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Objective:To investigate the relationship between enteral nutrition-related diarrhea and intestinal flora in critically ill patients and the effect of microflora transplantation.Methods:A total of 60 critically ill patients with enteral nutrition-related diarrhea who were scheduled to undergo microflora transplantation in Taizhou Hospital of Integrated Traditional Chinese and Western Medicine from January 2020 to August 2021 were prospectively and continuously selected as the research group, and 60 critically ill patients without enteral nutrition-related diarrhea were selected as the control group. The bacterial count of 4 kinds of intestinal flora in the feces including bifidobacterium, lactobacillus, enterococcus, and escherichia coli were detected and compared between the two groups, and the value of the fecal colony numbers of 4 kinds of intestinal flora in diagnosing non-enteral nutrition-related diarrhea in critically ill patients was analyzed by receiver operating characteristic (ROC) curve. All patients in the research group received microflora transplantation, and the diarrhea score, hematochezia score, partial Mayo score and European five-dimension health scale (EQ-5D) were detected and compared before treatment, 1 week after treatment and 1 month after treatment to evaluate the treatment effect. The Pearson linear correlation method was used to analyze the relationship between the colony count of 4 kinds of intestinal flora colonies in the feces of the research group at baseline and the therapeutic indexes for 1 week and 1 month after treatment.Results:The number of fecal bifidobacterium and lactobacillus colonies in the study group were lower than those in the control group: (7.12 ± 0.58) × 10 7 cfu/L vs. (11.85 ± 1.25) × 10 7 cfu/L, (8.78 ± 1.05) × 10 7 cfu/L vs. (11.25 ± 1.57) ×10 7 cfu/L. The colony number of enterococcus and Escherichia coli were higher than those of control group: (8.58 ± 0.88) × 10 7 cfu/L vs. (3.84 ± 0.72) ×10 7 cfu/L, (8.25 ± 0.97) ×10 7 cfu/L vs. (3.66 ± 0.63) ×10 7 cfu/L. The differences were statistically significant ( P<0.05). ROC curve analysis results showed that the area under the curve of fecal bifidobacterium, lactobacillus, enterococcus and escherichia coli colonies in diagnosing patients with enteral nutrition-related diarrhea were all >0.7, which had certain diagnostic value. The diarrhea scores, stool blood scores and some Mayo scores of the study group at 1 week and 1 month after treatment were lower than those before treatment: (1.52 ± 0.36) and (1.13 ± 0.24) points vs. (2.45 ± 0.51) points, (0.95 ± 0.28) and (0.77 ± 0.21) points vs. (2.39 ± 0.54) points, (4.17 ± 1.24) and (3.26 ± 0.85) points vs. (7.86 ± 1.82) points, and the EQ-5D score of patients 1 week and 1 month after treatment was higher than that before treatment: (0.66 ± 0.11) and (0.79 ± 0.13) points vs. (0.58 ± 0.08) points, the difference was statistically significant ( P<0.05). Conclusions:The intestinal flora of critically ill patients is closely related to enteral nutrition-related diarrhea, and can affect the therapeutic effect of bacterial flora transplantation and the health status of patients.
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Objective To develop and allocate regional elderly care resources based on local service needs.Methods From February 2016 to May 2016,a face-to-face questionnaire survey was conducted to measure the elderly care service needs among residents over 60 years of age in Malu Township of Shanghai Jiading District.A telephone survey on the old-age care resources in Malu Township was carried out in November 2016.The demarcation of the aged care service needs was considered according to the resource classification from supplier side and the needs scores from the demander side.Kappa consistency test was used to compare the current care setting and the care setting matched to the real needs on the basis of the demarcation criteria.Results The results of the demarcation showed that 8 old-aged with score ≥ 44.5 in the survey (0.2％) should have the skilled nursing facility-based care;218 with the score of 24.1 to 44.4 (5.1％) should have the welfare institution-based care;60 with score of 23.2 to 24.0 (1.4％) should have elderly home-based care;72 with scores of 22.1 to 23.1 (1.7％) should have the community-based care;3 954 with score ≤ 22.0 (91.6％) should have home-based care.The consistency between the status of current care setting and the care setting matched to the real needs based on the demarcation criteria was poor (Kappa=0.092,P＜0.01).Conclusions This study sets a grading criterion for the service objects of the various aged care services in Malu Township,and provides a basis for the orderly,rational and fair distribution of the regional old-age care service resources.However,the current resource allocation in the region is not accurately matched to the real needs,the problem should be solved with the application of the demarcation criterion.
