Early prediction of cerebral-cardiac syndrome after ischemic stroke: the PANSCAN scale.

BACKGROUND: Cerebral-cardiac syndrome, newly developed cardiac damage manifestations subsequent to cerebral injuries, is a common complication of stroke and leads to increased morbidity and mortality. The current study is aimed to develop a risk prediction scale to stratify high-risk population of CCS among ischemic stroke patients. METHODS: The study included 410 cases from four tertiary medical centers from June 2018 to April 2019. The risk prediction model was established via logistic regression from the derivation cohort including 250 cases admitted between June 2018 and December 2018. Another 160 cases admitted from January 2019 to April 2019 were included as the validation cohort for external validation. The performance of the model was determined by the area under curve of the receiver operating characteristic curve. A rating scale was developed based on the magnitude of the logistic regression coefficient. RESULTS: The prevalence of CCS was 55.2% in our study. The predictive model derived from the derivation cohort showed good calibration by Hosmer-Lemeshow test (P = 0.492), and showed sensitivity of 0.935, specificity of 0.720, and Youden index of 0.655. The C-statistic for derivation and validation cohort were 0.888 and 0.813, respectively. Our PANSCAN score (0 to 10 points) was then established, which consists of the following independent risk factors: PT(12 s-14 s = 0; otherwise = 1), APTT(30s-45s = 0, otherwise = 1), Neutrophils(50-70% = 0; otherwise = 1), Sex(female = 1), Carotid artery stenosis(normal or mild = 0; moderate to severe = 2), Age(≥65 years = 1), NIHSS score(1 to 4 = 2; ≥5 = 3). Patients scored 3 or more points were stratified as high risk. CONCLUSION: The risk prediction model showed satisfactory prediction effects. The PANSCAN scale provides convenient reference for preventative treatment and early management for high-risk patients. TRIAL REGISTRATION: The study was retrospectively registered in Chinese Trial Registry. The date of registration is April 17, 2019. TRIAL REGISTRATION NUMBER: ChiCTR1900022587 .

Development and validation of fall risk perception scale for patients with Parkinson's disease.

Background: Perception assessment plays an important role in fall risk awareness and fall prevention. Parkinson's disease patients with motor dysfunction are at high risk of falling. Currently, no instrument has been explicitly crafted to assess the risk perception of fall in PD patients. The purpose of this study was to develop and validate the fall risk perception scale for PD patients (FRPS-PD), providing healthcare professionals with a effective assessment tool to enhance proactive fall prevention initiatives. Method: Based on the Proactive Health theory and Risk Perception Attitude (RPA) Framework, the questionnaire was developed through literature review, semi-structure interview, expert consultation and pilot testing. A total of 428 patients with PD from Grade A tertiary hospitals in Shanghai, Hangzhou and Anhui from January 2023 to July 2023 were recruited. The items and dimensions in the scale were explored and confirmed using item-analysis, content validity, exploratory factor analytical (EFA), confirmatory factor analytical (CFA), internal consistency and test-retest reliability analysis. Results: A total of 16-items, 2-dimensions structure were identified, including 12 items of risk perception and 4 items of self-efficacy dimension. The cumulative variance of EFA model was 73.669%, further CFA showed that acceptable model fit (χ2/df = 2.226, RMSEA = 0.074, NF = 0.928, TLI = 0.951, CFI = 0.959, GFI = 0.887 and AGFI = 0.848). The content validity index was 0.956. The reliability of the scale was 0.952 using Cronbach's α coefficient method. The test-retest reliability was 0.944. Conclusion: The FRPS-PD is a valid and reliable measurement for evaluating fall risk perception level for individuals with PD in mainland China.

Stress overload, influencing factors, and psychological experiences of nurse managers during early stages of the COVID-19 pandemic: a sequential explanatory mixed method study.

