BACKGROUND Stress ulcers are common complications in critically ill patients,with a higher incidence observed in older patients following gastrointestinal surgery.This study aimed to develop and evaluate the effective...BACKGROUND Stress ulcers are common complications in critically ill patients,with a higher incidence observed in older patients following gastrointestinal surgery.This study aimed to develop and evaluate the effectiveness of a multi-modal intervention protocol to prevent stress ulcers in this high-risk population.AIM To assess the impact of a multi-modal intervention on preventing stress ulcers in older intensive care unit(ICU)patients postoperatively.METHODS A randomized controlled trial involving critically ill patients(aged≥65 years)admitted to the ICU after gastrointestinal surgery was conducted.Patients were randomly assigned to either the intervention group,which received a multimodal stress ulcer prevention protocol,or the control group,which received standard care.The primary outcome measure was the incidence of stress ulcers.The secondary outcomes included ulcer healing time,complication rates,and length of hospital stay.RESULTS A total of 200 patients(100 in each group)were included in this study.The intervention group exhibited a significantly lower incidence of stress ulcers than the control group(15%vs 30%,P<0.01).Additionally,the intervention group demonstrated shorter ulcer healing times(mean 5.2 vs 7.8 days,P<0.05),lower complication rates(10%vs 22%,P<0.05),and reduced length of hospital stay(mean 12.3 vs 15.7 days,P<0.05).CONCLUSION This multi-modal intervention protocol significantly reduced the incidence of stress ulcers and improved clinical outcomes in critically ill older patients after gastrointestinal surgery.This comprehensive approach may provide a valuable strategy for managing high-risk populations in intensive care settings.展开更多
BACKGROUND At present,there are few studies on the risk factors for bile leakage after laparoscopic common bile duct exploration(LCBDE)for older patients with choledocholithiasis.AIM To identify the potential risk fac...BACKGROUND At present,there are few studies on the risk factors for bile leakage after laparoscopic common bile duct exploration(LCBDE)for older patients with choledocholithiasis.AIM To identify the potential risk factors for bile leakage after LCBDE in older patients.METHODS A retrospective,single-center observational analysis was performed on patients aged≥70 years with choledocholithiasis treated by LCBDE who were admitted to our center between January 2011 and August 2022.The included patients were divided into non-bile leakage and bile leakage groups.Risk factors were determined by analyzing the observation indicators.RESULTS Seventy older patients with choledocholithiasis who underwent LCBDE were included.Univariate analysis showed that positive culture of bile bacteria was a risk factor for bile leakage after LCBDE(P<0.05).We further analyzed the bile bacteria,and univariate analysis showed that Enterococcus faecalis(E.faecalis)(P<0.05)and Pseudomonas aeruginosa(P<0.05)were associated with an increased risk of postoperative bile leakage in older patients(P<0.05).Multivariate analysis showed that E. faecalis was an independent risk factor for postoperative bile leakage in older patients (P < 0.05). Theresults of antibiotic sensitivity analysis showed that E. faecalis had 100% susceptibility to penicillin, ampicillin,linezolid, vancomycin, and furantoin.CONCLUSIONE. faecalis-associated biliary tract infection is an independent risk factor for bile leakage after LCBDE in olderpatients with choledocholithiasis. We suggest coverage with antibiotics to which E. faecalis is sensitive.展开更多
Objective This study examines utilizes the advantages of machine learning algorithms to discern key determinants in prognosticate postoperative circulatory complications(PCCs)for older patients.Methods This secondary ...Objective This study examines utilizes the advantages of machine learning algorithms to discern key determinants in prognosticate postoperative circulatory complications(PCCs)for older patients.Methods This secondary analysis of data from a randomized controlled trial involved 1,720 elderly participants in five tertiary hospitals in Beijing,China.Participants aged 60–90 years undergoing major non-cardiac surgery under general anesthesia.The primary outcome metric of the study was the occurrence of PCCs,according to the European Society of Cardiology and the European Society of Anaesthesiology diagnostic criteria.The analysis metrics contained 67 candidate variables,including baseline characteristics,laboratory tests,and scale assessments.Results Our feature selection process identified key variables that significantly impact patient outcomes,including the duration of ICU stay,surgery,and anesthesia;APACHE-II score;intraoperative average heart rate and blood loss;cumulative opioid use during surgery;patient age;VAS-Move-Median score on the 1st to 3rd day;Charlson comorbidity score;volumes of intraoperative plasma,crystalloid,and colloid fluids;cumulative red blood cell transfusion during surgery;and endotracheal intubation duration.Notably,our Random Forest model demonstrated exceptional performance with an accuracy of 0.9872.Conclusion We have developed and validated an algorithm for predicting PCCs in elderly patients by identifying key risk factors.展开更多
BACKGROUND Cardio-oncology has received increasing attention especially among older patients with colorectal cancer(CRC).Cardiovascular disease(CVD)-specific mortality is the second-most frequent cause of death.The ri...BACKGROUND Cardio-oncology has received increasing attention especially among older patients with colorectal cancer(CRC).Cardiovascular disease(CVD)-specific mortality is the second-most frequent cause of death.The risk factors for CVDspecific mortality among older patients with CRC are still poorly understood.AIM To identify the prognostic factors and construct a nomogram-based model to predict the CVD-specific mortality among older patients with CRC.METHODS The data on older patients diagnosed with CRC were retrieved from The Surveillance,Epidemiology,and End Results database from 2004 to 2015.The prognostic factors and a nomogram-based model predicting the CVD-specific mortality were assessed using least absolute shrinkage and selection operator and Cox regression.RESULTS A total of 141251 eligible patients with CRC were enrolled,of which 41459 patients died of CRC and 12651 patients died of CVD.The age at diagnosis,sex,marital status,year of diagnosis,surgery,and chemotherapy were independent prognostic factors associated with CVD-specific mortality among older patients with CRC.We used these variables to develop a model to predict CVD-specific mortality.The calibration curves for CVD-specific mortality probabilities showed that the model was in good agreement with actual observations.The C-index value of the model in the training cohort and testing cohort for predicting CVD-specific mortality was 0.728 and 0.734,respectively.CONCLUSION The proposed nomogram-based model for CVD-specific mortality can be used for accurate prognostic prediction among older patients with CRC.This model is a potentially useful tool for clinicians to identify high-risk patients and develop personalized treatment plans.展开更多
AIM To evaluate the clinical outcome of endoscopic submucosal dissection using the Clutch Cutter(ESDCC) in older patients. METHODS We reviewed 232 consecutive patients with early gastric cancer who underwent ESDCC bet...AIM To evaluate the clinical outcome of endoscopic submucosal dissection using the Clutch Cutter(ESDCC) in older patients. METHODS We reviewed 232 consecutive patients with early gastric cancer who underwent ESDCC between June 2010 and February 2014 at Aso Iizuka Hospital. We divided patients into two groups according to age: Older patients(> 80 years, n = 64) and non-older patients(≤ 80 years, n = 168). We retrospectively compared the prevalence rates of pre-existing comorbidities, anticoagulant therapy, en bloc resection, mean duration of hospitalization, incidence of ESDCC-related complications, change in performance status(PS) before and after ESDCC, and financial cost of admission. RESULTS The older group comprised 64 patients with a mean age of 84.1 years, and the non-older group comprised 168 patients with a mean age of 69.5 years. Older patients had significantly more pre-existing comorbidities than did non-older patients, specifically heart disease(P < 0.05). The en bloc resection rate in non-older patients was significantly higher than that in older patients(100% vs 95.3%, P = 0.02). There were no significant differences between the older and non-older groups in the incidence of ESDCC-related complications(i.e., postoperative bleeding and perforation) and the post-ESDCC change in PS. There were also no significant differences between the older and non-older groups in the mean duration of hospitalization(11.4 and 10.7 d, respectively) and financial cost of admission(657040 JPY and 574890 JPY, respectively).CONCLUSION ESDCC has a good clinical outcome in older patients.展开更多
