Predictive value of frailty assessment tools in patients undergoingsurgery for gastrointestinal cancer: An observational cohort study

BACKGROUND Few studies have simultaneously compared the predictive value of various frailty assessment tools for outcome measures in patients undergoing gastrointestinal cancer surgery.Therefore,it is difficult to determine which assessment tool is most relevant to the prognosis of this population.AIM To investigate the predictive value of three frailty assessment tools for patient prognosis in patients undergoing gastrointestinal cancer surgery.METHODS This single-centre,observational,prospective cohort study was conducted at the Affiliated Lianyungang Hospital of Xuzhou Medical University from August 2021 to July 2022.A total of 229 patients aged≥18 years who underwent surgery for gastrointestinal cancer were included in this study.We collected baseline data on the participants and administered three scales to assess frailty:The comprehen-sive geriatric assessment(CGA),Fried phenotype and FRAIL scale.The outcome measures were the postoperative severe complications and increased hospital RESULTS The prevalence of frailty when assessed with the CGA was 65.9%,47.6%when assessed with the Fried phenotype,and 34.9%when assessed with the FRAIL scale.Using the CGA as a reference,kappa coefficients were 0.398 for the Fried phenotype and 0.291 for the FRAIL scale(both P<0.001).Postoperative severe complications and increased hospital costs were observed in 29(12.7%)and 57(24.9%)patients,respectively.Multivariate logistic analysis confirmed that the CGA was independently associated with increased hospital costs(odds ratio=2.298,95%confidence interval:1.044-5.057;P=0.039).None of the frailty assessment tools were associated with postoperative severe complications.CONCLUSION The CGA was an independent predictor of increased hospital costs in patients undergoing surgery for gastro-intestinal cancer.

Pulse oximeter as a home assessment tool:Knowledge and user experience among the community in Malaysia during the COVID-19 pandemic

Objective:To determine the degree of knowledge in the usage of pulse oximeter as a home assessment tool among the community in Malaysia.Methods:A cross-sectional survey was conducted in November 2021.The questionnaire assessed the knowledge in using pulse oximeters,user experience and opinions in using pulse oximeter as a home assessment tool during the pandemic.Results:A total of 504 respondents were included in the study,and the mean score in knowledge related to application of pulse oximetry was 73.00%,while the mean score in knowledge related to factors affecting pulse oximetry readings was only 38.51%.A total of 90.5% of the respondents recognised normal pulse rate and 88.5% knew the blood oxygen saturation levels of a healthy adult,while 69.4% recognised the definition of silent hypoxia.In addition,the majority of the respondents agreed that factors such as poor blood circulation(71.2%),excessive movements(69.8%),and hand position(60.7%)affected oximetry readings.However,61.7%,81.7%,77.2% and 76.8% of the respondents could not identify nail polish,skin colour,skin thickness and tattoos as factors that may affect oximetry readings respectively.Conclusions:The respondents showed a satisfactory level of knowledge related to application of pulse oximetry,but a poor level of knowledge related to factors affecting pulse oximetry readings among the community in Malaysia.Continuous efforts in educating the community on the correct use of pulse oximeters are crucial for appropriate home assessment and avoiding unnecessary stress.

Development of a skill assessment tool for the Korea operational oceanographic system

A standard skill assessment （SA） tool was developed and implemented to evaluate the performance of op- erational forecast models in the Korea operational oceanographic system. The SA tool provided a robust way to assess model skill in the system by comparing predictions and observations, and involved the com- putation of multiple skill metrics including correlation and error skills. User- and system-based acceptance criteria of skill metrics were applied to determine whether predictions were acceptable for the system. To achieve this, the tool produced a time series comparison plot, a skill score table, and an advanced sum- marized diagram to effectively demonstrate the multiple skill scores. Moreover, the SA was conducted to evaluate both atmospheric and hydrodynamic forecast variables. For the atmospheric variables, acceptable error criteria were preferable to acceptable correlation criteria over short timescales, since the mean square error overwhelmed the observation variance. Conversely, for the hydrodynamic variables, acceptable root mean square percentage error （e.g., perms） criteria were preferable to acceptable error （e.g., erms） criteria owing to the spatially variable tidal intensity around the Korean Peninsula. Furthermore, the SA indicated that predetermined acceptance error criteria were appropriate to satisfy a target central frequency （fc） for which errors fell within the specified limits （i.e., the .fc equals 70%）.

