Application of immersive virtual reality (IVR) for the care of common diseases of older adults course: A mixed methods study.

OBJECTIVE: This study aimed to enhance understanding, engagement, and learning efficiency in the course "The Care of Common Diseases of Older Adults" using a developed Immersive Virtual Reality(IVR) system. METHODS: A mixed-methods study with 32 students was conducted. The quantitative part involved a randomized controlled trial, and the qualitative part included thematic interviews with students and teachers. RESULTS: The intervention group using the IVR system showed significant improvements in positivity and performance evaluation scores (P < 0.05) compared to the control group. Negative affect scores also decreased significantly (P < 0.05). Qualitative data from interviews supported the quantitative findings, highlighting increased curiosity, learning enthusiasm, and academic performance. CONCLUSION: IVR significantly enhances learning by stimulating curiosity and active participation, making education more accessible and improving student performance. Future IVR enhancements should focus on user-friendliness and empathetic feedback in adult care.

Self-efficacy mediates the effect of professional identity on learning engagement for nursing students in higher vocational colleges: A cross-sectional study.

BACKGROUND: Learning engagement is a crucial predictor of academic achievement. It is essential to understand the factors influencing learning engagement among nursing students, especially from the learner's perspective, which is notably scarce but vital for designing effective educational interventions. OBJECTIVES: This study aims to investigate the mediating effect of self-efficacy on the relationship between professional identity and learning engagement for nursing students in higher vocational colleges. DESIGN: A cross-sectional electronic survey was conducted. SETTING: The study was conducted in four higher vocational colleges located in Guangdong Province, China. PARTICIPANTS: A total of 944 first- and second-year nursing students participated in the study between October and November 2022. METHODS: Data were collected with questionnaires on general information, professional identity, self-efficacy, and learning engagement and analyzed with SPSS 26.0 and PROCESS v4.1 (Model 4), exploring relationships among professional identity, self-efficacy, and learning engagement through Pearson correlations, multivariate regression, and mediation analysis with 5000 bootstrap samples. RESULTS: The participants exhibited moderate levels of professional identity (85.37 ± 13.52), self-efficacy (25.58 ± 5.74), and learning engagement (71.26 ± 16.17), which were all significantly correlated with each other (P < 0.01). In the model of the mediating effect, professional identity directly (ß = 0.811, t = 27.484, P < 0.001) and indirectly [ß = 0.112,95%CI (0.074-0.154)] significantly predicts college students' learning engagement; professional identity has a significant positive predictive effect on self-efficacy (ß = 0.182, t = 14.459, P < 0.001) and self-efficacy significantly predicts learning engagement (ß = 0.614, t = 8.292, P < 0.001). Furthermore, the direct effect of professional identity on learning engagement (0.699) and its mediating effect (0.112) account for 86.19 % and 13.81 % of the total effect (0.811), respectively. CONCLUSION: Participants exhibited moderate levels of professional identity, self-efficacy, and learning engagement. Professional identity and self-efficacy are interconnected and positively correlated, influencing learning engagement among nursing students, which highlights the need to foster these qualities to enhance education and future practice.

Using Virtual Reality in the Care of Older Adults With Dementia: A Randomized Controlled Trial.

There is a shortage of personnel to provide care for older adults with dementia, and traditional teaching methods could be improved. The teaching method used in the Care for Older Adults With Dementia course is mainly theoretical, lacking real-life care scenarios and practical procedural training. In the current study, we developed a virtual reality (VR) teaching system and designed a randomized controlled trial aimed at testing the availability of the VR-assisted teaching system, filling the gap in teaching through care scenarios, enabling students majoring in intelligent health and oldage care service management to have a more positive attitude toward learning, and improving students' knowledge and course satisfaction. This study showed that the developed VR system can meet the initial needs of daily teaching, help students have a more positive attitude toward learning, and improve their academic performance and course satisfaction. [Journal of Gerontological Nursing, 49(11), 25-32.].

Cumulative remnant cholesterol predicts cardiovascular outcomes in elderly patients with atherosclerotic cardiovascular disease.

