BACKGROUND Nosocomial fever of unknown origin(nFUO)is a frequent and challenging diagnostic entity,encompassing diverse infectious and non-infectious etiologies.Timely identification is crucial,yet evidence on the dia...BACKGROUND Nosocomial fever of unknown origin(nFUO)is a frequent and challenging diagnostic entity,encompassing diverse infectious and non-infectious etiologies.Timely identification is crucial,yet evidence on the diagnostic accuracy of commonly employed sepsis screening tools and biomarkers remains sparse.We hypothesized that these tools and biomarkers measured at fever onset could distinguish infectious from non-infectious causes of nFUO in critically ill adults.AIM To evaluate the diagnostic utility of sepsis tools and biomarkers in identifying infectious causes of nFUO.METHODS This prospective observational study included patients admitted to the Acute Care Emergency Medicine Unit,Postgraduate Institute of Medical Education and Research,Chandigarh,India(July 2023 to December 2024).nFUO was defined by Durack and Street criteria.Diagnostic performance of sepsis screening tools(systemic inflammatory response syndrome,Sequential Organ Failure Assessment,quick Sequential Organ Failure Assessment,National Early Warning Score,and Modified Early Warning Score)and biomarkers[procalcitonin(PCT),C-reactive protein(CRP)]at fever onset was assessed using receiver operating characteristic curve analysis.RESULTS Of 80 cases(mean age 42.9±16.5 years;80% male),42.5% had infectious causes,38.7% non-infectious,and 18.8% remained undiagnosed.Pneumonia(26.2%)and bloodstream infections(11.2%)were the most common infectious etiologies,while central fever and thrombophlebitis(each 7.5%)were predominant among non-infectious causes.Sepsis tools showed poor diagnostic accuracy,with area under the receiver operating characteristic curve(AUC)values close to 0.5.PCT demonstrated modest performance(AUC=0.61;optimal cut-off:0.85μg/L),while CRP was paradoxically higher in non-infectious cases(AUC=0.45).Overall mortality was 20% and was highest among undiagnosed patients(33.3%).Fever duration and hospitalization length were significantly greater in infectious cases.CONCLUSION Sepsis tools,PCT,and CRP have limited utility in identifying infectious causes of nFUO in critically ill adults and should not solely guide initial decision-making.展开更多
BACKGROUND Motoric cognitive risk(MCR)syndrome represents an“ultra-early”stage of dementia prevention,highlighting the need for effective screening tools.AIM To develop and validate a novel tool for MCR identificati...BACKGROUND Motoric cognitive risk(MCR)syndrome represents an“ultra-early”stage of dementia prevention,highlighting the need for effective screening tools.AIM To develop and validate a novel tool for MCR identification,comparing its effectiveness with existing methods.METHODS As part of a community study on healthy aging,a cross-sectional study recruited 1189 Chinese participants aged 50 years and older between May 1,2022,and March 15,2023.The cohort was randomly split into training(70%)and testing(30%)datasets.Relevant features were selected for logistic regression(LR)and decision tree(DT)models using the training dataset,and their performance was subsequently assessed using the testing dataset to validate reliability and generalizability.RESULTS The prevalence of MCR was 13.12%among 1189 participants.DT models had the area under the curves(AUCs)of 0.834 and 0.821 for training and testing datasets,respectively,while LR models indicated AUCs of 0.840 and 0.859.Non-inferiority tests confirmed the DT model’s comparable effectiveness to the LR models in predicting MCR.Both models demonstrated good calibration and clinical utility.Seven modifiable risk factors were identified:Age,education level,social engagement,physical activity,nutritional status,depressive symptoms,and purpose in life.Notably,social engagement emerged as a novel factor compared to those previously identified.Both models are integrated into an easy-to-use,interpretable web-based user interface.CONCLUSION The interactive,web-based user interface of both models effectively identifies MCR,with the DT model recommended for its simplicity and interpretability,supporting community nurses and clinicians in triaging MCR.展开更多
School-based universal screening for behavioral/emotional risk is a necessary first step to providing services in an educational setting for students with emotional and behavioral disorders (EBDs). Psychometric proper...School-based universal screening for behavioral/emotional risk is a necessary first step to providing services in an educational setting for students with emotional and behavioral disorders (EBDs). Psychometric properties are critical to making decisions about choosing a screening instrument. The purpose of the present study was to examine the psychometric properties of the student risk screening scale for internalizing and externalizing behaviors (SRSS-IE). Participants included 3145 students and their teachers. Item-level analyses of the current sample supported the retention of all items. The internal consistency of the SRSS items ranged from 0.83 to 0.85. Convergent validity between the SRSS-IE and a well-established screening tool, the strength and difficulties questionnaire (SDQ), was found for the total score (r = 0.70). Additionally, the results of this study demonstrate strong social validity, suggesting the SRSS-IE to be a useful and functional screening tool. We conclude that the SRSS-IE is a valid and reliable instrument for assessing the level of emotional and behavioral difficulties among elementary students.展开更多
Borderline personality disorder, conversion disorder and obsessive compulsive disorder frequently have dissociative symptoms. The literature has demonstrated that the level of dissociation might be correlated with the...Borderline personality disorder, conversion disorder and obsessive compulsive disorder frequently have dissociative symptoms. The literature has demonstrated that the level of dissociation might be correlated with the severity of obsessive compulsive disorder(OCD) and that those not responding to treatment had high dissociative symptoms. The structured clinical interview for DSM-IV dissociative disorders, dissociation questionnaire, somatoform dissociation questionnaire and dissociative experiences scale can be used for screening dissociative symptoms and detecting dissociative disorders in patients with OCD. However, a history of neglect and abuse during childhood is linked to a risk factor in the pathogenesis of dissociative psychopathology in adults. The childhood trauma questionnaire-53 and childhood trauma questionnaire-40 can be used for this purpose. Clinicians should not fail to notice the hidden dissociative symptoms and childhood traumatic experiences in OCD cases with severe symptoms that are resistant to treatment. Symptom screening and diagnostic tools used for this purpose should be known. Knowing how to treat these pathologies in patients who are diagnosed with OCD can be crucial.展开更多
In this article,we comment on the article by Blüthner et al.The article provides a comprehensive analysis of the factors contributing to the late detection of Crohn’s disease and ulcerative colitis within a Germ...In this article,we comment on the article by Blüthner et al.The article provides a comprehensive analysis of the factors contributing to the late detection of Crohn’s disease and ulcerative colitis within a German cohort.It highlights the conse-quences on patient outcomes,particularly disease progression and the increased risk of developing complications.The study identifies specific predictors asso-ciated with both patient-related and physician-related delays,offering a detailed exploration of the initial approach.Additionally,the article delves into the distinct patterns observed in the German population,stressing the unique aspects of diagnostic delays that may differ from those reported in other regions.This detailed examination offers valuable insights into the specific challenges faced within the German healthcare system and underscores the necessity of targeted interventions to facilitate early diagnosis.The importance of improved screening tools,patient education,and better healthcare infrastructure is emphasized as crucial steps toward improving patient care in inflammatory bowel disease.展开更多