Background: Healthcare systems had an exceptionally difficult time during the early COVID-19 pandemic. Nurse managers in particular made enormous contributions to ensuring the safety of patients and front-line nurses while being under excessive psychological stress. However, little is known about their experiences during this time. Objective: The aim of this study was thus to assess the level of stress overload and psychological feelings of nurse managers during the early COVID-19 pandemic. Methods: A mixed methods sequential explanatory design study with non-random convenience sampling was performed, following the STROBE and COREQ checklists. The study was conducted at the Affiliated Dongyang Hospital, Wenzhou Medical University, with data collected from six provinces in southern China (Zhejiang, Hubei, Shanghai, Jiangsu, Hunan and Jiangxi) during March 2020 and June 2020. A total of 966 nurse managers completed the Stress Overload Scale and Work-Family Support Scale. In addition, a nested sample of nurse managers participated in semi-structured face-to-face interviews. The data were then analyzed using qualitative content analysis, Pearson correlation, and multiple linear regression. Results: The quantitative results showed that nurse managers experienced a moderate level of stress load. There was a significant negative correlation between work-family support and stress load (r = -0.551, p < 0.01). Concerns about protecting front-line nurses and work-family support were the main factors affecting the stress load, which accounted for 34.0% of the total variation. Qualitative analysis identified four main thematic analyses that explained stress load: (1) great responsibility and great stress, (2) unprecedented stress-induced stress response, (3) invisible stress: the unknown was even more frightening, and (4) stress relief from love and support. Taken together these findings indicate that concern about protecting front-line nurses and negative work-family support of nurse managers were the main factors causing stress overload. Conclusion: Implementing measures focused on individual psychological adjustment combined with community and family support and belongingness is one potential strategy to reduce psychological stress among nurse managers.

Psychometric properties of the Chinese version of the preoperative assessment of readiness tool among surgical patients.

Background: The evaluation of the surgical readiness of patients plays an important role in clinical care. Preoperative readiness assessment is needed to identify the inadequacy among surgical patients, which provides guide for interventions to improve patients' preoperative readiness. However, there is a paucity of high-level, quality tool that evaluate surgical readiness of patients in China. The purpose of this study is to translate the Preoperative Assessment of Readiness Tool (PART) into Chinese and determine the reliability and validity of the Chinese version in the population of surgical patients. Methods: Using a standard translation-backward method, the original English version of PART was translated into Chinese. A convenient sampling of 210 surgical patients was recruited from 6 hospitals in Zhejiang Province to test the psychometric properties of this scale including internal consistency, split-half reliability, content validity, structure validity, and floor/ceiling effect. Results: A total of 194 patients (92%) completed questionnaires. The Chinese version of PART achieved Cronbach's alphas 0.948 and McDonald's omega coefficient 0.947, respectively, for the full scale. The estimated odd-even split-half reliability was 0.959. The scale-level content validity index was 0.867, and the items content validity index ranged from 0.83 to 1.0.The output of confirmatory factor analysis (CFA) revealed a two-factor model (χ2 = 510.96; df = 86; p < 0.001; root mean square error approximation = 0.08) with no floor/ceiling effect. Conclusion: The Chinese version of PART demonstrated acceptable reliability and validity among surgical patients. It can be used to evaluate patients' preoperative preparation and help health professionals provide proper preoperative support.

Behavioral Intentions and Factors Influencing Nurses' Care of COVID-19 Patients: A Cross-Sectional Study.

Objective: Behavioral intentions to care for patients with infectious diseases are crucial for improving quality of care. However, there have been few studies of the behavioral intentions and factors influencing patient care by clinical nurses during the COVID-19 pandemic. This study aims to explore cognition, attitudes, subjective norms, self-efficacy, and behavioral intentions of clinical nurses while caring for COVID-19 patients and to explore any influencing factors. Method: A cross-sectional survey was conducted of nurses through convenience sampling in southeast China from February 2020 to March 2020. The questionnaire was developed based on the theory of planned behavior and self-efficacy. Results: A total of 774 nurses completed the survey. Of these, 69.12% (535/774) reported positive behavioral intentions, 75.58% (585/774) reported a positive attitude, and 63.82% (494/774) reported having the confidence to care for patients. However, the lack of support from family and friends and special allowance affected their self-confidence. Attitude, self-efficacy, subjective norms, and ethical cognition were significantly positively correlated with behavioral intentions (r = 0.719, 0.690, 0.603, and 0.546, respectively, all P < 0.001). Structural equation model showed that self-efficacy, attitude, ethical cognition, and subjective norms had positive effects on behavioral intentions (ß = 0.402, 0.382, 0.091, and 0.066, respectively, P < 0.01). The total effect of behavioral intentions was influenced by attitude, ethical cognition, self-efficacy, and subjective norms (ß = 0.656, 0.630, 0.402, and 0.157, respectively, P < 0.01). In addition, ethical cognition had a positive mediating effect on behavioral intentions (ß = 0.539, P < 0.001). Conclusion: The study results indicated that attitude, ethical cognition, and self-efficacy were the main factors influencing nurses' behavioral intention. Efforts should be made to improve nurses' attitude and self-efficacy through ethical education and training to increase behavioral intentions to care for patients with infectious diseases, which will improve the quality of nursing care.