AIMS: Remnant cholesterol (RC) reportedly mediates residual cardiovascular risk in atherosclerotic cardiovascular diseases (ASCVD). However, few studies have characterized long-term cumulative RC exposure among elderly people. The study aimed to evaluate the association between cumulative exposure to RC and incident major adverse cardiovascular events (MACE) by analysing a cohort of elderly patients with ASCVD. METHODS AND RESULTS: This retrospective multicentre cohort study enrolled ASCVD participants aged ≥75 years with baseline visits occurring from 2006 to 2012 followed by four in-person visits. Cumulative RC was estimated as the area under the curve using measurements from the first to fourth visits by using 9-year data. The time-weighted average (TWA) RC was expressed as cumulative exposure to RC averaged by years. All outcomes were follow-up from the fourth visit to the year 2021. Outcomes included a composite of MACE (stroke, unstable angina pectoris, myocardial infarction, and cardiac death). We included 4,680 participants (73.1% male, mean age 79.3 ± 2.5 years). The median follow-up duration was 6.1 years (interquartile range: 3.4-6.6 years). In the multivariable model adjusted for traditional cardiovascular risk factors, low-density lipoprotein cholesterol level, and most recent RC level, the hazard ratios for MACE that compared the high and low tertiles of the RC variables were 1.30 [95% confidence interval (CI), 1.16-1.44] for cumulative RC and 1.36 (95% CI, 1.23-1.52) for TWA RC. Consistent significant associations were observed among most propensity score analyses. CONCLUSIONS: Long-term cumulative RC was independently associated with incident MACE in elderly participants with ASCVD, suggesting that achieving and maintaining optimal RC levels later in life may still improve cardiovascular outcomes.

This retrospective multicentre cohort study, enrolling 4680 participants aged ≥75 years with pre-existing atherosclerotic cardiovascular diseases (ASCVD), found that greater cumulative exposure to remnant cholesterol (RC) across a 9-year span was independently associated with an increased incidence of cardiovascular events, suggesting that cumulative RC may be a powerful predictor of cardiovascular outcomes in patients with ASCVD.

Incremental Benefit of Lipid Lowering in a Large Chinese Population Aged 75 Years and Older With Established Atherosclerotic Cardiovascular Disease.

OBJECTIVE: To explore the optimal low-density lipoprotein cholesterol (LDL-C) level in patients aged 75 years and older with established atherosclerotic cardiovascular disease (ASCVD). PATIENTS AND METHODS: We conducted a retrospective multicenter cohort study of veterans aged 75 years and older with ASCVD who were regularly hospitalized or medically examined in 15 medical institutions in southern China from January 1, 2006, to December 31, 2013. Follow-up continued through October 1, 2021. The time-weighted average (TWA) LDL-C level represented the average LDL-C level during follow-up. Participants were divided into TWA LDL-C groups of 55.0 mg/dL or lower, 55.1 to 70.0 mg/dL, 70.1 to 85.0 mg/dL, 85.1 to 100.0 mg/dL, and greater than 100.0 mg/dL. The subgroup with LDL-C levels lower than 55.0 mg/dL was further subdivided into groups with LDL-C levels from 40.1 to 55.0 mg/dL and 40.0 mg/dL or less. The association of TWA LDL-C levels with outcomes was evaluated with Cox proportional hazards models. RESULTS: Overall, 6387 patients aged 75 years or older with ASCVD were included (mean age, 79.4 years). In total, 4267 major adverse cardiovascular events, 1518 stroke events, and 515 myocardial infarction events occurred during a mean follow-up of 12.7 years. Generally, lower TWA LDL-C level was associated with a lower risk of cardiovascular events but was not associated with a higher risk of adverse events in elderly individuals with ASCVD, with the lowest cardiovascular risk observed for LDL-C levels of less than 55.0 mg/dL. After multivariable adjustment, the risk of a major adverse cardiovascular event was 1.30 (95% CI, 1.26 to 1.34; P<.001) for a per SD increment in TWA LDL-C level. Compared with TWA LDL-C levels of 40.1 to 55.0 mg/dL, TWA LDL-C levels of 40.0 mg/dL or less were associated with an increased risk of hemorrhagic stroke (hazard ratio, 3.71; 95% CI, 1.89 to 7.26). CONCLUSION: Low-density lipoprotein cholesterol levels from 40.1 to 55.0 mg/dL exhibited the maximum cardiovascular benefit in patients aged 75 years and older who had ASCVD. Lowering LDL-C levels to 40.0 mg/dL or less might increase the risk of hemorrhagic stroke.