Assessment tools for differential diagnosis of neglect: Focusing on egocentric neglect and allocentric neglect

BACKGROUND There are very few studies on the differential diagnosis between egocentric neglect(EN)and allocentric neglect(AN).AIM To investigate the overall trend of the previously developed assessment tools by conducting a descriptive review of the studies on assessment tools that can perform a differential diagnosis of EN and AN.METHODS The data were collected by using databases such as Google Scholar,PubMed,and ScienceDirect.The most commonly used search terms were“neglect”,“stroke”,“egocentric neglect”,and“allocentric neglect”.RESULTS A total of seven studies that met the inclusion criteria were selected and analyzed.We were able to confirm the research process,test method,and differential diagnosis criteria of the seven presented assessment tools from four studies on paper-based tests and three studies on computerized tests.The majority of the tests were carried out via the cancellation method using stimuli such as everyday objects or numbers.EN distinguished the left from right based on the test paper,while AN distinguished the left from right based on stimuli.In order to perform differential diagnosis,the difference in the number of left and right responses or non-responses was used based on the EN and AN criteria.CONCLUSION It was confirmed that all the seven assessment tools can effectively perform differential diagnosis of EN and AN.This study may provide important data that can be used in clinical practice for differential diagnosis and future intervention planning for neglect patients.

Impact Assessment of Land-Use Changes on Nutrient Load in Song Cau Watershed Using Soil and Water Assessment Tool （SWAT） Model

The objective of this paper is to implement ＂Soil and Water Assessment Tool （SWAT）＂ model to assess the possible impact of land-use changes on nutrient yields from Song Cau watershed located in Northern Viet Nam. Organic nitrogen （N） as well as phosphorus （P） output due to nonpoint source erosion was estimated through SWAT. Parameters governing the mechanics of streamflow discharge, sediment yield, nitrogen, and phosphorus output in SWAT were calibrated in a distributed fashion. A five-year period of record for nutrient was used for model calibration, while a four-year period was used for model validation. Comparing measured versus simulated average monthly total N, and P loads for the calibration and validation periods; respectively, we found that SWAT model performed reasonably well for Song Cau watershed. Simulation results showed that monthly Nash-Sutcliffe coefficient of Efficiency （NSE） ranged from 0.65 to 0.83, observation＇s standard deviation ratio （RSR） and percent bias （PBIAS） ranged from 0.41 to 0.58 and -36.12 to 2.78, respectively. Additionally, SWAT simulation results also showed that land-use changes caused significant percentage of changes in sediment yield, total N, and P loads within Song Cau watershed.

The Hospital Assessment Tool： An Integrated Solution to Evaluate and Reduce Solid Medical Waste

The Hospital Assessment Tool （HAT） is an assessment technique that provides technical support to the healthcare industry for accessing solid waste generation, selecting products, and work practices to eliminate or reduce environmental hazards and solid waste, and to maintain quality patient care. Since 2007, this tool has been applied as part of an innovative partnership between the Lucas County Solid Waste Management District and College of Engineering of the University of Toledo. The purpose of this paper is to provide a complete overview and framework of this program and the HAT so that other institutions may learn from it and adopt similar concepts to help reduce solid waste generation and improve economic conditions in their regions. A focus of this paper is a discussion of a case study that details the process and results of an assessment conducted at a large hospital in Northwest, Ohio, USA. Also, included in this paper is a discussion of the project＇s background, a comparison to similar project＇s between colleges and government agencies, and results and benefits of the program, and an overview of the opportunities and barriers to this type of research. The project demonstrates that through a cooperative effort and a creative alliance, businesses, governments, universities, and industries can work together to improve environmental quality, reduce waste, and improve profitability. The project also educates college students through practical, real-world environmental work experience and trains them to become future environmental leaders

