Obesity paradox of cardiovascular mortality in older adults in the United States: A cohort study using 1997-2018 National Health Interview Survey data linked with the National Death Index.

BACKGROUND: Large-scale, population-based investigations primarily investigating the association between body mass index (BMI) and cardiovascular disease (CVD) mortality among older and younger adults in the United States (U.S.) are lacking. OBJECTIVE: To evaluate the relationship between BMI and CVD mortality in older (≥65 years) and younger (<65 years) adults and to identify the nadir for CVD mortality. DESIGN: This cohort study used serial cross-sectional data from the 1997 to 2018 National Health Interview Survey (NHIS) linked with the National Death Index. NHIS is an annual nationally representative household interview survey of the civilian noninstitutionalized U.S. SETTING: Residential units of the civilian noninstitutionalized population in the U.S. PARTICIPANTS: The target population for the NHIS is the civilian noninstitutionalized U.S. population at the time of the interview. We included all adults who had BMI data collected at 18 years and older and with mortality data being available. To minimize the risk of reverse causality, we excluded adults whose survival time was ≤2 years of follow-up after their initial BMI was recorded and those with prevalent cancer and/or CVD at baseline. METHODS: We used the BMI record obtained in the year of the NHIS survey. Total CVD mortality used the NHIS data linked to the latest National Death Index data from the survey inception to December 31, 2019. We performed multivariable Cox proportional hazards regression models to estimate adjusted hazard ratios (aHRs) and 95 % confidence intervals (CIs). RESULTS: The study included 425,394 adults; the mean (SD) age was 44 (16.7) years. During a median follow-up period of 11 years, 12,089 CVD-related deaths occurred. In older adults, having overweight was associated with a lower risk of CVD mortality (aHR 0.92 [95 % CI, 0.87-0.97]); having class I obesity (1.04 [0.97-1.12]) and class II obesity (1.12 [1.00-1.26]) was not significantly associated with an increased CVD mortality; and having class III obesity was associated with an increased risk of CVD mortality (1.63 [1.35-1.98]), in comparison with adults who had a normal BMI. Yet, in younger adults, having overweight, class I, II, and III obesity was associated with a progressively higher risk of CVD mortality. The nadir for CVD mortality is 28.2 kg/m2 in older adults and 23.6 kg/m2 in younger adults. CONCLUSION: This U.S. population-based cohort study highlights the significance of considering age as a crucial factor when providing recommendations and delivering self-care educational initiatives for weight loss to reduce CVD mortality.

Development and Usability Testing of a Mobile App-Based Clinical Decision Support System for Delirium: Randomized Crossover Trial.

Background: The 3-Minute Diagnostic Interview for Confusion Assessment Method-Defined Delirium (3D-CAM) is an instrument specially developed for the assessment of delirium in general wards, with high reported sensitivity and specificity. However, the use of the 3D-CAM by bedside nurses in routine practice showed relatively poor usability, with multiple human errors during assessment. Objective: This study aimed to develop a mobile app-based delirium assessment tool based on the 3D-CAM and evaluate its usability among older patients by bedside nurses. Methods: The Delirium Assessment Tool With Decision Support Based on the 3D-CAM (3D-DST) was developed to address existing issues of the 3D-CAM and optimize the assessment process. Following a randomized crossover design, questionnaires were used to evaluate the usability of the 3D-DST among older adults by bedside nurses. Meanwhile, the performances of both the 3D-DST and the 3D-CAM paper version, including the assessment completion rate, time required for completing the assessment, and the number of human errors made by nurses during assessment, were recorded, and their differences were compared. Results: The 3D-DST included 3 assessment modules, 9 evaluation interfaces, and 16 results interfaces, with built-in reminders to guide nurses in completing the delirium assessment. In the usability testing, a total of 432 delirium assessments (216 pairs) on 148 older adults were performed by 72 bedside nurses with the 3D-CAM paper version and the 3D-DST. Compared to the 3D-CAM paper version, the mean usability score was significantly higher when using the 3D-DST (4.35 vs 3.40; P<.001). The median scores of the 6 domains of the satisfactory evaluation questionnaire for nurses using the 3D-CAM paper version and the 3D-DST were above 2.83 and 4.33 points, respectively (P<.001). The average time for completing the assessment reduced by 2.1 minutes (4.4 vs 2.3 min; P<.001) when the 3D-DST was used. Conclusions: This study demonstrated that the 3D-DST significantly improved the efficiency of delirium assessment and was considered highly acceptable by bedside nurses.

