Significant risk factors for intensive care unit-acquired weakness:A processing strategy based on repeated machine learning

BACKGROUND Intensive care unit-acquired weakness(ICU-AW)is a common complication that significantly impacts the patient's recovery process,even leading to adverse outcomes.Currently,there is a lack of effective preventive measures.AIM To identify significant risk factors for ICU-AW through iterative machine learning techniques and offer recommendations for its prevention and treatment.METHODS Patients were categorized into ICU-AW and non-ICU-AW groups on the 14th day post-ICU admission.Relevant data from the initial 14 d of ICU stay,such as age,comorbidities,sedative dosage,vasopressor dosage,duration of mechanical ventilation,length of ICU stay,and rehabilitation therapy,were gathered.The relationships between these variables and ICU-AW were examined.Utilizing iterative machine learning techniques,a multilayer perceptron neural network model was developed,and its predictive performance for ICU-AW was assessed using the receiver operating characteristic curve.RESULTS Within the ICU-AW group,age,duration of mechanical ventilation,lorazepam dosage,adrenaline dosage,and length of ICU stay were significantly higher than in the non-ICU-AW group.Additionally,sepsis,multiple organ dysfunction syndrome,hypoalbuminemia,acute heart failure,respiratory failure,acute kidney injury,anemia,stress-related gastrointestinal bleeding,shock,hypertension,coronary artery disease,malignant tumors,and rehabilitation therapy ratios were significantly higher in the ICU-AW group,demonstrating statistical significance.The most influential factors contributing to ICU-AW were identified as the length of ICU stay(100.0%)and the duration of mechanical ventilation(54.9%).The neural network model predicted ICU-AW with an area under the curve of 0.941,sensitivity of 92.2%,and specificity of 82.7%.CONCLUSION The main factors influencing ICU-AW are the length of ICU stay and the duration of mechanical ventilation.A primary preventive strategy,when feasible,involves minimizing both ICU stay and mechanical ventilation duration.

Optimization Strategies of Beijing Elderly Care Service Stations Based on Questionnaire Survey Method: A Case Study of Zhanlan Road Street of Xicheng District

4 elderly care service stations in Zhanlan Road Street,Xicheng District,Beijing are selected,and questionnaires are designed and distributed to the surrounding elderly population to understand their needs and satisfaction with the station environment.By observing elderly care service stations on site,the characteristics,obstacles,and shortcomings of the environment are recorded,and relevant data are collected and analyzed,such as the characteristics of the elderly population being interviewed,the planning and design data of the station environment,and the distribution of service facilities.The overall characteristics of the spatial environment of elderly care stations are summarized,and renovation measures and optimization suggestions are provided for the current shortcomings,thereby providing some basis for the spatial design of community elderly care service stations in the future.

Implementation Strategy of“Eight in One”of Integrated Medical and Care Service System in China:A Case Study of Anshan City of Liaoning

With the gradual intensification of aging in China,the issue of elderly care has become the primary issue that needs to be urgently solved in society.The construction of a reasonable and scientific integrated medical and care service system can not only efficiently allocate medical resources and services,but also better meet the needs of the elderly.Due to the involvement of multiple disciplines such as architecture,sociology,psychology,and behavioral science in the construction of the system,as well as the restriction of various objective factors such as medical capacity,spatial scale,and operating costs,the government and elderly care institutions have always been unable to find the best solution for how to scientifically and reasonably construct an integrated medical and care service system.This paper is based on Anshan City,Liaoning Province,which has prominent aging issues and distinct characteristics of the elderly population.Through extensive field research in elderly care institutions,and face-to-face communication with personnel from relevant government departments such as the Municipal Commission on Aging,the Civil Affairs Bureau,the Health Commission,the Medical Insurance Bureau,and the Human Resources and Social Security Bureau,it truly understands the problems that arise in the construction of the urban integrated medical and care service system.From three aspects:urban situation,institutional situation and the needs of the elderly,it is proposed to establish a clear departmental linkage mechanism with clear rights and responsibilities,a policy guarantee mechanism tailored to local conditions,a multi-measure operation mechanism,a technology first intelligent response mechanism,a warm and efficient service mechanism for the people,an overall layout mechanism,an evaluation and supervision mechanism for full process control,and a talent supply mechanism of external introduction and internal training.It aims to provide reference for the construction of an integrated medical and care service system in similar cities.

