BACKGROUND Psychological assessment after intensive care unit(ICU)discharge is increasingly used to assess patients'cognitive and psychological well-being.However,few studies have examined those who recovered from...BACKGROUND Psychological assessment after intensive care unit(ICU)discharge is increasingly used to assess patients'cognitive and psychological well-being.However,few studies have examined those who recovered from coronavirus disease 2019(COVID-19).There is a paucity of data from the Middle East assessing the post-ICU discharge mental health status of patients who had COVID-19.AIM To evaluate anxiety and depression among patients who had severe COVID-19.METHODS This is a prospective single-center follow-up questionnaire-based study of adults who were admitted to the ICU or under ICU consultation for>24 h for COVID-19.Eligible patients were contacted via telephone.The patient’s anxiety and depression six months after ICU discharge were assessed using the Hospital Anxiety and Depression Scale(HADS).The primary outcome was the mean HADS score.The secondary outcomes were risk factors of anxiety and/or depression.RESULTS Patients who were admitted to the ICU because of COVID-19 were screened(n=518).Of these,48 completed the questionnaires.The mean age was 56.3±17.2 years.Thirty patients(62.5%)were male.The main comorbidities were endocrine(n=24,50%)and cardiovascular(n=21,43.8%)diseases.The mean overall HADS score for anxiety and depression at 6 months post-ICU discharge was 11.4(SD±8.5).A HADS score of>7 for anxiety and depression was detected in 15 patients(30%)and 18 patients(36%),respectively.Results from the multivariable ordered logistic regression demonstrated that vasopressor use was associated with the development of anxiety and depression[odds ratio(OR)39.06,95% confidence interval:1.309-1165.8;P<0.05].CONCLUSION Six months after ICU discharge,30% of patients who had COVID-19 demonstrated a HADS score that confirmed anxiety and depression.To compare the psychological status of patients following an ICU admission(with vs without COVID-19),further studies are warranted.展开更多
BACKGROUND Delirium is a neuropsychiatric syndrome characterized by acute disturbances of consciousness with rapid onset,rapid progression,obvious fluctuations,and preventable,reversible,and other characteristics.Pati...BACKGROUND Delirium is a neuropsychiatric syndrome characterized by acute disturbances of consciousness with rapid onset,rapid progression,obvious fluctuations,and preventable,reversible,and other characteristics.Patients with delirium in the intensive care unit(ICU)are often missed or misdiagnosed and do not receive adequate attention.AIM To analyze the risk factors for delirium in ICU patients and explore the applica-tion of emotional nursing with pain nursing in the management of delirium.METHODS General data of 301 critically ill patients were retrospectively collected,including histories(cardiovascular and cerebrovascular diseases,hypertension,smoking,alcoholism,and diabetes),age,sex,diagnosis,whether surgery was performed,and patient origin(emergency/clinic).Additionally,the duration of sedation,Richmond Agitation Sedation Scale score,combined emotional and pain care,ven-tilator use duration,vasoactive drug use,drainage tube retention,ICU stay du-ration,C-reactive protein,procalcitonin,white blood cell count,body tempe-rature,Acute Physiology and Chronic Health Evaluation II(APACHE II)score,and Sequential Organ Failure Assessment score were recorded within 24 h after ICU admission.Patients were assessed for delirium according to confusion assessment method for the ICU,and univariate and multivariate logistic regre-ssion analyses were performed to identify the risk factors for delirium in the patients.RESULTS Univariate logistic regression analysis was performed on the 24 potential risk factors associated with delirium in ICU patients.The results showed that 16 risk factors were closely related to delirium,including combined emotional and pain care,history of diabetes,and patient origin.Multivariate logistic regression analysis revealed that no combined emotional and pain care,history of diabetes,emergency source,surgery,long stay in the ICU,smoking history,and high APACHE II score were independent risk factors for de-lirium in ICU patients.CONCLUSION Patients with diabetes and/or smoking history,postoperative patients,patients with a high APACHE II score,and those with emergency ICU admission need emotional and pain care,flexible visiting modes,and early intervention to reduce delirium incidence.展开更多
Recently developed ‘super’ rice cultivars with greater yield potentials often suffer from the problem of poor grain filling, especially in inferior spikelets. Here, we studied the activities of enzymes related to st...Recently developed ‘super’ rice cultivars with greater yield potentials often suffer from the problem of poor grain filling, especially in inferior spikelets. Here, we studied the activities of enzymes related to starch metabolism in rice stems and grains, and the microstructures related to carbohydrate accumulation and transportation to investigate the effects of different water regimes on grain filling. Two ‘super’ rice cultivars were grown under two irrigation regimes of well-watered(WW) and alternate wetting and moderate soil drying(AWMD). Compared with the WW treatment,the activities of ADP glucose pyrophosphorylase(AGPase), starch synthase(StSase) and starch branching enzyme(SBE), and the accumulation of non-structural carbohydrates(NSCs) in the stems before heading were significantly improved, and more starch granules were stored in the stems in the AWMD treatment. After heading, the activities of α-amylase, β-amylase, sucrose phosphate synthase(SPS) and sucrose synthase in the synthetic direction(SSs)were increased in the stems to promote the remobilization of NSCs for grain filling under AWMD. During grain filling, the enzymatic activities of sucrose synthase in the cleavage direction(SSc), AGPase, StSase and SBE in the inferior spikelets were increased, which promoted grain filling, especially for the inferior spikelets under AWMD.However, there were no significant differences in vascular microstructures. The grain yield and grain weight could be improved by 13.1 and 7.5%, respectively, by optimizing of the irrigation regime. We concluded that the low activities of key enzymes in carbon metabolism is the key limitation for the poor grain filling, as opposed to the vascular microstructures, and AWMD can increase the amount of NSC accumulation in the stems before heading, improve the utilization rate of NSCs after heading, and increase the grain filling, especially in the inferior spikelets, by altering the activities of key enzymes in carbon metabolism.展开更多