Impact of delirium intervention on cognitive load among nurses in the intensive care unit: A multi-centre cluster randomized controlled trial.

BACKGROUND: High cognitive load in nurses is a common problem in the intensive care unit (ICU). However, it remains unclear what different types of cognitive load the ICU nurses have experienced during the implementation of delirium interventions. AIM: To describe the characteristics and explore the effect of implementing a delirium intervention on the cognitive load of nurses working in the ICU. METHODS: A cluster-randomized controlled clinical trial was conducted. Six ICUs were randomized in a 1:1 ratio, and eligible nurses from these units provided either a delirium bundle intervention in addition to usual care (27 nurses) or usual care alone. An instrument was used to measure different types of cognitive load (MDT-CL), assessing intrinsic, extraneous and germane cognitive load. The repeated measures analysis of variance was used to detect between-group differences. RESULTS: Among these nurses, significant between-group differences were identified in terms of their overall (P < 0.001), intrinsic (P < 0.001) and extraneous (P < 0.001) cognitive load. There was no significant change observed in the germane cognitive load (P = 0.489) in the delirium intervention group. CONCLUSION: It is important to understand how the implementation of a delirium intervention affects different types of cognitive load in nurses, in order that tailored strategies can be applied to reduce cognitive load in ICU nurses.

Time Perspective, Dietary Behavior, and Glycemic Control in Patients With Type 2 Diabetes.

BACKGROUND: Dietary behavior is a key component in the self-management of patients with Type 2 diabetes (T2DM), as it is essential for glycemic control and preventing diabetic complications. However, it is challenging for patients with diabetes to make sustainable dietary behavior changes and achieve long-term optimal glycemic control. OBJECTIVES: Dietary behavior changes involve present efforts to achieve future benefits. The primary aim of this study was to investigate the relationships among time perspective, dietary behaviors, and health outcomes in patients with T2DM. Based on the temporal self-regulation theory and previous research, the secondary aim of the study was to explore how time perspective influences dietary behaviors. METHODS: Following convenient sampling ( N = 329), a cross-sectional study was conducted in patients with T2DM between November 2021 and October 2022. Data were collected using self-reported questionnaires and the retrieval of clinical information from medical records. Hierarchical regression and path analysis were used to explore the relationships among study variables. RESULTS: Our analyses showed that a future-oriented time perspective was associated with better dietary behavior but was not significantly related to hemoglobin A1c. Hierarchical regression analysis also demonstrated that having a more future-oriented time perspective was associated with healthier dietary behavior after controlling covariates. Based on the theory and path analysis, there was an indirect effect of future time perspective on dietary behavior through self-control capacity and intention. DISCUSSION: The study reveals that a future-oriented time perspective can promote healthier dietary behavior when providing care for patients with T2DM. As a theoretical framework, the temporal self-regulation theory offers references for researchers and clinicians to take into consideration patients' time perspectives and their intentions and self-control capacity when developing interventional programs to improve dietary behaviors.

Accuracy of a clinical decision support system based on the 3-minute diagnostic interview for CAM-defined delirium: A validation study✰.

OBJECTIVE: To evaluate the accuracy of the 3D-DST for delirium assessment in older adults by the nurse researcher. METHODS: The 3D-DST was administered by a trained nurse researcher to assess delirium among eligible older adults (aged ≥70 years). The criteria for identifying delirium was based on the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-V). RESULTS: A total of 95 older adults were enrolled in the current study, and 23 patients were identified as positive for delirium by the psychiatrist. The sensitivity and specificity of the 3D-DST were 96% and 94%, respectively. High sensitivities of the 3D-DST were also observed among patients with hypoactive delirium (95%) and those with cognitive impairment (93%). CONCLUSION: The 3D-DST was demonstrated as an appropriate instrument with highly acceptable sensitivities and specificities for delirium detection in hospitalized older patients.

Neutrophil to lymphocyte ratio may be a useful marker in distinguishing MOGAD and MS and platelet to lymphocyte ratio associated with MOGAD activity.

