Table of Content

20 November 2024, Volume 38 Issue 11 Previous Issue    Next Issue

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Development of an evidence-based management programme for the prevention of adhesive-related skin injuries in elderly patients SHAO Siyu, ZHAI Yuting, WU Haiyan, ZHANG Jianwei 2024, 38 (11):  1081-1085.  doi: 10.3969/j.issn.1003-9198.2024.11.001 Abstract ( 75 )   PDF (1154KB) ( 220 )   Save Objective To develop an evidence-based prevention and management programme for medical adhesive-related skin injuries in the elderly patients. Methods A systematic literature review was conducted based on evidence-based methods. The quality of the literature was evaluated according to inclusion and exclusion criteria. After discussions within the research team and two rounds of Delphi expert consultation, a prevention and management programme for medical adhesive-related skin injuries in the elderly patients was formulated. Results The positive coefficients of the experts in both rounds were 100%. Ultimately, a prevention and management programme was established, which included 7 first-level indicators, 14 second-level indicators, and 29 third-level indicators, covering patient assessment, operator assessment, pre-operation preparation, operation technique, post-operation observation, health education, supervision and training. Conclusions The prevention and management programme for medical adhesive-related skin injuries in the elderly patients established in this study has scientificity and feasibility, and can be further applied in clinical practice. References | Related Articles | Metrics

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Analysis of relevant indicators of hospital-acquired pressure injury in elderly patients SHEN Yuanjuan, ZHU Jianhua, GAO Juanjuan, SUN Min, LI Juyun 2024, 38 (11):  1086-1090.  doi: 10.3969/j.issn.1003-9198.2024.11.002 Abstract ( 64 )   PDF (1094KB) ( 323 )   Save Objective To analyze the relevant indicators of hospital-acquired pressure injury (HAPI) in the elderly patients, and to provide a basis for clinical prevention and management. Methods A retrospective analysis of the data of 49 elderly patients with stage 2 or above HAPI in Affiliated Hospital of Nanjing University of Chinese Medicine from 2021 to 2023 was conducted. The clinical characteristics of the patients with HAPI were analyzed, and Apriori algorithm was used to analyze the causal factors in adverse event reports system. Results Among the 49 patients, 53 pressure injuries occurred, 92.45%(49/53) being stage 2 pressure injuries, and 35.85% (19/53) occurring at the sacral area. Most patients were from Intensive Care Unit (ICU) and surgical wards. 81.63%(40/49) of the patients had a hemoglobin level of less than 120 g/L, and 75.51%(37/49) had a serum albumin level of less than 35 g/L. Braden Scale assessment showed that almost half of the patients were defined as low risk. Apriori algorithm association analysis identified 23 pairs of strong-association risk factors during nursing process. Conclusions In response to the physiological characteristics of elderly patients, clinical practice should focus on the prevention and management of high-risk wards and populations, strengthen nutritional management and skin condition monitoring, and scientifically formulate pressure injury prevention and management plans. At the same time, it is necessary to combine clinical judgment to optimize risk assessment and reduce the incidence of HAPI. References | Related Articles | Metrics