Optimizing pain management in elderly patients post-knee surgery:A novel collaborative strategy

Total knee replacement,a common surgery among the elderly primarily necessitated by osteoarthritis,replaces the damaged knee joint with an artificial one.Given the aging population and the increasing prevalence of such surgeries,the article highlights the critical need for effective postoperative care strategies.This editorial provides an overview of rehabilitation care for pain in elderly knee replacement patients,emphasizing the importance of a multimodal approach to postoperative recovery.Furthermore,the article advocates for a patient-centered,comprehensive rehabilitation regimen that enhances recovery and quality of life in elderly patients undergoing knee replacement surgery.

Advancing critical care recovery:The pivotal role of machine learning in early detection of intensive care unit-acquired weakness

This editorial explores the significant challenge of intensive care unit-acquiredweakness(ICU-AW),a prevalent condition affecting critically ill patients,characterizedby profound muscle weakness and complicating patient recovery.Highlightingthe paradox of modern medical advances,it emphasizes the urgent needfor early identification and intervention to mitigate ICU-AW's impact.Innovatively,the study by Wang et al is showcased for employing a multilayer perceptronneural network model,achieving high accuracy in predicting ICU-AWrisk.This advancement underscores the potential of neural network models inenhancing patient care but also calls for continued research to address limitationsand improve model applicability.The editorial advocates for the developmentand validation of sophisticated predictive tools,aiming for personalized carestrategies to reduce ICU-AW incidence and severity,ultimately improving patientoutcomes in critical care settings.

Ten misconceptions regarding decision-making in critical care

Diagnostic errors are prevalent in critical care practice and are associated with patient harm and costs for providers and the healthcare system.Patient complexity,illness severity,and the urgency in initiating proper treatment all contribute to decision-making errors.Clinician-related factors such as fatigue,cognitive overload,and inexperience further interfere with effective decision-making.Cognitive science has provided insight into the clinical decision-making process that can be used to reduce error.This evidence-based review discusses ten common misconceptions regarding critical care decision-making.By understanding how practitioners make clinical decisions and examining how errors occur,strategies may be developed and implemented to decrease errors in Decision-making and improve patient outcomes.

Alphabet Strategy for diabetes care: A multi-professional, evidence-based, outcome-directed approach to management

With the rising global prevalence in diabetes, healthcare systems are facing a growing challenge to provide efficient and effective diabetes care management in the face of spiralling treatment costs. Diabetes is a major cause of premature mortality and associated with devastating complications especially if managed poorly. Although diabetes care is improving in England and Wales, recent audit data suggests care remains imperfect with wide geographical variations in quality. Diabetes care is expensive with a sizeable amount of available expenditure used for treating the complications of diabetes. A target driven, long-term, multifactorial intervention in patients with type 2 diabetes has been shown to reduce mortality and morbidity. The alphabet strategy is a novel approach to effective diabetes care provision, aiming to address patient education and empowerment, provide consistent comprehensive care delivered in a timely fashion, and allowing multidisciplinary team work.

Family care and subjective well-being of coronary heart disease patients after percutaneous coronary intervention:Mediating effects of coping strategies

Objectives To analyze the correlations between family care,coping strategies and the subject well-being(SWB)of patients with coronary heart disease(CHD)after percutaneous coronary intervention(PCI).Methods From November 2019 to October 2020,264 CHD patients who had undergone PCI were enrolled in this questionnaire survey.The research tools applied included General Information Questionnaire,the Adaptation,Partnership,Growth,Affection and Resolve,Medical Coping Modes Questionnaire,and the General Well-being Schedule.SPSS 24.0 and Amos 23.0 software packages were used for statistical analysis.Results The mean scores for family care,confrontation,avoidance,acceptance-resignation and SWB,were 7.59±2.24,20.03±3.78,16.49±2.70,10.42±2.01,and 73.31±11.63,respectively.Subgroup analysis showed that the path coefficient between family care and subjective well-being was higher in males than females.Family care was directly related to coping strategies.The coping strategies were directly related to SWB,while family care showed an indirect association with SWB via coping strategies.Conclusions Family care can improve CHD patients’SWB post-PCI,and coping strategies are important for the link between family care and SWB.Also,men received more family care than women.Based on a patient's characteristics,healthcare providers can promote patients’positive coping strategies,increase their perceived family care,and improve the patient's SWB.

