Prevalence of Malnutrition and Frailty in Elderly Cancer Patients and Resulting Impact on Primary Treatment Recommendations in Colorectal and Breast Cancer

Objectives To estimate the prevalence of malnutrition in elderly cancer patients and its association with frailty and primary cancer treatment recommendations in patients with the two most prevalent cancers(colorectal cancer,CRC and breast cancer,BC)in the Centre-Val de Loire region of France.Methods The entire cohort of 704 patients aged 75 years or older presenting with cancer who underwent comprehensive geriatric assessment(CGA)between 2014 and 2017 was included.Nutritional status,frailty(defined by the Balducci classification system based on CGA parameters and comorbidity),and pathological criteria were analyzed in terms of the cancer treatment recommendations suggested by geriatricians both in the whole cohort and in those with CRC and BC.Results In the whole group of 704 patients(84.3+/-4.8 years),the prevalence of malnutrition was 62.9%,and was higher in CRC than in BC patients(71.1%vs 55.4%,P<0.01).In a multivariate analysis,malnutrition and frailty(as determined by the Balducci classification system)were independently related in CRC patients(OR:7.28,95%CI,1.58~34.03;P=0.012)and were unrelated to metastasis[odds ratio(OR):1.34,95%CI,0.56~3.18;P=0.5].By contrast,malnutrition in BC patients was related exclusively to the extent of metastasis(OR:3.52,95%CI,1.50~8.24;P=0.002).It was also demonstrated that geriatricians had a greater tendency to suggest only palliative care to CRC patients presenting with malnutrition(15.4%vs 2.7%,P=0.006)than to BC patients(9.8%vs 5.4%,NS).Conclusion Malnutrition in elderly cancer patients is prevalent,especially in those with colorectal cancer,where malnutrition is frailty-related and may strongly impact on cancer treatment strategies.

Intensive care unit-acquired weakness:Unveiling significant risk factors and preemptive strategies through machine learning

This editorial discusses an article recently published in the World Journal of Clinical Cases,focusing on risk factors associated with intensive care unit-acquired weak-ness(ICU-AW).ICU-AW is a serious neuromuscular complication seen in criti-cally ill patients,characterized by muscle dysfunction,weakness,and sensory impairments.Post-discharge,patients may encounter various obstacles impacting their quality of life.The pathogenesis involves intricate changes in muscle and nerve function,potentially leading to significant disabilities.Given its global significance,ICU-AW has become a key research area.The study identified critical risk factors using a multilayer perceptron neural network model,highlighting the impact of intensive care unit stay duration and mechanical ventilation duration on ICU-AW.Recommendations were provided for preventing ICU-AW,empha-sizing comprehensive interventions and risk factor mitigation.This editorial stresses the importance of external validation,cross-validation,and model tran-sparency to enhance model reliability.Moreover,the application of machine learning in clinical medicine has demonstrated clear benefits in improving disease understanding and treatment decisions.While machine learning presents oppor-tunities,challenges such as model reliability and data management necessitate thorough validation and ethical considerations.In conclusion,integrating ma-chine learning into healthcare offers significant potential and challenges.Enhan-cing data management,validating models,and upholding ethical standards are crucial for maximizing the benefits of machine learning in clinical practice.

全程救援指挥决策系统中多网络无线通信保障策略研究

目的:研究多种无线通信技术在动静态医学救援单元与指挥平台通信中的应用,满足"全程救治链"中应急救援指挥决策系统的信息传输需求。方法:分析现有多种无线通信技术特点及救治链系统通信需求,设计不同应用环境的多网络无线通信保障策略。结果:提出了基于GPRS、3G移动公网及卫星通信等动态可切换无线通信和数据可靠传输的保障策略,研制了多网络无线通信链路终端一体机。结论:该无线通信保障策略和多网络无线通信链路终端一体机有利于保持各救援单元与指挥平台通信链路的持续畅通,保证了指挥决策系统在应急医学救援行动中的稳定可靠。

身份证IC卡识别在全程连续救治指挥决策系统中的应用研究

目的:研究一种身份证IC卡识别技术在医学应急救援指挥决策系统中的应用。方法:采用对比分析现有识别模式的方法,遴选数据来源广泛的身份证IC卡模式,并与计算机系统连接使用。结果:解决了医学应急救援中医护人员身份的高效验证及伤病员基本信息的快速采集问题。结论:采用身份证IC卡作为验证医护人员身份及采集伤病员基本信息的方法简便易行,原始数据提取快捷,具有良好的唯一性、可靠性和易操作性。