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Best evidence summary for the use of stress redistribution strategies in skin management for elderly adults MA Wanqiu, ZHU Huanhuan, WENG Yajuan, LIU Wenyan, DA Jing, SUN Lu 2024, 38 (11):  1091-1096.  doi: 10.3969/j.issn.1003-9198.2024.11.003 Abstract ( 69 )   PDF (1125KB) ( 180 )   Save Objective To systematically retrieve, evaluate and summarize the best evidence on stress redistribution strategies in skin management for elderly adults, and to provide a reference for the development of evidence-based standardized skin management strategies in clinical practice. Methods Based on the “6S” evidence resource model, this study systematically searched the computerized decision support systems, thematic evidence summaries and databases for evidence on stress redistribution strategies in skin management for elderly adults, such as clinical decisions, guidelines, expert consensus, clinical practice, evidence summaries, systematic evaluations and meta-analysis, with a timeframe from the establishment of the databases to April 2024. The literatures were screened and evaluated independently by 2 researchers, and the guidelines were evaluated by 4 researchers. The evidences were extracted, summarized and aggregated according to themes. Results A total of 14 pieces of literatures were selected and 36 items of eveidence were collected, which were classified into 3 aspects as support surfaces, static body position placement and continuous rotation, and 7 topics as effectiveness of support surface application, key points in selecting support surfaces, the applicability of different types of support surfaces to different groups of people, the principles of static body position placement, posture and tilt, change of position, and the role and purpose of continuous rotation. Conclusions The study summarizes the best evidence for pressure redistribution strategies in skin management for elderly adults and suggests that clinical healthcare staffs can combine clinical scenarios, clinical resources and patients’ own conditions to rationally apply evidence and evaluate the effects of evidence application to improve the quality of clinical care. References | Related Articles | Metrics

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Effects of resistance exercise on blood glucose control and activity in elderly patients with type 2 diabetes mellitus with sarcopenia YANG Liping, KANG Yufeng, PENG Zhenzhen 2024, 38 (11):  1097-1100.  doi: 10.3969/j.issn.1003-9198.2024.11.004 Abstract ( 67 )   PDF (1082KB) ( 376 )   Save Objective To explore the effects of resistance exercise on blood glucose control and activity in the elderly patients with type 2 diabetes mellitus with sarcopenia. Methods A total of 100 elderly patients with type 2 diabetes mellitus with sarcopenia admitted to the Second Affiliated Hospital of Nanchang University from January 2022 to February 2023 were enrolled in this study, and were randomly divided into control group and observation group, with 50 cases in each group. The patients in the control group received routine exercise guidance. On the basis of the control group, the patients in the observation group received elastic band resistance exercise intervention. The results of fasting plasma glucose (FPG), postprandial blood glucose (PBG), glycosylated hemoglobin (HbA1c), Berg balance scale (BBS) and timed up and go test (TUG) were compared between the two groups before intervention, 3 months and 6 months after the intervention. Results Before intervention, there were no significant differences in the levels of FPG, PBG, HbA1c, BBS score and TUG time between the two groups (P>0.05); After 3 and 6 months of intervention, the levels of FPG, PBG, HbA1c and TUG time were significantly decreased, and the score of BBS was sinificantly increased in the two groups (P<0.05), especially in the observation group (P<0.05). Conclusions Elastic band resistance exercise is helpful to control blood glucose, and to improve the patients’ physical balance and walking ability in the elderly patients with type 2 diabetes mellitus with sarcopenia. References | Related Articles | Metrics

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Effective dose of remimazolam to inhibit cardiovascular response to double-lumen tracheal intubation in elderly patients ZHONG Zhigang, CHEN Jing 2024, 38 (11):  1101-1104.  doi: 10.3969/j.issn.1003-9198.2024.11.005 Abstract ( 69 )   PDF (1745KB) ( 351 )   Save Objective To investigate the effective dose of remimazolam to inhibit the cardiovascular response to double-lumen endotracheal intubation during general anesthesia with sufentanil in the elderly patients who receiving thoracic non-cardiac surgery. Methods In this study, 21 elderly patients who underwent double-lumen tracheal intubation during thoracic non-cardiac surgery under general anesthesia were selected from October 2022 to April 2023, and the sequential method was used in this study. The first patient received intravenous injection of remimazolam 0.3 mg/kg, and the dose of remimazolam for the next patient was determined according to the cardiovascular response to tracheal intubation of the previous patient. If the cardiovascular response was positive, the dose was increased by 0.01 mg/kg; Instead, the dose of the next patient was decreased by 0.01 mg/kg, and the experiment was terminated when there were ≥6 consecutive alternating positive and negative waveforms. The Probit method was used to calculate the median effective dose (ED50) and the 90% effective dose (ED90) of remimazolam in inhibiting the cardiovascular response to double-lumen tracheal intubation. Results A total of 10 positive and 11 negative cases were observed in 21 patients. The ED50 of remimazolam combined with sufentanil in suppressing the cardiovascular response to double-lumen tracheal intubation during thoracic non-cardiac surgery in the elderly patients was 0.306 mg/kg, with a 95%CI of 0.291-0.328 mg/kg, and the ED90 was 0.322 mg/kg, with a 95%CI of 0.312-0.488 mg/kg. Conclusions The ED50 of remimazolam in inhibiting cardiovascular response to double-lumen endotracheal intubation was 0.306 mg/kg and the ED90 was 0.322 mg/kg in the elderly patients who underwent thoracic surgery under general anesthesia with sufentanil. References | Related Articles | Metrics