Association of long-term time in target range for systolic blood pressure with cardiovascular risk in the elderly: a Chinese veteran cohort study.

AIMS: Short-term blood pressure (BP) time in target range (TTR) independently predicts cardiovascular (CV) outcomes in adults. However, there are limited data regarding long-term TTR for BP among elderly participants. We aimed to determine whether future CV risk varies for those who can maintain a long-term systolic BP (SBP) target range by assessing TTR in elderly individuals with hypertension. METHODS AND RESULTS: The Chinese veteran cohort study included 943 elderly participants with hypertension aged over 75 years. The primary outcome was the first occurrence of CV events during annual visits. Time in target range was estimated over 15 years of follow-up using linear interpolation. The target range was defined as 120-140 mmHg according to guidelines. The association between SBP TTR and CV outcomes was estimated using multivariable Cox proportional hazards models. During the 15 year follow-up, the probability of CV events gradually decreased with increasing TTR for SBP. After multivariable adjustment for traditional CV risk factors and mean BP, comparing the highest vs. lowest quartiles of TTR for SBP, the hazard ratios (HRs) [95% confidence intervals (CIs)] were 0.424 (0.289-0.624) for the primary outcome. For each 1 SD increase in TTR, the risk of the primary outcome decreased by 25.4% (HR: 0.746; 95% CI: 0.666-0.834). Consistent findings were observed in sensitivity analyses. CONCLUSION: Greater long-term TTR for SBP was associated with a decreased risk of CV events in elderly individuals independent of mean BP, suggesting that SBP TTR might serve as a modifiable risk factor for future CV health in elderly patients with hypertension. LAY SUMMARY: This ongoing Chinese veteran cohort study adds to the understanding of the relationship between higher long-term systolic blood pressure (SBP) time in target range (TTR) and cardiovascular benefits among elderly individuals with hypertension.

Higher long-term systolic blood pressure (SBP) time in target range (TTR) is associated with a significantly decreased risk of cardiovascular events independent of mean SBP, suggesting that TTR might serve as an essential measure for monitoring BP status. It might be helpful for lowering the risk of cardiovascular events when the time in SBP target range is maintained after antihypertensive therapy.

The efficacy of pediatric ultrasound guided brachial plexus block anesthesia and determination of optimal anesthetic drug dosage.

BACKGROUND: The objective of the present study was to investigate the effect of pediatric ultrasound guided brachial plexus block anesthesia and to determine the optimal anesthetic drug dosage. METHODS: Ninety-seven children who required elective upper limb surgery were randomly divided into three groups: group A with 32 cases, group B with 35 cases and group C with 30 cases. All three groups of patients underwent ultrasound guided brachial plexus block anesthesia. To compare differences of anesthetic effect, group A received 0.30% ropivacaine, group B received 0.40% ropivacaine, and group C received 0.50% ropivacaine. RESULTS: The total volume was 24 mL in each group. The onset time of ulnar nerve block in Group A was significantly longer than in Group B and Group C (P<0.05); there were no significant differences in onset time of nerve block of the other nerves among the three groups (P>0.05). Block maintenance time in Group A was significantly less than in Group B and Group C (P<0.05). The effective rate of anesthesia of Group A was lower than in Group B and Group C and the differences were statistically significant (P<0.05). There was no significant difference in the incidence of anesthetic complications among the three groups (P>0.05). CONCLUSIONS: Pediatric ultrasound guided brachial plexus block anesthesia is safe and reliable. Ropivacaine used at 0.40% is the optimal lower-concentration anesthetic dosage.