BACKGROUND Improvements in the standard of living have led to increased attention to perianal disease.Although surgical treatments are effective,the outcomes of postoperative recovery(POR)are influenced by various fac...BACKGROUND Improvements in the standard of living have led to increased attention to perianal disease.Although surgical treatments are effective,the outcomes of postoperative recovery(POR)are influenced by various factors,including individual differences among patients,the characteristics of the disease itself,and the psychological state of the patient.Understanding these factors can help healthcare providers develop more personalized and effective post-operative care plans for patients with perianal disease.AIM To investigate the effect of illness perception(IP)and negative emotions on POR outcomes in patients with perianal disease.METHODS A total of 146 patients with perianal disease admitted to the First People's Hospital of Changde City from March to December 2023 were recruited.We employed a general information questionnaire,the Brief Illness Perception Questionnaire(B-IPQ),and the Hospital Anxiety and Depression Scale(HADS).We used the 15-item Quality of Recovery Score(QoR-15)to measure patients’recovery effects.Finally,we conducted Pearson’s correlation analysis to examine the relationship between pre-operative IP and anxiety and depression levels with POR quality.RESULTS Fifty-three(36.3%)had poor knowledge of their disease.Thirty(20.5%)were suspected of having anxiety and 99(67.8%)exhibited symptoms.Forty(27.4%)were suspected of having depression and 102(69.9%)displayed symptoms.The B-IPQ,HADS-A,HADS-D,and QoR-15 scores were 46.82±9.97,12.99±3.60,12.58±3.36,and 96.77±9.85,respectively.There was a negative correlation between pre-operative IP,anxiety,and depression with POR quality.The influence of age and disease course on post-operative rehabilitation effect are both negative.The impact of B-IPQ,HADS-A,and HADS-D on POR was negative.Collectively,these variables accounted for 72.6%of the variance in POR.CONCLUSION The quality of POR in patients with perianal disease is medium and is related to age,disease course,IP,anxiety,and depression.展开更多
Athletes are commonly advised not to compete or train during major symptoms of a viral acute respiratory illness(ARI),which most commonly is a common cold.It has been traditionally thought that heavy physical stress c...Athletes are commonly advised not to compete or train during major symptoms of a viral acute respiratory illness(ARI),which most commonly is a common cold.It has been traditionally thought that heavy physical stress could induce the worsening of symptoms of ARI and possibly cause potentially severe complications like myocarditis or sudden cardiac death(SCD).In addition,viral ARI may decrease athlete's performance.1 These concerns have been recently stressed during the coronavirus disease 2019(COVID-19)pandemic.2 However,it is anecdotally well-known that athletes commonly compete while experiencing common colds,most commonly due to picornaviral ARIs.In this perspective,we discuss what is known or not known regarding the risks of exercising during the viral ARI.展开更多
Objective:To assess the psychometric properties of the Thai version of the Self-Care Self-Efficacy Scale version 3.0(SCSES-v3.0)in individuals with chronic illnesses.Although originally developed and tested in a Weste...Objective:To assess the psychometric properties of the Thai version of the Self-Care Self-Efficacy Scale version 3.0(SCSES-v3.0)in individuals with chronic illnesses.Although originally developed and tested in a Western context,its applicability in Asian populations,including Thailand,remains inadequately explored.Methods:Psychometric tests were guided by COSMIN principles.This included the translation of the English version into Thai based on the ISPOR framework.Nine nursing experts evaluated the content validity.Data were obtained from a multicenter cross-sectional study conducted between July and November 2022.This study included individuals with chronic conditions from 16 primary care centers in Thailand.We tested the structural validity using exploratory factor analysis(EFA)and confirmatory factor analysis(CFA),and concurrent validity in relation to the Self-Care of Chronic Illness Inventory version 4.c(SC-CII-v4.c).We tested the scale’s reliability with McDonald’s u,Cronbach’s a,and the intraclass correlation coefficient(ICC).Results:The Thai SCSES-v3.0 demonstrated excellent content validity(k¼1.00).Thefinal analysis included a total of 385 participants.The EFA with thefirst split-half subsample(n¼193)extracted a twofactor structure.One reflected SCSES for maintenance and monitoring behaviors and another captured SCSES for management behaviors(item 6e10).CFA with the second split-half subsample(n¼192)and the overall sample(n¼385)supported the scale’s two-factor model with high factor loadings.Each dimension and the overall SCSES-v3.0 positively correlated with each scale and the overall SC-CII-v4.c.McDonald’s u and Cronbach’s a(both ranged 0.91e0.94)and ICC(ranged 0.95e0.96),indicated excellent internal reliability and test-retest reliability,respectively.Conclusions:The identification of a valid and reliable two-factor model for the Thai SCSES-v3.0 renders it a valuable tool for clinicians and investigators,facilitating the assessment of self-efficacy in self-care across diverse contexts.展开更多
Background:Determining the incidence and prevalence of injury and illness in short-course triathletes would improve understanding of their etiologies and therefore assist in the development and implementation of preve...Background:Determining the incidence and prevalence of injury and illness in short-course triathletes would improve understanding of their etiologies and therefore assist in the development and implementation of prevention strategies.This study synthesizes the existing evidence on the incidence and prevalence of injury and illness and summarizes reported injury or illness etiology and risk factors affecting short-course triathletes.Methods:This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Studies reporting health problems(injury and illness)in triathletes(all sexes,ages,and experience levels)training and/or competing in short-course distances were included.Six electronic databases(Cochrane Central Register of Controlled Trials,MEDLINE,Embase,APA PsychINFO,Web of Science Core Collection,and SPORTDiscus)were searched.Risk of bias was independently assessed by 2 reviewers using the Newcastle-Ottawa Quality Assessment Scale.Two authors independently completed data extraction.Results:The search yielded 7998 studies,with 42 studies eligible for inclusion.Twenty-three studies investigated injuries,24 studies investigated illnesses,and 5 studies investigated both injuries and illnesses.The injury incidence rate ranged 15.7-24.3 per 1000 athlete exposures,and the illness incidence rate ranged 1.8-13.1 per 1000 athlete days.Injury and illness prevalence ranged between 2%-15%and 6%-84%,respectively.Most injuries reported occurred during running(45%-92%),and the most frequently reported illnesses affected the gastrointestinal(7%-70%),cardiovascular(14%-59%),and respiratory systems(5%-60%).Conclusion:The most frequently reported health problems in short-course triathletes were:overuse and lower limb injuries associated with running;gastrointestinal illnesses and altered cardiac function,primarily attributable to environmental factors;and respiratory illness mostly caused by infection.展开更多
