Validation of the Barthel Index in Chinese nursing home residents: an item response theory analysis.

Background: The Barthel Index (BI) is used to standardize the grading of assessments for clinical needs, insurance support, and long-term care resource allocation in China. However, its psychometric properties among nursing home residents remain unclear. Therefore, this study aims to assess and modify the psychometric properties of BI in nursing home residents. Methods: A total of 1,402 individuals undergoing evaluation in a nursing home facility in China were included in this study from November 2021 to November 2022. Correlations between items were examined to identify the potential multicollinearity concerns. The unidimensional item response theory (IRT) was used to validate and modify the single structure of BI. Furthermore, the logistic regression/IRT hybrid DIF detection method was conducted to assess differential item functioning (DIF) between the dementia group and the normal group. Results: The pairing of items 5 ("bowl control") and 6 ("bladder control") revealed a local dependence issue, leading to their consolidation. Items 56 (bowel and bladder control) and 9 (mobility) both displayed poor fit indices and underwent category collapsing. Through the application of the generalized partial credit model, the adjusted scale displayed better fit indices, demonstrating a robust discriminative power (DC >1.5) and orderly thresholds. Furthermore, non-uniform DIF was identified in item 2 (bathing) between the dementia group and the normal group. Conclusion: The modified BI demonstrated favorable psychometric properties and proved to be suitable for evaluating nursing home residents experiencing moderate functional impairment, which may provide a precise evaluation for long-term care resource allocation. Future studies could explore integrating supplementary measurements, such as objective indices, to assess a broader spectrum of functional statuses to potentially enhance the limited precision width observed in BI.

Sentinel and networked symptoms in patients with breast cancer undergoing chemotherapy.

PURPOSE: It was designed to identify the symptom clusters and sentinel symptoms among patients with breast cancer receiving chemotherapy at the community level, and to explore core and bridge symptoms at the global level. METHODS: A cross-sectional survey was conducted using the MD Anderson Symptom Inventory. Patients with breast cancer receiving chemotherapy, recruited from the "Be Resilient to Breast Cancer" project between January 2023 and December 2023, were included in the study. Symptom clusters and their sentinel symptoms were identified using exploratory factor analysis and Apriori algorithm. Core and bridge symptoms were identified using network analysis. RESULTS: A total of 468 patients with breast cancer participated in the current study. At the community level, three symptom clusters and their corresponding sentinel symptoms were identified: a gastrointestinal symptom cluster (with nausea as the sentinel symptom), a psycho-sleep-related symptom cluster (with distress as the sentinel symptom), and a neurocognition symptom cluster (with dry mouth as the sentinel symptom). At the global level, fatigue emerged as the core symptom, while disturbed sleep and lack of appetite as bridge symptoms. CONCLUSION: Addressing nausea, distress, and dry mouth are imperative for alleviating specific symptom clusters at the community level. Furthermore, targeting fatigue, disturbed sleep, and lack of appetite are crucial to break the interactions among diverse symptoms at the global level.

A qualitative meta-synthesis of patient dignity from the perspective of caregivers.

BACKGROUND: The concept of dignity remains disputed, with most studies defining dignity based on its external dimension. Although its inherent dimension is a rooted attribute of dignity, it has received scarce attention. Caregivers have close relationships with their care recipients and thus may perceive their patient's inherent as well as external dimensions of dignity. Therefore, in this study, we aimed to identify, analyze, and synthesize evidence on human dignity presented in qualitative studies from the perspective of caregivers to gain a deeper comprehension of the preservation of patients' dignity by their caregivers. METHODS: A qualitative meta-synthesis was performed by searching for relevant qualitative literature via systematic electronic databases, including MEDLINE, PsycINFO, ProQuest, CINAHL, Embase, Health Source, and Web of Science, from inception to March 15, 2022. RESULTS: Nine studies were eligible for inclusion and included in the meta-synthesis. Three overarching categories were identified: integrated person, "rootedness" and "growth" atmosphere, and balanced state. CONCLUSIONS: Dignity is rooted in its inherent dimension, whereas its external dimension may promote individual dignity. Furthermore, caregiver-patient relationships may be a key factor linking the inherent dimension of dignity with its external dimension. Thus, further studies should focus on the mechanism of relationships in preserving dignity.

Neuropsychological Interventions for Cancer-Related Cognitive Impairment: A Network Meta-Analysis of Randomized Controlled Trials.