Objective： Correct nutritional assessment is essential for leukemia patients after hematopoietic stem cell transplantation （HSCT）. This study aimed to investigate the best nutritional assessment method for leukemia...Objective： Correct nutritional assessment is essential for leukemia patients after hematopoietic stem cell transplantation （HSCT）. This study aimed to investigate the best nutritional assessment method for leukemia patients after HSCT, and find the possible nutritional risk of the patients during the transplantation process in order to intervene in the patients with nutritional risks and undernourished patients timely, so that the entire transplantation process could be successfully completed. Methods： A prospective study was performed in 108 leukemia patients after HSCT, and different nutritional assessment methods, including nutritional risk screening 2002 （NRS2002）, mini nutritional assessment （MNA）, subjective globe assessment （SGA） and malnutritional universal screening tools （MUST）, were used. The associations between nutritional status of these patients and nutritional assessment methods were analyzed. Results： A total of 108 patients completed SGA, and 99 patients completed NRS2002, MNA and MUST. During the treatment process, 85.2% of the patients lost weight, wherein, 50% lost weight greater than 5%, and 42.6% had significantly reduced food intake. For nutritional risk assessment, the positive rates of NRS2002, MNA and MUST were 100%, 74.7% and 63.6%, respectively. There was a significant difference （P〈0.05） among the positive rates of NRS2002, MNA and MUST. In undernutrition assessment, the positive rate of SGA （83.3%） was significantly higher than that of MNA （17.2%） （P〈0.05）, and the incidence rate of nutritional risk among leukemia patients _〈30 years old was greater than that of patients 〉30 years old （P〈0.05）. Conclusions： Patients with leukemia were in poor nutritional status during and after HSCT. The leukemia patients 〈30 years old had a greater incidence rate of nutritional risk. As nutritional risk screening tool, the specificity of NRS2002 is not high, but it can be used for evaluating nutritional deficiencies. MNA is a good nutritional risk screening tool, but not an adequate tool for nutritional assessment. If assessment of undernutrition is necessary, the combination of all these screening tools and clinical laboratory indicators should he applied to improve accuracy.展开更多
Currently,there is a lack of sepsis screening tools that can be widely used worldwide.Pulmonary sepsis can be of sufficient concern to physicians due to their noticeable symptoms,which usually rely less on screening t...Currently,there is a lack of sepsis screening tools that can be widely used worldwide.Pulmonary sepsis can be of sufficient concern to physicians due to their noticeable symptoms,which usually rely less on screening tools.AIM To investigate the efficiency of the international normalized ratio(INR)for the early rapid recognition of adult nonpulmonary infectious sepsis.METHODS This is a prospective observational study.A total of 108 sepsis patients and 106 nonsepsis patients were enrolled according to relevant inclusion and exclusion criteria.Commonly used clinical indicators,such as white blood cell,neutrophil count,lymphocyte count,neutrophil-lymphocyte count ratio(NLCR),platelets(PLT),prothrombin time,INR,activated partial thromboplastin time,and quick Sequential“Sepsis-related”Organ Failure Assessment(qSOFA)scores were recorded within 24 h after admission.The diagnostic performances of these clinical indicators were analyzed and compared through multivariate logistic regression analysis,Spearman correlation,and receiver operating characteristic curve analysis.The INR value of the sepsis group was significantly higher than that of the nonsepsis group.INR has superior diagnostic efficacy for sepsis,with an area under the curve value of 0.918,when those preexisting diseases which significantly affect coagulation function were excluded.The diagnostic efficacy of the INR was more significant than that of NLCR,PLT,and qSOFA(P<0.05).Moreover,INR levels of 1.17,1.20,and 1.22 could be used to categorize the relative risk of nonpulmonary infections sepsis into three categories:low,medium and high risk,respectively.CONCLUSION The INR is a promising and easily available biomarker for diagnosis,and it can be used as one of the indicators for early screening of adult nonpulmonary infectious sepsis.When its value is higher than the optimal cutoff value(1.22),high vigilance is required for adult nonpulmonary infectious sepsis.展开更多
Objective According to literature,cancer patients have the highest incidence of malnutrition among hospital patients(40%-80%).Despite this high prevalence,this condition is still under-diagnosed.The aim of this study ...Objective According to literature,cancer patients have the highest incidence of malnutrition among hospital patients(40%-80%).Despite this high prevalence,this condition is still under-diagnosed.The aim of this study was to conduct a systematic literature review and meta-analysis to assess the diagnostic performance of the Malnutrition Screening Tool(MST),a simple tool that can be applied in a busy setting where a comprehensive assessment at screening would be impractical.Methods PubMed,EMBASE and Cochrane central register of controlled trials were systematically searched to identify records relevant to the research question.The QUADAS-2 was used to assess the quality of each included study and the meta-analysis was conducted using the hierarchical bivariate model in STATA.Results Seven records were included in this study and the overall sensitivity specificity,diagnostic odds ratio(DOR).The pooled sensitivity and specificity generated after the meta-analysis in STATA were 0.78(95%CI:0.64-0.88)and 0.82(95%CI:0.76-0.87),respectively.The corresponding DOR was 16.33(95%CI:7.08-37.67).The positive likelihood ratio(LR+)was+4.39(95%CI:3.02-6.38),and the negative likelihood ratio(LR-)were 0.27(95%CI:0.16-0.47)and the 1/LR-3.72(2.14-6.46).Conclusion These results showed that the MST provides weak diagnostic evidence when used to screen for malnutrition in adult cancer patients.展开更多
In a study published in the current issue of the Journal of Geriatric Cardiology, Ang and co-investigators used the highresolution 64-slice CT coronary angiography to detect coronary lesions in a group of patients... In a study published in the current issue of the Journal of Geriatric Cardiology, Ang and co-investigators used the highresolution 64-slice CT coronary angiography to detect coronary lesions in a group of patients with atypical angina.1 The clinical data of these patients were also used to calculate their risk according the Framingham and PROCAM scoring system.2,3 As the cohort is composed with a majority of low risk patients with atypical angina, only a small minority of the patients were classified as having medium and high risk. The results showed that MDCT uncovered 18% either significant lesions (＞50% stenosis) or calcifications (＞400Agatston units)in the low risk patients and 33% in the medium and high risk subgroups.……展开更多
BACKGROUND Premenstrual syndrome(PMS)is the constellation of physical and psychological symptoms before menstruation.Premenstrual dysphoric disorder(PMDD)is a severe form of PMS with more depressive and anxiety sympto...BACKGROUND Premenstrual syndrome(PMS)is the constellation of physical and psychological symptoms before menstruation.Premenstrual dysphoric disorder(PMDD)is a severe form of PMS with more depressive and anxiety symptoms.The Mini international neuropsychiatric interview,module U(MINI-U),assesses the diagnostic criteria for probable PMDD.The Premenstrual Symptoms screening tool(PSST)measures the severity of these symptoms.AIM To compare the PSST ordinal scores with the corresponding dichotomous MINI-U answers.METHODS Arab women(n=194)residing in Doha,Qatar,received the MINI-U and PSST.Receiver Operating Characteristics(ROC)analyses provided the cut-off scores on the PSST using MINI-U as a gold standard.RESULTS All PSST ratings were higher in participants with positive responses on MINI-U.In addition,ROC analyses showed that all areas under the curves were significant with the cutoff scores on PSST.CONCLUSION This study confirms that the severity measures from PSST can recognize patients with moderate/severe PMS and PMDD who would benefit from immediate treatment.展开更多