BACKGROUND AND OBJECTIVE: Clinical overlap is observed between multiple sclerosis (MS) and myelin oligodendrocyte glycoprotein immunoglobulin-G (MOG-IgG) associated disease (MOGAD) and the difficulty in distinguishing between the two diseases. Here, we measured and compared the readily available neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and monocyte to lymphocyte ratio (MLR) to determine whether these three biomarkers can help to distinguish MOGAD and MS at disease onset. The impact of these three biomarkers on MOGAD and MS relapse also needs to be explored. METHODS: In this retrospective analysis, we obtained clinical and paraclinical data from the first attacks of MOGAD (N = 31) and MS (N = 50). Electronic medical records were used to collect demographic data (gender, age at onset), clinical symptoms, EDSS at onset, and medical treatments. The primary outcome was relapse within one year of onset. Four hematological parameters were recorded, including neutrophil count, platelet count, lymphocyte count, and monocyte count. NLR, PLR, and MLR were calculated and compared between MOGAD, MS, and HC. Receiver operator curve (ROC) analysis was performed to assess the ability of NLR, PLR, and MLR to distinguish between MOGAD and MS, MOGAD and HC, respectively. A logistic regression analysis was performed to determine the impact of NLR/PLR/MLR on MOGAD/MS relapse within one year of onset. RESULTS: Compared to HC, NLR is significantly higher in MOGAD and MS (p<0.001, p = 0.04, respectively). The PLR and MLR are elevated in MOGAD compared to HC (p<0.001, p<0.001, respectively), and MLR in MS are also statistically higher than in HC (p = 0.023). It is worth noting that NLR and PLR were much higher in MOGAD compared to MS (p<0.001, p = 0.001, respectively), but a significant difference regarding MLR has not been found between MOGAD and MS. Based on ROC curve analyses, we found that using NLR, PLR, and MLR to discriminate between MOGAD and MS yielded a ROC-plot area under the curve (AUC) value of 0.794, 0.727, and 0.681, respectively. Meanwhile, the AUC of NLR, PLR, and MLR to discriminate between MOGAD and HC were 0.926, 0.772, and 0.786. Furthermore, the logistics analysis revealed a significant positive association between PLR and MOGAD relapse. CONCLUSION: NLR helps differentiate MOGAD and MS in disease onset, and higher PLR was related to MOGAD relapse.

DUSP12 ameliorates myocardial ischemia-reperfusion injury through HSPB8-induced mitophagy.

This study aimed to explore the role of dual specificity phosphatase 12 (DUSP12) in regulating myocardial ischemia-reperfusion (I/R) injury and the underlying mechanism. The expression of DUSP12 in myocardial tissues and heat-shock protein beta-8 (HSPB8) and mitophagy-related proteins in myocardial tissues and H9c2 cells were detected by western blot analysis. The serum creatine kinase isoenzymes (CK-MB) and lactate dehydrogenase (LDH), levels of reactive oxygen species and malondialdehyde, superoxide dismutase activity in myocardial tissues and H9c2 cells, and caspase-3 activity in H9c2 cells were analyzed by corresponding assay kits. The infarct area in the rat's heart was observed by triphenyl tetrazolium chloride staining. The apoptosis of myocardial cells in myocardial tissues and H9c2 cells was detected by terminal-deoxynucleotidyl transferase dUTP-biotin nick-end labeling assay. The interaction between DUSP12 and HSPB8 was clarified by the coimmunoprecipitation assay. The transfection efficacy of si-HSPB8#1 and si-HSPB8#2 in H9c2 cells was confirmed by real-time quantitative-polymerase chain reaction and western blot analysis. As a result, DUSP12 expression was downregulated in I/R rats, which was promoted by lentivirus-expressing DUSP12. DUSP12 overexpression reduced the serum creatine kinase isoenzymes (CK-MB) and LDH, decreased the infarct area in the rat's heart, and suppressed the apoptosis and oxidative stress in myocardial tissues. DUSP12 overexpression also upregulated the expression of HSPB8 to promote mitophagy. The coimmunoprecipitation assay indicated that DUSP12 could be combined with HSPB8. In addition, DUSP12 overexpression could inhibit hypoxia/reoxygenation-elicited apoptosis as well as oxidative stress in H9c2 cells by upregulating HSPB8 expression to promote mitophagy, which was countervailed by HSPB8 deficiency. In conclusion, DUSP12 overexpression decreased the apoptosis and oxidative stress in myocardial I/R injury through HSPB8-induced mitophagy.

Coping with multiple chronic conditions among Chinese older couples: A community of shared destiny.