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Objective To survey on the elderly care needs in the community of Shanghai.Methods From February 2017 to May 2017,a survey on the elderly care needs was conducted using stratified sampling method among 4 312 residents aged ≥60 years in Malu township of Shanghai Jiading District.The survey involved physical health status (illness,self-care ability,vision,risk of falls),mental health status (expression ability in feelings of self-will/information,comprehension in others' willingness/information,depression,anxiety),social health status(family care ability),and willingness for elderly care method (self-desires for old-age support,family-desires for old-age support).The survey was implemented by family doctors.Results The total demand for elderly care services for the elderly in Malu Township was skewed,with a median score of 9.9 points (5.7,15.1).In terms of physical health status,72.7％(3 135) of the elderly suffered from one or more diseases,90.8％(3 915) of the elderly had good self-care ability,83.5％ (3 600) of the elderly had good eyesight,and 98.5％(4 247) of the elderly had only mild risk of falling;in terms of mental health status,81.8％(3 527) of the elderly had normal expression ability of self-willingness/information,and 98.3％(4 239) of the elderly had normal understanding ability of wishes/information expressed by others,87.5％(3 773) of elderly people did not have depression,97.0％(4 183) of the elderly had no anxiety;in terms of social health,58.7％(2 531) of elderly people had normal family care ability;58.7％(2 531) of elderly people were willing to get home-based care,and 53.0％(2 285) of their families also hoped that the elderly could get home-based care.Conclusion The needs of elderly care services is at a lower level among old-aged residents in Malu township,however,there is a relatively low social health status.This study provides an objective quantitative basis for the targeted development of medical care and support services for the elderlv in the communitv in the future.
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Objective To develop a measuring tool for the elderly care service needs in the community.Methods Based on the literature search and Delphi expert consultation,a measuring tool for elderly care service needs was developed.The reliability (internal consistency coefficient) and validity (surface validity,content validity,criterion-related validity) of the developed measurement tool were evaluated with on-site expert consultation and the cross-sectional survey.Results A 11-dimension measurement tool was developed,which covered physical health,mental health and desires for old-age support assessment.The reliability evaluation showed that there was significant correlation (P＜0.05) among the measurement dimensions of the physical health and the mental health of the elderly in community.The validity evaluation showed that the measurement methods for the measurement dimensions of the elderly care needs,including the evaluation items,evaluation methods,and rating methods,all got below 2 scores in applicability assessment,and the measurement methods of the self-care ability,vision,the self-willingness/information expression of the elderly,the ability of the elderly to understand the willingness/information expressed by others,and the ability to provide family care were all supported by more than 50％ experts,which indicated that the surface validity and content validity were good.There was a significant positive correlation between the living places of the elderly and the needsof elderly care services (r=0.214,P＜0.01),and there were significant correlations between all measurement dimensions with the living place except anxiety (P＜0.05),which indicated that the measurement tool had an acceptable criterion-related validity.The consistency of self-supporting willingness,the family willingness to care for the elderly with the current old-age care place were relatively poor (Kappa=0.063,P=0.007;Kappa=0.051,P=0.006).Conclusion The overall performance of the measurement tool for the elderly care service needs developed in this study is acceptable.It has been approved by both the elderly care service suppliers and the elderly care service needs evaluators.It also shows some internal consistency in measurement results of the demanders,and is consistent with the actual living place.
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Objective To define the assessment dimensions of community-based elderly care service.Methods Firstly 11 assessment dimensions of elderly care service needs were teased out through literature review and group discussion, these were illness, self-care ability, vision, risk of falls, willingness/information self-expression ability, the comprehension in others' willingness/information, depression, anxiety, family care ability, self-desires for old-age support, family-desires for old-age support.Then 37 experts were invited to reconfirm and empower theose assessment dimensions with two rounds of Delphi method.Results Results showed that the enthusiasm and authority degree of experts were favorable in two rounds, and the results from the second round showed strong opinion coordination.Finally, 12 assessment dimensions were confirmed, in which financial situation of the aged added and used for reference.After weight calculation, illness was weighted the highest (0.11), while vision and the degree of anxiety were weighted lowest in 11 dimensions (0.07).Conclusion The reliability of the assessment dimensions of the aged service needs is high.This study had positive significance on the solution of the dilemma in elderly care at the present stage.