Development of a Chinese version of the Stress Adaption Scale and the assessment of its reliability and validity among Chinese patients with multimorbidity / 浙江大学学报·医学版

OBJECTIVES@#To develop a Chinese version of the Stress Adaption Scale (SAS) and to assess its reliability and validity among Chinese patients with multimorbidity.@*METHODS@#The Brislin model was used to translate, synthesize, back-translate, and cross culturally adapt the SAS. A total of 323 multimorbidity patients selected by convenience sampling method from four hospitals in Zhejiang province. The critical ratio method, total question correlation method, and graded response model (item characteristic curve and item discrimination) were used for item analysis. Cronbach's alpha coefficient and split-half reliability were used for the reliability analysis. Content validity analysis, structural validity analysis, and criterion association validity analysis were performed by expert scoring method, confirmatory factor analysis, and Pearson correlation coefficient method, respectively.@*RESULTS@#The Chinese version of the SAS contained 2 dimensions of resilience and thriving, with a total of 10 items. In the item analysis, the critical ratio method showed that the critical ratio of all items was greater than 3.0 (P<0.001); the correlation coefficient method showed that the Pearson correlation coefficients for all items exceeded 0.4 (P<0.01). The graded response model showed that items of the revised scale exhibited distinct item characteristic curves and all items had discrimination parameters exceeding 1.0. In the reliability analysis, Cronbach's alpha coefficient of the revised Chinese version of the SAS scale was 0.849, and the split-half reliability was 0.873. In the validity analysis, the item-level content validity index and scale-level content validity index both exceeded 0.80. In the confirmatory factor analysis, the revised two-factor model showed satisfactory fit indices (χ2/df=3.115, RMSEA=0.081, RMR=0.046, GFI=0.937, AGFI=0.898, CFI=0.936, TLI=0.915). In the criterion-related validity analysis, the Chinese version of the SAS score was negatively correlated with the Perceived Stress Scale and the Treatment Burden Questionnaire, with correlation coefficients of －0.592 and －0.482, respectively (both P<0.01).@*CONCLUSIONS@#The Chinese version of the SAS has good reliability and validity, which can be used to evaluate the stress adaption capacity among multimorbidity patients in China, and provides a reference for developing individualized health management measures.

Influencing factors of self-management behavior in cancer patients based on a theoretical domain framework / 浙江大学学报·医学版

OBJECTIVES@#To explore the factors that influence self-management behavior in cancer patients based on the theoretical domain framework.@*METHODS@#Studies in Chinese and English about factors influencing self-management behavior in cancer patients were searched from Wanfang database, CNKI, VIP, SinoMed, PubMed, Embase, CINAHL, Web of Science Core Collection, Cochrane library and Medline from inception to June 2022. Two investigators independently identified, extracted data, and collected characteristics and methodology of the studies. Factors were analyzed with Nvivo12, and the theoretical domain framework was mapped to the theoretical domain. Then the secondary node was generalized by theme analysis. Finally, the specific influencing factors were summarized and analyzed.@*RESULTS@#Thirty-four studies were included for analysis. A total of 194 factors were mapped to 13 theoretical domains, and 31 secondary nodes were summarized. Theoretical domains environmental context and resources, social/professional role and identity, and beliefs about consequences were the most common factors. Knowledge, age, self-efficacy, disease stage, social support, gender, economic status and physical status were the most influential factors for self-management in cancer patients.@*CONCLUSIONS@#The influencing factors of self-management of cancer patients involve most of the theoretical domains, are intersectional, multi-source and complex.