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Analysis of the current situation and influencing factors of demoralization syndrome in elderly patients with chronic heart failure GAO Wenjun, SUN Qing, LIU Mengtan, ZHOU Dan 2024, 38 (11):  1105-1109.  doi: 10.3969/j.issn.1003-9198.2024.11.006 Abstract ( 68 )   PDF (1106KB) ( 581 )   Save Objective To investigate the current situation of demoralization syndrome in the elderly patients with chronic heart failure (CHF) and to analyze the influencing factors. Methods Convenience sampling method was used to enroll the elderly patients with CHF admitted to Changhai Hospital from June 2022 to June 2023 in this study. The patients were surveyed using a general information questionnaire, Chinese version of the Demoralization Scale-Ⅱ, Heart Failure Somatic Perception Scale (HFSPS), Fear of Progression Questionnaire-Short Form (FoP-Q-SF), International Physical Activity Questionnaire (IPAQ) and Perceived Social Support Scale (PSSS). Multiple linear regression was used to analyze the influencing factors of demoralization syndrome. Results The score of Demoralization Scale-Ⅱ in 245 elderly patients with CHF was 16.55±4.76, which was at a medium level. Pearson correlation analysis showed that demoralization syndrome was positively correlated with body perception, fear of disease progression and sedentary behavior (r=0.475, 0.440, 0.499, respectively), and negatively correlated with social support (r=-0.491). Multiple linear regression analysis showed that per capita monthly household income, disease duration, physical perception, fear of disease progression, sedentary behavior, and social support were independent influencing factors (P<0.05) for demoralization syndrome in the elderly patients with CHF, and could jointly explain 45.9% of the variation in demoralization syndrome. Conclusions The level of demoralization syndrome in the elderly patients with CHF is at a medium level. Low income, long course of disease, strong physical perception, high fear of disease progression and sedentary lifestyle were risk factors for the demoralization syndrome of patients with CHF, while social support is a protective factor. References | Related Articles | Metrics

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Analysis of current situation and influencing factors of activities of daily living in the elderly with decreased subjective cognition in community YANG Cunmei, HU Yixin, LIU Cuie, MA Hongying, YAN Jin, XU Qiuli, XING Dan, ZHANG Tianyi 2024, 38 (11):  1110-1115.  doi: 10.3969/j.issn.1003-9198.2024.11.007 Abstract ( 51 )   PDF (1174KB) ( 585 )   Save Objective To investigate the activities of daily living (ADL) of the community elderly with subjective cognitive decline (SCD) and to analyze the influencing factors. Methods Convenient sampling method was used to enroll a total of 459 elderly people in a community in Beijing from January 2019 to January 2022 in this study. The patients’ demographic data, anxiety and depression status, lifestyle, exercise style, nutrition, disease history and medication history were collected by self-designed questionnaire; And barthel index rating scale was used to evaluate the level of basic activities of daily living (BADL), Lawton instrumental activities of daily living (IADL) scale was used to evaluate the level of IADL. Univariate analysis and multivariate Logistic regression analysis were used to explore the influencing factors of ADL. Results A total of 209 cases (45.5%) presented with dependence on BADL, with a higher frequency of functional decline in ascending and descending stairs and urination; 256 cases (55.8%) presented with dependence on IADL; The frequency of functional decline is higher when going out, shopping and taking medication. Logistic regression analysis showed that age, decreased vision, BMI and physical activity time were the independent influencing factors of BADL dependence; Gender, hearing loss, anxiety, alcohol consumption, and nutrition were independent influencing factors of IADL dependence (P<0.05). Conclusions The incidence of ADL dependence in the elderly with SCD in community is high, but the degree is light; Community healthcare workers should focus on the elderly people being elderly, male, obesity, anxious, having decreased vision and hearing, having low physical activity, drinking alcohol, and having a risk of malnutrition, and should assist the elderly in establishing a healthy lifestyle to improve or delay their cognitive impairment. References | Related Articles | Metrics