Multiple chronic conditions (MCCs) affect patients and their spouses. We explored the experience of Chinese older couples living with MCCs to gain deeper understanding of how they cope with MCCs as dyads. A qualitative research design using semi-structured in-depth interviews was conducted. Sixteen couples (≥60 years) were included and a thematic analysis was undertaken using NVivo software. Four themes under an overarching theme "A community of shared destiny" were identified: (i) various changes and impacts in normal life; (ii) perceived dynamic stress and dyadic challenges of MCCs; (iii) acceptance and reflection on MCCs influenced by aging and fatalism; (iv) mutual support and dyadic adjustment based on a shared destiny. Coping with MCCs was a dyadic and periodic journey for older couples. They perceived themselves as a community of shared destiny. Our findings are important for healthcare professionals to develop targeted interventions for older couples living with MCCs.

Oxycodone protects cardiac microvascular endothelial cells against ischemia/reperfusion injury by binding to Sigma-1 Receptor.

Endothelial dysfunction is an important mechanism involved in myocardial ischemia-reperfusion (I/R) injury. We aimed to explore the effects of Oxycodone on myocardial I/R injury in vivo and in vitro to reveal its mechanisms related to Sigma-1 Receptor (SIGMAR1). A rat model of I/R-induced myocardial injury was developed. The ischemic area and myocardial histopathological changes after oxycodone addition were evaluated by TTC staining and H&E staining. LDH, CK-MB and cTnI levels were used to assess myocardial function. Then, the endothelial integrity was reflected by the expressions of ZO-1, Claudin-1 and Occludin. Afterward, ELISA, RT-qPCR, western blot and immunofluorescence assays were adopted for the detection of inflammation-related genes. SIGMAR1 expression in myocardial tissues induced by I/R and cardiac microvascular endothelial cells (CMECs) under hypoxic/reoxygenation (H/R) was determined using RT-qPCR and western blotting. Subsequently, after SIGMAR1 silencing or BD1047 addition (a SIGMAR1 antagonist), cell apoptosis and endothelial integrity were analyzed in the presence of Oxycodone in H/R-stimulated CMECs. Results indicated that Oxycodone decreased the ischemic area and improved myocardial function in myocardial I/R injury rat. Oxycodone improved myocardial histopathological injury and elevated endothelial integrity, evidenced by upregulated ZO-1, Claudin-1 and Occludin expressions. Moreover, inflammatory response was alleviated after Oxycodone administration. Molecular docking suggested that SIGMAR1 could directly bind to Oxycodone. Oxycodone elevated SIGMAR1 expression and SIGMAR1 deletion or BD1047 addition attenuated the impacts of Oxycodone on apoptosis and endothelial integrity of CMECs induced by H/R. Collectively, Oxycodone alleviates myocardial I/R injury in vivo and in vitro by binding to SIGMAR1.

Inclusion of interleukin-6 improved performance of postoperative delirium prediction for patients undergoing coronary artery bypass graft (POD-CABG): A derivation and validation study.

BACKGROUND: Patients undergoing coronary artery bypass graft (CABG) are at high risk for developing postoperative delirium (POD). A simple prediction rule may benefit patients from early identification of POD followed by adequate preventive strategies. The purpose of the current study was to develop and validate a POD prediction rule for patients undergoing CABG (POD-CABG), by considering all possible perioperative factors. METHODS: In this prospective cohort study, patients who underwent first elective isolated CABG were continuously enrolled from May 2014 to November 2015 in a tertiary hospital. Delirium was assessed using the Confusion Assessment Method for Intensive Care Unit. Patients' perioperative risk factors were collected through interviews and review of medical records. The area under receiver-operating characteristic curve (AUC) was used to assess the overall performance of the predictive rule. RESULTS: A total of 242 and 148 patients were enrolled in the derivation and validation cohorts, respectively. Multiple logistic regression analysis identified seven variables that were independently associated with POD: age (≥65 years), gender (female), history of myocardial infarction and diabetes mellitus, postoperative atrial fibrillation, the use of intra-aortic balloon pump, and serum interleukin-6 ≥478 pg/ml at 18 hours after surgery. The AUC of the POD-CABG was 0.84 (95% CI, 0.79-0.90) in the derivation cohort, and was 0.86 (95% CI, 0.80-0.91) after bootstrap resampling. The AUC was 0.81 (95% CI, 0.73-0.88) after the POD-CABG was applied to the validation cohort. CONCLUSIONS: The POD-CABG with inclusion of interleukin-6 demonstrated good performance in predicting POD.