Objective:To investigate the effect of manual reduction with traditional small splints fixation for distal radius fractures in older patients in the emergency department.Methods:Older patients(aged at least 60 years)w...Objective:To investigate the effect of manual reduction with traditional small splints fixation for distal radius fractures in older patients in the emergency department.Methods:Older patients(aged at least 60 years)with distal radius fractures were enrolled in this study.The patients were randomly divided into the treatment group and the control group.The treatment group was treated with manual reduction and small splints fixation.The control group was treated with manual reduction and resin plaster fixation.Before treatment,after reduction,and 3 months after treatment,the palmar tilt angle,ulnar deviation angle,and radial length were recorded.Before treatment and 3 months after treatment,the Cooney wrist joint scores were recorded.The time of fracture healing and related adverse events during the treatment were recorded.Results:Before treatment and after reduction,there were no statistically significant differences between the two groups in palmar tilt angle,ulnar deviation angle,or radial length(P>0.05).Three months after treatment,the palmar tilt angle,ulnar deviation angle,and radial length of the treatment group were better than those of the control group(P<0.05).The Cooney wrist scores of the treatment group was significantly higher than that of the control group three months after the treatment(P<0.05).The time of fracture healing of the treatment group was shorter than that of the control group,but the difference was no statistically significant(P>0.05).Conclusions:Compared with resin plaster fixation,traditional small splints fixation for distal radius fractures in older patients have the advantages of less loss of fracture reduction and faster functional recovery.Besides,the method is simple and low cost thus,it needs to be promoted.展开更多
Background： The world is facing increasing pressure with the continuous growth of the older population. Older patients are usually discharged with complex medical problems, high stress and vulnerability, and these fa...Background： The world is facing increasing pressure with the continuous growth of the older population. Older patients are usually discharged with complex medical problems, high stress and vulnerability, and these factors place the elderly at risk for poor outcomes. Purpose： The present review summarizes a method for providing appropriate and affordable health services by nursing professionals to meet older patient＇s health care needs during their transitional period which is defined as a period from discharge after hospitalization for a major disorder to recovery in a home setting. Summary： Older patients with chronic diseases need seamless health care during a transitional period-a highly stressful and vulnerable period for them. Nurse professionals can conduct decent discharge planning to assist older patients with transitional problems through continuous healthcare. This review summarized the need of continuing care for older patients during the transitional period, the definition of discharge planning, the conceptual framework of discharge planning, and the professionals involved in discharge planning. It also highlighted the problems of discharge planning and follow-up intervention implementation in the mainland of China. Clinical implications： Inadequate discharge planning and follow-up were leading factors associ- ated with the readmission of discharged older patients. Further nursing-led discharge planning should be reinforced in China.展开更多
BACKGROUND Cognitive decline is common among older patients with cardiovascular disease(CVD) and can decrease their self-management abilities. However, the instruments for identifying mild cognitive impairment(MCI) ar...BACKGROUND Cognitive decline is common among older patients with cardiovascular disease(CVD) and can decrease their self-management abilities. However, the instruments for identifying mild cognitive impairment(MCI) are not always feasible in clinical practice. Therefore, this study evaluated whether MCI could be detected using the Japanese version of the Rapid Dementia Screening Test(RDST-J), which is a simple screening tool for identifying cognitive decline.METHODS This retrospective single-center study included patients who were ≥ 65 years old and hospitalized because of CVD.Patients with a pre-hospitalization diagnosis of dementia were excluded. Each patient's cognitive function had been measured at discharge using the RDST-J and the Japanese version of the Montreal Cognitive Assessment(Mo CA-J), which is a standard tool for MCI screening. The correlation between the two scores was evaluated using Spearman's rank correlation coefficient. Receiver operating characteristic(ROC) analysis was also to evaluate whether the RDST-J could identify MCI, which was defined as a Mo CA-J score of ≤ 25 points.RESULTS The study included 78 patients(mean age: 77.2 ± 8.9 years). The RDST-J and Mo CA-J scores were strongly correlated(r = 0.835, P < 0.001). The ROC analysis revealed that an RDST-J score of ≤ 9 points provided 75.4% sensitivity and 95.2% specificity for identifying MCI, with an area under the curve of 0.899(95% CI: 0.835-0.964). The same cut-off value was identified when excluding patients with a high probability of dementia(RDST-J score of ≤ 4 points).CONCLUSIONS The RDST-J may be a simple and effective tool for identifying MCI in older patients with CVD.展开更多
Objective:With the continuous advancement of aging in China,the number of older inpatients has increased sharply.Older patients have a high demand for planning their discharge services.Nurses serve as the leader of di...Objective:With the continuous advancement of aging in China,the number of older inpatients has increased sharply.Older patients have a high demand for planning their discharge services.Nurses serve as the leader of discharge planning for patients;there is a lack of reliable evaluation tool to evaluate the core competitiveness of nurses who implement discharge planning for older patients in China.The purpose of this study was to validate the index for the core competence of nurses who lead discharge planning for older patients developed by a project team through the Delphi method in the early stage.Methods:A cross-sectional questionnaire survey with 3-stage stratified sampling was used to select 1075 nurses from 17 public general hospitals in Ningxia,China.Results:The index consists of 4 first-level indicators,13 second-level indicators,and 57 third-level indicators.The results show that 57 third-level indicators had good discrimination.With exploratory factor analysis(EFA),4 common factors that explained 72.79%of the total variance were extracted.The Cronbach's a was 0.98,and the retest reliability within a 14-d interval was 0.86.The confirmatory factor analysis(CFA)results show that the fit of the index structure was good.The criterion validity was 0.73.Conclusions:The index presented excellent psychometric proper ties and can be used to measure the core competence of nurses in implementing discharge planning for older patients in China.展开更多
Research fails to provide an overview of the challenges involved in caring for older patients with multimorbidity. Multimorbidity is defined as the presence of two or more chronic conditions in the same person, leadin...Research fails to provide an overview of the challenges involved in caring for older patients with multimorbidity. Multimorbidity is defined as the presence of two or more chronic conditions in the same person, leading to a high risk of care dependency. The aim of this review was to illuminate the challenges faced by the healthcare services in managing the needs of older patients with multimorbidity. A systematic review was performed, a total of 1,965 abstracts were read and nine quantitative studies included. Data were analysed by thematic synthesis, revealing six themes: A frequent problem in older female patients;High healthcare expenditure and costs, Medication management problems, Social inequities, Complex healthcare and consultation needs and High mortality. The study highlights that healthcare professionals struggle to obtain suitable guidelines for the care of patients with multimorbidity while trying to respond to their needs. Patient-centred integration across settings and coordination in clinical practice are necessary. The healthcare system today does not seem to focus on patient safety and preventing harm. Older patients should be reviewed by a healthcare professional responsible for coordinating their care. To ensure safe and effective care for elderly persons with multimorbidity, the healthcare services should abandon the current focus on managing innumerable individual diseases and conditions.展开更多