Background: Zimbabwe recorded a 55% increase in HIV testing from 2011 to 2018 but with decreasing HIV-testing yields from 20% to 6% respectively as we aim to identify the narrowing gap of undiagnosed people living wit...Background: Zimbabwe recorded a 55% increase in HIV testing from 2011 to 2018 but with decreasing HIV-testing yields from 20% to 6% respectively as we aim to identify the narrowing gap of undiagnosed people living with HIV. As such adoption of screening tools during targeted HIV testing services improves efficiency by identifying individuals who are likely to test positive. Effective utilization of screening tools requires an understanding of health care worker perception and willingness to use the tools. Methods: We conducted a qualitative study among healthcare workers at 8 selected primary healthcare facilities in Zimbabwe. Interviewer-guided, in-depth interviews were conducted with healthcare workers and their immediate supervisors. Thematic analysis was performed following a framework built around the grounded theory model to describe perspectives that influence the utilization of HIV screening tools and suggestions for improved eligibility screening. Results: Behavioural factors facilitating the utilisation of the screening tool included motivation to adhere to standard practice, awareness of screening in targeting testing, and its ability to manage workload through screening out ineligible clients. This was evident across service delivery levels. Barriers included limited healthcare capacity, confidentiality space, multiple screening tools and opaque screening in/out criteria and the potential of clients not responding to screening questions truthfully. Conclusions: Across geographical and service delivery levels, placing screening tools at HIV testing entry points, healthcare worker knowledge on screening in/out criteria emerged as enablers for correct and consistent utilization. Further, standardizing the tools and adopting a decision aid algorithm would improve the accurate utilisation of screening tools.展开更多
Malnutrition is common, and is a significant contributing factor to morbidity and mortality in the oncology setting. Previous research suggests that dietetic services in rural oncology clinics need to be well organize...Malnutrition is common, and is a significant contributing factor to morbidity and mortality in the oncology setting. Previous research suggests that dietetic services in rural oncology clinics need to be well organized, timely and flexible with routine screening processes. In the absence of routine nutrition screening, it is hypothesized that oncology patients are only referred to dietetic services when malnutrition is overt or advanced. The aim of this study was to describe and compare dietetic services in two rural Australian oncology clinics and investigate nutrition screening and referral practices to determine if oncology patients at nutritional risk were appropriately referred. A retrospective file audit of medical and treatment records was conducted for a sample of oncology patients to determine the proportion of patients at risk of malnutrition by using the Malnutrition Screening Tool retrospectively. Dietetic treatment statistics and key stakeholders were consulted to compare dietetic service provision across the two sites. Seventy-eight percent of patients (n = 129) were retrospectively determined to be at nutritional risk during the study period, however, only 66% of these patients were referred to a dietitian. Dietetic treatment statistics varied across the two sites ranging from 26 to 62 treated patients, an average of 2.4 to 4.5 dietetic interventions per patient and an average difference in patient intervention time of 62 minutes during the 12-month study period. This study confirmed findings from previous research, highlighting that without routine nutrition screening in oncology, at least one third of patients at nutritional risk were failing to be identified and referred to dietetic services for appropriate treatment. Routine nutrition screening should be implemented to standardise and prioritise dietetic service provision, and oncology specific funding should be allocated to the dietetic service to ensure that staffing is adequate to provide a timely service.展开更多
Flood risk analysis is the instrument for local officials to create a sound strategy and adaptation plans for the impacts of inundation due to heavy rains, climate change and sea level rise. Hence, cities with aging i...Flood risk analysis is the instrument for local officials to create a sound strategy and adaptation plans for the impacts of inundation due to heavy rains, climate change and sea level rise. Hence, cities with aging infrastructure are retrofitting their stormwater management systems to mitigate the impacts. However determining the most at risk areas and the options for corrections is more challenging. As a result, there is an urgent need to develop a screening tool to analyze watersheds and identify the most at-risk areas. High-quality, open source data and sophisticated spatial analysis techniques allow engineers to create innovative ways to conduct watershed wide inundation analysis. In th</span><span style="font-family:Verdana;">is study, the investigators developed </span></span></span></span><span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">a </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">screening tool to identify at-ri</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">sk properties by combining readily available data on topography, groundwater, surface water, tidal information for coastal communities, soils, open space, and rainfall data. Once the screening tool is developed, the means to identify and prioritize improvements to be funded with scarce capital funds is the next step.</span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">A tool box of solutions was developed to address flood risk and vulnerability. Testing of the screening tool was conducted in Browa</span><span style="font-family:Verdana;">rd County, Florida and shows encouraging results. Comparison wit</span><span style="font-family:Verdana;">h FEMA Flood maps and repetitive loss mapping indicates that the process works in a coastal community. The framework appears to be viable across cities that may be inundated with water due to sea-level rise, rainfall, runoff upstream, and other natural events.展开更多
Cerebral venous thrombosis(CVT)is a rare condition that can be fatal in severe cases.The limited occurrence of CVT poses challenges in conducting randomized controlled trials,leading to uncertainty regarding the effec...Cerebral venous thrombosis(CVT)is a rare condition that can be fatal in severe cases.The limited occurrence of CVT poses challenges in conducting randomized controlled trials,leading to uncertainty regarding the effectiveness of endovascular thrombectomy(EVT)in specific subgroups of patients with CVT.Currently,a growing body of new evidence has been published on various aspects of CVT diagnosis and treatment,including studies on prognosis assessment scales and EVT therapy.Anticoagulation remains the primary treatment during the acute phase of CVT,as demonstrated by the thrombolysis or anticoagulation for cerebral venous thrombosis(TOACT)clinical trial.This study revealed that EVT combined with standard medical care did not improve functional outcomes for patients with severe CVT.Several risk screening scores have been developed to predict CVT prognosis,and some of these scales have been shown to perform adequately.The question of whether EVT is beneficial for patients with CVT,and to which subgroups of patients it should be offered,still remains unsettled.Large global research collaborations should be established to address current challenges and facilitate the execution of clinical trials.展开更多
Objective: Cancer is one of the most common diagnoses in elderly patients. Of all types of abdominal cancer, colorectal cancer(CRC) is undoubtedly the most frequent. Median age at diagnosis is approximately 70 years o...Objective: Cancer is one of the most common diagnoses in elderly patients. Of all types of abdominal cancer, colorectal cancer(CRC) is undoubtedly the most frequent. Median age at diagnosis is approximately 70 years old worldwide. Due to the multiple comorbidities affecting elderly people, frailty evaluation is very important in order to avoid over- or undertreatment. This pilot study was designed to investigate the variables capable of predicting the long-term risk of mortality and living situation after surgery for CRC.Methods: Patients with 70 years old and older undergoing elective surgery for CRC were prospectively enrolled in the study. The patients were preoperatively screened using 11 internationally-validated-frailty-assessment tests. The endpoints of the study were long-term mortality and living situation. The data were analyzed using univariate Cox proportional-hazard regression analysis to verify the predictive value of score indices in order to identify possible risk factors.Results: Forty-six patients were studied. The median follow-up time after surgery was 4.6 years(range, 2.9-5.7 years) and no patients were lost to follow-up. The overall mortality rate was 39%. Four of the patients who survived(4/28, 14%) lost their functional autonomy. The preoperative impaired Timed Up and Go(TUG), Eastern Cooperative Group Performance Status(ECOG PS), Instrumental Activities of Daily Living(IADLs), Vulnerable Elders Survey(VES-13) scoring systems were significantly associated with increased long term mortality risk.Conclusion: Simplified frailty-assessing tools should be routinely used in elderly cancer patients before treatment in order to stratify patient risk. The TUG, ECOG-PS, IADLs and VES-13 scoring systems are potentially able to predict long-term mortality and disability. Additional studies will be needed to confirm the preliminary data in order to improve management strategies for oncogeriatric surgical patients.展开更多