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Establishment of prediction model of death risk in elderly patients with chronic heart failure treated with ARNI YAN Hongjuan, SHI Pengxiao, SONG Yuanyuan, LI Yan, FENG Lisa, LUO Qiuhua 2024, 38 (11):  1116-1120.  doi: 10.3969/j.issn.1003-9198.2024.11.008 Abstract ( 46 )   PDF (1382KB) ( 181 )   Save Objective To establish a prediction model of death risk in the elderly patients with chronic heart failure (CHF) treated with angiotensin receptor neprilysin inhibitors (ARNI), and to provide reference for early identification of high-risk patients with poor prognosis and formulation of more effective intervention programs. Methods A total of 183 elderly patients with CHF who received ARNI treatment in the First Hospital of Handan from January 2018 to January 2020 were retrospectively enrolled in this study, and were divided into death group (n=50) and survival group (n=133) according to the results of 3 years follow-up. The independent risk factors for death in elderly patients with CHF treated with ARNI were assessed by multivariate Cox regression analysis, and a prediction model of death risk was established. Results The median survival time of all patients was 25.0(22.0,34.0)months. The 1-year, 2-year, 3-year survival rate was 93.44% (171/183), 82.51% (151/183) and 72.68% (133/183), respectively. The results of multiple Cox regression analysis showed that left ventricular ejection fraction, left ventricular end-diastolic diameter, the levels of N-terminal pro-B-type natriuretic peptide and troponin Ⅰ were related to prognosis (P<0.05). ROC curve showed that the area under the curve of nomogram model predicting the 1-year, 2-year, 3-year survival rate was 0.741, 0.862 and 0.730, respectively. Conclusions The death risk of the elderly patients with CHF treated with ARNI may be related to a variety of cardiac structural and functional indicators. The model based on cardiac structural and functional indicators is more suitable in predicting the death risk of the patients. References | Related Articles | Metrics

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Effect of bone cement perfusion rate on early efficacy and complications in elderly patients with osteoporotic vertebral compression fractures receiving percutaneous vertebroplasty NIU Maolin, WU Dapeng, ZHAO Endian, SUN Haoyuan, LIANG Qiudong 2024, 38 (11):  1121-1125.  doi: 10.3969/j.issn.1003-9198.2024.11.009 Abstract ( 48 )   PDF (1242KB) ( 263 )   Save Objective To explore the effects of different bone cement perfusion rates on the early clinical efficacy and complications in the elderly patients with osteoporotic vertebral compression fractures undergoing percutaneous vertebroplasty (PVP) surgery. Methods A retrospective analysis was conducted on the clinical data of 167 elderly patients who underwent PVP surgery for osteoporotic vertebral compression fractures. The patients were divided into the high perfusion rate group (20%≤bone cement perfusion rate<30%, Group Ⅰ, n=71) and the low perfusion rate group (10%≤bone cement perfusion rate<20%, Group Ⅱ, n=96). The preoperative and postoperative visual analogue scale (VAS) scores and Oswestry disability index (ODI) scores, as well as the rates of bone cement leakage, adjacent vertebral fractures, and postoperative re-fracture rate of injured vertebra in the two groups were recorded and compared. Results The postoperative VAS and ODI scores in both groups were significantly improved, with statistically significant differences (P<0.01). However, there was no statistically significant difference in VAS and ODI scores between the two groups (P>0.05). The leakage rate of bone cement in Group Ⅰ was 42.25%, the fracture rate of adjacent vertebral bodies was 18.31%, compared with 23.95% and 7.29% in Group Ⅱ with significant difference(P<0.05), respectively. The postoperative re-fracture rate of injured vertebra in Group Ⅰ was 2.82%, compared with 4.17% in Group Ⅱ with no significant difference (P>0.05). Conclusions Different bone cement perfusion rates within 10%-30% can bring the same early clinical efficacy, while low bone cement perfusion rate can reduce the risk of bone cement leakage and adjacent vertebral fractures. References | Related Articles | Metrics