Analysis of characteristics of the location of lower extremity deep vein thrombosis and the site of pulmonary embolism in hospitalized patients / 中华危重病急救医学

Objective:To investigate the characteristics and relationship between the location of lower extremity deep vein thrombosis (DVT) and the site of pulmonary embolism in hospitalized patients.Methods:The data of patients with lower extremity DVT diagnosed by ultrasound examination and pulmonary embolism diagnosed by CT pulmonary angiography from December 2017 to December 2021 were analyzed retrospectively. According to the location of lower extremity DVT, the patients were divided into mixed DVT, proximal DVT, and distal DVT which was further divided into anterior/posterior tibial vein or peroneal vein thrombosis and calf muscular venous thrombosis. Mixed DVT was referred to the presence of both proximal and distal DVT. According to the involved site of pulmonary artery, pulmonary embolism was divided into three types: main pulmonary artery, left or right pulmonary artery trunk embolism, lobar pulmonary artery embolism and segmental pulmonary artery embolism. The location of lower extremity DVT, the site of pulmonary embolism, the clinical manifestation (shortness of breath, chest tightness, chest pain, hemoptysis, cough, lower limb swelling, lower limb pain, syncope, fever) and risk factors (fracture/trauma, tumor, diabetes, hypertension, atrial fibrillation, infection, surgery, autoimmune diseases, paralysis, pregnancy) of venous thromboembolism (VTE), and the level of D-dimer were analyzed.Results:A total of 209 patients were enrolled finally, including 127 patients with left lower extremity DVT (60.8%) and 82 with right lower extremity DVT (39.2%). Mixed DVT accounted for 39.2%, proximal DVT accounted for 17.3%, and distal DVT accounted for 43.5% (anterior/posterior tibial vein and peroneal vein thrombosis accounted for 14.8%, calf muscular venous thrombosis accounted for 28.7%). The incidences of main pulmonary artery embolism, left or right pulmonary artery trunk embolism in the mixed DVT and proximal DVT were significantly higher than those in the anterior/posterior tibial vein or peroneal vein thrombosis and calf muscular venous thrombosis [41.5% (34/82), 38.8% (14/36) vs. 16.2% (5/31), 10.0% (6/60)], with statistically significant differences (all P < 0.05). The incidences of pulmonary segmental artery embolism in the anterior/posterior tibial vein or peroneal vein thrombosis were higher than those in the mixed DVT and proximal DVT [41.9% (13/31) vs. 26.8% (22/82), 30.6% (11/36)], but the difference was not statistically significant (both P > 0.05). The incidences of pulmonary segmental artery embolism in the calf muscular venous thrombosis were significantly higher than those in the mixed DVT and the proximal DVT [66.7% (40/60) vs. 26.8% (22/82), 30.6% (11/36)], and the difference was statistically significant (both P < 0.05). The levels of D-dimer in patients with calf muscular venous thrombosis combined with main pulmonary artery embolism, left or right pulmonary artery trunk embolism were significantly higher than those in patients with calf muscular venous thrombosis combined pulmonary segmental artery embolism (mg/L: 6.08±3.12 vs. 3.66±2.66, P < 0.05). There were no significant differences in D-dimer levels in other patients with DVT combined with pulmonary embolism in different sites. In terms of the clinical manifestations of VTE, the incidences of lower limb swelling in the mixed DVT and proximal DVT were significantly higher than those in the anterior/posterior tibial vein or peroneal vein thrombosis and calf muscular venous thrombosis [54.9% (45/82), vs. 29.0% (9/31), 15.0% (9/60), both P < 0.05], the incidences of lower limb swelling in the proximal DVT were significantly higher than those in the calf muscular venous thrombosis [41.7% (15/63) vs. 15.0% (9/60), P < 0.05], there were no significant difference in the other clinical manifestations among the DVT groups. There was no significant difference in the incidence of VTE risk factors among the groups. Conclusions:The DVT of inpatients mostly occurred in the left lower limb, and the incidence of distal DVT was higher than that of proximal DVT. Mixed DVT and proximal DVT combined with pulmonary embolism mostly occurred in the main pulmonary artery, left or right pulmonary artery trunk, while distal DVT combined with pulmonary embolism mostly occurred in the pulmonary segmental artery. The levels of D-dimer in patients with lower extremity DVT combined with main pulmonary artery or left and right pulmonary artery trunk embolism were higher than those in patients with pulmonary lobe and segmental artery embolism. The incidence of lower extremity swelling in patients with mixed DVT and proximal DVT was higher than that in patients with distal DVT.