The aim of this network meta-analysis was to evaluate the comparative effects of neuropsychological interventions for cancer-related cognitive impairment (CRCI), and to rank the best intervention options for adult cancer patients with CRCI. Twenty-seven eligible randomized controlled trials (RCTs) were searched, and a total of six interventions identified: cognitive behavioral therapies (CBT), cognitive rehabilitation (CR), cognitive training (CT), meditation/mindfulness-based interventions, psychoeducation, and supportive care. In terms of effectiveness, the relative effect size of CBT, CR, and CT in managing subjective cognition had statistically significant differences - 0.94 (0.43-1.44), 0.54 (0.03-1.05), and 0.47 (0.13-0.81), respectively. The most effective interventions to manage the objective cognition of attention were meditation or mindfulness-based interventions: intervention effect size was 0.58 (0.24-0.91). The relative effect size of CT had a statistically significant difference in managing verbal memory, and the intervention effect size was 1.16 (0.12-2.20). The relative effect size of psychoeducation in managing executive function compared with control had a statistically significant difference, which was 0.56 (0.26-0.86). For managing information processing speed, the most effective intervention was CT and the effect size was -0.58 (-1.09--0.06). This network meta-analysis found that CT is the most effective intervention for managing the objective cognition of verbal memory and processing speed; meditation/mindfulness-based interventions may be the best option for enhancing attention; psychoeducation is the most effective intervention for managing executive function; CT may be the best option for managing verbal fluency as the intervention ranking probability. For the management of subjective cognition, CBT may be the most effective intervention.

Effects of aerobic, resistance, and combined exercise on metabolic syndrome parameters and cardiovascular risk factors: a systematic review and network meta-analysis.

This study examines the effects of aerobic, resistance, and combined exercise on metabolic syndrome parameters and cardiovascular risk factors, to identify the most effective way of improving metabolic syndrome and preventing cardiovascular disease. We searched EMBASE, the Cochrane Library, PubMed, MEDLINE, Ovid, the Chinese Biological Medicine Database (CBM), the Wanfang Database, the China National Knowledge Infrastructure (CNKI) database, and the Chinese Scientific Journal Database (VIP), for randomized controlled trials (RCTs), identifying 15 comparing the effects of aerobic, resistance, and combined exercise on metabolic syndrome parameters and cardiovascular risk factors (e.g., glucose, triglyceride, blood pressure, body mass index, etc.). We assessed the quality of the articles and performed a network meta-analysis with a Bayesian random effects model to synthesize direct and indirect evidence. Combined exercise was most effective at controlling glucose and total triglyceride (TG) levels. Aerobic, resistance, and combined exercise groups achieved significant effects regarding body fat. Aerobic exercise was superior to resistance exercise regarding body mass index (BMI). There was no statistically significant difference in weight, waist circumference (WC), levels of high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), insulin, systolic blood pressure (SBP), and diastolic blood pressure (DBP) among the exercise groups. Combined exercise was the best exercise scheme for improving weight, WC, DBP, TG, TC, glucose, and insulin levels. Resistance exercise was most effective at ameliorating body fat, LDL-C levels, and SBP. Aerobic exercise was the optimal way of improving BMI and HDL-C levels. This network meta-analysis suggests combined exercise is the most effective choice in improving the metabolic syndrome and cardiovascular risk parameters, whereas aerobic exercise reveals the minimum effect. Further studies should certify the role resistance exercises play in metabolic syndrome and cardiac rehabilitation.

Hypoxic preconditioning with cobalt of bone marrow mesenchymal stem cells improves cell migration and enhances therapy for treatment of ischemic acute kidney injury.

Mesenchymal stem cell (MSC) administration is known to enhance the recovery of the kidney following injury. Here we tested the potential of hypoxic-preconditioned-MSC transplantation to enhance the efficacy of cell therapy on acute kidney injury (AKI) by improving MSC migration to the injured kidney. Cobalt was used as hypoxia mimetic preconditioning (HMP). MSC were subjected to HMP through 24 h culture in 200 µmol/L cobalt. Compared to normoxia cultured MSC (NP-MSC), HMP significantly increased the expression of HIF-1α and CXCR4 in MSC and enhanced the migration of MSC in vitro. This effect was lost when MSC were treated with siRNA targeting HIF-1α or CXCR4 antagonist. SPIO labeled MSC were administered to rats with I/R injury followed immediately by magnetic resonance imaging. Imaging clearly showed that HMP-MSC exhibited greater migration and a longer retention time in the ischemic kidney than NP-MSC. Histological evaluation showed more HMP-MSC in the glomerular capillaries of ischemic kidneys than in the kidneys receiving NP-MSC. Occasional tubules showed iron labeling in the HMP group, while no tubules had iron labeling in NP group, indicating the possibility of tubular transdifferentiation after HMP. These results were also confirmed by fluorescence microscopy study using CM-DiI labeling. The increased recruitment of HMP-MSC was associated with reduced kidney injury and enhanced functional recovery. This effect was also related to the increased paracrine action by HMP-MSC. Thus we suggest that by enhancing MSC migration and prolonging kidney retention, hypoxic preconditioning of MSC may be a useful approach for developing AKI cell therapy.