Postoperative accurate pain assessment of children and artificial intelligence: A medical hypothesis and planned study

Although the pediatric perioperative pain management has been improved in recent years,the valid and reliable pain assessment tool in perioperative period of children remains a challenging task.Pediatric perioperative pain management is intractable not only because children cannot express their emotions accurately and objectively due to their inability to describe physiological characteristics of feeling which are different from those of adults,but also because there is a lack of effective and specific assessment tool for children.In addition,exposure to repeated painful stimuli early in life is known to have short and long-term adverse sequelae.The short-term sequelae can induce a series of neurological,endocrine,cardiovascular system stress related to psychological trauma,while long-term sequelae may alter brain maturation process,which can lead to impair neurodevelopmental,behavioral,and cognitive function.Children’s facial expressions largely reflect the degree of pain,which has led to the developing of a number of pain scoring tools that will help improve the quality of pain mana-gement in children if they are continually studied in depth.The artificial inte-lligence(AI)technology represented by machine learning has reached an unprecedented level in image processing of deep facial models through deep convolutional neural networks,which can effectively identify and systematically analyze various subtle features of children’s facial expressions.Based on the construction of a large database of images of facial expressions in children with perioperative pain,this study proposes to develop and apply automatic facial pain expression recognition software using AI technology.The study aims to improve the postoperative pain management for pediatric population and the short-term and long-term quality of life for pediatric patients after operational event.

Research Progress of Measuring Tools for Patient Medication Compliance

This paper introduced the content, compilation process, reliability and validity, scoring method of the evaluation tool for patients’ medication compliance at home and abroad, and reviewed the research progress of the tool. The evaluation method, dimension, scoring method, evaluation content and application scope of the tool were compared, so as to provide reference for nurses to comprehensively and accurately evaluate patients’ medication status.

Defining Soil and Water Assessment Tool(SWAT)hydrologic responseunits(HRUs)by field boundaries

The Soil and Water Assessment Tool(SWAT)is widely used to relate farm management practices to their impacts on surface waters at the watershed scale,yet its smallest spatial unit is not generally defined by physically meaningful boundaries.The hydrologic response unit(HRU)is the smallest spatial unit of the model,and the standard HRU definition approach lumps all similar land uses,soils,and slopes within a subbasin based upon user-defined thresholds.This standard method provides an efficient way to discretize large watersheds where simulation at the field scale may not be computationally feasible.In relatively smaller watersheds,however,defining HRUs to specific spatial locations bounded by property lines or field borders would often be advantageous,yet this is not currently possible within the ArcSWAT interface.In this study,a simple approach is demonstrated that defines HRUs by field boundaries through addition of uniquely named soils to the SWAT user soil database and creation of a field boundary layer with majority land use and soil attributes.Predictions of nitrogen,phosphorus,and sediment losses were compared in a case study watershed where SWAT was set up using both the standard HRU definition and field boundary approach.Watershed-scale results were reasonable and similar for both methods,but aggregating fields by majority soil type masked extremely high soil erosion predicted for a few soils.Results from field-based HRU delineation may be quite different from the standard approach due to choosing a majority soil type in each farm field.This approach is flexible such that any land use and soil data prepared for SWAT can be used and any shapefile boundary can divide HRUs.

