson's disease patients.
基金provided by the Canadian Institutes of Health Research Canada Graduate Scholarshipsthe Michael Smith Foreign Study Supplement program (Funding number:162728)
文摘Background Although previous studies have examined the effects of exercise training on other International Classification of Functioning,Disability and Health(ICF)component levels in persons with multiple sclerosis(MS),the effects of exercise training on participation remain unclear.The objectives of this review were to:(1)characterize systematically the use of outcome measures that capture participation in exercise training studies;(2)quantify the effect of exercise training on participation in persons with MS.Methods A search of 6 electronic databases(CINAHL,SPORTDiscuss,Embase,MEDLINE,Cochrane Central,and Scopus)was conducted to identify controlled and noncontrolled trials involving exercise training and participation in persons with MS.Search strings were built from Medical Subject Headings and CINAHL headings.ICF linking rules were used to identify participation chapters and categories captured.Meta-analysis was used to quantify the effect of exercise training on participation in randomized controlled trials comparing exercise effects to no intervention/usual care.Results We included 49 articles involving controlled and noncontrolled exercise trials in the systematic review of outcome measures.We captured 16 different outcome measures that captured all 9 participation chapters and identified 89 unique participation categories.Across these 16 outcome measures,mobility was the most commonly represented participation chapter,with 108 items.A subsample of 23 randomized controlled trials was included in the meta-analysis.An overall effect of 0.60(standard error=0.12,95%confidence interval:0.36-0.84,z=4.9,p<0.001)was calculated,indicating a moderate,positive effect of exercise training on participation.Conclusion The current review provides information that can be used to guide the selection of outcome measures that capture participation in studies of exercise training in persons with MS.Exercise training has a positive effect on outcomes that capture participation,providing further evidence for the role of exercise training in promoting and maintaining engagement in everyday life.
文摘The design of diabetes inpatient educational preparation should be based on the needs of the nurses involved in terms of skills in this area. The objective of this qualitative study is to identify the preparatory needs of nurses working in the medical and surgical units of a Lebanese hospital in terms of Survival Skills Education for Hospitalized Diabetic Patients (SSEHDP). Method: The focus group method is used for data collection using a semi-structured interview guide. The needs expressed by the thirty-two participating nurses were classified into categories of the competency framework for providing self-management education to diabetic patients proposed by the American Diabetes Association. Results: By focusing on the themes of an SSEHDP, a list of preparatory needs was drawn up. The needs identified and analyzed are then translated into general and specific learning objectives for educational preparation. Conclusion: The needs analysis is only the first step in a work that will ideally continue into the implementation and eventual evaluation of an educational program developed to help nurses acquire skills in the education of diabetic patients.
基金supported in part by the National Natural Science Foundation of China under Grant 62293513/62293510in part by the Natural Science Foundation of Tianjin under Grant 22JCZDCJ00810in part by the Fundamental Research Funds for the Central Universities
文摘In recent years,reinforcement learning-based aerial combat strategy design has shown significant advantages in decision-making efficiency and flexibility.However,improper opponent strategy selection during training may hinder the agent's ability to handle diverse and complex scenarios,reducing the generalization and performance of its strategies.To address this,this paper proposes"IOS-RAFS",a framework that dynamically adjusts opponent levels at different stages to provide a more diverse and adaptive environment.In the IOS-RAFS training framework,IOS refers to intelligent opponent selection,RA represents the"Rule-AI"dual strategy libraries,which are established to enhance the flexibility and diversity of opponent strategies,and FS represents a fuzzy logic-based method for switching between opponent strategy libraries,periodically selecting the strategy library for the next training phase based on training trends and model performance.Finally,the effectiveness of the proposed algorithm is validated through comparisons with the landmark methods in aerial combat,namely,the genetic fuzzy tree(GFT)algorithm and the expert-designed weapon engagement zones(WEZs)algorithm,demonstrating a significant improvement in rewards and achieving a win rate of at least 82.3%.
文摘Background The Registrar Clinical Encounters in Training(ReCEnT)project is an Australian general practice vocational training programme with integrated and interdependent education and research functions.Trainees(registrars)contemporaneously document in-consultation clinical experience and actions.Objectives Using a realist lens,we elucidate the mechanisms underpinning project outcomes to answer questions around programme effectiveness,impacts,sustainability and the lessons and findings that are translatable to other primary care training programmes.Methods The context,input,process and product framework was used.As a means to understand the interactions between each of the interdependent components,it allows for inferences regarding causal mechanisms for specific outcomes.Results Context:ReCEnT occurs within an apprenticeship-like model of general practice vocational training entailing a central supervisor/apprentice relationship.ReCEnT has demystified the content and characteristics of registrar consultations.Input:multiple stakeholder involvement is both advantageous and a logistical challenge,with the programme’s success dependent on registrars,practices and training providers providing detailed and accurate data,with prompt subsequent processing.Process:contemporaneous consultation data collection in different stages of training constitutes a component of registrars’programmatic assessment.Product:individualised feedback provides educational benefit through reflection.Clinical and educational research questions can be addressed with resulting research translation feeding back into the programme model and government policy.Clinical behaviour change is also evaluated.Conclusion ReCEnT is unique,globally,in its scope and longevity(2010–present).Creation of meaningful,individualised feedback facilitates reflection and provides both immediate educational benefits and the substrate for further research,programme and policy design and targeted formal teaching and learning.
文摘Background: Mobility limitations and cognitive impairments which are common with ageing often coexist, causing a reduction in the levels of physical and mental activity and are prognostic of future adverse health events and falls. Consequently, multi-task training paradigms that simultaneously address both mobility and cognition benefit healthy ageing are important to consider in rehabilitation as well as primary prevention. Objectives: An exploratory RCT is being conducted to: a) describe the feasibility and acceptability of the study design and process, procedures, resources and management in two game-based dual-task training programs delivered in the community;b) to explore the lived experiences of the study participants who completed their respective exercise programs. A secondary objective is to obtain preliminary data on the therapeutic effectiveness of the two dual-task training programs. Methods: Thirty healthy older community dwelling participants aged 70 - 85 with previous history of falls will be recruited and randomized to either dual- task treadmill walking (experimental group) or dual-task recumbent bicycle (control group). Data analysis: The qualitative data will be analyzed by two investigators using a content analysis approach. For the quantitative data, outcome measures will be collected pre and post intervention and included measures to assess core balance, spatial-temporal gait variables, visual tracking and cognitive function, as well as, balance and gait analysis under dual-task conditions. Discussion: This research will demonstrate the feasibility of the dual-task training programs in the community, and demonstrate the system’s ability to improve targeted and integrated (dual-task) aspects of balance, mobility, gaze, and cognitive performance. A blended analysis of balance, mobility gaze and cognition will also contribute to a better understanding of the functional consequences of decline in physical and mental skills with age. Trial registration: This pilot clinical trial has been registered at ClinicalTrials.gov Protocol Registration System: NCT01940055.
