Identification and analysis of key risk factors for prehospital delay in patients with stroke.

BACKGROUND: Although recent advances have been made in the treatment of acute stroke, only a few patients have received reperfusion therapy. Studies on prehospital delay in patients with stroke have revealed a wide range of associated factors in different countries. However, a unified risk management system for stroke remains unavailable. There are no published risk management systems to manage prehospital delay in stroke patients across China. AIM: This study aimed to identify key risk factors that affect the prehospital delay risk prediction of acute ischemic stroke (AIS) patients and develop a crux of recommendations using the identified risk factors. METHODS: Prehospital delay predictors were collected through literature and expert interviews. We also developed a risk assessment questionnaire via two rounds of expert inquiry. From October 2017 to July 2019, 447 patients admitted for AIS and 202 relevant medical personnel from the Heilongjiang province of China were recruited. The risk factors were analyzed using the Technique for Order Preference by Similarity to an Ideal Solution (TOPSIS) to extract those that significantly impacted prehospital delay. RESULTS: A total of seven key risk factors were extracted from the 22 factors that were evaluated. Of these factors, five were associated with the patient delay stage and two with the transportation delay stage. CONCLUSIONS: A multi-dimensional and whole-process risk management mechanism should be established for AIS patients. These patients should be advised to improve their risk coping ability and relevant departments should formulate complete medical treatment procedures and medical systems to ameliorate prehospital delay effectively.

Mediating role diet self-efficacy plays in the relationship between social support and diet self-management for patients with type 2 diabetes.

BACKGROUND: It has previously been established that patients who have strong barriers to their diet self-management are more likely to have weak social support; however, the key mechanisms underlying the association between these two variables have not yet been established. This study aims to examine the potential role that diet self-efficacy plays in the relationship between social support and diet behavior in patients with type 2 diabetes mellitus (T2DM). METHODS: It was a cross-sectional survey. Three hundred-eighty patients diagnosed with T2DM were recruited for this study from five community health centers in China. The Chronic Disease Resource Scale (CIRS), Cardiac Diet Self-efficacy Scale (CDSE), and Food Control Behavior Scale (FCBS) were used to estimate participants' utilization of social resources, diet self-efficacy, and diet self-management, respectively. The data were analyzed utilizing structural equation modelling. RESULTS: The results suggest that both higher levels of social support and diet self-efficacy are related to higher levels of diet self-management. The mediating effect that diet self-efficacy has on the relationship between social support and diet self-management was significant (ß = .30, p < .05), explaining 55.68% of the total effect of social support on diet self-management. CONCLUSIONS: Diet self-efficacy plays a mediating role in the association between social support and diet behavior in patients with type 2 diabetes mellitus.

Family Functioning Mediates the Relationship Between Activities of Daily Living and Poststroke Depression.

BACKGROUND: Poststroke depression is common and includes depressive and somatic symptoms. However, few studies have confirmed the influence of family functioning on poststroke depression or explored the association among daily activities, family functioning, and poststroke depression. OBJECTIVES: We examined the independent risk factors of daily activities and family functioning for poststroke depression and identified the mediating effect of family functioning on the association between daily activities and poststroke depression. METHODS: This cross-sectional study design used convenience sampling to recruit 422 stroke survivors from the neurology department of a hospital in Harbin, China, from February to July 2018. We assessed participants' demographic and clinical variables, including depression, daily activities, and family functioning. Pearson's correlations and multiple linear regression analyses were conducted, and a path analysis with bootstrapping was utilized to define direct/indirect effects. RESULTS: Daily activities and family functioning had a significant and direct negative effect on participants' depression. The indirect effect of 1,000 bootstrap samples after bias correction with a 95% confidence interval was below zero, indicating that family function had a significant mediating effect on the association between depression and daily activities. DISCUSSION: This study revealed the importance of family functioning in the association between depression and daily activities in stroke survivors. To the best of our knowledge, this study was the first to explore the mediating role of family functioning in poststroke depression, emphasizing the importance of family for the mental health of stroke patients. To reduce the incidence of poststroke depression, interventions that enhance daily activities and family functioning may include nurses, family therapists, rehabilitation physicians, and community workers.