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Application of puncture path planning based on surface anatomical markers in elderly patients undergoing drainage surgery for thalamus and internal capsule hematoma JIA Baoming, ZHAO Jiankai, ZHANG Yanli, FENG Guoqiang, ZHOU Xiguang, PEI Hongsha, WANG Lizhen, KU Hongbin 2024, 38 (11):  1126-1130.  doi: 10.3969/j.issn.1003-9198.2024.11.010 Abstract ( 41 )   PDF (1424KB) ( 119 )   Save Objective To evaluate the application value of puncture path planning based on surface anatomical markers in the elderly patients undergoing drainage surgery for thalamus and internal capsule hematoma. Methods The clinical data of 175 elderly patients with thalamus and internal capsule hematoma who underwent drainage surgery were retrospectively analyzed. Among them, 91 patients using surface anatomical landmarks to plan the puncture path for drainage were enrolled in the study group, and 84 patients receiving stereotactic hematoma drainage were enrolled in the control group. The differences in path planning time, postoperative rebleeding rate, catheter placement accuracy, hematoma clearance rate, postoperative concurrent hydrocephalus, treatment efficiency and good prognosis rate between the two groups were compared. Results The path planning time showed significant difference between the study group and the control group (7.4±2.6 min vs 40.5±10.5 min, P<0.01). There were no significant differences in catheter placement accuracy, postoperative rebleeding rate, hematoma clearance rate, postoperative concurrent hydrocephalus, treatment effectiveness and good prognosis rate between the study group and the control group (P>0.05). Conclusions The application of puncture path planning based on surface anatomical markers in the elderly patients undergoing drainage surgery for thalamus and internal capsule hematoma can shorten path planning time with accuracy. The surgical effect is consistent with stereotactic surgery. References | Related Articles | Metrics

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Therapeutic effect of enhanced exetrnal counterpulsation therapy in elderly patients with chronic heart failure and renal insufficiency OU Dongbo, WANG Qi, FENG Guangqin, LI Wei, HUANG Xiaolian, WEI Li 2024, 38 (11):  1131-1135.  doi: 10.3969/j.issn.1003-9198.2024.11.011 Abstract ( 55 )   PDF (1103KB) ( 165 )   Save Objective To explore the therapeutic effect of enhanced exetrnal counterpulsation (EECP) therapy in the elderly patients with chronic heart failure and renal insufficiency. Methods A total of 90 patients with chronic heart failure and renal insufficiency who were hospitalized in Jiangbin Hospital of Guangxi Zhuang Autonomous Region were randomly divided into the counterpulsation group and the control group, with 45 patients in each group. The control group received conventional internal medicine treatment, while the counterpulsation group received EECP on the basis of conventional treatment. The levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP), left ventricular ejection fraction (LVEF), New York Heart Association (NYHA) cardiac function classification, serum creatinine (Scr), 24-hour urine output, maximal oxygen uptake (VO2max), anaerobic threshold (AT) and activities of daily living (ADL) were recorded and compared between the two groups before and after treatment. Results Finally, there were 40 patients finished the treatment in each group. Before treatment, there were no significant differences in the levels of NT-proBNP, LVEF, NYHA classification, Scr, 24-hour urine output, VO2max, AT and ADL between the two groups (P>0.05). After 18 days of treatment, the levels of NT-proBNP, NYHA classification, Scr, 24-hour urine output in the two groups and the levels of VO2max and AT in the counterpulsation group were significantly improved than those before treatment (P＜0. 05 or P＜0. 01). And the counterpulsation group showed better results in the levels of LVEF, NYHA classification, 24-hour urine output, VO2max and AT compared to the control group, with significant differences (P<0.05 or P＜0. 01). Conclusions EECP treatment is a relatively low-risk and non-invasive adjuvant therapy for elderly patients with chronic heart failure and renal insufficiency. It has short-term effects such as increasing urine output, improving heart function and benefiting cardiac rehabilitation. References | Related Articles | Metrics