Qualitative study on influencing factors of refusal of gastric tube placement in stroke patients with dysphagia

Objective:To explore the influencing factors of patients with dysphagia after stroke who refuse to accept gastric tube implantation,and to provide intervention basis for improving the compliance of patients with gastric tube implantation.Methods:Asemi-structured interview method was used to conduct in-depth interviews with 11 patients who refused gastric tube placement,and the interview data were analyzed by Colaizzi analysis method.Results:The influencing factors of patients with dysphagia after stroke can be summarized into the following three themes:patient factors(patient's cognition of disease,patient's subjective pain perception and fear),family factors(patient's caregiver's cognition of disease,economic conditions)and medical factors(trust in medical staff,medical education methods).Conclusion:Medical staff should understand the influencing factors of dysphagia after stroke and take positive measures to improve the compliance of patients with gastric tube placement and ensure the treatment effect.

心房颤动患者抗凝治疗决策冲突现状及影响因素研究

目的调查房颤患者抗凝治疗决策冲突现状,并分析其影响因素。方法采用一般资料调查表、心房颤动知识问卷及决策冲突量表对219例房颤患者进行调查。结果房颤患者抗凝治疗决策冲突总分为(41.47±17.54)分,其中有33例(15.07%)患者不存在决策冲突,90例(41.10%)患者决策冲突处于中等水平,96例(43.83%)患者决策冲突水平较高,存在决策延迟情况。多元线性回归分析显示,患者的年龄、性别、婚姻状况、文化程度、合并症种类、对疾病了解程度是抗凝治疗决策冲突的影响因素(P<0.05,P<0.01)。结论房颤患者抗凝治疗决策冲突水平较高,不容忽视。决策冲突受多种因素影响,医护人员应针对影响因素制定个性化的治疗决策辅助方案,以降低患者决策冲突水平,改善医患关系,提高治疗满意度。

中年肺癌化疗患者参与跨专业共享决策方案的制订及实施

目的 提高中年肺癌化疗患者诊疗共享决策的参与度及效果。方法 将76例中年肺癌化疗患者按住院时间分为对照组和试验组各38例,对照组实施常规诊疗告知与相关护理,试验组在常规护理基础上实施跨专业共享决策干预。结果 干预后,试验组患者健康素养得分及参与医疗决策满意度得分显著高于对照组,决策困境得分显著低于对照组(均P<0.05)。结论 中年肺癌化疗患者参与跨专业共享决策方案的实施有利于提高患者健康素养,降低患者决策困境,提升参与决策满意度。

原发性开角型青光眼患者决策辅助方案的构建及应用

目的探讨决策辅助方案在原发性开角型青光眼患者中的应用效果。方法将100例原发性开角型青光眼患者按住院时间分为对照组与观察组各50例;对照组行常规护理,观察组在常规护理基础上实施决策辅助方案。分别于干预后(出院前)、出院后1、3个月评价干预效果。结果干预后观察组决策困境得分显著低于对照组,决策准备得分显著高于对照组,出院后1、3个月药物依从性得分显著高于对照组,出院后3个月目标眼压达标率显著高于对照组(均P<0.05)。结论决策辅助方案的应用可有效降低原发性开角型青光眼患者决策困境水平,提高决策准备度,增强用药依从性,从而提高目标眼压达标率。

基于问题提示清单和个人决策指导的急性阑尾炎患儿决策辅助干预

目的 探讨基于问题提示清单和个人决策指导的决策辅助干预在急性阑尾炎患儿治疗决策中的应用效果。方法 便利选取急性阑尾炎患儿监护人为研究对象,按照患儿就诊时间分为对照组和干预组各49人。对照组实施常规术前谈话和健康教育,干预组在对照组基础上实施基于问题提示清单和个人决策指导的决策辅助干预。比较两组决策困境、决策准备度和决策参与满意度。结果 干预后,干预组患儿监护人决策困境总分显著低于对照组,决策准备度及决策参与满意度总分显著高于对照组(均P<0.05)。结论 基于问题提示清单和个人决策指导的决策辅助干预,能够降低急性阑尾炎患儿监护人决策困境,提高其决策准备度和决策参与满意度。