Alphabet strategy for diabetes care:A checklist approach in the time of COVID-19 and beyond

Chronic disease management requires achievement of critical individualised targets to mitigate again long-term morbidity and premature mortality associated with diabetes mellitus.The responsibility for this lies with both the patient and health care professionals.Care plans have been introduced in many healthcare settings to provide a patient-centred approach that is both evidence-based to deliver positive clinical outcomes and allow individualised care.The Alphabet strategy(AS) for diabetes is based around such a care plan and has been evidenced to deliver high clinical standards in both well-resourced and underresourced settings.Additional patient educational resources include special care plans for those people with diabetes undertaking fasting during Ramadan,Preconception Care, Prevention and Remission of Diabetes.The Strategy and Care Plan has facilitated evidence-based,cost-efficient multifactorial intervention with an improvement in the National Diabetes Audit targets for blood pressure,cholesterol levels and glycated haemoglobin.Many of these attainments were of the standard seen in intensively treated cohorts of key randomized controlled trials in diabetes care such as the Steno-2 and United Kingdom Prospective Diabetes Study.This is despite working in a relatively under-resourced service within the United Kingdom National Health Service.The AS for diabetes care is a useful tool to consider for planning care, education of people with diabetes and healthcare professional.During the time of the coronavirus disease 2019 pandemic the risk factors for the increased mortality observed have to be addressed aggressively.The AS has the potential to help with this aspiration.

Supporting mothers to bond with their newborn babies:Strategies used in a neonatal intensive care unit at a tertiary hospital in Malawi

Background:Maternalenewborn bonding during the first hours of is crucial to infant development.Effective bonding requires that newborn baby and mother be close to each another,so that the baby can signal his/her needs and the mother can respond.However,normal bonding process is hindered by illness,as the infants will be separated from their mothers and admitted to neonatal intensive care units.No study has explored the techniques applied by nurses and midwives to facilitate bonding between mothers and their sick newborn babies admitted in neonatal intensive care units in Malawi.Purpose:This study aimed to investigate the strategies for supporting maternalenewborn bonding for mothers whose neonates were admitted to an intensive care unit at a tertiary hospital in Malawi.Methods:An explorative qualitative design was used,and 15 participants(10 mothers and five nurses/midwives)were recruited.Data were collected by conducting in-depth interviews.Audio recorded data were transcribed verbatim and analyzed by utilizing ATLAS.ti version 7 in accordance with Hennink's stages of content analysis.Results:It was showed that nurses and midwives used different approaches to facilitate maternal enewborn bonding.The responses revealed two major themes:motherenewborn interaction and motherenurse/midwife interaction.Motherenewborn interaction involved breastfeeding and maternal involvement in newborn care,whereas motherenurse/midwife interaction involved effective communication and psychosocial support.Maternalenewborn bonding promotes a mother's successful transition into motherhood,nurses and midwives should actively initiate strategies facilitating early maternal enewborn bonding.

党建引领视角下医疗卫生人才培养的实践研究

加强党建工作建设,充分发挥党组织领导核心的作用,为医疗卫生教育机构深化医疗人才培养提供坚强保障。在党建引领背景下对医疗卫生人才培养进行探索和研究,构建全员、全方位、全过程育人体系,聚焦党建引领,建强育人队伍,凸显全员育人合力,培养兼具扎实专业理论和综合素质能力的复合型人才成为重要的育人目标。推动党建引领实践育人工作,即有利于强化党对医疗卫生教育机构的领导,还有利于创新党建引领、医疗卫生教育机构主导和社会力量参与的实践育人模式。文章从党建引领,在医疗人才培养的实践探索、实践策略等方面,探索党建引领实践育人策略,以为相关工作提供一定的借鉴和参考依据。

积极应对人口老龄化战略下养老服务的均衡发展

党的二十大将实现养老服务均衡发展摆在了突出位置。在以均衡治理原则助推高质量发展的格局下,老龄化国家战略再次升级了养老服务在格局、空间、模式、性质、内容五个方面的均衡关系。然而,由于多重原因,目前我国养老服务均衡发展中存在保障对象收入差异的起点非均衡、准入条件欠缺灵活的过程非均衡、运作机制维持困境的结构非均衡问题。在积极应对人口老龄化战略背景下,亟需实现养老服务的结构优化、功能提升、内容提质,并需重点关注:一是基本养老服务均衡化的基础环境已初步形成;二是科学把握城乡区域人口老龄化分布格局趋势;三是改变现有基本养老服务制度建设的基本理念;四是区域一体化是基本养老服务均衡化的重要步伐;五是坚持基本养老服务制度全国统筹的基本思路;六是建立新型的基本养老服务事权格局。