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Establishment of a hypoglycemia risk prediction model based on decision tree for elderly patients with type 2 diabetes combined with cognitive impairment YI Mengting, ZHOU Yi, ZONG Qianxing, WANG Xuefei, YUAN Yingying, CHEN Jing, WU Haidi, MO Yongzhen 2024, 38 (11):  1136-1141.  doi: 10.3969/j.issn.1003-9198.2024.11.012 Abstract ( 52 )   PDF (1639KB) ( 267 )   Save Objective To analyze the risk factors for hypoglycemia in the elderly patients with type 2 diabetes mellitus combined with cognitive impairment, and to establish a prediction model for hypoglycemia based on decision tree. Methods A total of 261 elderly patients with type 2 diabetes mellitus combined with cognitive impairment in the Affiliated Geriatric Hospital of Nanjing Medical University from February 2022 to June 2023 were enrolled in this study by convenient sampling method. Decision tree model was established based on CART algorithm. Receiver operating characteristic (ROC) curve was drawn to evaluate the model. Results In the decision tree, the group with a history of hypoglycemia and HbA1c≥8.3% had the highest risk of 80% of hypoglycemia in the next 6 months, followed by the group with a history of hypoglycemia, HbA1c < 8.3%, insulin use and disease duration ≥20 years, with a risk of 74%. The area under ROC curve (AUC) of the training set was 0.805, with the sensitivity of 0.779, the specificity of 0.725, and the accuracy of 0.840. The AUC of the validation set was 0.722, with the sensitivity of 0.668, the specificity of 0.766, and the accuracy of 0.739. Conclusions The decision tree prediction model established in this study can better predict the risk of hypoglycemia in the elderly type 2 diabetic patients with cognitive impairment in the next 6 months, and can provide a scientific and effective tool to assess the risk of hypoglycemia in clinic. References | Related Articles | Metrics

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A cross-sectional study of the influencing factors associated with immobility in elderly patients ZHANG Wanshu, LIU Pan, SONG Yu, LI Xiaojun, LI Xiaxia, LI Yun, MA Lina 2024, 38 (11):  1142-1147.  doi: 10.3969/j.issn.1003-9198.2024.11.013 Abstract ( 42 )   PDF (1119KB) ( 161 )   Save Objective To explore the influencing factors of immobility in the elderly patients. Methods The demographic information, medical history and serological indicators of 244 hospitalized patients aged ≥60 years old in Department of Geriatrics, Xuanwu Hospital, Capital Medical University from May 2022 to March 2023 were collected. The elderly patients were divided into immobility group and normal group according to the score of Short Physical Performance Battery (SPPB) scale, and the score of SPPB ≤ 9 was diagnosed as immobility. Cognitive function, depressive state, nutritional function and frailty were assessed in two groups. Univariate analysis and multiple Logistic regression analysis were performed to explore the influencing factors of immobility in the elderly patients. Results The prevalence rate of immobility in the elderly patients was 24.6%(60/244). The results of univariate analysis showed that age, application of more than three prescribed medications, comorbid with hypertension, Montreal Cognitive Assessment Scale (MoCA) score, frailty, the levels of albumin, prealbumin, alanine aminotransferase and D-dimer showed statistically significant differences between the two groups (P<0.05). Multiple Logistic regression analysis showed that age (OR=1.065, 95%CI: 1.011-1.122, P=0.017), application of more than three prescribed medications (OR=3.110, 95%CI: 1.431-6.760, P=0.004) and frailty grade (OR=1.709, 95%CI: 1.243-2.350, P=0.001) were independent influencing factors of immobility in the elderly patients. Conclusions Age, application of more than three prescribed medications and frailty grade can influence the incidence of immobility, which informs future intervention programs for immobility. References | Related Articles | Metrics