An Intelligent Individualized Cardiovascular App for Risk Elimination (iCARE) for Individuals With Coronary Heart Disease: Development and Usability Testing Analysis.

BACKGROUND: Death and disability from coronary heart disease (CHD) can be largely reduced by improving risk factor management. However, adhering to evidence-based recommendations is challenging and requires interventions at the level of the patient, provider, and health system. OBJECTIVE: The aim of this study was to develop an Intelligent Individualized Cardiovascular App for Risk Elimination (iCARE) to facilitate adherence to health behaviors and preventive medications, and to test the usability of iCARE. METHODS: We developed iCARE based on a user-centered design approach, which included 4 phases: (1) function design, (2) iterative design, (3) expert inspections and walkthroughs of the prototypes, and (4) usability testing with end users. The usability testing of iCARE included 2 stages: stage I, which included a task analysis and a usability evaluation (January to March 2019) of the iCARE patient app using the modified Health Information Technology Usability Survey (Health-ITUES); and stage II (June 2020), which used the Health-ITUES among end users who used the app for 6 months. The end users were individuals with a confirmed diagnosis of CHD from 2 university-affiliated hospitals in Beijing, China. RESULTS: iCARE consists of a patient app, a care provider app, and a cloud platform. It has a set of algorithms that trigger tailored feedback and can send individualized interventions based on data from initial assessment and health monitoring via manual entry or wearable devices. For stage I usability testing, 88 hospitalized patients (72% [63/88] male; mean age 60 [SD 9.9] years) with CHD were included in the study. The mean score of the usability testing was 90.1 (interquartile range 83.3-99.0). Among enrolled participants, 90% (79/88) were satisfied with iCARE; 94% (83/88) and 82% (72/88) reported that iCARE was useful and easy to use, respectively. For stage II usability testing, 61 individuals with CHD (85% [52/61] male; mean age 53 [SD 8.2] years) who were from an intervention arm and used iCARE for at least six months were included. The mean total score on usability testing based on the questionnaire was 89.0 (interquartile distance: 77.0-99.5). Among enrolled participants, 89% (54/61) were satisfied with the use of iCARE, 93% (57/61) perceived it as useful, and 70% (43/61) as easy to use. CONCLUSIONS: This study developed an intelligent, individualized, evidence-based, and theory-driven app (iCARE) to improve patients' adherence to health behaviors and medication management. iCARE was identified to be highly acceptable, useful, and easy to use among individuals with a diagnosis of CHD. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR-INR-16010242; https://tinyurl.com/2p8bkrew.

Individualized mobile health interventions for cardiovascular event prevention in patients with coronary heart disease: study protocol for the iCARE randomized controlled trial.

BACKGROUND: Mobile health-based individualized interventions have shown potential effects in managing cardiovascular risk factors. This study aims to assess whether or not mHealth based individualized interventions delivered by an Individualized Cardiovascular Application system for Risk Elimination (iCARE) could reduce the incidence of major cardiovascular events in individuals with coronary heart disease. METHODS: This study is a large-scale, multi-center, parallel-group, open-label, randomized controlled clinical trial. This study will be conducted from September 2019 to December 2025. A total of 2820 patients with coronary heart disease will be recruited from two clinical sites and equally randomized into three groups: the intervention group and two control groups. All participants will be informed of six-time points (at 1, 3, 6, 12, 24, and 36 months after discharge) for follow-up visits. Over a course of 36 months, patients who are randomized to the intervention arm will receive individualized interventions delivered by a fully functional iCARE that using various visualization methods such as comics, videos, pictures, text to provide individualized interventions in addition to standard care. Patients randomized to control group 1 will receive interventions delivered by a modified iCARE that only presented in text in addition to routine care. Control group 2 will only receive routine care. The primary outcome is the incidence of major cardiovascular events within 3 years of discharge. Main secondary outcomes include changes in health behaviors, medication adherence, and cardiovascular health score. DISCUSSION: If the iCARE trial indeed demonstrates positive effects on patients with coronary heart disease, it will provide empirical evidence for supporting secondary preventive care in this population. Results will inform the design of future research focused on mHealth-based, theory-driven, intelligent, and individualized interventions for cardiovascular risk management. TRIAL REGISTRATION: Trial registered 24th December 2016 with the Chinese Clinical Trial Registry (ChiCTR-INR-16010242). URL: http://www.chictr.org.cn/showproj.aspx?proj=17398 .