医学生安宁疗护知晓情况的影响因素分析

目的:了解医学生安宁疗护的知晓情况及其影响因素,为开展安宁疗护教育提供参考。方法:采用分层整群随机抽样的方法选取某医科大学2152名医学生为研究对象,采用自编“医学生安宁疗护知晓情况调查问卷”进行现场问卷调查,以卡方检验和Logistic回归分析影响因素。结果:医学生安宁疗护认知平均得分为17.12±6.012分,性别、照护经历、《医学伦理学》课程和安宁疗护教育等是影响医学生安宁疗护知晓率的主要因素。结论:多重因素影响医学生安宁疗护认知水平,需要设置多元立体化的安宁疗护课程补充学生安宁疗护知识盲区、借助性别差异化教学和同伴教育实现认知水平的精准提高,同时拓展医学生安宁疗护实践经验渠道,在医学教育中突出医学的社会性,实现医学观从“病”向“人”的转变。

人工智能赋能的居家社区养老服务发展及其生态系统优化策略研究

伴随人工智能技术在养老领域的应用,居家社区养老服务呈现协同演化的发展趋势。这既为人口老龄化下破解养老服务供给不足难题带来重大机遇,也给传统居家养老服务模式转型升级提出新的挑战。基于人工智能的技术特征,从“技术创新—要素整合—系统优化”过程维度揭示人工智能赋能的居家养老服务发展路径,并以生态系统理论为分析框架,从“宏观—中观—微观”层面剖析人工智能赋能居家社区养老服务面临规范性与引领性政策缺位、参与主体协作网络不紧密、养老服务供给和需求结构性失衡三个障碍。据此,应从宏观层面完善配套政策,加大对人工智能养老服务的支持力度;从中观层面推进数据汇聚与整合,促进多主体协同联动;从微观层面精准识别老年人需求,提升养老服务供给效率与能力。

慢性心功能不全急性加重后病情稳定患者自护行为与应对方式、生存质量的中介效应

目的 探讨慢性心功能不全急性加重后病情稳定患者应对方式、生存质量与自护行为的中介效应。方法 采用便利抽样法选取江阴市中医院心内科2020年1月—2022年7月收治的205例慢性心功能不全急性加重后病情稳定的出院患者资料作为研究对象,采用自制一般资料调查问卷、自我护理行为量表(ESCA)、医学应对问卷(MCMQ)及明尼苏达州心功能不全生命质量量表(MLHFQ)进行调查。采用SPSS26.0软件对收集数据进行统计分析,包括Pearson相关性、多元回归及中介效应分析。结果 受试患者自我护理能力得分为(124.34±12.37)分、生存质量得分为(55.36±5.19)分,均处于较低水平,应对方式主要采用回避方式,其得分为(24.35±1.24)分。自我护理能力、积极应对方式及生存质量间呈正相关(P<0.05);经多元线性回归发现,自我护理能力在受试患者应对方式和生存质量间起到部分中介效应。自我护理可直接预测医学应对方式(标准化路径系数为0.311),应对方式可直接预测生存质量(标准化路径系数为0.427),自护护理能力可间接预测生存质量(标准化路径系数为0.519)。结论 对慢性心功能不全急性加重后病情稳定患者开展自我护理时,增强患者心理韧性,进而提高生存质量。

团队协作式照护策略联合舒适护理对巨大子宫肌瘤术后患者的影响

目的:探讨团队协作式照护策略联合舒适护理对巨大子宫肌瘤术后患者的影响。方法:选取2023年4月—2024年4月南昌市第一医院收治的80例巨大子宫肌瘤患者,随机分为两组,各40例,对照组行常规护理,观察组行团队协作式照护策略联合舒适护理。评估两组术后康复指标、疾病认知水平、心理状态、自我效能、自护能力。结果:观察组住院时间、下床活动时间、术后清醒时间、进食时间均优于对照组,差异均有统计学意义(P<0.05)。干预后,两组疾病认知水平、一般自我效能感量表(GSES)、自我护理能力测定量表(ESCA)各项评分均高于干预前,焦虑自评量表(SAS)及抑郁自评量表(SDS)评分均低于干预前,且观察组疾病认知水平、GSES评分均高于对照组,SDS、SAS评分均低于对照组,差异均有统计学意义(P<0.05)。结论:团队协作式照护策略联合舒适护理可缓解子宫肌瘤患者术后情绪状态,加强患者的疾病知识水平,提升自护能力,改善患者的自我效能,有利于促进身体康复。