Background:Subjective measures of auditory development are equally important as objective measures to obtain a realistic image of the hearing status in infants and toddlers.Objectives:The objectives of the current stu...Background:Subjective measures of auditory development are equally important as objective measures to obtain a realistic image of the hearing status in infants and toddlers.Objectives:The objectives of the current study were to translate and validate the LittleEARS questionnaire into the Hindi language,to calculate its psychometric properties and establish a regression curve of the scores obtained as a function of age,to calculate the inter-test and test retest reliability of the same.The secondary objectives were to compare the scores obtained by the normal hearing children and those with hearing impairment and to plot a regression curve of total scores obtained by the hearing-impaired children as a function of the duration of auditory training attended since their first fit of the device.Materials and methods:The procedures involved conventional translation,reverse translation,and content validation before administering the questionnaire.The translated version was administered to parents of 59 children with normal hearing and 41 children with hearing impairment.Results:The finalized version had good reliability and efficient internal consistency with a Cronbach alpha value of 0.96.The mean scores obtained by the normal hearing children showed a progressive pattern as a function of age.Conclusion:The LittleEARS questionnaire has been successfully translated and validated into the Hindi language with excellent validity and reliability and can be used for screening and early identification of hearing impairment and in evaluating the outcome of audiological treatment approaches.展开更多
Advances in medical therapeutics have undoubtedly contributed to health gains and increases in life expectancy over the last century. However, there is growing evidence to suggest that therapeutic decisions in older p...Advances in medical therapeutics have undoubtedly contributed to health gains and increases in life expectancy over the last century. However, there is growing evidence to suggest that therapeutic decisions in older patients are frequently suboptimal or potentially inappropriate and often result in negative outcomes such as adverse drug events, hospitalisation and increased healthcare resource utilisation. Several factors influence the appropriateness of medication selectionin older patients including age-related changes in pharmacokinetics and pharmacodynamics, high numbers of concurrent medications, functional status and burden of co-morbid illness. With ever-increasing therapeutic options, escalating proportions of older patients worldwide, and varying degrees of prescriber education in geriatric pharmacotherapy, strategies to assist physicians in choosing appropriate pharmacotherapy for older patients may be helpful. In this paper, we describe important age-related pharmacological changes as well as the principal domains of prescribing appropriateness in older people. We highlight common examples of drugdrug and drug-disease interactions in older people. We present a clinical case in which the appropriateness of prescription medications is reviewed and corrective strategies suggested. We also discuss various approaches to optimising prescribing appropriateness in this population including the use of explicit and implicit prescribing appropriateness criteria, comprehensive geriatric assessment, clinical pharmacist review, prescriber education and computerized decision support tools.展开更多
“Let them eat cake”： a retrospective service evaluation of Focus on Undernutrition in care homes. Introduction： Undernutrition is a major cause and consequence of poor health in older people, affecting 35% of res...“Let them eat cake”： a retrospective service evaluation of Focus on Undernutrition in care homes. Introduction： Undernutrition is a major cause and consequence of poor health in older people, affecting 35% of residents in care homes. Focus on Undernutrition （FoU）, a dietetic service delivered by dietetic assistants uses a multifaceted approach to undernutrition management. This study aims to evaluate FoU’s impact on undernutrition outcome measures in care homes; including FoU’s influence on weight change in residents “at risk” of undernutrition, and prevalence of undernutrition and pressure ulcers （PU）. Methods： A retrospective pragmatic service evaluation was undertaken using pseudonymised data collected over 13 years on weight, undernutrition risk and PU from long-stay residents’ notes before and six months after training （FoU）. Results： Analysis completed on 104 homes, 4,315 residents （71.3% female; mean stay 10.8 （1-278） months） in County Durham. Following FoU a significant difference was identified for： improved rate of weight change for “at risk” residents （p 〈 0.001）. Undernutrition risk significantly influenced weight change （low： B1.04 kg, E0.01 kg; moderate： B-1.79 kg, E-0.38 kg; high： B-0.83kg, E1.00 kg, Bp 〈 0.001, Ep = 0.001）. Reduced undernutrition prevalence （p 〈 0.001） from 32.7% to 29.1% residents “at risk” of undernutrition （moderate： B13.1%, E8.9%; high： B19.6%, E15.9%）. Nutrition screening significantly improved （B76.3%, E98.7%, p 〈 0.001）, reduced prevalence PU （51%, p 〈 0.001）. PU prevalence significantly increased with undernutrition severity at baseline （p 〈 0.001）, but not following FoU （p = 0.233） （low： B5%, E2.3%; moderate： B6.9%, E1.6%; high： B10.5%, E3.9%）. Odds of developing PU reduced 53% （OR： 0.47）. B：baseline; E：evaluation; OR： odds ratio. Conclusion： These results demonstrate dietetic assistants delivering FoU significantly improves weight, undernutrition and PU prevalence in care homes. Indicating FoU is an effective model for improving undernutrition outcomes, with the potential of reducing possible harm, such as PU in care homes.展开更多
Background Developmental delay(DD)poses challenges to children's overall development,necessitating early detection and intervention.Existing screening tools in China focus mainly on children with developmental iss...Background Developmental delay(DD)poses challenges to children's overall development,necessitating early detection and intervention.Existing screening tools in China focus mainly on children with developmental issues in two or more domains,diagnosed as global developmental delay(GDD).However,the recent rise of early childhood development(ECD)concepts has expanded the focus to include not only those with severe brain development impairments but also children who lag in specific domains due to various social-environmental factors,with the aim of promoting positive development through active intervention.To support this approach,corresponding screening tools need to be developed.Methods The current study used a two-phase design to develop and validate the Parent-Reported Indicator of Developmental Evaluation for Chinese Children(PRIDE)tool.In Phase 1,age-specific milestone forms for PRIDE were created through a survey conducted in urban and rural primary care clinics across four economic regions in China.In Phase 2,PRIDE was validated in a community-based sample.Sensitivity and specificity of both PRIDE and Ages and Stages Questionnaires(ASQ)-3 were estimated using inverse probability weights(IPW)and multiple imputation(MI)to address planned and unplanned missing data.Results In Phase 1 involving a total of 1160 participants aged 1 to 48 months,63 items were selected from the initial item pool to create 10 age-specific PRIDE forms.Our Phase 2 study included 777 children within the same age range.PRIDE demonstrated an estimated sensitivity and specificity of 83.3%[95%confidence interval(CI):56.8%–100.0%]and 84.9%(95%CI:82.8%–86.9%)in the identification of DD.Conclusion The findings suggest that PRIDE holds promise as a sensitive tool for detecting DD in community settings.展开更多