Correlation of Symptom Distress, Self-Efficacy, and Social Support With Problem-Solving and Glycemic Control Among Patients With Type 2 Diabetes.

PURPOSE: The purpose of the study was to examine the associations of self-efficacy, social support, and symptom distress with perceived problem-solving and glycemic control among patients with type 2 diabetes. METHOD: Using baseline data from a parent study, which examined the effect of a problem-solving-focused intervention on medication adherence among patients with type 2 diabetes, this secondary analysis examined the relationships among self-efficacy, social support, symptom distress, problem-solving, and A1C. Of 358 patients enrolled at baseline, 304 (mean age = 64.1 years, 57.2% female) were included in the current analysis. Multiple linear regression was used to identify potential correlates of problem-solving and A1C. RESULTS: The results showed that self-efficacy, social support, and symptom distress were independent predictors of problem-solving; they significantly improved the prediction of perceived problem-solving in diabetes management after controlling covariates. Adding problem-solving to the model did not improve the prediction for A1C. CONCLUSION: The current study suggests that self-efficacy, social support, and symptom distress are essential factors associated with patients' perceived problem-solving in diabetes management. Researchers and clinicians should consider both personal factors and psychosocial factors such as self-efficacy, social support, and symptom distress when examining patients perceived problem-solving and developing tailored interventions to improve diabetes management. In addition, health care providers should consider these important aspects when providing tailored care to this patient population.

Delirium screening for patients in the intensive care unit: A prospective validation study of the iCAM-ICU by nurse researchers and bedside nurses in routine practice.

BACKGROUND: Daily delirium assessment using the Confusion Assessment Method for the Intensive Care Unit was recommended for patients in the intensive care unit, yet implementation may be difficult because of lack of simple and standardized data collection schemes which may result in low sensitivities when used by bedside nurses. OBJECTIVE: This study was to validate the diagnostic accuracy of the intelligent Confusion Assessment Method for the Intensive Care Unit (iCAM-ICU) used by both nurse investigators and bedside nurses in Chinese patients in the intensive care unit. DESIGN: Prospective cohort study. SETTING: A university affiliated tertiary hospital in China. PARTICIPANTS: A total of 373 hospitalized patients (181 in phase I and 192 in phase II) in the intensive care units met the inclusion criteria and participated in the study. There were two nursing researchers (phase I) and 24 bedside nurses (phase II) used the iCAM-ICU to assess delirium among patients. METHODS: Two prospective cohort studies were conducted to validate the diagnostic accuracy of iCAM-ICU on delirium screening when it was used by nurse investigators and bedside nurses in the intensive care unit. Using the Diagnostic and Statistical Manual of Mental Disorders as the gold standard, the sensitivity, specificity, predictive values along with the likelihood ratios were determined to estimate the performance of the iCAM-ICU in patients in the intensive care setting. The Kappa consistency test was examined to determine the inter-rater consistency. Subgroup analysis in terms of different age, level of education, severity of illness and cognitive status were also conducted to evaluate potential variations of the iCAM-ICU performance in different patient groups. RESULTS: A total of 373 patients were included in the validation studies. In comparing with the gold standard, the sensitivities of the iCAM-ICU demonstrated by the two nurse investigators were 95.2 % and 93.7%, while the specificities of the iCAM-ICU were 93.3% and 93.2%. The Kappa consistency between two nurse investigators was 0.96. The sensitivity and specificity of the iCAM-ICU demonstrated by bedside nurses in intensive care patients were 86.7% and 97.7%, respectively. Subgroup analysis also revealed that the sensitivities and specificities in those different subgroups were acceptable, with all statistics being above 80%. CONCLUSIONS: The iCAM-ICU, an information technology enabled delirium screening tool, showed highly acceptable accuracy in detecting delirium in the intensive care units. It can assist bedside nurses to detect delirium reliably and identify potential patients with delirium accurately. REGISTRATION NUMBER: ChiCTR-OCH-13003050.

Validation of the 3-minute diagnostic interview for CAM-defined Delirium in Chinese older adults.

Delirium is a common complication among older adults, but it is often unrecognized in routine practice. The 3-Minute Diagnostic Interview for CAM-defined Delirium (3D-CAM) was developed to identify delirium in the general unit. This prospective diagnostic study was conducted to validate the accuracy of the 3D-CAM Chinese version among older adults in the general units. A total of 204 hospitalized older adults from a geriatric hospital were enrolled in the study, of whom 54 were identified as positive for delirium. The sensitivity and specificity of the 3D-CAM Chinese version were 94% and 97%, respectively. The median duration of assessment using the 3D-CAM was about 3 minutes. The 3D-CAM had highly acceptable sensitivity and specificity when it was used by nurse researchers among Chinese older adults.