Introduction: The in-hospital rehabilitation of patients who have undergone surgery for hip fracture requires a team-based effort, in which nurses play an all-embracing role throughout the patients’ hospital stays. A...Introduction: The in-hospital rehabilitation of patients who have undergone surgery for hip fracture requires a team-based effort, in which nurses play an all-embracing role throughout the patients’ hospital stays. Although discharge planning has been widely studied, little is known about discharge planning from hospitals to homes in rural settings. Aim: To describe nurses’ views on discharge planning for older patients after hip fracture surgery who live in their own homes in rural areas. Methods: A qualitative method was used. Four focus group interviews were conducted with 18 nurses who work at an orthopaedic clinic. The interview texts were analysed with qualitative content analysis. Findings: Nurses expressed that patients needed support from healthcare personnel as well as relatives in order to prepare for life at home. They also expressed that patients were not supported in all aspects of discharge planning because they faced difficulties in having their voices heard. Nurses described that many of those aspects were beyond their own control, which had left them with little to non-ability to influence discharge planning. Findings additionally indicate that discharge planning seems not affected by occurring in rural settings. Conclusions: Although discharge planning is intended to meet the unique wishes and needs of each patient given the realities of existing resources, nurses’ responsibilities in discharge planning are unclear. This study shows an organisation in which healthcare personnel continue to make decisions for patients. Significance for nurses to perform a discharge planning that support patients’ participation seems to be a communication based on shared understanding.展开更多
Objective To discuss perioperative features,operative approach and surgical effects of spinal tuberculosis in older patients.Methods Retrospective analysis was conducted to analyze the clinical data of 45 patients wit...Objective To discuss perioperative features,operative approach and surgical effects of spinal tuberculosis in older patients.Methods Retrospective analysis was conducted to analyze the clinical data of 45 patients with spinal展开更多
Gastroesophageal reflux disease (GERD) is the most common upper gastrointestinal disorder seen in the elderly. The worldwide incidence of GERD is increasing as the incidence of Helicobacter pylori is decreasing. Altho...Gastroesophageal reflux disease (GERD) is the most common upper gastrointestinal disorder seen in the elderly. The worldwide incidence of GERD is increasing as the incidence of Helicobacter pylori is decreasing. Although elderly patients with GERD have fewer symptoms, their disease is more often severe. They have more esophageal and extraesophageal complications that may be potentially life threatening. Esophageal complications include erosive esophagitis, esophageal stricture, Barrett's esophagus and adenocarcinoma of the esophagus. Extraesophageal complications include atypical chest pain that can simulate angina pectoris; ear, nose, and throat manifestations such as globus sensation, laryngitis, and dental problems; pulmonary problems such as chronic cough, asthma, and pulmonary aspiration. A more aggressive approach may be warranted in the elderly patient, because of the higher incidence of severe complications. Although the evaluation and management of GERD are generally the same in elderly patients as for all adults, there are specific issues of causation, evaluation and treatment that must be considered when dealing with the elderly.展开更多
Objective: Reflection is a process of deliberating thinking and examining one's practice in the past and thereby encouraging nurses to make improvements in future care delivery. This work outlines a piece of refle...Objective: Reflection is a process of deliberating thinking and examining one's practice in the past and thereby encouraging nurses to make improvements in future care delivery. This work outlines a piece of reflection involving the practice of communication between nurses and the elderly, to emancipate the authors from their constraints, help to find values as practitioners, and gain a greater understanding of the nurse-patient relationship.Methods: Using Smyth's four-stage model as a guide, as well as empirical and theoretical knowledge on nurse-patient relationships, this paper presents a deep reflection on the relationship that the authors developed with elderly patients and their families, encountered during the practice as a nurse. By applying the four main stages consisting of describe, inform, confront, and reconstruct, this model enabled the authors to frame, describe the practice issue, and explore the meaning behind it, which helps to facilitate a structured reflection.Results: Critical emancipatory reflection, in association with the Espoused theory and Theory-in-use, as well as reflexivity, critical social theory, and hegemony, was applied to uncover the various power relationships and constraining forces in the authors' practice involved in communicating with the elderly, such as the underlying false consciousness, hegemony, hidden assumptions, influential values, and dominant power structure, which are subtle and persuasive. By applying this process of critical reflection, transformative practice could be achieved.Conclusions: The process of critical reflection facilitated the development of the abilities required to develop and maintain the nursepatient relationship. It helps to enhance the care of old patients and their families, which illuminates the future nursing practice.展开更多
Serenity is an emotional experience that contributes to the acceptance of a situation. One phenomenon in the care of chronically ill older patients and patients in end of life care is that too much focus is placed on ...Serenity is an emotional experience that contributes to the acceptance of a situation. One phenomenon in the care of chronically ill older patients and patients in end of life care is that too much focus is placed on the patient’s disease. This can contribute to anxiety, sadness or sense of isolation. For older people that are chronically ill or in care at the end of life, it is important that the registered nurse can help them to find serenity. Further knowledge is needed about how the concept of serenity is used in relation to the care of older chronically ill patients. Aim: The purpose of this concept analysis was to clarify how serenity is used in nursing and in relation to the care of chronically ill older patients. Method: The study follows Rodgers’ evolutionary method of concept analysis. Findings: Serenity is a state of physical, mental, emotional and spiritual balance when life conditions can be managed or accepted. Through the experience of serenity the chronically ill older patient is able to find or develop the self in order to continue with dignity. The concept is most used at the lowest described levels of the self, including a perception of personal safety. The highest level involves a sense of wholeness and awareness. Conclusion: The concept of serenity is used in relation to chronically ill older patients as a condition where the patient finds balance and thus can manage or accept their situation. Chronically ill older patients will not recover. For that reason it needed a better understanding about what factors to experience serenity are needed. Further research is also needed to examine how registered nurses can support older chronically patients in finding serenity with the help of nursing interventions.展开更多
