老年原发性高血压患者生活质量量表编制的商榷

目的 编制和检验适合国情、符合老年原发性高血压特点的生活质量评定工具。 方法 形成条目库并进行条目分析和因子分析以选取合适条目构成多维度量表 ,然后选择 96例老年轻、中度高血压患者 ,对量表进行信度和效度检验。 结果 经筛选和测试形成包括躯体健康、心理健康和社会功能 3个分量表共 2 2项条目的自评量表。各分量表的Cronbachα系数 0 787～ 0 819,重测信度 0 749～ 0 82 1,校正后折半信度 0 6 76～ 0 773;因子分析显示因子数与量表的理论结构一致 ;各分量表与SF 36健康调查表对应部分存在中度相关 ,中度或新近诊断高血压患者量表得分与轻度或非新近诊断高血压患者存在统计学差异。 结论 本量表通过信度和效度检验 。

Efficacy of comprehensive cognitive health management for Shanghai community older adults with mild cognitive impairment

Background The management of modifiable risk factors and comorbidities may impact the future trajectory of cognitive impairment,but easy-to-implement management methods are lacking.Aims This study investigated the effects of simple but comprehensive cognitive health management practices on the cognitive function of older adults in the community with normal cognition(NC)and mild cognitive impairment(MCI).Methods The comprehensive cognitive health management programme included a psychiatric assessment of the cognitive risk factors for those in the intervention groups and individualised recommendations for reducing the risks through self-management supported by regular medical professional follow-up.The intervention groups for this study included 84 elderly participants with NC and 43 elderly participants with MCI who received comprehensive cognitive health management.The control groups included 84 elderly participants with NC and 43 elderly participants with MCI who matched the intervention group’s general characteristics and scale scores using the propensity matching score analysis.The Montreal Cognitive Assessment(MoCA)scale and Geriatric Depression Scale(GDS)scores were compared after a 1-year follow-up.Results For older adults with MCI in the intervention group,MoCA scores were higher at the 1-year followup than at baseline(24.07(3.674)vs 22.21(3.052),p=0.002).For the MoCA subscales,the intervention group’s abstract and delayed memory scores had significantly increased during the 1-year follow-up.Furthermore,in a generalised linear mixed model analysis,the interaction effect of group×follow-up was statistically significant for the MCI group(F=6.61,p=0.011;coefficients=5.83).Conclusions After the comprehensive cognitive health management intervention,the older adults with MCI in the community showed improvement at the 1-year follow-up.This preliminary study was the first to demonstrate an easy-to-implement strategy for modifying the cognitive risk factors of elderly individuals with MCI in the community,providing new insight into early-stage intervention for dementia.

An objective measure for the assessment and management of fluid shifts in acute major burns

Background: Major burns are life threatening. Fluid resuscitation is required for survival to maintain intravascular volumes and prevent hypovolemic shock. Bioimpedance spectroscopy (BIS) has been recognised as a potential method of monitoring fluid shifts after burn and in other disease states. The aims of this study were to examine the reliability of BIS across different dressing conditions and electrode positions, establish the influence of Acticoat?on BIS variable measures and determine the validity of whole-body BIS to assess net fluid shift in the presence of moderate to major burns. Methods: An observational longitudinal cohort study was conducted from December 2014 to February 2016. Patients with over 15% total body surface area (TBSA) burns and injury less than 48 h were enrolled in the study. BIS triplicate measures were collected in an open wound and with an ActicoatTMdressing (at 5 half hour intervals). Standard and alternate electrode placements were utilised for the reliability analysis and standard placement only for determining the validity of BIS in moderate to major burns. The ImpediMde SFB7 was used to collect whole-body and segmental BIS measures. Stata statistical software, release 14 was utilised to analyse all results. Descriptive analyses were performed and were reported using the means and standard deviations (SD). Results: BIS-repeated measures established BIS raw resistance (R), and predicted volume variables were reliable in any condition (intra-class correlation coefficient (ICC) 0.996-0.999, 95% confidence intervals (CI) 0.996-0.999) without a systematic difference. Acticoat?dressings significantly influenced all BIS-predicted volumes (p≤0.01) as determined by multilevel mixed effects (MLME) linear regression analysis. Validity of BIS was demonstrated by resistance variables significantly decreasing with increasing net ionic fluid shift and increased TBSA (severity of injury) and calculated fluid volumes increasing with increasing net fluid shift and TBSA. BIS resistance also decreased with time as oedema reduced. For clinical use, a calculator was developed to adjust BIS variables when an Acticoat?dressing is in situ, thus facilitating BIS variable change estimates in real time, with dressings intact. Conclusion: BIS may be used clinically to monitor fluid volume change in major acute burns.

Demonstration of the test-retest reliability and sensitivity of the Lower Limb Functional Index-10 as a measure of functional recovery post burn injury:a cross-sectional repeated measures study design

Background:Lower limb burns can significantly delay recovery of function.Measuring lower limb functional outcomes is challenging in the unique burn patient population and necessitates the use of reliable and valid tools.The aims of this study were to examine the test-retest reliability,sensitivity,and internal consistency of Sections 1 and 3 of the Lower Limb Functional Index-10(LLFI-10)questionnaire for measuring functional ability in patients with lower limb burns over time.Methods:Twenty-nine adult patients who had sustained a lower limb burn injury in the previous 12 months completed the test-retest procedure of the study.In addition,the minimal detectable change(MDC)was calculated for Section 1 and 3 of the LLFI-10.Section 1 is focused on the activity limitations experienced by patients with a lower limb disorder whereas Section 3 involves patients indicating their current percentage of pre-injury duties.Results:Section 1 of the LLFI-10 demonstrated excellent test-retest reliability(intra-class correlation coefficient(ICC)0.98,95%CI 0.96–0.99)whilst Section 3 demonstrated high test-retest reliability(ICC 0.88,95%CI 0.79–0.94).MDC scores for Sections 1 and 3 were 1.27 points and 30.22%,respectively.Internal consistency was demonstrated with a significant negative association(rs=?0.83)between Sections 1 and 3 of the LLFI-10(p<0.001).Conclusions:This study demonstrates that Section 1 and 3 of the LLFI-10 are reliable for measuring functional ability in patients who have sustained lower limb burns in the previous 12 months,and furthermore,Section 1 is sensitive to changes in patient function over time.