Iron is a double-edged sword!Despite being essential for numerous physiological processes of the body,a dysregulated iron metabolism can result in tissue da-mage,exaggerated inflammatory response,and increased suscept...Iron is a double-edged sword!Despite being essential for numerous physiological processes of the body,a dysregulated iron metabolism can result in tissue da-mage,exaggerated inflammatory response,and increased susceptibility to infection with certain pathogens that thrive in iron-rich environment.During sepsis,there is an alteration of iron metabolism,leading to increased transport and uptake into cells.This increase in labile iron may cause oxidative damage and cellular injury(ferroptosis)which progresses as the disease worsens.Critically ill patients are often complicated with systemic inflammation which may contribute to multiple organ dysfunction syndrome or sepsis,a common cause of mortality in intensive care unit.Originally,ferritin was known to play an important role in the hematopoietic system for its iron storage capacity.Recently,its role has emerged as a predictor of poor prognosis in chronic inflammation and critical illnesses.Apart from predicting the disease outcome,serum ferritin can poten-tially reflect disease activity as well.展开更多
Breast cancer is considered one of the most frequent causes of morbidity and death in women.Individuals’response to information regarding health threats and illness can influence the adjustment of the treatment to exi...Breast cancer is considered one of the most frequent causes of morbidity and death in women.Individuals’response to information regarding health threats and illness can influence the adjustment of the treatment to existing conditions including the issues of non-completion of treatment or non-attendance at medical appointments.The study aimed to examine the relationship between illness perception,body image dissatisfaction and(mal)adaptive coping styles in breast cancer patients.A sample of 197 patients with diagnosed breast cancer hospitalized at the Center for Oncology and Radiology,Kragujevac,Serbia,was surveyed.The instruments included sociodemographic questionnaire,a Brief Illness Perception Questionnaire(BIPQ),a Body Image Scale(BIS),and a Mini-Mental Adjustment to Cancer Scale(Mini-MAС).Results showed that 52%of the variance of maladaptive coping style in women who underwent mastectomy was explained by the negative illness perception,while body image dissatisfaction reflected through this connection(CFI>.95,GFI>.95,RMSEA=.01,SRMR=.08).Similar results were found in patients with breast-conserving surgery but with lower percentage(36%)of variance explained(CFI>.95,GFI>.95,RMSEA<.02,SRMR<.05).If confirmed by further studies,these results would suggest that patients who underwent mastectomy tend to be more dissatisfied with their body image,have tendency to perceive illness as threatening and resort to maladaptive coping styles.However,any form of appearance modification,including breast-conserving surgery,carries the risk of body image dissatisfaction,and consequently the risk of maladaptive coping behaviors.Our results suggest that health professionals and public policies should put an additional focus on the assessment of the patient’s body image dissatisfaction,to improve the health and wellbeing of the affected women.展开更多
Hepatic encephalopathy(HE)is one of the main complications of cirrhosis,characterized by a wide spectrum of neuropsychiatric alterations that lead to an increase in mortality,morbidity and recurrent hospitalizations.D...Hepatic encephalopathy(HE)is one of the main complications of cirrhosis,characterized by a wide spectrum of neuropsychiatric alterations that lead to an increase in mortality,morbidity and recurrent hospitalizations.Due to the central role in HE pathogenesis of ammonia and other neurotoxins primarily produced by the gut microbiota,the main therapeutic approaches for the treatment of HE are based on the modulation of the gut microbiota.Rifaximin is a non-absorbable broad-spectrum antibiotic,that is effective against ammonia-producing grampositive,gram-negative,and anaerobic species,approved for the treatment of HE in secondary prophylaxis.The chronic administration of rifaximin in this setting is associated with a lower risk of HE recurrence and mortality,while the role of rifaximin for the treatment of an overt-HE episode in inpatients is still unclear.Limited data exist about the coadministration of rifaximin and broad-spectrum antibiotics commonly used to treat concomitant infections,as patients receiving or recently treated with antibiotics were frequently excluded from clinical trials.In this editorial we comment on the article by Ward et al published in the recent issue of the World Journal of Hepatology.It is a single center,retrospective,quasiexperimental,pharmacist-driven protocol,with the aim to evaluate the feasibility and safety of rifaximin discontinuation in critically ill patients with HE and chronic liver disease receiving broad-spectrum antibiotic therapies in intensive care units.The study revealed no differences between the protocol and control group in terms of primary outcome(days alive and free of delirium and coma to day 14)and secondary outcomes which include:Intensive care mortality,intensive care length of stay,intravenous vasopressor requirement changes and adverse effects rate.Therefore,rifaximin discontinuation during broad-spectrum antibiotic therapy does not appear to negatively impact the clinical status of critically ill liver patients,with a similar safety profile and significant cost savings,as compared to the coadministration of rifaximin and broad-spectrum antibiotics.In agreement with Ward et al,a recently published double-blind,randomized controlled trial provided additional evidence to support the feasibility of withholding rifaximin during broad-spectrum antibiotic therapy in critically ill cirrhotic patients.However,given the limitations of these studies,further multicentric and prospective clinical trials,enrolling a larger sample of non-critically ill patients,are needed to better establish the role of rifaximin in this setting.展开更多