A nurse-administered 3-Minute diagnostic interview for CAM-defined Delirium (3D-CAM Chinese version) in hospitalized elderly patients: A validation study.

BACKGROUND: Delirium is a common complication in hospitalized elderly patients, yet often remains unrecognized in the clinical care unit. The newly developed 3-Minute Diagnostic Interview for CAM-Defined Delirium (3D-CAM) has high sensitivity and specificity when administered by trained researchers. However, diagnostic characteristics of the 3D-CAM as performed in routine practice are unclear. OBJECTIVE: To determine the diagnostic characteristics of a Chinese version of the 3D-CAM administered to hospitalized elderly patients by bedside nurses. DESIGN: A prospective cohort study. SETTING: A tertiary geriatric hospital in China. PARTICIPANTS: 323 patients and 49 bedside nurses. METHODS: This prospective cohort study was conducted at a tertiary geriatric hospital in China. A Chinese version of 3D-CAM was administered by trained bedside nurses and compared against the reference standard performed by experienced neurologists using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria. All assessors were blinded to each other's assessment results. Sensitivity and specificity of the 3D-CAM among bedside nurses were analysed by comparing with the reference standard to test the ability of 3D-CAM in detecting delirium. RESULTS: A total of 323 patients were included in the study, of whom 64 were classified as delirium positive by the neurologists. The 3D-CAM had a sensitivity of 92% (95% confidence interval, 82-97%), specificity of 89% (95% confidence interval, 84-92%), respectively. CONCLUSION: The Chinese version of 3D-CAM demonstrated good performance as a bedside nurse-administered screening tool for delirium detection among hospitalized Chinese geriatric patients. Registration number: ChiCTR-IOR-17,010,368.

Self-Management Behaviors, Glycemic Control, and Metabolic Syndrome in Type 2 Diabetes.

BACKGROUND: Diabetes self-management and glycemic control are suboptimal among Chinese patients with Type 2 diabetes with a large proportion of patients identified with metabolic syndrome. OBJECTIVES: Based on social cognitive theory, this study examines the effect of selected personal, behavioral, and environmental factors on self-management behaviors, glycemic control, metabolic syndrome and Type 2 diabetes. METHODS: A cross-sectional study was conducted among 207 Chinese with Type 2 diabetes living in a suburban area of Beijing, China. Regression models were applied to examine the effect of selected personal, behavioral, and environmental factors on self-management behaviors, glycemic control, and metabolic syndrome. The relationship among individual self-management behaviors, glycemic control, and metabolic syndrome was also examined. RESULTS: Self-efficacy was significantly associated with all self-management behaviors. Social support was related to overall self-management, diabetes knowledge was related to diet, and depressive symptoms was related to self-monitoring. Problem-solving and self-management behaviors related to medication adherence and diet were significant correlates of glycemic control. Health literacy and self-management behaviors related to physical activity were correlates of metabolic syndrome. DISCUSSION: Findings suggest that a multifactorial approach may be beneficial when providing care for Chinese with Type 2 diabetes. In addition, these findings provide support for developing and testing tailored interventions that address problem-solving, health literacy, and self-efficacy, among other factors, to help patients achieve optimal glycemic control and thereby reduce their risk for metabolic syndrome and related complications.

Predictors of weight regain after sleeve gastrectomy: an integrative review.

BACKGROUND: Sleeve gastrectomy (SG) is one of the most effective treatments for severe obesity, but weight regain after surgery is a challenging issue. The mechanism of postoperative weight relapse is barely understood because of the lack of long-term data. OBJECTIVES: To review and synthesize current evidence related to factors that contribute to weight regain after SG. METHODS: Whittemore and Knafl's integrative method guided the research. The databases PubMed, EMBASE, and CINAHL, as well as 2 selected journals, were searched through October 2018 to gather English-language journal articles on the potential predictors of post-SG weight regain among adult populations. Only articles with sample size ≥10 were included. A narrative synthesis was used to analyze the 17 studies included in the review. RESULTS: In recent years there has been an upward trend in the published reports of SG on longer-term outcomes. After a review of 6863 records, 17 eligible studies were identified, reporting various definitions of weight regain and 3 main categories of predictors: surgical/anatomic factors, hormonal/metabolic imbalance, and behavioral/mood factors. The 17 studies used quantitative (n = 16) and qualitative methods (n = 1). CONCLUSION: There is a dearth of available literature addressing predictors of weight regain after SG, and the inconsistency in the definition of regain limited the comparability between studies. Besides the surgical/anatomic factors that have been reported as significant predictors, other modifiable factors such as behavioral and psychosocial determinants need to be further investigated.

