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Based on the theory of "Johari Window", this study introduced how to stimulate information content obtained in doctor-patient communication and how to apply the comprehensive geriatric assessment creatively from the four modules of open area, blind area, hidden area and unknown area in the model. It helped students to gain the trust and cooperation of patients, rapidly narrow down the blind area, hidden area and unknown area, guide patients to actively extend the open area, improve the teaching quality of doctor-patient communication in a scientific way.
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Objective@#To analyze the influence of malnutrition in the elderly patients with acute coronary syndrome on related factors and short-term prognosis.@*Methods@#415 elderly patients with acute coronary syndrome were selected.Comprehensive geriatric assessment was used to investigate the risk of acute coronary syndrome by examining coexisting diseases and using the NRS2000 score.The mortality and emergency visits were followed up.@*Results@#The patients were divided into two groups according to NRS2000 score: malnutrition group (n=179) and non-malnutrition group (n=236). (1) In malnutrition group, the proportions of female, over 85 years old, more than 3 kinds of coexisting diseases were 47.5%(85/179), 11.7%(21/179), 62.6%(112/179), respectively, which were higher than those of the non-malnutrition group[36.9%(87/236), 4.7%(11/236), 41.9%(99/236)](χ2=4.732, 7.152, 17.318, all P<0.05). (2) In malnutrition group, the incidence rates of geriatric syndromes such as uracratia, falls, visual disorder, hearing disorder, constipation, sleep disorders, oral problems were 47.5%(85/179), 30.2%(54/179), 40.2%(72/179), 41.9%(75/179), 54.7%(98/179), 52.0%(93/179), 76.5%(137/179), respectively, which were higher than those of the non-malnutrition group[31.4%(74/236), 14%(33/236), 29.2% (69/236), 29.7% (70/236), 30.5%(72/236), 36.0%(85/236), 53.0%(125/236)](χ2=11.206, 16.092, 5.477, 6.707, 24.732, 10.577, 24.297, all P<0.05). (3) In malnutrition group, the incidence rates of coexisting chronic diseases such as hypertension, chronic obstructive pulmonary disease, heart failure, severe renal insufficiency, cerebrovascular disease, dementia, anemia, osteoporosis were 77.1%(138/179), 16.2% (29/179), 22.9%(41/179), 17.9%(32/179), 46.9%(84/179), 6.7%(12/179), 27.4%(49/179), 26.8%(48/179), respectively, which were higher than those of the non-malnutrition group[61.9%(146/236), 7.6%(18/236), 14.4%(34/236), 7.2%(17/236), 32.2%(76/236), 1.3%(3/236), 13.1%(31/236), 17.4%(41/236)](χ2=10.931, 7.451, 4.965, 11.137, 9.315, 8.624, 13.262, 5.388, all P<0.05). (4)Cox regression analysis showed that malnutrition risk score was the independent risk predictor for all-cause mortality (HR=0.034, 95% CI: 0.072-0.904) and emergency department visits (HR=0.328, 95% CI: 0.197-0.548) in elderly patients with acute coronary syndrome.@*Conclusion@#Comprehensive geriatric assessment and nutritional assessment are useful to evaluate the clinical features of acute coronary syndrome in elderly patients.Malnutrition risk score is an independent predictor of all-cause mortality and emergency treatment in elderly patients with acute coronary syndrome.