Objective: The present study aimed to demonstrate the patient outcomes after cochlear implantation in a rural area of Germany with special respect to older patients. Study Design: Retrospective Study. Setting: ENT-Dep...Objective: The present study aimed to demonstrate the patient outcomes after cochlear implantation in a rural area of Germany with special respect to older patients. Study Design: Retrospective Study. Setting: ENT-Department of Bad Hersfeld as an academic teaching hospital of the Justus-Liebig-University of Giessen. This is located in a rural county in Germany. Patients: A consecutive series of 217 patients implanted between 2003 and 2017. Intervention: Patients were implanted with different cochlear implant devices by the same surgeon in a standard procedure. In cases of chronic otitis media a middle ear obliteration was performed 6 months prior to cochlear implantation. Main Outcome Measures: Patients were divided in two groups: group 1 was 18 to 65 years of age and group 2 was older than 65 years. Pre- and postoperative hearing and speech understanding evaluated by the Freiburg monosyllable word test and the HSM-sentence test in the group of patients. Results: The mean preoperative speech understanding of group 1 was 0.5% for monosyllables at 60 dB and 2.7% at 80 dB. Group 2 showed similar results with 0.2% and 1.2%. In the HSM-test, group 1 had a speech understanding of 2.6% and group 2 of 3.2%. No statistically significant difference could be found between both groups. After cochlear implantation mean speech understanding at 60 dB increased in group 1 to 53.2% and 65.1% at 80 dB respectively. Group 2 had an improvement to 51.8% at 60 dB and 68.3% and 80 dB. The results in the HSM-sentence test were 77.8% in group 1 and 83.7% in group 2 (p = 0.47). Both groups had a significant increase in speech understanding concerning both tests after cochlear implantation (p = 0.0001) whereas we could not confirm any significant difference between the younger and older CI-recipients in the monosyllable word test. During the observation period no major complications had to be observed. Conclusion: Our data suggest that cochlear implantation in a rural area of Germany is feasible without increased risk and provides good hearing results even in older patients.展开更多
Objective:This study evaluated the optimal systolic blood pressure(SBP)target for older patients with hypertension.Method:A Bayesian network meta-analysis was conducted.The risk of bias of the included studies was ass...Objective:This study evaluated the optimal systolic blood pressure(SBP)target for older patients with hypertension.Method:A Bayesian network meta-analysis was conducted.The risk of bias of the included studies was assessed by using a modified version of the Cochrane risk of bias.The trial outcomes comprised the following clinical events:ma-jor adverse cardiovascular events(MACE),cardiovascular mortality,all-cause mortality,myocardial infarction,heart failure and stroke.Results:A total of six trials were included.We reclassified all treatment therapies into three conditions according to the final achieved SBP after intervention(<130 mmHg,130–139 mmHg and≥140 mmHg).Our results demon-strated that anti-hypertensive treatment with an SBP target<130 mmHg,compared with treatment with an SBP target≥140 mmHg,significantly decreased the incidence of MACE(OR 0.43,95%CI 0.19–0.76),but no statistical difference was found in other comparisons.Although the results showed a trend toward more intensive anti-hypertension therapy having better effects on preventing cardiovascular mortality,all-cause mortality,myocardial infarction,heart failure,and stroke,no significant differences were found among groups.Conclusions:Our meta-analysis suggested that SBP<130 mmHg might be the optimal BP control target for patients≥60 years of age;however,further evidence is required to support our findings.展开更多
Purpose:Coronary no-reflow phenomenon(NRP),a common adverse complication in patients with ST-segment eleva-tion myocardial infarction(STEMI)treated by percutaneous coronary intervention(PCI),is associated with poor pa...Purpose:Coronary no-reflow phenomenon(NRP),a common adverse complication in patients with ST-segment eleva-tion myocardial infarction(STEMI)treated by percutaneous coronary intervention(PCI),is associated with poor patient prognosis.In this study,the correlation between the systemic immune-inflammation index(SII)and NRP in older patients with STEMI was studied,to provide a basis for early identification of high-risk patients and improve their prognosis.Materials and methods:Between January 2017 and June 2020,578 older patients with acute STEMI admitted to the Department of Cardiology of Hebei General Hospital for direct PCI treatment were selected for this retrospective study.Patients were divided into an NRP group and normal-flow group according to whether NRP occurred during the operation.Clinical data and the examination indexes of the two groups were collected.Logistic regression was used to analyze the independent predictors of NRP,and the receiver operating characteristic curve was used to further analyze the ability of SII to predict NRP in older patients with STEMI.Results:Multivariate logistic analysis indicated that hypertension(OR=2.048,95%CI:1.252–3.352,P=0.004),lymphocyte count(OR=0.571,95%CI:0.368–0.885,P=0.012),platelet count(OR=1.009,95%CI:1.005–1.013,P<0.001),hemoglobin(OR=1.015,95%CI:1.003–1.028,P=0.018),multivessel disease(OR=2.237,95%CI:1.407–3.558,P=0.001),and SII≥1814(OR=3.799,95%CI:2.190–6.593,P<0.001)were independent predictors of NRP after primary PCI in older patients with STEMI.Receiver operating characteristic curve analysis demonstrated that SII had a high predictive value for NRP(AUC=0.738;95%CI:0.686–0.790),with the best cut-off value of 1814,a sensitivity of 52.85%and a specificity of 85.71%.Conclusion:For older patients with STEMI undergoing primary PCI,SII is a valid predictor of NRP.展开更多
BACKGROUND Although the 2021 Chinese Clinical Practice Guidelines for Enhanced Recovery after Surgery(ERAS)provide recommendations for ERAS in gastrointestinal surgery,the clinical application of standard ERAS nursing...BACKGROUND Although the 2021 Chinese Clinical Practice Guidelines for Enhanced Recovery after Surgery(ERAS)provide recommendations for ERAS in gastrointestinal surgery,the clinical application of standard ERAS nursing models is challenging due to the variety of diseases involved in gastrointestinal surgery and the com-plex factors contributing to patient stress responses.Moreover,stress responses are more severe in older adult patients.Therefore,precision medicine is required to improve the quality of nursing care and promote postoperative recovery in gastrointestinal surgery.and demonstrate nursing benefits through clinical practice.METHODS This randomized clinical trial first established an evidence-based nursing ERAS protocol in older adult patients based on literature related to perioperative nursing measures for gastrointestinal surgery stress response.Next,392 older adult patients who underwent gastrointestinal surgery and were admitted to our hospital between December 2021 and June 2023 were categorized into two groups to receive evidence-based(study group)or conventional(control group)ERAS nursing models,respectively.Intraoperative physiological parameters during surgery and postoperative recovery indicators were compared between the groups.RESULTS Among 64 domestic and international studies,the stress responses of older adult patients mainly included emotional anxiety,sleep disorders,gastrointestinal discomfort,physical weakness,pain,and swelling.The appropriate nursing interventions included comprehensive psychological counseling,pre-and postoperative nutritional support,temperature control,pain management,and rehabilitation training.Compared with the control group,the study group showed lower heart rate,mean arterial pressure,blood glucose level,and adrenaline level;shorter duration of drainage tube placement,time to first flatus,time to first ambulation,and postoperative hospital stay;lower anxiety scores on postoperative day 3;and lower incidences of postoperative infection,obstruction,poor wound healing,and gastrointestinal reactions were lower in the study group(all P<0.05).CONCLUSION The evidence-based nursing measures targeting stress responses based on the conventional ERAS nursing model resulted in stable intraoperative physiological parameters during surgery,promoted postoperative recovery,and reduced the incidence of complications.展开更多