Anti-inflammatory and anti-rheumatic activities in vitro of alkaloids separated from Aconitum soongoricum Stapf.

The aim of the present study was to investigate the cell proliferation-inhibiting and anti-rheumatic activities of chemical components from Aconitum soongoricum Stapf. Chemical constituents of Aconitum soongoricum Stapf. were separated and purified by silica gel and Sephadex LH-20 chromatography. Structure was identified by spectroscopic technique, and physical/chemical properties were analyzed. The following four compounds were identified: i) Aconitine, ii) songorine, iii) 16, 17-dihydro-12ß, 16ß-epoxynapelline, and iv) 12-epi-napelline. Cell Counting kit-8 assay was performed to assess cell proliferation. ELISA was conducted to determine the cytokine contents, and reverse transcription-quantitative polymerase chain reaction and Western blot analysis were performed to detect the mRNA and protein expression levels. Compared with the lipopolysaccharide (LPS) group, the contents of IL-6, IL-1ß, TNF-α and PGE-2 in the culture supernatant were significantly declined in the leflunomide + LPS and intervention+LPS groups, as well as the mRNA expression levels of HIF-1α, VEGFA and TLR4. Treatments with songorine, benzoylaconine and aconitine (at different concentrations) significantly inhibited the proliferation of HFLS-RA cells. Compared with the LPS group, the contents of PGE-2, IL-6, IL-1ß and TNF-α in the culture supernatant were significantly decreased in the intervention groups, and the mRNA expression levels of TLR4, HIF-1α and VEGFA in the cells in the intervention groups. Songorine, benzoylaconine and aconitine from Aconitum soongoricum Stapf. have anti-rheumatic activities in vitro, which may inhibit the proliferation of HFLS-RA cells, and the underlying mechanisms may be associated with inhibiting the inflammatory cytokine production and downregulating the expression levels of HIF-1α, VEGF and TLR4.

Application of refined management in prevention and control of the coronavirus disease 2019 epidemic in non-isolated areas of a general hospital.

OBJECTIVE: This article summarizes the experience in the prevention and control of coronavirus disease 2019(COVID-19) epidemic in non-isolated areas in a general hospital. METHODS: Based on refined management theory, we professionally developed the standards for prevention and control of COVID-19 in non-isolated areas, systematically implemented various prevention and control measures, performed gridding audits, effectively communicated among teams and between medical staff and patients assisted by information techniques, and reported results for quality improvement. RESULTS: There was no hospital-acquired COVID-19 infections among staff in the hospital. The rates of mask-wearing, epidemiological history screening, and the medical supplies disinfection were all 100% in the hospital. The accuracy rate of mask-wearing of patients and their families was 73.79% and the compliance rate of their hand hygiene was 40.78%. CONCLUSION: Refined management strategies for the prevention and control of COVID-19 infection in non-isolated areas of the general hospital are effective. The accuracy rate of mask-wearing and hand hygiene compliance of patients and their families need to be further improved.

Defining the rehabilitation adherence curve and adherence phases of stroke patients: an observational study.

BACKGROUND: Patient adherence is a crucial determinant of rehabilitation in the long term after stroke. However, adherence is inconstant and fluctuates along a time course, and the underlying regular pattern of adherence variation remains to be clarified. OBJECTIVE: We aimed to describe the longitudinal pattern of adherence to rehabilitation exercises in stroke patients and to determine different adherence phases based on formulated rehabilitation adherence curve. PATIENTS AND METHODS: Rehabilitation adherence levels were prospectively collected using the Questionnaire of Exercise Adherence (EAQ) among patients diagnosed with first-onset stroke since the second week of stroke onset, with a follow-up of 24 weeks. SPSS19.0 was used to formulate a fitting curve based on a scatter diagram. Possible causal factors for the different adherence phases are also discussed from the psychological, socioeconomic, and behavioral aspects. RESULTS: A total of 98 patients were included in this study. General adherence of the included subjects was classified as low to medium during follow-up. The adherence fitting curve was an "S" curve, with the fitting function y =0.005x3-0.211x2+1.963x+52.345. Three phases, namely, rapid increase phase, slow decrease phase, and stable phase, were identified based on the adherence curve, and relevant theories are explored. CONCLUSION: Rehabilitation adherence of stroke patients is a dynamic behavioral process that continuously changes along a time course, with a regular pattern of an "S" curve and includes a rapid increase phase, a slow decrease phase, and a stable phase.