[Prevalence of symptomatic orthostatic hypotension and orthostatic blood pressure changes].

OBJECTIVE: To analyze the prevalence and orthostatic blood pressure changes in subjects with symptomatic orthostatic hypotension (OH), and to observe the relation between symptoms and orthostatic blood pressure change in this population. METHODS: A total of 193 subjects who consulted physicians due to OH related symptoms were selected, and divided into three groups: young (n = 37), middle-aged (n = 66) and elder (n = 90). Height, body weight, waist circumference, hip circumference and resting heart rate were measured. Symptom scores of every subject were obtained. CAVI and ABI were measured. Blood pressure including recumbent position, orthostatic systolic and diastolic blood pressure was measured at the morning and at the afternoon on two separate examination days with at least one week interval. After that, orthostatic changes in systolic blood pressure (OCs) and orthostatic changes in diastolic blood pressure (OCd) were calculated. RESULTS: OH prevalence was 32.6% in this cohort. The prevalence of three groups was similar [young: 32.4%, middle-aged: 25.8%, and elderly: 37.8%, respectively (P > 0.05)]. Only 9 cases (14.29% of confirmed OH cases) reached the OH diagnostic criteria with equal or more than 2 times orthostatic blood pressure measurements. OH was diagnosed in 63 patients during the 4 times orthostatic blood pressure check, of which 19.5% to 57.14% cases were diagnosed with single orthostatic blood pressure check. Age, weight, body mass index, waist-to-hip ratio, smoking, drinking habit, sex, coronary heart disease, hypertension, Parkinson's disease, stroke history, antihypertensive drug use were similar between OH group and non-OH group. Height, waist circumference, hip circumference, and resting heart rate were significantly lower in OH group than in non-OH group (P < 0.05). The values of the factors in OH group were lower. CAVI was 8.45 ± 0.19 in non-OH group and 8.37 ± 0.27 in OH group (P > 0.05), ABI was significantly lower in OH group than in non-OH group (1.004 ± 0.013 vs. 1.051 ± 0.009, P < 0.01). CONCLUSION: The prevalence of OH in people with related symptoms is high. Repeated orthostatic blood pressure measurements can improve OH detection rate.

1H-NMR-based metabolic analysis of human serum reveals novel markers of myocardial energy expenditure in heart failure patients.

OBJECTIVE: Elevated myocardial energy expenditure (MEE) is related with reduced left ventricular ejection fraction, and has also been documented as an independent predictor of cardiovascular mortality. However, the serum small-molecule metabolite profiles and pathophysiological mechanisms of elevated MEE in heart failure (HF) are still lacking. Herein, we used 1H-NMR-based metabolomics analysis to screen for potential biomarkers of MEE in HF. METHODS: A total of 61 subjects were enrolled, including 46 patients with heart failure and 15 age-matched controls. Venous serum samples were collected from subjects after an 8-hour fast. An INOVA 600 MHz nuclear magnetic resonance spectrometer with Carr-Purcell-Melboom-Gill (CPMG) pulse sequence was employed for the metabolomics analysis and MEE was calculated using colored Doppler echocardiography. Metabolomics data were processed using orthogonal signal correction and regression analysis was performed using the partial least squares method. RESULTS: The mean MEE levels of HF patients and controls were 139.61±58.18 cal/min and 61.09±23.54 cal/min, respectively. Serum metabolomics varied with MEE changed, and 3-hydroxybutyrate, acetone and succinate were significantly elevated with the increasing MEE. Importantly, these three metabolites were independent of administration of angiotensin converting enzyme inhibitor, ß-receptor blockers, diuretics and statins (P>0.05). CONCLUSIONS: These results suggested that in patients with heart failure, MEE elevation was associated with significant changes in serum metabolomics profiles, especially the concentration of 3-hydroxybutyrate, acetone and succinate. These compounds could be used as potential serum biomarkers to study myocardial energy mechanism in HF patients.