Background: Patients commonly develop postoperative pain after total knee arthroplasty(TKA).Acupuncture-related techniques and low-level laser therapy could be beneficial for pain management for older individuals.Obje...Background: Patients commonly develop postoperative pain after total knee arthroplasty(TKA).Acupuncture-related techniques and low-level laser therapy could be beneficial for pain management for older individuals.Objective: To examine the effect of low-level laser acupuncture(LA) in reducing postoperative pain, painrelated interference in daily life, morphine consumption, and morphine-related side effects in older patients with knee osteoarthritis who underwent TKA.Design, setting, participants and intervention: A single-blind randomized placebo-controlled trial was conducted. Patients(N = 82) were recruited and randomly assigned via a computer-generated list to the LA group or a placebo group. The LA group received low-level laser therapy at Sanyinjiao(SP6), Taixi(KI3),Kunlun(BL60), Fengshi(GB31), Futu(ST32) and Neiguan(PC6) after TKA, while the placebo acupuncture group received the same treatment procedure without laser energy output.Main outcome measures: The primary outcome was postoperative pain intensity, and it was measured at baseline and hours 2, 6, 10, 24, 48 and 72 after TKA. The secondary outcomes, including relative pain,postoperative pain-related interference in daily life and morphine consumption, were measured at hours24, 48 and 72 after TKA.Results: Generalized estimating equations revealed significant between-group differences in pain intensity(P = 0.01), and trend differences in pain intensity for the LA group starting at hours 10 to 72(P < 0.05)and morphine consumption at hours 48 and 72(P < 0.05). The changes in pain-related interference in daily life were significant(P < 0.05) at 72 h, with the exception of the parameters for worst pain, mood,and sleep. Nausea and vomiting side effects from morphine had significant between-group differences at hours 10 and 24(P < 0.05).Conclusion: Low-level LA gradually reduced older patients’ postoperative pain intensity and morphine consumption within the first 72 h after their TKA for osteoarthritis. Low-level LA may have benefits as an adjuvant pain management technique for clinical care.Trial registration: ClinicalTrials.gov registration number NCT03995446.展开更多
文摘BACKGROUND Stress ulcers are common complications in critically ill patients,with a higher incidence observed in older patients following gastrointestinal surgery.This study aimed to develop and evaluate the effectiveness of a multi-modal intervention protocol to prevent stress ulcers in this high-risk population.AIM To assess the impact of a multi-modal intervention on preventing stress ulcers in older intensive care unit(ICU)patients postoperatively.METHODS A randomized controlled trial involving critically ill patients(aged≥65 years)admitted to the ICU after gastrointestinal surgery was conducted.Patients were randomly assigned to either the intervention group,which received a multimodal stress ulcer prevention protocol,or the control group,which received standard care.The primary outcome measure was the incidence of stress ulcers.The secondary outcomes included ulcer healing time,complication rates,and length of hospital stay.RESULTS A total of 200 patients(100 in each group)were included in this study.The intervention group exhibited a significantly lower incidence of stress ulcers than the control group(15%vs 30%,P<0.01).Additionally,the intervention group demonstrated shorter ulcer healing times(mean 5.2 vs 7.8 days,P<0.05),lower complication rates(10%vs 22%,P<0.05),and reduced length of hospital stay(mean 12.3 vs 15.7 days,P<0.05).CONCLUSION This multi-modal intervention protocol significantly reduced the incidence of stress ulcers and improved clinical outcomes in critically ill older patients after gastrointestinal surgery.This comprehensive approach may provide a valuable strategy for managing high-risk populations in intensive care settings.
基金Supported by the Ke Qiao Science and Technology Plan Projects,No.2022KZ70.
文摘BACKGROUND At present,there are few studies on the risk factors for bile leakage after laparoscopic common bile duct exploration(LCBDE)for older patients with choledocholithiasis.AIM To identify the potential risk factors for bile leakage after LCBDE in older patients.METHODS A retrospective,single-center observational analysis was performed on patients aged≥70 years with choledocholithiasis treated by LCBDE who were admitted to our center between January 2011 and August 2022.The included patients were divided into non-bile leakage and bile leakage groups.Risk factors were determined by analyzing the observation indicators.RESULTS Seventy older patients with choledocholithiasis who underwent LCBDE were included.Univariate analysis showed that positive culture of bile bacteria was a risk factor for bile leakage after LCBDE(P<0.05).We further analyzed the bile bacteria,and univariate analysis showed that Enterococcus faecalis(E.faecalis)(P<0.05)and Pseudomonas aeruginosa(P<0.05)were associated with an increased risk of postoperative bile leakage in older patients(P<0.05).Multivariate analysis showed that E. faecalis was an independent risk factor for postoperative bile leakage in older patients (P < 0.05). Theresults of antibiotic sensitivity analysis showed that E. faecalis had 100% susceptibility to penicillin, ampicillin,linezolid, vancomycin, and furantoin.CONCLUSIONE. faecalis-associated biliary tract infection is an independent risk factor for bile leakage after LCBDE in olderpatients with choledocholithiasis. We suggest coverage with antibiotics to which E. faecalis is sensitive.
基金The trial protocol was approved by the Institutional Review Board of Peking University(approval number 00001052-11048)and the ethics committees of the five participating centerswas registered with the China Clinical Trial Registry(www.chictr.org.cn,identifier:Chi CTR-TRC-09000543)ClinicalTrials.gov(identifier:NCT01661907).
文摘Objective This study examines utilizes the advantages of machine learning algorithms to discern key determinants in prognosticate postoperative circulatory complications(PCCs)for older patients.Methods This secondary analysis of data from a randomized controlled trial involved 1,720 elderly participants in five tertiary hospitals in Beijing,China.Participants aged 60–90 years undergoing major non-cardiac surgery under general anesthesia.The primary outcome metric of the study was the occurrence of PCCs,according to the European Society of Cardiology and the European Society of Anaesthesiology diagnostic criteria.The analysis metrics contained 67 candidate variables,including baseline characteristics,laboratory tests,and scale assessments.Results Our feature selection process identified key variables that significantly impact patient outcomes,including the duration of ICU stay,surgery,and anesthesia;APACHE-II score;intraoperative average heart rate and blood loss;cumulative opioid use during surgery;patient age;VAS-Move-Median score on the 1st to 3rd day;Charlson comorbidity score;volumes of intraoperative plasma,crystalloid,and colloid fluids;cumulative red blood cell transfusion during surgery;and endotracheal intubation duration.Notably,our Random Forest model demonstrated exceptional performance with an accuracy of 0.9872.Conclusion We have developed and validated an algorithm for predicting PCCs in elderly patients by identifying key risk factors.
基金Supported by the Youth Project of Natural Science Foundation of Shandong Province,No.ZR2022QH346.
文摘BACKGROUND Cardio-oncology has received increasing attention especially among older patients with colorectal cancer(CRC).Cardiovascular disease(CVD)-specific mortality is the second-most frequent cause of death.The risk factors for CVDspecific mortality among older patients with CRC are still poorly understood.AIM To identify the prognostic factors and construct a nomogram-based model to predict the CVD-specific mortality among older patients with CRC.METHODS The data on older patients diagnosed with CRC were retrieved from The Surveillance,Epidemiology,and End Results database from 2004 to 2015.The prognostic factors and a nomogram-based model predicting the CVD-specific mortality were assessed using least absolute shrinkage and selection operator and Cox regression.RESULTS A total of 141251 eligible patients with CRC were enrolled,of which 41459 patients died of CRC and 12651 patients died of CVD.The age at diagnosis,sex,marital status,year of diagnosis,surgery,and chemotherapy were independent prognostic factors associated with CVD-specific mortality among older patients with CRC.We used these variables to develop a model to predict CVD-specific mortality.The calibration curves for CVD-specific mortality probabilities showed that the model was in good agreement with actual observations.The C-index value of the model in the training cohort and testing cohort for predicting CVD-specific mortality was 0.728 and 0.734,respectively.CONCLUSION The proposed nomogram-based model for CVD-specific mortality can be used for accurate prognostic prediction among older patients with CRC.This model is a potentially useful tool for clinicians to identify high-risk patients and develop personalized treatment plans.