The Effect of Symptom Clusters on Quality of Life Among Patients With Type 2 Diabetes.

PURPOSE: The purpose of this study was to examine the collective effect of a symptom cluster (depression, anxiety, fatigue, and impaired sleep quality) at baseline on the quality of life (QOL) of patients with type 2 diabetes (T2DM) over time. METHODS: This was a secondary data analysis of 302 patients with T2DM who presented with both hypertension and hyperlipidemia. All of the participants were enrolled in a randomized controlled intervention study testing strategies to improve medication adherence. The psychological symptoms and QOL were assessed at baseline, 6 months, and 12 months. Cluster analysis was used to identify subgroups of patients based on the severity of symptoms at baseline. RESULTS: Hierarchical cluster analysis identified 4 patient subgroups: all low severity, mild, moderate, and all high severity. There were significant differences in patients' QOL overall among the 4 subgroups. Compared with the all-low-severity subgroup, subgroups with higher severity of the 4 symptoms had poorer QOL across all 3 time points. QOL was most impacted by trait anxiety across the 3 time points. CONCLUSION: QOL was significantly impacted by psychological symptom clusters among patients with T2DM. Healthcare providers should not neglect psychological symptoms that patients experience. It is important to assess and manage these symptoms to improve QOL among patients with diabetes.

Development and validation of a dynamic delirium prediction rule in patients admitted to the Intensive Care Units (DYNAMIC-ICU): A prospective cohort study.

BACKGROUND: Delirium is one of the most common cognitive complications among patients admitted to the intensive care units (ICU). OBJECTIVE: To develop and validate a DYNAmic deliriuM predICtion rule for ICU patients (DYNAMIC-ICU) and to stratify patients into different risk levels among patients in various types of ICUs. DESIGN: Prospective cohort study. SETTING AND PARTICIPANTS: A total of 560 (median age of 66 years, 62.5% male) consecutively enrolled patients from four ICUs were included in the study. The patients were randomly assigned into either the derivation (n = 336, 60%) or the validation (n = 224, 40%) cohort by stratified randomization based on delirium/non-delirium and types of ICU. METHODS: The simplified Chinese version of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) was used to assess delirium until patients were discharged from the ICUs. Potential predisposing, disease-related, and iatrogenic and environmental risk factors as well as data on patients' outcomes were collected prospectively. RESULTS: Of the enrolled patients, 20.2% and 20.5% developed delirium in the derivation and validation cohorts, respectively. Predisposing factors (history of chronic diseases, hearing deficits), disease-related factors (infection, higher APACHE II scores at admission), and iatrogenic and environmental factors (the use of sedatives and analgesics, indwelling catheter, and sleep disturbance) were identified as independent predictors of delirium. Points were assigned to each predictor according to their odds ratio to create a prediction rule which was internally validated based on total scores and by bootstrapping (AUCs of 0.907 [95% CI 0. 871 -0.944], 0.888 [95% CI 0.845-0.932], and 0.874 [95% CI 0.828-0.920]), respectively. The total score of the DYNAMIC-ICU ranged from 0 to 33 and patients were divided into low risk (0-9), moderate risk (10-17), high risk (18-33) groups in developing delirium according to their total score with incidence of delirium at 2.8%, 16.8% and 75.9% in the derivation group, respectively. The DYNAMIC-ICU and its performance of risk level stratification were further validated in the validation cohort (AUC = 0.900 [95% CI 0.858-0.941]). The all-cause mortality was increased and the length of hospital stay was prolonged dramatically with the increase of delirium risk levels in both derivation (p = 0.034, p < 0.001) and validation cohorts (p < 0.001, p < 0.001). CONCLUSIONS: Seven predictors for ICU delirium were identified to create DYNAMIC-ICU, which could well stratify ICU patients into three different delirium risk levels, tailor risk level changes, and predict in-hospital outcomes by a dynamic assessment approach.