[The correlation between postural hypotension and myocardial infarction in the elderly population].

OBJECTIVE: To investigate the association between the systolic/diastolic orthostatic hypotension (OH-S/OH-D) and myocardial infarction (MI) in the elderly. METHODS: Health screening physical examination were carried in 1081 subjects without MI aged over 65 years in Guangzhou Military region. The orthostatic blood pressure and heart rate were measured in supine position after resting for more than 5 minutes and at 0 and 2 minutes after standing. All the cases were divided into systolic or diastolic group on the basis of definition of orthostatic hypotension and followed up by telephone or inpatient medical records with mean period of 315.8 days. The primary endpoint was MI occurrence. RESULTS: The prevalence of OH in this cohort was 24.5% (OH-S/OH-D: 19.3%/17.2%). Significant differences in the occurrence of OH and OH-S were found in the elderly and the very elderly subjects (≥ 80 years) (26.1% vs 20.1%, P = 0.045 ; 21.0% vs 14.6%, P = 0.018), while no difference was found in OH-D. The prevalence of MI in the OH positive subjects was significantly higher than that in the OH negative subjects, as well as in OH-S or OH-D group. After adjustment of age, supine blood pressure, creatinine and cerebrovascular history by logistic regression, the association was observed between MI and OH (HR 15.635, 95%CI 3.299 - 74.091, P = 0.001), OH-S(HR 8.760, 95%CI 2.487-30.851, P = 0.001)and OH-D(HR 3.889, 95%CI 1.097 - 13.790, P = 0.035). CONCLUSION: OH-S and OH-D hypotension are robust predictors for MI in the elderly.

[Impact of attack frequency and therapy strategies on outcome of patients with vasovagal syncope].

OBJECTIVE: To analyze the impact of attack frequency as well as therapy strategies on outcome of patients with vasovagal syncope (VVS). METHODS: A total of 159 patients (aged from 15 - 59 years old) with VVS were included in this study. Patients were divided into low frequency (< 3) group (n = 95) and high (≥ 3) frequency group (n = 64) according to the attack frequency in the past 5 years at the primary survey. Patients received one of the three therapies: no treatment, physical therapy, and comprehensive treatment. All cases were followed up with telephone or outpatient visit for 24 months. RESULTS: Incidence of syncope was significantly higher in the high frequency group and in the low frequency group [40.6% (26/64) vs. 11.6% (11/95), P < 0.01]. The overall improvement rate was significantly higher in the low frequency group than that of high frequency group (P < 0.01). Improvement rate was significantly higher in the physical therapy subgroup and the comprehensive treatment subgroup than no treatment subgroup for patients with low attack frequency [81.8% (27/33) vs. 47.1% (8/17), P < 0.05; 82.2% (37/45) vs. 47.1% (8/17), P < 0.05], and in comprehensive treatment subgroup than in physical therapy subgroups observed between and [62.2% (28/45) vs. 31.6% (6/19), P < 0.05] for patients with high attack frequency. CONCLUSION: Outcome is related to previous attack frequency for patients with VVS, physical therapy is effective for reducing the recurrence rate of syncope in VVS patients with low attack frequency while physical therapy combined with pharmacotherapy should be applied for VVS patients with high attack frequency to improve outcome.

[Prevalence and clinical characteristics of orthostatic hypotension in the elderly and retired population].

OBJECTIVE: To determine the prevalence and clinical characteristics of orthostatic hypotension (OH) in the elderly and retired population. METHODS: A total of 1174 elderly and retired people underwent health screening physical examination in Guangzhou military region were included. The orthostatic blood pressure and heart rate were measured in supine position after resting for more than 5 minutes and at 0 and 2 min after standing. Subjects were divided into OH positive group and OH negative group. Orthostatic hypotension was defined as 20 mm Hg (1 mm Hg = 0.133 kPa) or greater decrease in SBP and/or 10 mm Hg or greater decrease in DBP after standing. RESULTS: The prevalence of OH in this cohort was 25.6% at either 0 or 2 min after standing (21.6% or 20.7% respectively). Incidence of hypertension, myocardial infarction (MI), heart failure (HF), ischemic stroke and diabetes was significantly higher in OH positive group than in OH negative group (all P < 0.05), however, antihypertensive medication was similar between the two groups. CONCLUSIONS: Orthostatic hypotension is common in the elderly and retired population and is associated with increased risk of hypertension, diabetes mellitus and cardiovascular disease.