BACKGROUND The prognosis of critically ill patients is closely linked to their gastrointestinal(GI)function.The acute GI injury(AGI)grading system,established in 2012,is extensively utilized to evaluate GI dysfunction...BACKGROUND The prognosis of critically ill patients is closely linked to their gastrointestinal(GI)function.The acute GI injury(AGI)grading system,established in 2012,is extensively utilized to evaluate GI dysfunction and forecast outcomes in clinical settings.In 2021,the GI dysfunction score(GIDS)was developed,building on the AGI grading system,to enhance the accuracy of GI dysfunction severity assessment,improve prognostic predictions,reduce subjectivity,and increase reproducibility.AIM To compare the predictive capabilities of GIDS and the AGI grading system for 28-day mortality in critically ill patients.METHODS A retrospective study was conducted at the general intensive care unit(ICU)of a regional university hospital.All data were collected during the first week of ICU admission.The primary outcome was 28-day mortality.Multivariable logistic regression analyzed whether GIDS and AGI grade were independent risk factors for 28-day mortality.The predictive abilities of GIDS and AGI grade were compared using the receiver operating characteristic curve,with DeLong’s test assessing differences between the curves’areas.RESULTS The incidence of AGI in the first week of ICU admission was 92.13%.There were 85 deaths(47.75%)within 28 days of ICU admission.There was no initial 24-hour difference in GIDS between the non-survival and survival groups.Both GIDS(OR 2.01,95%CI:1.25-3.24;P=0.004)and AGI grade(OR 1.94,95%CI:1.12-3.38;P=0.019)were independent predictors of 28-day mortality.No significant difference was found between the predictive accuracy of GIDS and AGI grade for 28-day mortality during the first week of ICU admission(Z=-0.26,P=0.794).CONCLUSION GIDS within the first 24 hours was an unreliable predictor of 28-day mortality.The predictive accuracy for 28-day mortality from both systems during the first week was comparable.展开更多
Critically ill patients are a vulnerable group at high risk of developing secondary infections.High disease severity,prolonged intensive care unit(ICU)stay,sepsis,and multiple drugs with immunosuppressive activity mak...Critically ill patients are a vulnerable group at high risk of developing secondary infections.High disease severity,prolonged intensive care unit(ICU)stay,sepsis,and multiple drugs with immunosuppressive activity make these patients prone to immuneparesis and increase the risk of various opportunistic infections,including cytomegalovirus(CMV).CMV seroconversion has been reported in up to 33%of ICU patients,but its impact on patient outcomes remains a matter of debate.Even though there are guidelines regarding the management of CMV infection in immunosuppressive patients with human immunodeficiency virus/acquired immuno deficiency syndrome,the need for treatment and therapeutic approaches in immunocompetent critically ill patients is still ambiguous.Even the diagnosis of CMV infection may be challenging in such patients due to non-specific symptoms and multiorgan involvement.Hence,a better understanding of the symptomatology,diagnostics,and treatment options may aid intensive care physicians in ensuring accurate diagnoses and instituting therapeutic interventions.展开更多
Background: This study investigated serum Glucose transporter (GLUT) 4 levels and examined the relationship between serum GLUT4 levels and sepsis in critically ill children. Methods: This was a retrospective study of ...Background: This study investigated serum Glucose transporter (GLUT) 4 levels and examined the relationship between serum GLUT4 levels and sepsis in critically ill children. Methods: This was a retrospective study of 77 critically ill children and 33 non-diabetic healthy children (controls) who were admitted between 07/2015 and 05/2016. Patient data, clinical information, and blood samples were collected on admission, alongside a large number of laboratory parameters that were routinely assessed. Critically ill patients were divided into sepsis and non-sepsis/systemic inflammatory response syndrome (SIRS). Serum GLUT4 was measured using western blotting and enzyme-linked immunosorbent assays. Insulin resistance indexes, clinical data, laboratory parameters, and inflammatory cytokines were assessed. Results: GLUT4 serum levels were higher in critically ill children than in healthy children (90.5 vs. 30.3 μg/L, P 0.05). Compared to healthy children, hyperglycemic patients (n = 48) had elevated GLUT4 serum levels (30.3 vs. 103.7 g/L, P Conclusions: GLUT4 serum levels might be significantly increased in critically ill children compared with healthy children, particularly those in septic shock. Serum GLUT4 could predict disease severity.展开更多
Bipolar disorder is a serious mental condition that may be caused by any kind of stress or emotional upset experienced by the patient.It affects a large percentage of people globally,who fluctuate between depression a...Bipolar disorder is a serious mental condition that may be caused by any kind of stress or emotional upset experienced by the patient.It affects a large percentage of people globally,who fluctuate between depression and mania,or vice versa.A pleasant or unpleasant mood is more than a reflection of a state of mind.Normally,it is a difficult task to analyze through physical examination due to a large patient-psychiatrist ratio,so automated procedures are the best options to diagnose and verify the severity of bipolar.In this research work,facial microexpressions have been used for bipolar detection using the proposed Convolutional Neural Network(CNN)-based model.Facial Action Coding System(FACS)is used to extract micro-expressions called Action Units(AUs)connected with sad,happy,and angry emotions.Experiments have been conducted on a dataset collected from Bahawal Victoria Hospital,Bahawalpur,Pakistan,Using the Patient Health Questionnaire-15(PHQ-15)to infer a patient’s mental state.The experimental results showed a validation accuracy of 98.99%for the proposed CNN modelwhile classification through extracted featuresUsing SupportVectorMachines(SVM),K-NearestNeighbour(KNN),and Decision Tree(DT)obtained 99.9%,98.7%,and 98.9%accuracy,respectively.Overall,the outcomes demonstrated the stated method’s superiority over the current best practices.展开更多
Objective: To explore the effect of evidence-based quality control circle (QCC) in improving the implementation rate of airway management measures in adult critically ill patients. Methods: Based on the Joanna Briggs ...Objective: To explore the effect of evidence-based quality control circle (QCC) in improving the implementation rate of airway management measures in adult critically ill patients. Methods: Based on the Joanna Briggs Institute (JBI) evidence-based health care model, the best evidence of airway management in adult critically ill patients was obtained and applied to the clinic. Results: The total implementation rate of airway management measures in adult critically ill patients increased from 23.62% before the implementation of quality control circle to 88.82%, and the pulmonary infection rate in critically ill patients decreased from 42.31% to 21.74%, with statistical significance between the two groups (P 0.05). Conclusion: Evidence-based quality control circle activities can standardize the practice standards of airway management in critically ill patients, reduce the occurrence of patients’ airway related complications, and improve clinical outcomes.展开更多
基金the Researchers Supporting Project number,King Saud University,Riyadh,Saudi Arabia,No.RSPD2024R919.