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Consistency between Daytona ultra-wide-field scanning laser ophthalmoscope and FFA in screening diabetic retinopathy in elderly patients with cataract LIU Ge, LIU Yang, LUO Jie 2024, 38 (11):  1148-1152.  doi: 10.3969/j.issn.1003-9198.2024.11.014 Abstract ( 41 )   PDF (1107KB) ( 135 )   Save Objective To explore the consistency between Daytona ultra-wide-field scanning laser ophthalmoscope and fundus fluorescein angiography (FFA) in screening diabetic retinopathy (DR) in the elderly patients with cataract and diabetes mellitus (DM). Methods A cross-sectional study was conducted. A total of 172 (323 eyes) elderly patients with cataract complicated with DM aged ≥ 60 years old admitted to Ophthalmology Clinic of Daqing Oilfield General Hospital from April 2021 to August 2023 were enrolled in this study. Daytona ultra-wide-field scanning laser ophthalmoscope and FFA were applied to screen DR.The data were analyzed using chi-square test, weighted Kappa test and Spearman partial regression analysis. Results No significant difference was found in readability of fundus imaging betweeen Daytona ultra-wide-field scanning laser ophthalmoscope and FFA (93.8% vs. 94.1%, P=0.869).The examination duration of Daytona ultra-wide-field scanning laser ophthalmoscope was 2.3(1.7, 5.2) min, compared with 9.5(7.3, 12.0) min of FFA (Z=16.85, P＜0.001). The complete consistency rate in determining DR stage between Daytona ultra-wide-field scanning laser ophthalmoscope and FFA was 93.29% (278/298) (Kappa=0.925, 95%CI: 0.892-0.958). The sensitivity and specificity of Daytona ultra-wide-field scanning laser ophthalmoscope in detecting non-proliferative DR was 94.47% and 90.91%, respectively, with a Kappa value of 0.900. The sensitivity and specificity of Daytona ultra-wide-field scanning laser ophthalmoscope in detecting proliferative DR was 90.00% and 100.00%, respectively, with a Kappa value of 0.926. The results of DR stage diagnosed by Daytona ultra-wide-field scanning laser ophthalmoscope were significantly correlated with FFA (r=0.921). Conclusions There is a high consistency between Daytona ultra-wide-field scanning laser ophthalmoscope and FFA in screening and staging DR in the elderly patients with cataract and DM. References | Related Articles | Metrics

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Application of prehabilitation based on comprehensive geriatric assessment in elderly patients with lung cancer combined with preoperative frailty LIU Caiyun, HUO Xiaopeng, LIU Xiaoxuan, YAN Li, LI Wei, HE Zhijuan 2024, 38 (11):  1153-1157.  doi: 10.3969/j.issn.1003-9198.2024.11.015 Abstract ( 41 )   PDF (1105KB) ( 217 )   Save Objective To explore the effect of prehabilitation based on comprehensive geriatric assessment (CGA) in the elderly patients with lung cancer combined with preoperative frailty. Methods A total of 88 elderly patients with lung cancer combined with preoperative frailty were randomly divided into two groups, with 44 cases in each group. The control group received routine nursing, while the observation group received prehabilitation based on CGA before surgery additionally. The postoperative recovery, physical function, nutritional status and psychological status were assessed and compared between the two groups. Results A total of 43 patients in the observation group and 42 patients in the control group completed the study. The first time of getting out of bed, thoracic drainage tube retention time, amount of drainage fluid, postoperative hospital stay, the score of 15-item Quality of Recovery Scale on the 3rd day after surgery, the levels of forced expiratory volume in the first second(FEV1), forced vital capacity(FVC) on the 30th day after surgery and postoperative complications in 30 days in the observation group were significantly better than those in the control group (P＜0.05). 30 days after surgery, grip strength, walking speed, the levels of blood albumin, prealbumin and hemoglobin in the observation group were significantly higher than those in the control group. The scores of the Hospital Anxiety and Depression Scale in the observation group were significantly lower than those in the control group (all P<0.05). Conclusions Prehabilitation based on CGA is beneficial for perioperative management of the elderly patients with lung cancer combined with frailty, which can promote postoperative recovery. References | Related Articles | Metrics