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Objective To investigate the relationship between serum homocysteine (Hcy) level and heart rate variability (HRV) in patients with acute cerebral infarction.Methods A retrospective study was conducted in 76 elderly patients with acute cerebral infarction in the Second Affiliated Hospital of Nanjing Medical University from January 2015 to December 2016,and the patients were monitored by 24 hours electrocardiogram within three months.According to age and Hcy level,the patients were divided into three groups:normal Hcy low age group (5-15μmol/L,60-80 years old),high Hcy low age group (＞ 15μmol/L,60-80 years old),high Hcy high age group (＞15μmol/L,≥80 years old).The correlation between Hcy and HRV was analyzed.Results The standard deviation of the normal-to-normal RR intervals (SDNN),the mean standard deviation of 5-minute RR intervals means (SDANN),the root mean square of successive differences in RR intervals (RMSSD),adjacent RR intervals greater than 50 ms (PNN50) in the high Hcy low age group were (108.75 ±34.18)ms,(97.63 ±31.34) ms,(22.04 ±6.97) ms,(3.78 ± 4.07) ％,respectively,which in the high Hcy high age group were (81.43 ± 27.68) ms,(71.46 ±25.45) ms,(23.82 ± 7.59) ms,(3.95 ± 3.56) ％,respectively,which were significantly lower than those in the normal Hey low agc group[(127.21 ± 22.21) ms,(114.75 ± 23.55) ms,(29.17 ± 9.71) ms,(7.68 ± 6.17) ％](t =2.219,2.140,2.920,2.585,t =6.502,6.328,2.227,2.722,all P ＜ 0.05).The levels of SDNN and SDANN in the high Hcy low age group were lower than those in the high Hcy low age group (t =3.185,3.322,all P ＜ 0.05).The low frequency (LF) and high frequency (HF) values in the high Hcy low age group were (11.86 ± 5.39) ms,(8.47 ± 3.25) ms,respectively,which in the high Hcy high age group were (9.29 ± 4.98) ms,(71.46 ± 25.45) ms,respectively,which were lower than those in the normal Hcy low age group[(15.15 ±4.56) ms,(11.36 ±4.36) ms] (t =2.281,2.612,t =4.392,2.900,all P ＜ 0.05).The LF/HF value of high Hcy high age group (1.09 ± 0.3) was lower than (1.42 ± 0.36) in normal Hcy low age group and (1.41 ± 0.40) in the high Hcy low age group (t =3.569,3.339,all P ＜ 0.05).Logistic regression analysis showed that SDNN,SDANN,RMSSD,nocturnal HF and nocturnal LF/HF were correlated with hyperhomocysteinemia (r =-0.037,-0.132,-0.087,-0.468,-3.746,all P ＜ 0.05).Conclusion Hyperhomocysteinemia with acute cerebral infarction in elderly patients is more likely to have cardiac autonomic nerve dysfunction.And clinically we should strengthen HRV detection of elderly patients with acute cerebral infarction and hyperhomocysteinemia.
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Objective To investigate the relationship between the serum homocysteine(Hcy) level and heart rate variability in elderly patients with metabolic syndrome.Methods Retrospective analysis of 162 elderly patients with metabolic syndrome aged 60 and above was conducted in our hospital from January 2013 to August 2016.And the level of serum homocysteine and other biochemical indicators were measured.The 162 cases were divided into three groups of 42 cases in Hcy normal group(Hcy,5-15 μmol/L),70 cases in Hcy mildly high group(Hcy,16-30 μmol/L),50 cases in Hcy moderately high group (Hcy,31 ～ 100 μmol/L).Simultaneously 24-hour rhythm in ambulatory heart rate variability spectrum was used to detect HRV.And the relationship between heart rate variability(HRV) and Hcy levels were analyzed.Results Normal RR interval standand deviation (SDNN),5 min mean heart rate standard deviation (SDANN),Edinburg index (PNN50),root mean square value of adjacent RR interval difference(RMMSD)were all lower in Hcy mildly high group and Hcy moderately high group than in the Hcy normal group (P＜0.05).Low-frequency(LF) and highfrequency(HF)were lower in Hcy mildly high group and Hcy moderately high group than in the Hcy normal group(P ＜ 0.05).Sympathetic-vagal balance indicators (LF/HF) were higher in Hcy mildly high group and Hcy moderately high group than in the Hcy normal group (P＜ 0.05).The HRV indexes were lower in Hcy high groups than in the Hcy normal group.Hcy was negatively correlated with SDANN,RMSSD,LF,HF,and LF/HF at night(r=-0.578、-0.651、-0.531、-0.662、-0.729,all P ＜ 0.01).Conclusions The elevated homocysteine level and metabolic syndromecombined with decreased HRV in the elderly patients suggest that cardiac autonomic nervous system might be injuried.Enhancing the detection of HRV and homocysteine level in elderly patients with MS is clinically useful for early detection of autonomic neuropathy.