文摘BACKGROUND Psychological assessment after intensive care unit(ICU)discharge is increasingly used to assess patients'cognitive and psychological well-being.However,few studies have examined those who recovered from coronavirus disease 2019(COVID-19).There is a paucity of data from the Middle East assessing the post-ICU discharge mental health status of patients who had COVID-19.AIM To evaluate anxiety and depression among patients who had severe COVID-19.METHODS This is a prospective single-center follow-up questionnaire-based study of adults who were admitted to the ICU or under ICU consultation for>24 h for COVID-19.Eligible patients were contacted via telephone.The patient’s anxiety and depression six months after ICU discharge were assessed using the Hospital Anxiety and Depression Scale(HADS).The primary outcome was the mean HADS score.The secondary outcomes were risk factors of anxiety and/or depression.RESULTS Patients who were admitted to the ICU because of COVID-19 were screened(n=518).Of these,48 completed the questionnaires.The mean age was 56.3±17.2 years.Thirty patients(62.5%)were male.The main comorbidities were endocrine(n=24,50%)and cardiovascular(n=21,43.8%)diseases.The mean overall HADS score for anxiety and depression at 6 months post-ICU discharge was 11.4(SD±8.5).A HADS score of>7 for anxiety and depression was detected in 15 patients(30%)and 18 patients(36%),respectively.Results from the multivariable ordered logistic regression demonstrated that vasopressor use was associated with the development of anxiety and depression[odds ratio(OR)39.06,95% confidence interval:1.309-1165.8;P<0.05].CONCLUSION Six months after ICU discharge,30% of patients who had COVID-19 demonstrated a HADS score that confirmed anxiety and depression.To compare the psychological status of patients following an ICU admission(with vs without COVID-19),further studies are warranted.
文摘BACKGROUND Delirium is a neuropsychiatric syndrome characterized by acute disturbances of consciousness with rapid onset,rapid progression,obvious fluctuations,and preventable,reversible,and other characteristics.Patients with delirium in the intensive care unit(ICU)are often missed or misdiagnosed and do not receive adequate attention.AIM To analyze the risk factors for delirium in ICU patients and explore the applica-tion of emotional nursing with pain nursing in the management of delirium.METHODS General data of 301 critically ill patients were retrospectively collected,including histories(cardiovascular and cerebrovascular diseases,hypertension,smoking,alcoholism,and diabetes),age,sex,diagnosis,whether surgery was performed,and patient origin(emergency/clinic).Additionally,the duration of sedation,Richmond Agitation Sedation Scale score,combined emotional and pain care,ven-tilator use duration,vasoactive drug use,drainage tube retention,ICU stay du-ration,C-reactive protein,procalcitonin,white blood cell count,body tempe-rature,Acute Physiology and Chronic Health Evaluation II(APACHE II)score,and Sequential Organ Failure Assessment score were recorded within 24 h after ICU admission.Patients were assessed for delirium according to confusion assessment method for the ICU,and univariate and multivariate logistic regre-ssion analyses were performed to identify the risk factors for delirium in the patients.RESULTS Univariate logistic regression analysis was performed on the 24 potential risk factors associated with delirium in ICU patients.The results showed that 16 risk factors were closely related to delirium,including combined emotional and pain care,history of diabetes,and patient origin.Multivariate logistic regression analysis revealed that no combined emotional and pain care,history of diabetes,emergency source,surgery,long stay in the ICU,smoking history,and high APACHE II score were independent risk factors for de-lirium in ICU patients.CONCLUSION Patients with diabetes and/or smoking history,postoperative patients,patients with a high APACHE II score,and those with emergency ICU admission need emotional and pain care,flexible visiting modes,and early intervention to reduce delirium incidence.
基金This project was finically supported by the R&D Foundation of Jiangsu Province,China(BE2022425)the National Key Research and Development Program of China(2022YFD2300304)the Priority Academic Program Development of Jiangsu Higher-Education Institutions,China(PAPD).