The Tax Administration Diagnostic Assessment Tool: Overview and Insights To-date

Premised on international good practices,the Tax Administration Diagnostic Assessment Tool(TADAT)provides a standardized and objective framework for conducting an evidence-based and outcome-focused assessment of the key strengths and weaknesses of a country’s tax administration system.TADAT is a global tool that applies to any country’s system of tax administration.The results of a TADAT assessment provide country authorities,supported by their capacity development partners,with a baseline to strengthen or develop,and monitor tax administration reform strategies and work plans.

Preschoolers＇ Learning Disabilities Assessment： New Perspectives in Computerized Clinical Tools

This study looks into new perspectives in preschoolers＇ assessment of being at risk for learning disabilities. Precisely, two innovative assessment approaches are examined in order to reveal new research perspectives. The first tool, a traditional approach, is the ＂Early Dyslexia Identification Test＂ and the second tool, a computerized approach, is an lnternet based Speech Pathology Diagnostic Expert System named ＂APLo＂. Both evaluate the sectors of phonological awareness, memory, psychomotor development, pre-writing and pre-reading skills in Greek. The findings o f the current study formulate three directions： （1） the complementary of speech language and learning disorders as a systemic approach, （2） the diagnosis of suspicious factors and compatibilities of learning disabilities even at the preschool age, and （3） the application of alternative methods of assessment aiming for a multidimentional approach with the combined prospect and potential of web tools in the early diagnosis and intervention in learning disabilities.

Postoperative pain assessment and management among nurses in selected hospitals in Benin City,Edo State,Nigeria

Objective:This study was designed to determine the nurse assessment of postoperative pain and its management in selected hospitals,Benin City,Edo State,Nigeria.Materials and Methods:A descriptive cross-sectional survey was adopted.The target population consist of 222 purposely nurses who are in the cadre of nursing officer II to chief nursing officer who works in the various surgical wards/units of the selected health facilities.The data were collected from the participants using the pretested structured questionnaire developed by the researcher.Results:Results showed that 66.2%of nurses had a poor level of knowledge on postoperative pain assessment.The McGill Pain Questionnaire was the most used pain assessment tool with a mean score of 2.84 whereas the Dallas Pain Questionnaire was the least used with a mean score of 1.90.“Providing clean,calm,and well-ventilated ward environment”(3.69±0.61)was the most used nonpharmacological method for postoperative pain management,followed by“distraction,relaxation,and guided imagery”(3.52±0.50),“dressing,bandage,splint,and reinforce wound sites postoperatively”(3.39±0.54),and“early ambulation/exercise”(3.20±0.62).The most used pharmacological interventions were“acetaminophen”(3.63±0.55),“topical anesthetic”(2.92±0.62),“nonselective nonsteroidal anti-inflammatory drugs”(2.87±0.43),and“mixed opioid agonist-antagonist”(2.56±0.56).Conclusion:There is a poor level of knowledge on postoperative pain assessment among nurses in this study setting.It is,therefore,pertinent for hospitals to organize continuous in-service training for postoperative pain assessment and management,especially on nonpharmacological approaches among nurses.

Genomic Tools for the Impact Assessment of 'Hotspots' for Early Warning of MDR Threats

INTRODUCTION Antimicrobial resistance （AMR） has been a low-priority area of research in most developing countries even though it has much significant therapeutic value. The management of serious infections should include not only the treatment of patients but also the measures to ensure that microorganisms do not spread through hospital premises. Controlling the transfer of organisms among staff, patients, and the environment is important. Research related to antimicrobial use and resistance, regional variation, and intervention policies.

Determining Optimal Strategies to Reduce Maternal and Child Mortality in Rural Areas in Western China: an Assessment Using the Lives Saved Tool

China, as a whole, is about to meet the Millennium Development Goals for reducing the maternal mortality ratio (MMR) and infant mortality rate (IMR), but the disparities between rural area and urban area still exists. This study estimated the potential effectiveness of expanding coverage with high impact interventions using the Lives Saved Tool (LiST). It was found that gestational hypertension, antepartum and postpartum hemorrhage, preterm birth, neonatal asphyxia, and neonatal childhood pneumonia and diarrhea are still the major killers of mothers and children in rural area in China. It was estimated that 30% of deaths among 0-59 month old children and 25% of maternal deaths in 2008 could be prevented in 2015 if primary health care intervention coverage expanded to a feasible level. The LiST death cause framework, compared to data from the Maternal and Child Mortality Surveillance System, represents 60%-80% of neonatal deaths, 40%-50% of deaths in 1-59 month old children and 40%-60% of maternal deaths in rural areas of western China.