文摘AIM To evaluate the clinical outcome of endoscopic submucosal dissection using the Clutch Cutter(ESDCC) in older patients. METHODS We reviewed 232 consecutive patients with early gastric cancer who underwent ESDCC between June 2010 and February 2014 at Aso Iizuka Hospital. We divided patients into two groups according to age: Older patients(> 80 years, n = 64) and non-older patients(≤ 80 years, n = 168). We retrospectively compared the prevalence rates of pre-existing comorbidities, anticoagulant therapy, en bloc resection, mean duration of hospitalization, incidence of ESDCC-related complications, change in performance status(PS) before and after ESDCC, and financial cost of admission. RESULTS The older group comprised 64 patients with a mean age of 84.1 years, and the non-older group comprised 168 patients with a mean age of 69.5 years. Older patients had significantly more pre-existing comorbidities than did non-older patients, specifically heart disease(P < 0.05). The en bloc resection rate in non-older patients was significantly higher than that in older patients(100% vs 95.3%, P = 0.02). There were no significant differences between the older and non-older groups in the incidence of ESDCC-related complications(i.e., postoperative bleeding and perforation) and the post-ESDCC change in PS. There were also no significant differences between the older and non-older groups in the mean duration of hospitalization(11.4 and 10.7 d, respectively) and financial cost of admission(657040 JPY and 574890 JPY, respectively).CONCLUSION ESDCC has a good clinical outcome in older patients.
基金supported by scientific research project of China National Medicine Association(2019KYXM-Z199-35).
文摘Objective:To investigate the effect of manual reduction with traditional small splints fixation for distal radius fractures in older patients in the emergency department.Methods:Older patients(aged at least 60 years)with distal radius fractures were enrolled in this study.The patients were randomly divided into the treatment group and the control group.The treatment group was treated with manual reduction and small splints fixation.The control group was treated with manual reduction and resin plaster fixation.Before treatment,after reduction,and 3 months after treatment,the palmar tilt angle,ulnar deviation angle,and radial length were recorded.Before treatment and 3 months after treatment,the Cooney wrist joint scores were recorded.The time of fracture healing and related adverse events during the treatment were recorded.Results:Before treatment and after reduction,there were no statistically significant differences between the two groups in palmar tilt angle,ulnar deviation angle,or radial length(P>0.05).Three months after treatment,the palmar tilt angle,ulnar deviation angle,and radial length of the treatment group were better than those of the control group(P<0.05).The Cooney wrist scores of the treatment group was significantly higher than that of the control group three months after the treatment(P<0.05).The time of fracture healing of the treatment group was shorter than that of the control group,but the difference was no statistically significant(P>0.05).Conclusions:Compared with resin plaster fixation,traditional small splints fixation for distal radius fractures in older patients have the advantages of less loss of fracture reduction and faster functional recovery.Besides,the method is simple and low cost thus,it needs to be promoted.
文摘Background： The world is facing increasing pressure with the continuous growth of the older population. Older patients are usually discharged with complex medical problems, high stress and vulnerability, and these factors place the elderly at risk for poor outcomes. Purpose： The present review summarizes a method for providing appropriate and affordable health services by nursing professionals to meet older patient＇s health care needs during their transitional period which is defined as a period from discharge after hospitalization for a major disorder to recovery in a home setting. Summary： Older patients with chronic diseases need seamless health care during a transitional period-a highly stressful and vulnerable period for them. Nurse professionals can conduct decent discharge planning to assist older patients with transitional problems through continuous healthcare. This review summarized the need of continuing care for older patients during the transitional period, the definition of discharge planning, the conceptual framework of discharge planning, and the professionals involved in discharge planning. It also highlighted the problems of discharge planning and follow-up intervention implementation in the mainland of China. Clinical implications： Inadequate discharge planning and follow-up were leading factors associ- ated with the readmission of discharged older patients. Further nursing-led discharge planning should be reinforced in China.
文摘BACKGROUND Cognitive decline is common among older patients with cardiovascular disease(CVD) and can decrease their self-management abilities. However, the instruments for identifying mild cognitive impairment(MCI) are not always feasible in clinical practice. Therefore, this study evaluated whether MCI could be detected using the Japanese version of the Rapid Dementia Screening Test(RDST-J), which is a simple screening tool for identifying cognitive decline.METHODS This retrospective single-center study included patients who were ≥ 65 years old and hospitalized because of CVD.Patients with a pre-hospitalization diagnosis of dementia were excluded. Each patient's cognitive function had been measured at discharge using the RDST-J and the Japanese version of the Montreal Cognitive Assessment(Mo CA-J), which is a standard tool for MCI screening. The correlation between the two scores was evaluated using Spearman's rank correlation coefficient. Receiver operating characteristic(ROC) analysis was also to evaluate whether the RDST-J could identify MCI, which was defined as a Mo CA-J score of ≤ 25 points.RESULTS The study included 78 patients(mean age: 77.2 ± 8.9 years). The RDST-J and Mo CA-J scores were strongly correlated(r = 0.835, P < 0.001). The ROC analysis revealed that an RDST-J score of ≤ 9 points provided 75.4% sensitivity and 95.2% specificity for identifying MCI, with an area under the curve of 0.899(95% CI: 0.835-0.964). The same cut-off value was identified when excluding patients with a high probability of dementia(RDST-J score of ≤ 4 points).CONCLUSIONS The RDST-J may be a simple and effective tool for identifying MCI in older patients with CVD.
基金supported by the Talent training project of General Hospital of Ningxia Medical University(No.XM2020163)the Nursing Young Talents Training Program of General Hospital of Ningxia Medical University(No.dangfa[2020]39)。
文摘Objective:With the continuous advancement of aging in China,the number of older inpatients has increased sharply.Older patients have a high demand for planning their discharge services.Nurses serve as the leader of discharge planning for patients;there is a lack of reliable evaluation tool to evaluate the core competitiveness of nurses who implement discharge planning for older patients in China.The purpose of this study was to validate the index for the core competence of nurses who lead discharge planning for older patients developed by a project team through the Delphi method in the early stage.Methods:A cross-sectional questionnaire survey with 3-stage stratified sampling was used to select 1075 nurses from 17 public general hospitals in Ningxia,China.Results:The index consists of 4 first-level indicators,13 second-level indicators,and 57 third-level indicators.The results show that 57 third-level indicators had good discrimination.With exploratory factor analysis(EFA),4 common factors that explained 72.79%of the total variance were extracted.The Cronbach's a was 0.98,and the retest reliability within a 14-d interval was 0.86.The confirmatory factor analysis(CFA)results show that the fit of the index structure was good.The criterion validity was 0.73.Conclusions:The index presented excellent psychometric proper ties and can be used to measure the core competence of nurses in implementing discharge planning for older patients in China.