Background:Early detection of colorectal cancer(CRC)is crucial to enhance the disease treatment and prognosis of patients.Colonoscopy remains the gold standard for CRC detection;however,it requires trained personnel w...Background:Early detection of colorectal cancer(CRC)is crucial to enhance the disease treatment and prognosis of patients.Colonoscopy remains the gold standard for CRC detection;however,it requires trained personnel with expensive tools.Currently,serum metabolites have been discovered to be used to discriminate patients with polyps and CRC.This study aimed to identify the most commonly detected predictive serum metabolites for polyps and CRC.Methods:A systematic search of the Web of Science,PubMed,and Cochrane Library databases was conducted using PRISMA guidelines.Ten studies investigating serum metabolite biomarkers of CRC and polyps using different analytical platforms and study populations were included.QUADOMICS tool was used to analyse the quality of the included studies.All reported metabolites were then enriched into the pathways using MetaboAnalyst 5.0.Results:We found that several potential signature metabolites overlapped between studies,including tyrosine,lysine,cystine,arabinose,and lactate for CRC and lactate and glutamate for polyps.The most affected pathways related to CRC were the urea cycle,glutathione metabolism,purine metabolism,glutamate metabolism,and ammonia recycling.In contrast,those affected in the polyps were the urea cycle,glutamate metabolism,glutathione metabolism,arginine and proline metabolism,and carnitine synthesis.Conclusions:This review has found commonly detected serum metabolites for polyps and CRC with huge potential to be used in clinical settings.However,the differences between altered pathways in polyps and CRC,other external factors,and their effects on the regulation level,sensitivity,and specificity of each identified metabolite remained unclear,which could benefit from a further extensive cohort study and well-defined analysis equipment.展开更多
文摘BACKGROUND Nosocomial fever of unknown origin(nFUO)is a frequent and challenging diagnostic entity,encompassing diverse infectious and non-infectious etiologies.Timely identification is crucial,yet evidence on the diagnostic accuracy of commonly employed sepsis screening tools and biomarkers remains sparse.We hypothesized that these tools and biomarkers measured at fever onset could distinguish infectious from non-infectious causes of nFUO in critically ill adults.AIM To evaluate the diagnostic utility of sepsis tools and biomarkers in identifying infectious causes of nFUO.METHODS This prospective observational study included patients admitted to the Acute Care Emergency Medicine Unit,Postgraduate Institute of Medical Education and Research,Chandigarh,India(July 2023 to December 2024).nFUO was defined by Durack and Street criteria.Diagnostic performance of sepsis screening tools(systemic inflammatory response syndrome,Sequential Organ Failure Assessment,quick Sequential Organ Failure Assessment,National Early Warning Score,and Modified Early Warning Score)and biomarkers[procalcitonin(PCT),C-reactive protein(CRP)]at fever onset was assessed using receiver operating characteristic curve analysis.RESULTS Of 80 cases(mean age 42.9±16.5 years;80% male),42.5% had infectious causes,38.7% non-infectious,and 18.8% remained undiagnosed.Pneumonia(26.2%)and bloodstream infections(11.2%)were the most common infectious etiologies,while central fever and thrombophlebitis(each 7.5%)were predominant among non-infectious causes.Sepsis tools showed poor diagnostic accuracy,with area under the receiver operating characteristic curve(AUC)values close to 0.5.PCT demonstrated modest performance(AUC=0.61;optimal cut-off:0.85μg/L),while CRP was paradoxically higher in non-infectious cases(AUC=0.45).Overall mortality was 20% and was highest among undiagnosed patients(33.3%).Fever duration and hospitalization length were significantly greater in infectious cases.CONCLUSION Sepsis tools,PCT,and CRP have limited utility in identifying infectious causes of nFUO in critically ill adults and should not solely guide initial decision-making.
基金Supported by the National Natural Science Foundation of China,No.72174061 and No.71704053China Scholarship Council Foundation,No.202308330251Health Science and Technology Project of Zhejiang Provincial Health Commission,No.2022KY370 and No.2023KY1186.
文摘BACKGROUND Motoric cognitive risk(MCR)syndrome represents an“ultra-early”stage of dementia prevention,highlighting the need for effective screening tools.AIM To develop and validate a novel tool for MCR identification,comparing its effectiveness with existing methods.METHODS As part of a community study on healthy aging,a cross-sectional study recruited 1189 Chinese participants aged 50 years and older between May 1,2022,and March 15,2023.The cohort was randomly split into training(70%)and testing(30%)datasets.Relevant features were selected for logistic regression(LR)and decision tree(DT)models using the training dataset,and their performance was subsequently assessed using the testing dataset to validate reliability and generalizability.RESULTS The prevalence of MCR was 13.12%among 1189 participants.DT models had the area under the curves(AUCs)of 0.834 and 0.821 for training and testing datasets,respectively,while LR models indicated AUCs of 0.840 and 0.859.Non-inferiority tests confirmed the DT model’s comparable effectiveness to the LR models in predicting MCR.Both models demonstrated good calibration and clinical utility.Seven modifiable risk factors were identified:Age,education level,social engagement,physical activity,nutritional status,depressive symptoms,and purpose in life.Notably,social engagement emerged as a novel factor compared to those previously identified.Both models are integrated into an easy-to-use,interpretable web-based user interface.CONCLUSION The interactive,web-based user interface of both models effectively identifies MCR,with the DT model recommended for its simplicity and interpretability,supporting community nurses and clinicians in triaging MCR.
文摘School-based universal screening for behavioral/emotional risk is a necessary first step to providing services in an educational setting for students with emotional and behavioral disorders (EBDs). Psychometric properties are critical to making decisions about choosing a screening instrument. The purpose of the present study was to examine the psychometric properties of the student risk screening scale for internalizing and externalizing behaviors (SRSS-IE). Participants included 3145 students and their teachers. Item-level analyses of the current sample supported the retention of all items. The internal consistency of the SRSS items ranged from 0.83 to 0.85. Convergent validity between the SRSS-IE and a well-established screening tool, the strength and difficulties questionnaire (SDQ), was found for the total score (r = 0.70). Additionally, the results of this study demonstrate strong social validity, suggesting the SRSS-IE to be a useful and functional screening tool. We conclude that the SRSS-IE is a valid and reliable instrument for assessing the level of emotional and behavioral difficulties among elementary students.
文摘Borderline personality disorder, conversion disorder and obsessive compulsive disorder frequently have dissociative symptoms. The literature has demonstrated that the level of dissociation might be correlated with the severity of obsessive compulsive disorder(OCD) and that those not responding to treatment had high dissociative symptoms. The structured clinical interview for DSM-IV dissociative disorders, dissociation questionnaire, somatoform dissociation questionnaire and dissociative experiences scale can be used for screening dissociative symptoms and detecting dissociative disorders in patients with OCD. However, a history of neglect and abuse during childhood is linked to a risk factor in the pathogenesis of dissociative psychopathology in adults. The childhood trauma questionnaire-53 and childhood trauma questionnaire-40 can be used for this purpose. Clinicians should not fail to notice the hidden dissociative symptoms and childhood traumatic experiences in OCD cases with severe symptoms that are resistant to treatment. Symptom screening and diagnostic tools used for this purpose should be known. Knowing how to treat these pathologies in patients who are diagnosed with OCD can be crucial.
文摘In this article,we comment on the article by Blüthner et al.The article provides a comprehensive analysis of the factors contributing to the late detection of Crohn’s disease and ulcerative colitis within a German cohort.It highlights the conse-quences on patient outcomes,particularly disease progression and the increased risk of developing complications.The study identifies specific predictors asso-ciated with both patient-related and physician-related delays,offering a detailed exploration of the initial approach.Additionally,the article delves into the distinct patterns observed in the German population,stressing the unique aspects of diagnostic delays that may differ from those reported in other regions.This detailed examination offers valuable insights into the specific challenges faced within the German healthcare system and underscores the necessity of targeted interventions to facilitate early diagnosis.The importance of improved screening tools,patient education,and better healthcare infrastructure is emphasized as crucial steps toward improving patient care in inflammatory bowel disease.