Fragile hearts:Unveiling the crucial layers of frailty in elderly patients undergoing percutaneous coronary interventions

Wang and Liu's systematic review of frailty among elderly patients undergoing percutaneous coronary intervention(PCI)revealed that patients with frailty have significantly higher risks of all-cause and in-hospital death,major undesirable cardiovascular events,and major haemorrhage.Frailty is associated with adverse events,prolonged hospital stays,increased complications,and elevated mortality risk due to diminished physiological reserves.Integrating frailty into risk assessment tools is crucial,and gait speed has emerged as a key predictor of frailty.Recognizing the impact of frailty leads to personalized and informed decisionmaking,and frailty assessments should be performed.This holistic approach can inform tailored interventions,thereby optimizing outcomes for this vulnerable population undergoing PCI.

Integrated Hydrological Modeling of the Godavari River Basin in Maharashtra Using the SWAT Model: Streamflow Simulation and Analysis

Hydrological modeling plays a crucial role in efficiently managing water resources and understanding the hydrologic behavior of watersheds. This study aims to simulate daily streamflow in the Godavari River Basin in Maharashtra using the Soil and Water Assessment Tool (SWAT). SWAT is a process-based hydrological model used to predict water balance components, sediment levels, and nutrient contamination. In this research, we used integrated remote sensing and GIS data, including Digital Elevation Models (DEM), land use and land cover (LULC) maps, soil maps, and observed precipitation and temperature data, as input for developing the SWAT model to assess surface runoff in this large river basin. The Godavari River Basin under study was divided into 25 sub-basins, comprising 151 hydrological response units categorized by unique land cover, soil, and slope characteristics using the SWAT model. The model was calibrated and validated against observed runoff data for two time periods: 2003-2006 and 2007-2010 respectively. Model performance was assessed using the Nash-Sutcliffe efficiency (NSE) and the coefficient of determination (R2). The results show the effectiveness of the SWAT2012 model, with R2 value of 0.84 during calibration and 0.86 during validation. NSE values also ranged from 0.84 during calibration to 0.85 during validation. These findings enhance our understanding of surface runoff dynamics in the Godavari River Basin under study and highlight the suit-ability of the SWAT model for this region.

Understanding Osteoporosis: Pathophysiology, Risk Factors, Diagnosis, and Management

Osteoporosis is a systemic skeletal disease characterized by low bone mineral density (BMD) and deterioration of bone architecture, resulting in reduced bone strength and, consequently, increased susceptibility to fractures which poses a significant public health concern worldwide, particularly in aging populations [1]. The health-economic impact of vertebral and hip fractures has been extensively explored and it is well known that these fractures are associated with morbidity/disability and increased mortality;they also account for a substantial portion of the direct fracture costs. This review aims to provide a comprehensive overview of osteoporosis, including its pathophysiology, risk factors, diagnostic approaches, and management strategies. By elucidating the multifaceted nature of this condition, healthcare providers can better identify individuals at risk, implement preventive measures, and optimize treatment to reduce the burden of osteoporotic fractures.