Machine learning is a valid method for predicting prehospital delay after acute ischemic stroke.

OBJECTIVES: This study aimed to identify the influencing factors associated with long onset-to-door time and establish predictive models that could help to assess the probability of prehospital delay in populations with a high risk for stroke. MATERIALS AND METHODS: Patients who were diagnosed with acute ischemic stroke (AIS) and hospitalized between 1 November 2018 and 31 July 2019 were interviewed, and their medical records were extracted for data analysis. Two machine learning algorithms (support vector machine and Bayesian network) were applied in this study, and their predictive performance was compared with that of the classical logistic regression models after using several variable selection methods. Timely admission (onset-to-door time < 3 hr) and prehospital delay (onset-to-door time ≥ 3 hr) were the outcome variables. We computed the area under curve (AUC) and the difference in the mean AUC values between the models. RESULTS: A total of 450 patients with AIS were enrolled; 57 (12.7%) with timely admission and 393 (87.3%) patients with prehospital delay. All models, both those constructed by logistic regression and those by machine learning, performed well in predicting prehospital delay (range mean AUC: 0.800-0.846). The difference in the mean AUC values between the best performing machine learning model and the best performing logistic regression model was negligible (0.014; 95% CI: 0.013-0.015). CONCLUSIONS: Machine learning algorithms were not inferior to logistic regression models for prediction of prehospital delay after stroke. All models provided good discrimination, thereby creating valuable diagnostic programs for prehospital delay prediction.

Development and Validity of a Questionnaire on Dyslipidemia Dietary Knowledge.

OBJECTIVE: Dyslipidemia is one of the most important modifiable risk factors for cardiovascular disease. Diet and lifestyle interventions positively contribute to the management of dyslipidemia. Adequate knowledge of the correct diet for dyslipidemia is an effective preventive strategy against cardiovascular disease. METHOD: This study developed a questionnaire to test dyslipidemia dietary knowledge. The initial, multiple-choice dyslipidemia dietary knowledge questionnaire (DDKQ) was formed based on a literature review of previous studies. Two Delphi rounds were performed to ensure content validity and face validity, items were pretested and filtered through item analysis, and the reliability and validity of the final questionnaire were checked. RESULTS: The DDKQ consisted of 5 parts, with 25 items in total. It demonstrated adequate content validity (0.94), face validity, internal consistency (KR20 = 0.67), and test-retest reliability (0.74). The mean item difficulty (P) was 0.55 and ranged from 0.15 to 0.83, and the mean item discrimination index (D) was 0.36, ranging from 0.21 to 0.58. The questionnaire was also able to distinguish between participants with/without a medical background; medical workers produced significantly higher total scores (16.70±2.84 vs. 14.57±4.26, p< 0.05). CONCLUSION: The DDKQ is a reliable and valid measure of dyslipidemia dietary knowledge. It is suitable for providing scientific assessments for targeted health education interventions.

Effect of alumina shapes on dielectric properties of UV-cured epoxy acrylic composite with alumina.

Polymer-based composites with the advantages of ceramics and polymers exhibit high dielectric constant, good processing properties and low dielectric loss. The composites with a varied content of irregular alumina (i-Al2O3) filler were prepared by UV-cured epoxy acrylic (EA). Spherical alumina (s-Al2O3) was used as a filler to further investigate the effect of alumina (Al2O3) shapes on dielectric properties of composites in the frequency range of 50 Hz-1 MHz. Fourier transform infrared spectroscopy proved that the UV-cured epoxy acrylic/alumina (Al2O3/EA) composites were successfully fabricated. Scanning electron microscopy demonstrated that i-Al2O3 particles have superior homodispersion in the matrix. Through testing, for all samples, with the addition of Al2O3, the relative permittivity of composites increased as expected, and the dielectric loss decreased accordingly. These data show that the incorporation of i-Al2O3 particles presents better properties when compared with s-Al2O3/EA, which indicates that i-Al2O3 particles have more influence on the dielectric properties of the composites than those of s-Al2O3 particles. According to Weibull distribution, the characteristic breakdown strength of the Al2O3/EA composites was obtained and the results suggested that the composites of i-Al2O3/EA exhibited better breakdown performance.