文摘Objective： Correct nutritional assessment is essential for leukemia patients after hematopoietic stem cell transplantation （HSCT）. This study aimed to investigate the best nutritional assessment method for leukemia patients after HSCT, and find the possible nutritional risk of the patients during the transplantation process in order to intervene in the patients with nutritional risks and undernourished patients timely, so that the entire transplantation process could be successfully completed. Methods： A prospective study was performed in 108 leukemia patients after HSCT, and different nutritional assessment methods, including nutritional risk screening 2002 （NRS2002）, mini nutritional assessment （MNA）, subjective globe assessment （SGA） and malnutritional universal screening tools （MUST）, were used. The associations between nutritional status of these patients and nutritional assessment methods were analyzed. Results： A total of 108 patients completed SGA, and 99 patients completed NRS2002, MNA and MUST. During the treatment process, 85.2% of the patients lost weight, wherein, 50% lost weight greater than 5%, and 42.6% had significantly reduced food intake. For nutritional risk assessment, the positive rates of NRS2002, MNA and MUST were 100%, 74.7% and 63.6%, respectively. There was a significant difference （P〈0.05） among the positive rates of NRS2002, MNA and MUST. In undernutrition assessment, the positive rate of SGA （83.3%） was significantly higher than that of MNA （17.2%） （P〈0.05）, and the incidence rate of nutritional risk among leukemia patients _〈30 years old was greater than that of patients 〉30 years old （P〈0.05）. Conclusions： Patients with leukemia were in poor nutritional status during and after HSCT. The leukemia patients 〈30 years old had a greater incidence rate of nutritional risk. As nutritional risk screening tool, the specificity of NRS2002 is not high, but it can be used for evaluating nutritional deficiencies. MNA is a good nutritional risk screening tool, but not an adequate tool for nutritional assessment. If assessment of undernutrition is necessary, the combination of all these screening tools and clinical laboratory indicators should he applied to improve accuracy.
基金the Joint Scientific Research Project of Chongqing Science and Technology Commission and Health Commission,No.2019MSXM019 and No.2021MSXM033Natural Science Project of Science and Technology Department of Tibet Autonomous Region,No.XZ2019ZR-ZY55(Z)+1 种基金Chongqing Natural Science Foundation Project,No.cstc2020jcyjmsxmX0124and COVID-19 Emergency Projects of Chongqing Medical University,No.X1-2611.
文摘Currently,there is a lack of sepsis screening tools that can be widely used worldwide.Pulmonary sepsis can be of sufficient concern to physicians due to their noticeable symptoms,which usually rely less on screening tools.AIM To investigate the efficiency of the international normalized ratio(INR)for the early rapid recognition of adult nonpulmonary infectious sepsis.METHODS This is a prospective observational study.A total of 108 sepsis patients and 106 nonsepsis patients were enrolled according to relevant inclusion and exclusion criteria.Commonly used clinical indicators,such as white blood cell,neutrophil count,lymphocyte count,neutrophil-lymphocyte count ratio(NLCR),platelets(PLT),prothrombin time,INR,activated partial thromboplastin time,and quick Sequential“Sepsis-related”Organ Failure Assessment(qSOFA)scores were recorded within 24 h after admission.The diagnostic performances of these clinical indicators were analyzed and compared through multivariate logistic regression analysis,Spearman correlation,and receiver operating characteristic curve analysis.The INR value of the sepsis group was significantly higher than that of the nonsepsis group.INR has superior diagnostic efficacy for sepsis,with an area under the curve value of 0.918,when those preexisting diseases which significantly affect coagulation function were excluded.The diagnostic efficacy of the INR was more significant than that of NLCR,PLT,and qSOFA(P<0.05).Moreover,INR levels of 1.17,1.20,and 1.22 could be used to categorize the relative risk of nonpulmonary infections sepsis into three categories:low,medium and high risk,respectively.CONCLUSION The INR is a promising and easily available biomarker for diagnosis,and it can be used as one of the indicators for early screening of adult nonpulmonary infectious sepsis.When its value is higher than the optimal cutoff value(1.22),high vigilance is required for adult nonpulmonary infectious sepsis.
文摘Objective According to literature,cancer patients have the highest incidence of malnutrition among hospital patients(40%-80%).Despite this high prevalence,this condition is still under-diagnosed.The aim of this study was to conduct a systematic literature review and meta-analysis to assess the diagnostic performance of the Malnutrition Screening Tool(MST),a simple tool that can be applied in a busy setting where a comprehensive assessment at screening would be impractical.Methods PubMed,EMBASE and Cochrane central register of controlled trials were systematically searched to identify records relevant to the research question.The QUADAS-2 was used to assess the quality of each included study and the meta-analysis was conducted using the hierarchical bivariate model in STATA.Results Seven records were included in this study and the overall sensitivity specificity,diagnostic odds ratio(DOR).The pooled sensitivity and specificity generated after the meta-analysis in STATA were 0.78(95%CI:0.64-0.88)and 0.82(95%CI:0.76-0.87),respectively.The corresponding DOR was 16.33(95%CI:7.08-37.67).The positive likelihood ratio(LR+)was+4.39(95%CI:3.02-6.38),and the negative likelihood ratio(LR-)were 0.27(95%CI:0.16-0.47)and the 1/LR-3.72(2.14-6.46).Conclusion These results showed that the MST provides weak diagnostic evidence when used to screen for malnutrition in adult cancer patients.
文摘 In a study published in the current issue of the Journal of Geriatric Cardiology, Ang and co-investigators used the highresolution 64-slice CT coronary angiography to detect coronary lesions in a group of patients with atypical angina.1 The clinical data of these patients were also used to calculate their risk according the Framingham and PROCAM scoring system.2,3 As the cohort is composed with a majority of low risk patients with atypical angina, only a small minority of the patients were classified as having medium and high risk. The results showed that MDCT uncovered 18% either significant lesions (＞50% stenosis) or calcifications (＞400Agatston units)in the low risk patients and 33% in the medium and high risk subgroups.……
基金Supported by the Qatar National Research Fund,No. UREP 10-022-3-005
文摘BACKGROUND Premenstrual syndrome(PMS)is the constellation of physical and psychological symptoms before menstruation.Premenstrual dysphoric disorder(PMDD)is a severe form of PMS with more depressive and anxiety symptoms.The Mini international neuropsychiatric interview,module U(MINI-U),assesses the diagnostic criteria for probable PMDD.The Premenstrual Symptoms screening tool(PSST)measures the severity of these symptoms.AIM To compare the PSST ordinal scores with the corresponding dichotomous MINI-U answers.METHODS Arab women(n=194)residing in Doha,Qatar,received the MINI-U and PSST.Receiver Operating Characteristics(ROC)analyses provided the cut-off scores on the PSST using MINI-U as a gold standard.RESULTS All PSST ratings were higher in participants with positive responses on MINI-U.In addition,ROC analyses showed that all areas under the curves were significant with the cutoff scores on PSST.CONCLUSION This study confirms that the severity measures from PSST can recognize patients with moderate/severe PMS and PMDD who would benefit from immediate treatment.