文摘Recently developed ‘super’ rice cultivars with greater yield potentials often suffer from the problem of poor grain filling, especially in inferior spikelets. Here, we studied the activities of enzymes related to starch metabolism in rice stems and grains, and the microstructures related to carbohydrate accumulation and transportation to investigate the effects of different water regimes on grain filling. Two ‘super’ rice cultivars were grown under two irrigation regimes of well-watered(WW) and alternate wetting and moderate soil drying(AWMD). Compared with the WW treatment,the activities of ADP glucose pyrophosphorylase(AGPase), starch synthase(StSase) and starch branching enzyme(SBE), and the accumulation of non-structural carbohydrates(NSCs) in the stems before heading were significantly improved, and more starch granules were stored in the stems in the AWMD treatment. After heading, the activities of α-amylase, β-amylase, sucrose phosphate synthase(SPS) and sucrose synthase in the synthetic direction(SSs)were increased in the stems to promote the remobilization of NSCs for grain filling under AWMD. During grain filling, the enzymatic activities of sucrose synthase in the cleavage direction(SSc), AGPase, StSase and SBE in the inferior spikelets were increased, which promoted grain filling, especially for the inferior spikelets under AWMD.However, there were no significant differences in vascular microstructures. The grain yield and grain weight could be improved by 13.1 and 7.5%, respectively, by optimizing of the irrigation regime. We concluded that the low activities of key enzymes in carbon metabolism is the key limitation for the poor grain filling, as opposed to the vascular microstructures, and AWMD can increase the amount of NSC accumulation in the stems before heading, improve the utilization rate of NSCs after heading, and increase the grain filling, especially in the inferior spikelets, by altering the activities of key enzymes in carbon metabolism.
文摘BACKGROUND Improvements in the standard of living have led to increased attention to perianal disease.Although surgical treatments are effective,the outcomes of postoperative recovery(POR)are influenced by various factors,including individual differences among patients,the characteristics of the disease itself,and the psychological state of the patient.Understanding these factors can help healthcare providers develop more personalized and effective post-operative care plans for patients with perianal disease.AIM To investigate the effect of illness perception(IP)and negative emotions on POR outcomes in patients with perianal disease.METHODS A total of 146 patients with perianal disease admitted to the First People's Hospital of Changde City from March to December 2023 were recruited.We employed a general information questionnaire,the Brief Illness Perception Questionnaire(B-IPQ),and the Hospital Anxiety and Depression Scale(HADS).We used the 15-item Quality of Recovery Score(QoR-15)to measure patients’recovery effects.Finally,we conducted Pearson’s correlation analysis to examine the relationship between pre-operative IP and anxiety and depression levels with POR quality.RESULTS Fifty-three(36.3%)had poor knowledge of their disease.Thirty(20.5%)were suspected of having anxiety and 99(67.8%)exhibited symptoms.Forty(27.4%)were suspected of having depression and 102(69.9%)displayed symptoms.The B-IPQ,HADS-A,HADS-D,and QoR-15 scores were 46.82±9.97,12.99±3.60,12.58±3.36,and 96.77±9.85,respectively.There was a negative correlation between pre-operative IP,anxiety,and depression with POR quality.The influence of age and disease course on post-operative rehabilitation effect are both negative.The impact of B-IPQ,HADS-A,and HADS-D on POR was negative.Collectively,these variables accounted for 72.6%of the variance in POR.CONCLUSION The quality of POR in patients with perianal disease is medium and is related to age,disease course,IP,anxiety,and depression.
基金funded by the Jenny and Antti Wihuri Foundation(OR)。
文摘Athletes are commonly advised not to compete or train during major symptoms of a viral acute respiratory illness(ARI),which most commonly is a common cold.It has been traditionally thought that heavy physical stress could induce the worsening of symptoms of ARI and possibly cause potentially severe complications like myocarditis or sudden cardiac death(SCD).In addition,viral ARI may decrease athlete's performance.1 These concerns have been recently stressed during the coronavirus disease 2019(COVID-19)pandemic.2 However,it is anecdotally well-known that athletes commonly compete while experiencing common colds,most commonly due to picornaviral ARIs.In this perspective,we discuss what is known or not known regarding the risks of exercising during the viral ARI.
基金The original study wasfinancially supported by Walailak University(grant number:WU65240,Year 2022).
文摘Objective:To assess the psychometric properties of the Thai version of the Self-Care Self-Efficacy Scale version 3.0(SCSES-v3.0)in individuals with chronic illnesses.Although originally developed and tested in a Western context,its applicability in Asian populations,including Thailand,remains inadequately explored.Methods:Psychometric tests were guided by COSMIN principles.This included the translation of the English version into Thai based on the ISPOR framework.Nine nursing experts evaluated the content validity.Data were obtained from a multicenter cross-sectional study conducted between July and November 2022.This study included individuals with chronic conditions from 16 primary care centers in Thailand.We tested the structural validity using exploratory factor analysis(EFA)and confirmatory factor analysis(CFA),and concurrent validity in relation to the Self-Care of Chronic Illness Inventory version 4.c(SC-CII-v4.c).We tested the scale’s reliability with McDonald’s u,Cronbach’s a,and the intraclass correlation coefficient(ICC).Results:The Thai SCSES-v3.0 demonstrated excellent content validity(k¼1.00).Thefinal analysis included a total of 385 participants.The EFA with thefirst split-half subsample(n¼193)extracted a twofactor structure.One reflected SCSES for maintenance and monitoring behaviors and another captured SCSES for management behaviors(item 6e10).CFA with the second split-half subsample(n¼192)and the overall sample(n¼385)supported the scale’s two-factor model with high factor loadings.Each dimension and the overall SCSES-v3.0 positively correlated with each scale and the overall SC-CII-v4.c.McDonald’s u and Cronbach’s a(both ranged 0.91e0.94)and ICC(ranged 0.95e0.96),indicated excellent internal reliability and test-retest reliability,respectively.Conclusions:The identification of a valid and reliable two-factor model for the Thai SCSES-v3.0 renders it a valuable tool for clinicians and investigators,facilitating the assessment of self-efficacy in self-care across diverse contexts.