Research Progress of Minimally Destructive Medicine Applied to Multimorbidity

Objective:To review the research status and progress of minimally disruptive medicine(MDM)with a view and to provide a theoretical basis for reducing the treatment burden of patients with multimorbidity.Methods:"Minimal Destructive Medicine"was used as searching term in HowNet Database and Wanfang Database,and"Minimally Disruptive Medicine"was used as searching term in PubMed database.The literature was reviewed for a review of the concepts of minimally destructive medicine(MDM),four basic principles,care models,and tools and strategies for clinical implementation.Results:MDM was developed for the coexistence burden of chronic diseases.It had formed a detailed and detailed application of basic principles and care models.The tools and strategies developed by MDM have been applied in clinical practice with good Results.Conclusion:MDM has a positive effect on reducing the burden of treatment for the multimorbidity and it is worthy of further research and promotion.

Development of the Documentation and Appraisal Review Tool for systematic reviews

AIM:To develop a tool to more explicitly assess and document the quality of systematic reviews.METHODS:We developed the Documentation and Appraisal Review Tool(DART)using epidemiologic principles of study design and the following resources:the modified Overview Quality Assessment Questionnaire(modified OQAQ),Assessment of Multiple Systematic Reviews(AMSTAR),the Cochrane Handbook,and the standards promoted by the Agency for Healthcare Research and Quality,and the Institutes of Medicine(IOM).We designed the DART tool to include the following:more detail to provide guidance and improve standardization of use,an approach to assess quality of systematic reviews addressing a variety of research designs,and additional space for recording notes to facilitate recall.DART underwent multiple rounds of testing with methodologists of varying levels of training and experience.Based on the results of six phases of pilot testing,we revised DART to improve performance,clarity and consistency.Pilot testing also included comparisons between DART,and the two most commonly used tools to evaluate the quality of systematic reviews,the modified OQAQ and AMSTAR.RESULTS:Compared to AMSTAR and modified OQAQ,DART includes two unique questions and several questions covered by modified OQAQ or AMSTAR but not both.Modified OQAQ and DART had the highest reporting consistency.Four AMSTAR questions were unclear and elicited inconsistent responses.Identifying reviewer rationale was most difficult using the modified OQAQ tool,and easiest using DART.DART allowsfor documentation of reviewer rationale,facilitating reconciliation between reviewers and documentation for future updates.DART also provides a comprehensive,systematic approach for reviewers with limited experience with systematic review methodology,to critically analyze systematic reviews.In addition,DART is the only one of the three tools to explicitly include quality review for biases specific to observational studies.This is now more widely recognized as important for assessing risk in order to generate recommendations that balance benefit to harm.The tool also includes the assessment of standards recommended by the March 2011 IOM Standards for Systematic Review.CONCLUSION:This comprehensive tool improves upon existing tools for assessing the quality of systematic reviews and guides reviewers through critically analyzing a systematic review.

Strengthening Post-Operative Pain Assessment in Patients with Major Abdominal Surgery, University Teaching Hospitals, Zambia

Systematic, routine pain assessment using standardized clinical guidelines is the foundation of effective pain management for patients who are unable to self-report pain. In Zambia, there are no context appropriate standardised clinical guidelines for post-operative pain observations. This study sought to develop such a clinical guideline in form of an assessment tool. The study adopted an exploratory sequential mixed method through a three-phased approach and an adapted Clinical Decision Making Survey instrument was used. Snowball sampling was employed and in phases II and III, purposive sampling was used. The study was conducted at the University Teaching Hospitals where 120 participants were enrolled in the study. Phases II and III provided preliminary internal validation processes of the developed tool, where discussions, orientation and trial implementation of the tool were done. In phase II of the study, 47 participants comprising of nurses participated while in phase III, there were 11 nurses and 32 participants. The results yielded the first ever standardised post-operative pain assessment tool for patients with major abdominal surgery in Zambia. The tool is made up of six dimensions of the identified nonverbal indicators of post-operative pain in patients with major abdominal surgery namely: facial expressions, mobility, activity intolerance, behavioural disturbance, communication ability and vital signs. The present study showed that the developed post-operative pain assessment tool for Zambia is acceptable for use among patients who have had major abdominal surgery and can facilitate improved post-operative pain management for most patients.