文摘Background: Zimbabwe recorded a 55% increase in HIV testing from 2011 to 2018 but with decreasing HIV-testing yields from 20% to 6% respectively as we aim to identify the narrowing gap of undiagnosed people living with HIV. As such adoption of screening tools during targeted HIV testing services improves efficiency by identifying individuals who are likely to test positive. Effective utilization of screening tools requires an understanding of health care worker perception and willingness to use the tools. Methods: We conducted a qualitative study among healthcare workers at 8 selected primary healthcare facilities in Zimbabwe. Interviewer-guided, in-depth interviews were conducted with healthcare workers and their immediate supervisors. Thematic analysis was performed following a framework built around the grounded theory model to describe perspectives that influence the utilization of HIV screening tools and suggestions for improved eligibility screening. Results: Behavioural factors facilitating the utilisation of the screening tool included motivation to adhere to standard practice, awareness of screening in targeting testing, and its ability to manage workload through screening out ineligible clients. This was evident across service delivery levels. Barriers included limited healthcare capacity, confidentiality space, multiple screening tools and opaque screening in/out criteria and the potential of clients not responding to screening questions truthfully. Conclusions: Across geographical and service delivery levels, placing screening tools at HIV testing entry points, healthcare worker knowledge on screening in/out criteria emerged as enablers for correct and consistent utilization. Further, standardizing the tools and adopting a decision aid algorithm would improve the accurate utilisation of screening tools.
文摘Malnutrition is common, and is a significant contributing factor to morbidity and mortality in the oncology setting. Previous research suggests that dietetic services in rural oncology clinics need to be well organized, timely and flexible with routine screening processes. In the absence of routine nutrition screening, it is hypothesized that oncology patients are only referred to dietetic services when malnutrition is overt or advanced. The aim of this study was to describe and compare dietetic services in two rural Australian oncology clinics and investigate nutrition screening and referral practices to determine if oncology patients at nutritional risk were appropriately referred. A retrospective file audit of medical and treatment records was conducted for a sample of oncology patients to determine the proportion of patients at risk of malnutrition by using the Malnutrition Screening Tool retrospectively. Dietetic treatment statistics and key stakeholders were consulted to compare dietetic service provision across the two sites. Seventy-eight percent of patients (n = 129) were retrospectively determined to be at nutritional risk during the study period, however, only 66% of these patients were referred to a dietitian. Dietetic treatment statistics varied across the two sites ranging from 26 to 62 treated patients, an average of 2.4 to 4.5 dietetic interventions per patient and an average difference in patient intervention time of 62 minutes during the 12-month study period. This study confirmed findings from previous research, highlighting that without routine nutrition screening in oncology, at least one third of patients at nutritional risk were failing to be identified and referred to dietetic services for appropriate treatment. Routine nutrition screening should be implemented to standardise and prioritise dietetic service provision, and oncology specific funding should be allocated to the dietetic service to ensure that staffing is adequate to provide a timely service.
文摘Flood risk analysis is the instrument for local officials to create a sound strategy and adaptation plans for the impacts of inundation due to heavy rains, climate change and sea level rise. Hence, cities with aging infrastructure are retrofitting their stormwater management systems to mitigate the impacts. However determining the most at risk areas and the options for corrections is more challenging. As a result, there is an urgent need to develop a screening tool to analyze watersheds and identify the most at-risk areas. High-quality, open source data and sophisticated spatial analysis techniques allow engineers to create innovative ways to conduct watershed wide inundation analysis. In th</span><span style="font-family:Verdana;">is study, the investigators developed </span></span></span></span><span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">a </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">screening tool to identify at-ri</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">sk properties by combining readily available data on topography, groundwater, surface water, tidal information for coastal communities, soils, open space, and rainfall data. Once the screening tool is developed, the means to identify and prioritize improvements to be funded with scarce capital funds is the next step.</span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">A tool box of solutions was developed to address flood risk and vulnerability. Testing of the screening tool was conducted in Browa</span><span style="font-family:Verdana;">rd County, Florida and shows encouraging results. Comparison wit</span><span style="font-family:Verdana;">h FEMA Flood maps and repetitive loss mapping indicates that the process works in a coastal community. The framework appears to be viable across cities that may be inundated with water due to sea-level rise, rainfall, runoff upstream, and other natural events.
基金supported by the National Natural Science Foundation of China(82171278)Capital’s Funds for Health Improvement and Research(2024-2-2017).
文摘Cerebral venous thrombosis(CVT)is a rare condition that can be fatal in severe cases.The limited occurrence of CVT poses challenges in conducting randomized controlled trials,leading to uncertainty regarding the effectiveness of endovascular thrombectomy(EVT)in specific subgroups of patients with CVT.Currently,a growing body of new evidence has been published on various aspects of CVT diagnosis and treatment,including studies on prognosis assessment scales and EVT therapy.Anticoagulation remains the primary treatment during the acute phase of CVT,as demonstrated by the thrombolysis or anticoagulation for cerebral venous thrombosis(TOACT)clinical trial.This study revealed that EVT combined with standard medical care did not improve functional outcomes for patients with severe CVT.Several risk screening scores have been developed to predict CVT prognosis,and some of these scales have been shown to perform adequately.The question of whether EVT is beneficial for patients with CVT,and to which subgroups of patients it should be offered,still remains unsettled.Large global research collaborations should be established to address current challenges and facilitate the execution of clinical trials.
文摘Objective: Cancer is one of the most common diagnoses in elderly patients. Of all types of abdominal cancer, colorectal cancer(CRC) is undoubtedly the most frequent. Median age at diagnosis is approximately 70 years old worldwide. Due to the multiple comorbidities affecting elderly people, frailty evaluation is very important in order to avoid over- or undertreatment. This pilot study was designed to investigate the variables capable of predicting the long-term risk of mortality and living situation after surgery for CRC.Methods: Patients with 70 years old and older undergoing elective surgery for CRC were prospectively enrolled in the study. The patients were preoperatively screened using 11 internationally-validated-frailty-assessment tests. The endpoints of the study were long-term mortality and living situation. The data were analyzed using univariate Cox proportional-hazard regression analysis to verify the predictive value of score indices in order to identify possible risk factors.Results: Forty-six patients were studied. The median follow-up time after surgery was 4.6 years(range, 2.9-5.7 years) and no patients were lost to follow-up. The overall mortality rate was 39%. Four of the patients who survived(4/28, 14%) lost their functional autonomy. The preoperative impaired Timed Up and Go(TUG), Eastern Cooperative Group Performance Status(ECOG PS), Instrumental Activities of Daily Living(IADLs), Vulnerable Elders Survey(VES-13) scoring systems were significantly associated with increased long term mortality risk.Conclusion: Simplified frailty-assessing tools should be routinely used in elderly cancer patients before treatment in order to stratify patient risk. The TUG, ECOG-PS, IADLs and VES-13 scoring systems are potentially able to predict long-term mortality and disability. Additional studies will be needed to confirm the preliminary data in order to improve management strategies for oncogeriatric surgical patients.
文摘Background:Subjective measures of auditory development are equally important as objective measures to obtain a realistic image of the hearing status in infants and toddlers.Objectives:The objectives of the current study were to translate and validate the LittleEARS questionnaire into the Hindi language,to calculate its psychometric properties and establish a regression curve of the scores obtained as a function of age,to calculate the inter-test and test retest reliability of the same.The secondary objectives were to compare the scores obtained by the normal hearing children and those with hearing impairment and to plot a regression curve of total scores obtained by the hearing-impaired children as a function of the duration of auditory training attended since their first fit of the device.Materials and methods:The procedures involved conventional translation,reverse translation,and content validation before administering the questionnaire.The translated version was administered to parents of 59 children with normal hearing and 41 children with hearing impairment.Results:The finalized version had good reliability and efficient internal consistency with a Cronbach alpha value of 0.96.The mean scores obtained by the normal hearing children showed a progressive pattern as a function of age.Conclusion:The LittleEARS questionnaire has been successfully translated and validated into the Hindi language with excellent validity and reliability and can be used for screening and early identification of hearing impairment and in evaluating the outcome of audiological treatment approaches.