文摘Background:Determining the incidence and prevalence of injury and illness in short-course triathletes would improve understanding of their etiologies and therefore assist in the development and implementation of prevention strategies.This study synthesizes the existing evidence on the incidence and prevalence of injury and illness and summarizes reported injury or illness etiology and risk factors affecting short-course triathletes.Methods:This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Studies reporting health problems(injury and illness)in triathletes(all sexes,ages,and experience levels)training and/or competing in short-course distances were included.Six electronic databases(Cochrane Central Register of Controlled Trials,MEDLINE,Embase,APA PsychINFO,Web of Science Core Collection,and SPORTDiscus)were searched.Risk of bias was independently assessed by 2 reviewers using the Newcastle-Ottawa Quality Assessment Scale.Two authors independently completed data extraction.Results:The search yielded 7998 studies,with 42 studies eligible for inclusion.Twenty-three studies investigated injuries,24 studies investigated illnesses,and 5 studies investigated both injuries and illnesses.The injury incidence rate ranged 15.7-24.3 per 1000 athlete exposures,and the illness incidence rate ranged 1.8-13.1 per 1000 athlete days.Injury and illness prevalence ranged between 2%-15%and 6%-84%,respectively.Most injuries reported occurred during running(45%-92%),and the most frequently reported illnesses affected the gastrointestinal(7%-70%),cardiovascular(14%-59%),and respiratory systems(5%-60%).Conclusion:The most frequently reported health problems in short-course triathletes were:overuse and lower limb injuries associated with running;gastrointestinal illnesses and altered cardiac function,primarily attributable to environmental factors;and respiratory illness mostly caused by infection.
文摘Iron is a double-edged sword!Despite being essential for numerous physiological processes of the body,a dysregulated iron metabolism can result in tissue da-mage,exaggerated inflammatory response,and increased susceptibility to infection with certain pathogens that thrive in iron-rich environment.During sepsis,there is an alteration of iron metabolism,leading to increased transport and uptake into cells.This increase in labile iron may cause oxidative damage and cellular injury(ferroptosis)which progresses as the disease worsens.Critically ill patients are often complicated with systemic inflammation which may contribute to multiple organ dysfunction syndrome or sepsis,a common cause of mortality in intensive care unit.Originally,ferritin was known to play an important role in the hematopoietic system for its iron storage capacity.Recently,its role has emerged as a predictor of poor prognosis in chronic inflammation and critical illnesses.Apart from predicting the disease outcome,serum ferritin can poten-tially reflect disease activity as well.
文摘Breast cancer is considered one of the most frequent causes of morbidity and death in women.Individuals’response to information regarding health threats and illness can influence the adjustment of the treatment to existing conditions including the issues of non-completion of treatment or non-attendance at medical appointments.The study aimed to examine the relationship between illness perception,body image dissatisfaction and(mal)adaptive coping styles in breast cancer patients.A sample of 197 patients with diagnosed breast cancer hospitalized at the Center for Oncology and Radiology,Kragujevac,Serbia,was surveyed.The instruments included sociodemographic questionnaire,a Brief Illness Perception Questionnaire(BIPQ),a Body Image Scale(BIS),and a Mini-Mental Adjustment to Cancer Scale(Mini-MAС).Results showed that 52%of the variance of maladaptive coping style in women who underwent mastectomy was explained by the negative illness perception,while body image dissatisfaction reflected through this connection(CFI>.95,GFI>.95,RMSEA=.01,SRMR=.08).Similar results were found in patients with breast-conserving surgery but with lower percentage(36%)of variance explained(CFI>.95,GFI>.95,RMSEA<.02,SRMR<.05).If confirmed by further studies,these results would suggest that patients who underwent mastectomy tend to be more dissatisfied with their body image,have tendency to perceive illness as threatening and resort to maladaptive coping styles.However,any form of appearance modification,including breast-conserving surgery,carries the risk of body image dissatisfaction,and consequently the risk of maladaptive coping behaviors.Our results suggest that health professionals and public policies should put an additional focus on the assessment of the patient’s body image dissatisfaction,to improve the health and wellbeing of the affected women.
文摘Hepatic encephalopathy(HE)is one of the main complications of cirrhosis,characterized by a wide spectrum of neuropsychiatric alterations that lead to an increase in mortality,morbidity and recurrent hospitalizations.Due to the central role in HE pathogenesis of ammonia and other neurotoxins primarily produced by the gut microbiota,the main therapeutic approaches for the treatment of HE are based on the modulation of the gut microbiota.Rifaximin is a non-absorbable broad-spectrum antibiotic,that is effective against ammonia-producing grampositive,gram-negative,and anaerobic species,approved for the treatment of HE in secondary prophylaxis.The chronic administration of rifaximin in this setting is associated with a lower risk of HE recurrence and mortality,while the role of rifaximin for the treatment of an overt-HE episode in inpatients is still unclear.Limited data exist about the coadministration of rifaximin and broad-spectrum antibiotics commonly used to treat concomitant infections,as patients receiving or recently treated with antibiotics were frequently excluded from clinical trials.In this editorial we comment on the article by Ward et al published in the recent issue of the World Journal of Hepatology.It is a single center,retrospective,quasiexperimental,pharmacist-driven protocol,with the aim to evaluate the feasibility and safety of rifaximin discontinuation in critically ill patients with HE and chronic liver disease receiving broad-spectrum antibiotic therapies in intensive care units.The study revealed no differences between the protocol and control group in terms of primary outcome(days alive and free of delirium and coma to day 14)and secondary outcomes which include:Intensive care mortality,intensive care length of stay,intravenous vasopressor requirement changes and adverse effects rate.Therefore,rifaximin discontinuation during broad-spectrum antibiotic therapy does not appear to negatively impact the clinical status of critically ill liver patients,with a similar safety profile and significant cost savings,as compared to the coadministration of rifaximin and broad-spectrum antibiotics.In agreement with Ward et al,a recently published double-blind,randomized controlled trial provided additional evidence to support the feasibility of withholding rifaximin during broad-spectrum antibiotic therapy in critically ill cirrhotic patients.However,given the limitations of these studies,further multicentric and prospective clinical trials,enrolling a larger sample of non-critically ill patients,are needed to better establish the role of rifaximin in this setting.