东方大苇莺对大杜鹃雏鸟的识别与育雏分配

鸟类具有多种亲子识别机制(如鸣声识别、表型特征、巢位置),并影响其育雏策略.然而,在巢寄生鸟类中,大杜鹃的宿主普遍缺乏对雏鸟的识别.其中一种观点认为是大杜鹃雏鸟把宿主卵(或雏鸟)拱出巢外,宿主亲鸟缺乏表型对比,导致宿主表现出识别错误,无法识别寄生鸟类.本研究选用大杜鹃的一种主要宿主—东方大苇莺为实验对象,通过双巢实验来验证东方大苇莺对大杜鹃雏鸟的识别机制和育雏策略.2014—2016年,在辽河口国家级自然保护区对26个东方大苇莺巢进行了实验.研究发现,东方大苇莺缺乏对自然寄生和人工转移大杜鹃雏鸟的识别,对大杜鹃和东方大苇莺的育雏比例无明显偏差.另外,宿主巢的寄生状态没有影响东方大苇莺亲鸟对大杜鹃雏鸟育雏分配,而雏鸟所在巢位置(t=1.314,P=0.039)对亲鸟育雏分配有显著影响.在原巢的大杜鹃雏鸟被喂养的比例明显高于新加巢,表明东方大苇莺更倾向对原巢的雏鸟进行抚育,巢位置是鸟类进行亲代抚育的重要线索.

基于预见性策略的精准护理用于口腔颌面肿瘤皮瓣修复术后的临床观察

目的 探讨基于预见性策略的精准护理用于口腔颌面肿瘤皮瓣修复术后的临床效果。方法 本研究选取2021年6月至2023年6月于新乡市中心医院收治的口腔颌面肿瘤皮瓣修复术后患者81例,所有患者均接受基于预见性策略的精准护理,对患者护理前后康复情况进行比较分析。结果 患者术后3 d的疼痛、皮瓣颜色、温度及毛细血管充盈度评分较术后6 h显著降低,差异有统计学意义(P<0.05)。本组患者中发生轻微感染2例,皮肤感觉异常1例,血管危象1例患者,并发症发生率为4.94%(4/81)。护理后患者生活质量评分较护理前高,差异有统计学意义(P<0.05),护理满意度为96.30%。结论口腔颌面肿瘤皮瓣修复术后应用基于预见性策略的精准护理可改善皮瓣状态,减少并发症,患者生活质量及护理满意度高。

社区中医养生保健服务能力提升策略研究

社区卫生服务中心是提升中医药服务水平、满足多元化就医需求和推动中医药参与居民养生保健的重要载体。文章通过实地调查、实证分析的方法,在山东省烟台市、东营市开展社区中医养生保健服务能力的调查。发现居民对健康管理和中医养生保健服务的整体认知水平有待提升,但随着中医药特色服务与宣教的开展,居民对保健养生和慢性病治疗等服务的需求旺盛;社区卫生服务中心开展中医养生保健服务存在供需失衡的现象;居民对中医养生保健服务的满意度较高。文章从做好中医药文化宣传与推广、增加社区中医养生保健服务项目供给、培养中医养生保健服务技术技能人员等3个方面提出具体举措,为提升社区卫生服务中心中医养生保健服务能力提供参考建议。

广州市中心城区养老机构设计研究

本文以广州市中心城区为研究对象,随机抽取10个养老机构进行实地调研和访谈,发现其现存问题主要涉及场地规划、空间组织、公共空间配比、功能配置和适老化设计五个方面,进而提出设计策略。研究表明场地规划上要完善无障碍通行条件,合理组织人车流线;空间组织上要提高灵活性,注重空间的功能复合与分时利用;公共空间配比上要理性增加床位,保证公共空间配比稳定,找到二者的平衡点;功能配置上要加强对老年人需求的了解,并积极整合周边资源;适老化设计上要提高专业性,并改善物理环境品质。