文摘Advances in medical therapeutics have undoubtedly contributed to health gains and increases in life expectancy over the last century. However, there is growing evidence to suggest that therapeutic decisions in older patients are frequently suboptimal or potentially inappropriate and often result in negative outcomes such as adverse drug events, hospitalisation and increased healthcare resource utilisation. Several factors influence the appropriateness of medication selectionin older patients including age-related changes in pharmacokinetics and pharmacodynamics, high numbers of concurrent medications, functional status and burden of co-morbid illness. With ever-increasing therapeutic options, escalating proportions of older patients worldwide, and varying degrees of prescriber education in geriatric pharmacotherapy, strategies to assist physicians in choosing appropriate pharmacotherapy for older patients may be helpful. In this paper, we describe important age-related pharmacological changes as well as the principal domains of prescribing appropriateness in older people. We highlight common examples of drugdrug and drug-disease interactions in older people. We present a clinical case in which the appropriateness of prescription medications is reviewed and corrective strategies suggested. We also discuss various approaches to optimising prescribing appropriateness in this population including the use of explicit and implicit prescribing appropriateness criteria, comprehensive geriatric assessment, clinical pharmacist review, prescriber education and computerized decision support tools.
文摘“Let them eat cake”： a retrospective service evaluation of Focus on Undernutrition in care homes. Introduction： Undernutrition is a major cause and consequence of poor health in older people, affecting 35% of residents in care homes. Focus on Undernutrition （FoU）, a dietetic service delivered by dietetic assistants uses a multifaceted approach to undernutrition management. This study aims to evaluate FoU’s impact on undernutrition outcome measures in care homes; including FoU’s influence on weight change in residents “at risk” of undernutrition, and prevalence of undernutrition and pressure ulcers （PU）. Methods： A retrospective pragmatic service evaluation was undertaken using pseudonymised data collected over 13 years on weight, undernutrition risk and PU from long-stay residents’ notes before and six months after training （FoU）. Results： Analysis completed on 104 homes, 4,315 residents （71.3% female; mean stay 10.8 （1-278） months） in County Durham. Following FoU a significant difference was identified for： improved rate of weight change for “at risk” residents （p 〈 0.001）. Undernutrition risk significantly influenced weight change （low： B1.04 kg, E0.01 kg; moderate： B-1.79 kg, E-0.38 kg; high： B-0.83kg, E1.00 kg, Bp 〈 0.001, Ep = 0.001）. Reduced undernutrition prevalence （p 〈 0.001） from 32.7% to 29.1% residents “at risk” of undernutrition （moderate： B13.1%, E8.9%; high： B19.6%, E15.9%）. Nutrition screening significantly improved （B76.3%, E98.7%, p 〈 0.001）, reduced prevalence PU （51%, p 〈 0.001）. PU prevalence significantly increased with undernutrition severity at baseline （p 〈 0.001）, but not following FoU （p = 0.233） （low： B5%, E2.3%; moderate： B6.9%, E1.6%; high： B10.5%, E3.9%）. Odds of developing PU reduced 53% （OR： 0.47）. B：baseline; E：evaluation; OR： odds ratio. Conclusion： These results demonstrate dietetic assistants delivering FoU significantly improves weight, undernutrition and PU prevalence in care homes. Indicating FoU is an effective model for improving undernutrition outcomes, with the potential of reducing possible harm, such as PU in care homes.
基金National Natural Science Foundation of China(823B2087)Shanghai Municipal Health Commission(GWVI-11.2-XD16)+1 种基金National Natural Science Foundation of China Joint Fund Project(U23A20170)Shanghai Municipal Health Commission(Child Neurological and Psychological Development Screening and Intervention Project),Shanghai Key Laboratory of Child Brain and Development(24dz2260100).
文摘Background Developmental delay(DD)poses challenges to children's overall development,necessitating early detection and intervention.Existing screening tools in China focus mainly on children with developmental issues in two or more domains,diagnosed as global developmental delay(GDD).However,the recent rise of early childhood development(ECD)concepts has expanded the focus to include not only those with severe brain development impairments but also children who lag in specific domains due to various social-environmental factors,with the aim of promoting positive development through active intervention.To support this approach,corresponding screening tools need to be developed.Methods The current study used a two-phase design to develop and validate the Parent-Reported Indicator of Developmental Evaluation for Chinese Children(PRIDE)tool.In Phase 1,age-specific milestone forms for PRIDE were created through a survey conducted in urban and rural primary care clinics across four economic regions in China.In Phase 2,PRIDE was validated in a community-based sample.Sensitivity and specificity of both PRIDE and Ages and Stages Questionnaires(ASQ)-3 were estimated using inverse probability weights(IPW)and multiple imputation(MI)to address planned and unplanned missing data.Results In Phase 1 involving a total of 1160 participants aged 1 to 48 months,63 items were selected from the initial item pool to create 10 age-specific PRIDE forms.Our Phase 2 study included 777 children within the same age range.PRIDE demonstrated an estimated sensitivity and specificity of 83.3%[95%confidence interval(CI):56.8%–100.0%]and 84.9%(95%CI:82.8%–86.9%)in the identification of DD.Conclusion The findings suggest that PRIDE holds promise as a sensitive tool for detecting DD in community settings.
基金The authors are grateful to the Ministry of Higher Education(MOHE),Malaysia,for the allocation of the Fundamental Research Grant Scheme(FRGS),grant number FRGS/1/2021/SKK05/UKM/02/1.
文摘Background:Early detection of colorectal cancer(CRC)is crucial to enhance the disease treatment and prognosis of patients.Colonoscopy remains the gold standard for CRC detection;however,it requires trained personnel with expensive tools.Currently,serum metabolites have been discovered to be used to discriminate patients with polyps and CRC.This study aimed to identify the most commonly detected predictive serum metabolites for polyps and CRC.Methods:A systematic search of the Web of Science,PubMed,and Cochrane Library databases was conducted using PRISMA guidelines.Ten studies investigating serum metabolite biomarkers of CRC and polyps using different analytical platforms and study populations were included.QUADOMICS tool was used to analyse the quality of the included studies.All reported metabolites were then enriched into the pathways using MetaboAnalyst 5.0.Results:We found that several potential signature metabolites overlapped between studies,including tyrosine,lysine,cystine,arabinose,and lactate for CRC and lactate and glutamate for polyps.The most affected pathways related to CRC were the urea cycle,glutathione metabolism,purine metabolism,glutamate metabolism,and ammonia recycling.In contrast,those affected in the polyps were the urea cycle,glutamate metabolism,glutathione metabolism,arginine and proline metabolism,and carnitine synthesis.Conclusions:This review has found commonly detected serum metabolites for polyps and CRC with huge potential to be used in clinical settings.However,the differences between altered pathways in polyps and CRC,other external factors,and their effects on the regulation level,sensitivity,and specificity of each identified metabolite remained unclear,which could benefit from a further extensive cohort study and well-defined analysis equipment.