基金approved by the Ethics Committee of the First Affiliated Hospital of Zhejiang Chinese Medical University(No.2024-KLS-369-02).
文摘BACKGROUND The prognosis of critically ill patients is closely linked to their gastrointestinal(GI)function.The acute GI injury(AGI)grading system,established in 2012,is extensively utilized to evaluate GI dysfunction and forecast outcomes in clinical settings.In 2021,the GI dysfunction score(GIDS)was developed,building on the AGI grading system,to enhance the accuracy of GI dysfunction severity assessment,improve prognostic predictions,reduce subjectivity,and increase reproducibility.AIM To compare the predictive capabilities of GIDS and the AGI grading system for 28-day mortality in critically ill patients.METHODS A retrospective study was conducted at the general intensive care unit(ICU)of a regional university hospital.All data were collected during the first week of ICU admission.The primary outcome was 28-day mortality.Multivariable logistic regression analyzed whether GIDS and AGI grade were independent risk factors for 28-day mortality.The predictive abilities of GIDS and AGI grade were compared using the receiver operating characteristic curve,with DeLong’s test assessing differences between the curves’areas.RESULTS The incidence of AGI in the first week of ICU admission was 92.13%.There were 85 deaths(47.75%)within 28 days of ICU admission.There was no initial 24-hour difference in GIDS between the non-survival and survival groups.Both GIDS(OR 2.01,95%CI:1.25-3.24;P=0.004)and AGI grade(OR 1.94,95%CI:1.12-3.38;P=0.019)were independent predictors of 28-day mortality.No significant difference was found between the predictive accuracy of GIDS and AGI grade for 28-day mortality during the first week of ICU admission(Z=-0.26,P=0.794).CONCLUSION GIDS within the first 24 hours was an unreliable predictor of 28-day mortality.The predictive accuracy for 28-day mortality from both systems during the first week was comparable.
文摘Critically ill patients are a vulnerable group at high risk of developing secondary infections.High disease severity,prolonged intensive care unit(ICU)stay,sepsis,and multiple drugs with immunosuppressive activity make these patients prone to immuneparesis and increase the risk of various opportunistic infections,including cytomegalovirus(CMV).CMV seroconversion has been reported in up to 33%of ICU patients,but its impact on patient outcomes remains a matter of debate.Even though there are guidelines regarding the management of CMV infection in immunosuppressive patients with human immunodeficiency virus/acquired immuno deficiency syndrome,the need for treatment and therapeutic approaches in immunocompetent critically ill patients is still ambiguous.Even the diagnosis of CMV infection may be challenging in such patients due to non-specific symptoms and multiorgan involvement.Hence,a better understanding of the symptomatology,diagnostics,and treatment options may aid intensive care physicians in ensuring accurate diagnoses and instituting therapeutic interventions.
文摘Background: This study investigated serum Glucose transporter (GLUT) 4 levels and examined the relationship between serum GLUT4 levels and sepsis in critically ill children. Methods: This was a retrospective study of 77 critically ill children and 33 non-diabetic healthy children (controls) who were admitted between 07/2015 and 05/2016. Patient data, clinical information, and blood samples were collected on admission, alongside a large number of laboratory parameters that were routinely assessed. Critically ill patients were divided into sepsis and non-sepsis/systemic inflammatory response syndrome (SIRS). Serum GLUT4 was measured using western blotting and enzyme-linked immunosorbent assays. Insulin resistance indexes, clinical data, laboratory parameters, and inflammatory cytokines were assessed. Results: GLUT4 serum levels were higher in critically ill children than in healthy children (90.5 vs. 30.3 μg/L, P 0.05). Compared to healthy children, hyperglycemic patients (n = 48) had elevated GLUT4 serum levels (30.3 vs. 103.7 g/L, P Conclusions: GLUT4 serum levels might be significantly increased in critically ill children compared with healthy children, particularly those in septic shock. Serum GLUT4 could predict disease severity.
文摘Bipolar disorder is a serious mental condition that may be caused by any kind of stress or emotional upset experienced by the patient.It affects a large percentage of people globally,who fluctuate between depression and mania,or vice versa.A pleasant or unpleasant mood is more than a reflection of a state of mind.Normally,it is a difficult task to analyze through physical examination due to a large patient-psychiatrist ratio,so automated procedures are the best options to diagnose and verify the severity of bipolar.In this research work,facial microexpressions have been used for bipolar detection using the proposed Convolutional Neural Network(CNN)-based model.Facial Action Coding System(FACS)is used to extract micro-expressions called Action Units(AUs)connected with sad,happy,and angry emotions.Experiments have been conducted on a dataset collected from Bahawal Victoria Hospital,Bahawalpur,Pakistan,Using the Patient Health Questionnaire-15(PHQ-15)to infer a patient’s mental state.The experimental results showed a validation accuracy of 98.99%for the proposed CNN modelwhile classification through extracted featuresUsing SupportVectorMachines(SVM),K-NearestNeighbour(KNN),and Decision Tree(DT)obtained 99.9%,98.7%,and 98.9%accuracy,respectively.Overall,the outcomes demonstrated the stated method’s superiority over the current best practices.
文摘Objective: To explore the effect of evidence-based quality control circle (QCC) in improving the implementation rate of airway management measures in adult critically ill patients. Methods: Based on the Joanna Briggs Institute (JBI) evidence-based health care model, the best evidence of airway management in adult critically ill patients was obtained and applied to the clinic. Results: The total implementation rate of airway management measures in adult critically ill patients increased from 23.62% before the implementation of quality control circle to 88.82%, and the pulmonary infection rate in critically ill patients decreased from 42.31% to 21.74%, with statistical significance between the two groups (P 0.05). Conclusion: Evidence-based quality control circle activities can standardize the practice standards of airway management in critically ill patients, reduce the occurrence of patients’ airway related complications, and improve clinical outcomes.
