目的评价常用的安宁疗护筛查工具识别急诊科患者安宁疗护需求的准确性。方法计算机检索中国知网、万方数据库、中国生物医学文献数据库、PubMed、Cochrane Library、Embase、CINAHL、Web ofScience等数据库,从建库至2023年11月所有有关...目的评价常用的安宁疗护筛查工具识别急诊科患者安宁疗护需求的准确性。方法计算机检索中国知网、万方数据库、中国生物医学文献数据库、PubMed、Cochrane Library、Embase、CINAHL、Web ofScience等数据库,从建库至2023年11月所有有关安宁疗护筛查工具应用于急诊科患者的研究,由2名研究者独立进行文献筛选、资料提取和文献质量评价,采用Stata 15.0软件对资料数据进行Meta分析。结果共纳入20篇文献,包含20122例患者,一共涉及6种筛查工具,其中最常用的是惊讶问题(Surprise Questions,SQ)(n=9),其次是急诊安宁疗护快速筛查工具(the Palliative Care and Rapid Emergency Screening,P-CaRES)(n=7)及急诊科姑息治疗和临终关怀需求筛查工具(the Screen for Palliative and End-of-life care needs in the Emergency Department,SPEED)(n=2)。9项研究通过评估SQ预测患者病死率从而确定安宁疗护需求,总体而言,SQ预测病死率的敏感度为0.72(0.59,0.82),特异度为0.74(0.62,0.84),均为中等。SQ预测长期病死率(1年内、2年内)的敏感度0.75(0.64,0.84)高于预测短期病死率(1个月内、3个月内)的敏感度0.65(0.35,0.86)。此外,就1年内急诊入院或频繁急诊科就诊而言,SQ敏感度为0.72(0.41,0.90)、特异度为0.52(0.32,0.72)。P-CaRES预测安宁疗护需求合并敏感度为0.73(0.57,0.85)、特异度为0.64(0.48,0.77)。结论用于急诊科安宁疗护筛查的工具中SQ应用最广泛,其次是P-CaRES,两种工具在预测患者未来1年病死率方面均具有中等敏感度和特异度,但该结论仍需高质量、大样本研究进一步验证。展开更多
Objective:The institutionalization of care for patients with dementia is becoming a trend.Understanding the burden on employed caregivers and exploring associated factors are of great importance in practice.Therefore,...Objective:The institutionalization of care for patients with dementia is becoming a trend.Understanding the burden on employed caregivers and exploring associated factors are of great importance in practice.Therefore,this study aimed to examine the relationship between basic attributes,caring ability,and caregiver burden in employed caregivers practicing in nursing homes.Methods:This cross-sectional study included 541 employed caregivers in 11 four-star nursing homes in Zhejiang Province from April to December 2022.Caregiver burden was assessed using the Zarit Burden Interview(ZBI).Demographic characteristics of participants,characteristics of the older patients with dementia,caring characteristics,training in dementia care,and caring abilities were collected for analysis of influencing factors.A hierarchical multiple regression analysis was conducted to explore the factors influencing the burden on employed caregivers in nursing homes.Results:The ZBI score of employed caregivers in nursing homes was 40.42±10.18,representing a moderate caregiver burden.Factors such as age(U=27.82,P<0.001),residence(U=7.89,P<0.001),educational level(H=55.81,P<0.001),self-care of older patients with dementia(H=85.21,P<0.001),daily care hours(H=73.25,P<0.001),number of older people with dementia cared for(H=14.56,P<0.012)and training in dementia care(U=-9.43,P<0.001)were significantly associated with caregiver burden.Caring ability was negatively associated with caregiver burden(r=-0.22,P<0.01).Furthermore,after controlling for demographic characteristics,the characteristics of older people with dementia,caring characteristics,training in dementia care,and caring ability explained 8.5%,5.8%,and 4.8%of the caregiver burden,respectively.Conclusion:The burden of employed caregivers on patients with dementia in nursing homes can be attributed to various factors.We recommend tailored interventions,such as dementia care training and reviewing the number and duration of hours worked to reduce the burden experienced by caregivers.展开更多