文摘Research fails to provide an overview of the challenges involved in caring for older patients with multimorbidity. Multimorbidity is defined as the presence of two or more chronic conditions in the same person, leading to a high risk of care dependency. The aim of this review was to illuminate the challenges faced by the healthcare services in managing the needs of older patients with multimorbidity. A systematic review was performed, a total of 1,965 abstracts were read and nine quantitative studies included. Data were analysed by thematic synthesis, revealing six themes: A frequent problem in older female patients;High healthcare expenditure and costs, Medication management problems, Social inequities, Complex healthcare and consultation needs and High mortality. The study highlights that healthcare professionals struggle to obtain suitable guidelines for the care of patients with multimorbidity while trying to respond to their needs. Patient-centred integration across settings and coordination in clinical practice are necessary. The healthcare system today does not seem to focus on patient safety and preventing harm. Older patients should be reviewed by a healthcare professional responsible for coordinating their care. To ensure safe and effective care for elderly persons with multimorbidity, the healthcare services should abandon the current focus on managing innumerable individual diseases and conditions.
文摘Introduction: The in-hospital rehabilitation of patients who have undergone surgery for hip fracture requires a team-based effort, in which nurses play an all-embracing role throughout the patients’ hospital stays. Although discharge planning has been widely studied, little is known about discharge planning from hospitals to homes in rural settings. Aim: To describe nurses’ views on discharge planning for older patients after hip fracture surgery who live in their own homes in rural areas. Methods: A qualitative method was used. Four focus group interviews were conducted with 18 nurses who work at an orthopaedic clinic. The interview texts were analysed with qualitative content analysis. Findings: Nurses expressed that patients needed support from healthcare personnel as well as relatives in order to prepare for life at home. They also expressed that patients were not supported in all aspects of discharge planning because they faced difficulties in having their voices heard. Nurses described that many of those aspects were beyond their own control, which had left them with little to non-ability to influence discharge planning. Findings additionally indicate that discharge planning seems not affected by occurring in rural settings. Conclusions: Although discharge planning is intended to meet the unique wishes and needs of each patient given the realities of existing resources, nurses’ responsibilities in discharge planning are unclear. This study shows an organisation in which healthcare personnel continue to make decisions for patients. Significance for nurses to perform a discharge planning that support patients’ participation seems to be a communication based on shared understanding.
文摘Objective To discuss perioperative features,operative approach and surgical effects of spinal tuberculosis in older patients.Methods Retrospective analysis was conducted to analyze the clinical data of 45 patients with spinal
文摘Gastroesophageal reflux disease (GERD) is the most common upper gastrointestinal disorder seen in the elderly. The worldwide incidence of GERD is increasing as the incidence of Helicobacter pylori is decreasing. Although elderly patients with GERD have fewer symptoms, their disease is more often severe. They have more esophageal and extraesophageal complications that may be potentially life threatening. Esophageal complications include erosive esophagitis, esophageal stricture, Barrett's esophagus and adenocarcinoma of the esophagus. Extraesophageal complications include atypical chest pain that can simulate angina pectoris; ear, nose, and throat manifestations such as globus sensation, laryngitis, and dental problems; pulmonary problems such as chronic cough, asthma, and pulmonary aspiration. A more aggressive approach may be warranted in the elderly patient, because of the higher incidence of severe complications. Although the evaluation and management of GERD are generally the same in elderly patients as for all adults, there are specific issues of causation, evaluation and treatment that must be considered when dealing with the elderly.
文摘Objective: Reflection is a process of deliberating thinking and examining one's practice in the past and thereby encouraging nurses to make improvements in future care delivery. This work outlines a piece of reflection involving the practice of communication between nurses and the elderly, to emancipate the authors from their constraints, help to find values as practitioners, and gain a greater understanding of the nurse-patient relationship.Methods: Using Smyth's four-stage model as a guide, as well as empirical and theoretical knowledge on nurse-patient relationships, this paper presents a deep reflection on the relationship that the authors developed with elderly patients and their families, encountered during the practice as a nurse. By applying the four main stages consisting of describe, inform, confront, and reconstruct, this model enabled the authors to frame, describe the practice issue, and explore the meaning behind it, which helps to facilitate a structured reflection.Results: Critical emancipatory reflection, in association with the Espoused theory and Theory-in-use, as well as reflexivity, critical social theory, and hegemony, was applied to uncover the various power relationships and constraining forces in the authors' practice involved in communicating with the elderly, such as the underlying false consciousness, hegemony, hidden assumptions, influential values, and dominant power structure, which are subtle and persuasive. By applying this process of critical reflection, transformative practice could be achieved.Conclusions: The process of critical reflection facilitated the development of the abilities required to develop and maintain the nursepatient relationship. It helps to enhance the care of old patients and their families, which illuminates the future nursing practice.
文摘Serenity is an emotional experience that contributes to the acceptance of a situation. One phenomenon in the care of chronically ill older patients and patients in end of life care is that too much focus is placed on the patient’s disease. This can contribute to anxiety, sadness or sense of isolation. For older people that are chronically ill or in care at the end of life, it is important that the registered nurse can help them to find serenity. Further knowledge is needed about how the concept of serenity is used in relation to the care of older chronically ill patients. Aim: The purpose of this concept analysis was to clarify how serenity is used in nursing and in relation to the care of chronically ill older patients. Method: The study follows Rodgers’ evolutionary method of concept analysis. Findings: Serenity is a state of physical, mental, emotional and spiritual balance when life conditions can be managed or accepted. Through the experience of serenity the chronically ill older patient is able to find or develop the self in order to continue with dignity. The concept is most used at the lowest described levels of the self, including a perception of personal safety. The highest level involves a sense of wholeness and awareness. Conclusion: The concept of serenity is used in relation to chronically ill older patients as a condition where the patient finds balance and thus can manage or accept their situation. Chronically ill older patients will not recover. For that reason it needed a better understanding about what factors to experience serenity are needed. Further research is also needed to examine how registered nurses can support older chronically patients in finding serenity with the help of nursing interventions.
文摘Objective: The present study aimed to demonstrate the patient outcomes after cochlear implantation in a rural area of Germany with special respect to older patients. Study Design: Retrospective Study. Setting: ENT-Department of Bad Hersfeld as an academic teaching hospital of the Justus-Liebig-University of Giessen. This is located in a rural county in Germany. Patients: A consecutive series of 217 patients implanted between 2003 and 2017. Intervention: Patients were implanted with different cochlear implant devices by the same surgeon in a standard procedure. In cases of chronic otitis media a middle ear obliteration was performed 6 months prior to cochlear implantation. Main Outcome Measures: Patients were divided in two groups: group 1 was 18 to 65 years of age and group 2 was older than 65 years. Pre- and postoperative hearing and speech understanding evaluated by the Freiburg monosyllable word test and the HSM-sentence test in the group of patients. Results: The mean preoperative speech understanding of group 1 was 0.5% for monosyllables at 60 dB and 2.7% at 80 dB. Group 2 showed similar results with 0.2% and 1.2%. In the HSM-test, group 1 had a speech understanding of 2.6% and group 2 of 3.2%. No statistically significant difference could be found between both groups. After cochlear implantation mean speech understanding at 60 dB increased in group 1 to 53.2% and 65.1% at 80 dB respectively. Group 2 had an improvement to 51.8% at 60 dB and 68.3% and 80 dB. The results in the HSM-sentence test were 77.8% in group 1 and 83.7% in group 2 (p = 0.47). Both groups had a significant increase in speech understanding concerning both tests after cochlear implantation (p = 0.0001) whereas we could not confirm any significant difference between the younger and older CI-recipients in the monosyllable word test. During the observation period no major complications had to be observed. Conclusion: Our data suggest that cochlear implantation in a rural area of Germany is feasible without increased risk and provides good hearing results even in older patients.