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Application research of refined nursing model based on target control combined with Crede urination method in bedridden elderly patients with urinary incontinence WANG Yingjie, QIAO Ran, YU Tong, ZHU Hongwei, WANG Xiaojing 2024, 38 (11):  1174-1177.  doi: 10.3969/j.issn.1003-9198.2024.11.019 Abstract ( 53 )   PDF (1179KB) ( 187 )   Save Objective To evaluate the effect of refined nursing model based on target control combined with Crede urination method on urinary function and urinary tract infection in bedridden elderly patients with urinary incontinence. Methods A total of 70 bedridden elderly patients with urinary incontinence in Peking Union Medical College Hospital were selected and divided into two groups according to random number table method. The control group was given routine treatment and nursing, and the intervention group was given refined nursing model based on target control combined with Crede urination method. The urination function and urinary infection were evaluated after 3 months. Results After intervention, the average urinary incontinence rate in the intervention group was significantly lower than that in the control group (0.30±0.21 vs 0.49±0.30,P=0.004) . There were no significant differences in residual bladder urine, indwelling catheter rate and urinary tract infection rate between the two groups(P>0.05). Conclusions Refined nursing model based on target control combined with Crede urination method can effectively relieve urinary incontinence in bedridden elderly patients, but it shows no obvious effect in reducing the occurrence of urinary system infection. References | Related Articles | Metrics

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Construction and effectiveness evaluation of intervention program for chronic constipation in elderly patients XU Xin, ZHU Ling, HAN Yunxia 2024, 38 (11):  1178-1182.  doi: 10.3969/j.issn.1003-9198.2024.11.020 Abstract ( 41 )   PDF (1099KB) ( 152 )   Save Objective To construct a grading criteria and intervention program for chronic constipation in the elderly patients, and to reduce the incidence of chronic constipation and improve the quality of life. Methods A total of 50 elderly patients with chronic constipation who were admitted to Department of Geriatric Neurodigestion in Jiangsu Province Hospital from January to June 2022 were enrolled in this study, and were randomly divided into the intervention group and the control group, with 25 patients in each group. The established intervention plan for chronic constipation in the elderly were applied in the intervention group, including appropriate treatment plans according to the degree of constipation, such as psychological care, dietary management, exercise guidance, rehabilitation training and acupuncture. In the control group, the patients received knowledge and health education about chronic constipation, the education of the strategies for preventing and treating constipation, and the patients with anxiety and depression received psychological care. The anxiety, depression and quality of life between two groups were compared. Results The incidence of 3-d non-defecation in the intervention group was lower than that in the control group, and the scores of the Patient Self-rating Anxiety Scale, the Self-rating Depression Scale and the Patients with Constipation Quality of Life Scale (PAC-QOL) in the intervention group were all lower than those in the control group, with statistically significant difference (P<0.05). The total clinical effective rate in the observation group was higher than that in the control group (P<0.05). Conclusions The intervention program for chronic constipation in elderly patients can reduce the incidence of constipation, decrease the incidence of physical and mental health problems such as anxiety, depression, and discomfort caused by constipation, and improve the quality of life in the elderly patients References | Related Articles | Metrics