Effects of a psychological intervention programme on mental stress, coping style and immune function in percutaneous coronary intervention patients.

PURPOSE: This study aimed to assess the effects of a psychological intervention programme on the mental stress, coping style and cortisol and IL-2 levels of patients undergoing percutaneous coronary intervention (PCI). METHODS: A total of sixty cardiovascular patients scheduled for PCI with clear anxiety and depression screened by the Hospital Anxiety and Depression Scale were randomly divided into an experimental (n = 30) and control (n = 30) group. The participants in the experimental group received cognitive therapy, relaxation therapy and emotional support. Self-reported questionnaires, including the Self-Report Symptom Checklist (SCL-90) and the Medical Coping Mode Questionnaire (MCMQ), and levels of IL-2 and cortisol were collected at baseline and the day before discharge. RESULTS: Compared with the controls, patients in the intervention group had a better mental state and coping style (confrontation), higher levels of IL-2 and lower levels of cortisol (all P<0.05). CONCLUSIONS: The psychological intervention programme effectively improved mental state, reduced negative coping styles, increased levels of IL-2, and decreased cortisol levels in patients undergoing PCI. This programme may be an effective preoperative nursing intervention for PCI patients. TRIAL REGISTRATION: Chinese Clinical Trail Registry ChiCTR-IOR-16007864.

Effect of a comprehensive health education program on pre-hospital delay intentions in high-risk stroke population and caregivers.

OBJECTIVE: Many factors influence pre-hospital delays in the event of stroke. This study aimed to develop and evaluate a comprehensive educational program for decreasing pre-hospital delays in high-risk stroke population. METHODS: We enrolled 220 high-risk stroke population and caregivers from six urban communities in Harbin from May 2013 to May 2015, and randomly divided them into intervention and control groups. We implemented a comprehensive educational program (intervention group), comprising public lectures, instructional brochures, case videos, simulations, and role-playing from May 2013 to May 2015. We delivered conventional oral education in the control group. We compared stroke pre-hospital delay behavioral intention (SPDBI), pre-hospital stroke symptom coping test (PSSCT), and stroke pre-symptoms alert test (SPSAT) results between the groups before and 6, 12, and 18 months after health intervention. RESULTS: There were significant differences between before and after intervention (P < 0.01). SPDBI, PSSCT, and SPSAT scores were significantly different between the groups (P < 0.01). The interaction between time and intervention method was significant (P < 0.01). According to multivariate repeated measures analysis of variance, SPDBI, PSSCT, and SPSAT scores were significantly different at each time after intervention (P < 0.05). CONCLUSION: The comprehensive educational program was significantly effective in decreasing SPDBI, improving knowledge, enhancing stroke pre-symptoms alert, and reducing the possibility of pre-hospital delays.

Instrument development and validation of the stroke pre-hospital delay behavior intention scale in a Chinese urban population.

BACKGROUND: Several stroke impairment scales are currently available for stroke patients but none of them provide information regarding the pre-stroke behavioral intentions of high-risk stroke patients and their relatives. This study's objective was to generate and validate a new written tool, the Stroke Pre-hospital Delay Behavior Intention (SPDBI) scale. It is suitable for use with high-risk stroke patients and their relatives to predict the likelihood of pre-hospital delay. METHODS: From a review of related studies, we formulated a prototype scale. We interviewed ten stroke patients in a semi-structured iterative process that included interviews with experts, high-risk patients, and their family members. Then, we pretested and filtered items. We next used a large sample size and factor analysis to determine the scale's structure. Finally, we checked the reliability and validity of the scale. RESULTS: We identified five sub-domains (stroke warning signs, non-treatment justification, symptom attributions, habitual response style, and emergency system use). The SPDBI demonstrated good internal consistency and test-retest reliability (Cronbach's α =0.808; Intraclass Correlation Coefficient [ICC] =0.797). CONCLUSIONS: This SPDBI scale is a reliable, and valid measure of the likeliness of pre-hospital delay in high-risk stroke patients and their family members. It may provide scientific assessment for targeted health education intervention.