基金This work was supported by grants from the National Natural Science Foundation of China(81770251)National Natural Science Foundation of China Youth Science Fund Project(81800254),Natural Science Foundation of Chongqing Science and Technology Commission(cstc2020jcyjmsxmX0210)Medical research projects of Chongqing Science and Technology Commission and Chongqing Health Committee(2021MSXM217,2020FYYX047).
文摘Objective:This study evaluated the optimal systolic blood pressure(SBP)target for older patients with hypertension.Method:A Bayesian network meta-analysis was conducted.The risk of bias of the included studies was assessed by using a modified version of the Cochrane risk of bias.The trial outcomes comprised the following clinical events:ma-jor adverse cardiovascular events(MACE),cardiovascular mortality,all-cause mortality,myocardial infarction,heart failure and stroke.Results:A total of six trials were included.We reclassified all treatment therapies into three conditions according to the final achieved SBP after intervention(<130 mmHg,130–139 mmHg and≥140 mmHg).Our results demon-strated that anti-hypertensive treatment with an SBP target<130 mmHg,compared with treatment with an SBP target≥140 mmHg,significantly decreased the incidence of MACE(OR 0.43,95%CI 0.19–0.76),but no statistical difference was found in other comparisons.Although the results showed a trend toward more intensive anti-hypertension therapy having better effects on preventing cardiovascular mortality,all-cause mortality,myocardial infarction,heart failure,and stroke,no significant differences were found among groups.Conclusions:Our meta-analysis suggested that SBP<130 mmHg might be the optimal BP control target for patients≥60 years of age;however,further evidence is required to support our findings.
文摘Purpose:Coronary no-reflow phenomenon(NRP),a common adverse complication in patients with ST-segment eleva-tion myocardial infarction(STEMI)treated by percutaneous coronary intervention(PCI),is associated with poor patient prognosis.In this study,the correlation between the systemic immune-inflammation index(SII)and NRP in older patients with STEMI was studied,to provide a basis for early identification of high-risk patients and improve their prognosis.Materials and methods:Between January 2017 and June 2020,578 older patients with acute STEMI admitted to the Department of Cardiology of Hebei General Hospital for direct PCI treatment were selected for this retrospective study.Patients were divided into an NRP group and normal-flow group according to whether NRP occurred during the operation.Clinical data and the examination indexes of the two groups were collected.Logistic regression was used to analyze the independent predictors of NRP,and the receiver operating characteristic curve was used to further analyze the ability of SII to predict NRP in older patients with STEMI.Results:Multivariate logistic analysis indicated that hypertension(OR=2.048,95%CI:1.252–3.352,P=0.004),lymphocyte count(OR=0.571,95%CI:0.368–0.885,P=0.012),platelet count(OR=1.009,95%CI:1.005–1.013,P<0.001),hemoglobin(OR=1.015,95%CI:1.003–1.028,P=0.018),multivessel disease(OR=2.237,95%CI:1.407–3.558,P=0.001),and SII≥1814(OR=3.799,95%CI:2.190–6.593,P<0.001)were independent predictors of NRP after primary PCI in older patients with STEMI.Receiver operating characteristic curve analysis demonstrated that SII had a high predictive value for NRP(AUC=0.738;95%CI:0.686–0.790),with the best cut-off value of 1814,a sensitivity of 52.85%and a specificity of 85.71%.Conclusion:For older patients with STEMI undergoing primary PCI,SII is a valid predictor of NRP.
文摘BACKGROUND Although the 2021 Chinese Clinical Practice Guidelines for Enhanced Recovery after Surgery(ERAS)provide recommendations for ERAS in gastrointestinal surgery,the clinical application of standard ERAS nursing models is challenging due to the variety of diseases involved in gastrointestinal surgery and the com-plex factors contributing to patient stress responses.Moreover,stress responses are more severe in older adult patients.Therefore,precision medicine is required to improve the quality of nursing care and promote postoperative recovery in gastrointestinal surgery.and demonstrate nursing benefits through clinical practice.METHODS This randomized clinical trial first established an evidence-based nursing ERAS protocol in older adult patients based on literature related to perioperative nursing measures for gastrointestinal surgery stress response.Next,392 older adult patients who underwent gastrointestinal surgery and were admitted to our hospital between December 2021 and June 2023 were categorized into two groups to receive evidence-based(study group)or conventional(control group)ERAS nursing models,respectively.Intraoperative physiological parameters during surgery and postoperative recovery indicators were compared between the groups.RESULTS Among 64 domestic and international studies,the stress responses of older adult patients mainly included emotional anxiety,sleep disorders,gastrointestinal discomfort,physical weakness,pain,and swelling.The appropriate nursing interventions included comprehensive psychological counseling,pre-and postoperative nutritional support,temperature control,pain management,and rehabilitation training.Compared with the control group,the study group showed lower heart rate,mean arterial pressure,blood glucose level,and adrenaline level;shorter duration of drainage tube placement,time to first flatus,time to first ambulation,and postoperative hospital stay;lower anxiety scores on postoperative day 3;and lower incidences of postoperative infection,obstruction,poor wound healing,and gastrointestinal reactions were lower in the study group(all P<0.05).CONCLUSION The evidence-based nursing measures targeting stress responses based on the conventional ERAS nursing model resulted in stable intraoperative physiological parameters during surgery,promoted postoperative recovery,and reduced the incidence of complications.
文摘Background: Patients commonly develop postoperative pain after total knee arthroplasty(TKA).Acupuncture-related techniques and low-level laser therapy could be beneficial for pain management for older individuals.Objective: To examine the effect of low-level laser acupuncture(LA) in reducing postoperative pain, painrelated interference in daily life, morphine consumption, and morphine-related side effects in older patients with knee osteoarthritis who underwent TKA.Design, setting, participants and intervention: A single-blind randomized placebo-controlled trial was conducted. Patients(N = 82) were recruited and randomly assigned via a computer-generated list to the LA group or a placebo group. The LA group received low-level laser therapy at Sanyinjiao(SP6), Taixi(KI3),Kunlun(BL60), Fengshi(GB31), Futu(ST32) and Neiguan(PC6) after TKA, while the placebo acupuncture group received the same treatment procedure without laser energy output.Main outcome measures: The primary outcome was postoperative pain intensity, and it was measured at baseline and hours 2, 6, 10, 24, 48 and 72 after TKA. The secondary outcomes, including relative pain,postoperative pain-related interference in daily life and morphine consumption, were measured at hours24, 48 and 72 after TKA.Results: Generalized estimating equations revealed significant between-group differences in pain intensity(P = 0.01), and trend differences in pain intensity for the LA group starting at hours 10 to 72(P < 0.05)and morphine consumption at hours 48 and 72(P < 0.05). The changes in pain-related interference in daily life were significant(P < 0.05) at 72 h, with the exception of the parameters for worst pain, mood,and sleep. Nausea and vomiting side effects from morphine had significant between-group differences at hours 10 and 24(P < 0.05).Conclusion: Low-level LA gradually reduced older patients’ postoperative pain intensity and morphine consumption within the first 72 h after their TKA for osteoarthritis. Low-level LA may have benefits as an adjuvant pain management technique for clinical care.Trial registration: ClinicalTrials.gov registration number NCT03995446.