[Correlation between orthostatic hypotension and cardiovascular risks in elderly population].

OBJECTIVE: To investigate the correlation between orthostatic hypotension and cardiovascular risks and hospitalization rate in the elders. METHODS: A total of 1174 people over 65 years old underwent health screening physical examination through a self-made questionnaire at our hospital. Their clinical data were collected. The orthostatic blood pressure and heart rate were measured in supine position after resting for over 5 minutes and at 0 and 2 min after standing. Orthostatic hypotension was defined as 20 mm Hg or greater decrease in SBP or/and 10 mm Hg or greater decrease in DBP after standing. All cases were followed up by telephone or hospitalization medical records for a mean period of 315.8 days. The primary endpoint was the occurrence of such cardiovascular or cerebrovascular events as angina, fatal or nonfatal myocardial infarction (MI), congestive heart failure, sudden cardiac death, ischemic and hemorrhagic stroke. RESULTS: The prevalence of OH was 25.6% in this cohort. Significant differences could be found in the rate of all-cause and cardiovascular-related hospitalization between OH positive and OH negative (45.1% vs 32.5%; 19.1% vs 7.4%); the rates of angina and myocardial infarction in the OH positive group were significantly higher than those in the OH negative group (7.5% vs 3.7%: 4.8% vs 0.5%, P < 0.05); after adjusting for age, supine blood pressure, heart rate and cerebrovascular history by logistic regression, statistical differences could also be observed between OH and angina [P = 0.011, HR (hazard ratio): 2.122, 95%CI (confidence interval): 1.184-3.802 and MI (P < 0.001, HR: 8.995, 95%CI: 2.909 - 27.819)]. CONCLUSION: Orthostatic hypotension may increase the rates of all-cause and cardiovasular-related hospitalization. And it is a robust predictor of angina and myocardial infarction in the elders.

[A clinical analysis of morning blood pressure surge in middle and old aged male hypertensive patients].

OBJECTIVE: To investigate the morning blood pressure surge (MBPS) and its relationship with 24-hour blood pressure variability and anti-hypertensive drugs in middle-aged and elderly hypertensive patients. METHODS: A total of 521 middle-age and elderly men were surveyed with ambulatory blood pressure monitoring and ambulatory electrocardiograms recordings as well as questionnaire investigation from January 2009 to December 2010. Subjects were divided into MBPS positive group and MBPS negative group according to the level of MBPS [> 35 mm Hg (1 mm Hg = 0.133 kPa) or ≤ 35 mm Hg]. RESULTS: In all the cases, the prevalence of MBPS was 19.4%, of which the elderly and very elderly had higher prevalences (18.9% and 21.8%, respectively) than the middle-aged (5.6%, both P < 0.01). Significant differences could be found in age[(81.6 ± 6.4) years vs (78.7 ± 9.7) years], day mean systolic blood pressure [(132.8 ± 13.3) mm Hg vs (128.8 ± 13.3) mm Hg], fasting blood glucose [(5.96 ± 1.59) mmol/L vs (5.68 ± 1.22) mmol/L] and 24-hour blood pressure variability between the two groups (all P < 0.05). Significant difference could be observed in the prevalence of MBPS between the diuretics-taking group and non-taking group (27.4% vs 17.6%, P < 0.05). CONCLUSIONS: The elderly hypertensive patients are prone to appear MBPS phenomenon. Fasting blood glucose level, 24-hour blood pressure variability may be associated with MBPS. Diuretic antihypertensive treatment may not be conductive for MBPS control.