文摘目的评价常用的安宁疗护筛查工具识别急诊科患者安宁疗护需求的准确性。方法计算机检索中国知网、万方数据库、中国生物医学文献数据库、PubMed、Cochrane Library、Embase、CINAHL、Web ofScience等数据库,从建库至2023年11月所有有关安宁疗护筛查工具应用于急诊科患者的研究,由2名研究者独立进行文献筛选、资料提取和文献质量评价,采用Stata 15.0软件对资料数据进行Meta分析。结果共纳入20篇文献,包含20122例患者,一共涉及6种筛查工具,其中最常用的是惊讶问题(Surprise Questions,SQ)(n=9),其次是急诊安宁疗护快速筛查工具(the Palliative Care and Rapid Emergency Screening,P-CaRES)(n=7)及急诊科姑息治疗和临终关怀需求筛查工具(the Screen for Palliative and End-of-life care needs in the Emergency Department,SPEED)(n=2)。9项研究通过评估SQ预测患者病死率从而确定安宁疗护需求,总体而言,SQ预测病死率的敏感度为0.72(0.59,0.82),特异度为0.74(0.62,0.84),均为中等。SQ预测长期病死率(1年内、2年内)的敏感度0.75(0.64,0.84)高于预测短期病死率(1个月内、3个月内)的敏感度0.65(0.35,0.86)。此外,就1年内急诊入院或频繁急诊科就诊而言,SQ敏感度为0.72(0.41,0.90)、特异度为0.52(0.32,0.72)。P-CaRES预测安宁疗护需求合并敏感度为0.73(0.57,0.85)、特异度为0.64(0.48,0.77)。结论用于急诊科安宁疗护筛查的工具中SQ应用最广泛,其次是P-CaRES,两种工具在预测患者未来1年病死率方面均具有中等敏感度和特异度,但该结论仍需高质量、大样本研究进一步验证。
基金supported by the Department of Science and Technology of Zhejiang Province(LGF22H250002)the Health Commission of Zhejiang Province(2024KY002 to L.C.,2024KY617 to L.W.,2022KY004 to J.B.)The views expressed are those of the authors and not necessarily those of the funders.
文摘Objective:The institutionalization of care for patients with dementia is becoming a trend.Understanding the burden on employed caregivers and exploring associated factors are of great importance in practice.Therefore,this study aimed to examine the relationship between basic attributes,caring ability,and caregiver burden in employed caregivers practicing in nursing homes.Methods:This cross-sectional study included 541 employed caregivers in 11 four-star nursing homes in Zhejiang Province from April to December 2022.Caregiver burden was assessed using the Zarit Burden Interview(ZBI).Demographic characteristics of participants,characteristics of the older patients with dementia,caring characteristics,training in dementia care,and caring abilities were collected for analysis of influencing factors.A hierarchical multiple regression analysis was conducted to explore the factors influencing the burden on employed caregivers in nursing homes.Results:The ZBI score of employed caregivers in nursing homes was 40.42±10.18,representing a moderate caregiver burden.Factors such as age(U=27.82,P<0.001),residence(U=7.89,P<0.001),educational level(H=55.81,P<0.001),self-care of older patients with dementia(H=85.21,P<0.001),daily care hours(H=73.25,P<0.001),number of older people with dementia cared for(H=14.56,P<0.012)and training in dementia care(U=-9.43,P<0.001)were significantly associated with caregiver burden.Caring ability was negatively associated with caregiver burden(r=-0.22,P<0.01).Furthermore,after controlling for demographic characteristics,the characteristics of older people with dementia,caring characteristics,training in dementia care,and caring ability explained 8.5%,5.8%,and 4.8%of the caregiver burden,respectively.Conclusion:The burden of employed caregivers on patients with dementia in nursing homes can be attributed to various factors.We recommend tailored interventions,such as dementia care training and reviewing the number and duration of hours worked to reduce the burden experienced by caregivers.