Development and validation of the Pre-hospital Stroke Symptoms Coping Test.

BACKGROUND AND PURPOSE: Measures of specific knowledge of coping with pre-hospital stroke symptoms can help educate high-risk patients and family caregivers. This study aimed to develop and validate the Pre-hospital Stroke Symptoms Coping Test (PSSCT). MATERIALS AND METHODS: Reliability and validity were analyzed using multiple data sources. The Delphi expert consultation method was applied to assess the test's surface validity and content validity index. The final edition of the 19-item PSSCT contained 3 sections assessing coping with typical symptoms and symptoms associated with vomiting and twitching. Its psychometric properties were investigated in a community sample of 300 high-risk patients and family members. RESULTS: The PSSCT was readily accepted by participants. It demonstrated adequate surface validity and content validity, and good internal consistency (KR20 = 0.822) and test-retest reliability (0.769), with difficulty (P) and degree of differentiation (D) ranges of 0.28-0.83 and 0.15-0.66, respectively. It was also able to distinguish between individuals who had/had not experienced a stroke. Experienced individuals scored significantly higher overall and on coping with typical symptoms and twitching (P<0.01). CONCLUSIONS: The PSSCT can practically and directly assess critical knowledge regarding coping with pre-hospital stroke symptoms and has good reliability and validity.

Perspectives from nurse managers on informatics competencies.

BACKGROUND AND PURPOSE: Nurse managers are in an excellent position for providing leadership and support within the institutions they serve and are often responsible for accessing information that is vital to the improvement of health facility processes and patients' outcomes. Therefore, competency in informatics is essential. The purposes of this study are to examine current informatics competency levels of nurse managers and to identify the variables that influence these competencies. METHODS: A questionnaire designed to assess demographic information and nursing informatics competency was completed by 68 nurse managers. Multiple linear regression analysis was conducted to analyze the factors influencing informatics competency. RESULTS: Descriptive analysis of the data revealed that informatics competency of these nurse managers was in the moderate range (77.65 ± 8.14). Multiple linear regression analysis indicated that level of education, nursing administration experience, and informatics education/training were significant factors affecting competency levels. CONCLUSION: The factors identified in this study can serve as a reference for nurse managers who were wishing to improve their informatics competency, hospital administrators seeking to provide appropriate training, and nursing educators who were making decisions about nursing informatics curricula. These findings suggest that efforts to enhance the informatics competency of nurse managers have marked potential benefits.

Tetraphenylethene modified perylene bisimide: effect of the number of substituents on AIE performance.

Perylene bisimide derivatives substituted with one and two tetraphenylethene moieties at 1 and 1,7-postions show distinct optical properties. The former displays characteristic emission features of perylene bisimides in solution and red emission in the aggregate state, while the latter is nonemissive in solution but highly red-emissive in the aggregate state.

Synthesis of Functional Disubstituted Polyacetylenes Bearing Highly Polar Functionalities via Activated Ester Strategy.

We demonstrate a facile synthetic route to functional disubstituted polyacetylenes bearing highly polar groups based on polymer reactions. A pentafluorophenyl (PFP) ester-containing diphenylacetylene was designed and polymerized to obtain PFP activated ester-functionalized disubstituted polyacetylene (P1). P1 was used as a parent polymer to further react separately with diverse amines, giving rise to a series of functional disubstituted polyacetylenes with a chiral moiety and hydroxyl and carboxyl groups in high yields under mild condition. Spectral characterization data indicated that the polymers' structures were well consistent with the expected results. The helicity and emission property of polymers were also studied.