Instruments to Assess Cognitive Reserve Among Older Adults: a Systematic Review of Measurement Properties.

Cognitive reserve explains the differences in the susceptibility to cognitive impairment related to brain aging, pathology, or insult. Given that cognitive reserve has important implications for the cognitive health of typically and pathologically aging older adults, research needs to identify valid and reliable instruments for measuring cognitive reserve. However, the measurement properties of current cognitive reserve instruments used in older adults have not been evaluated according to the most up-to-date COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN). This systematic review aimed to critically appraise, compare, and summarize the quality of the measurement properties of all existing cognitive reserve instruments for older adults. A systematic literature search was performed to identify relevant studies published up to December 2021, which was conducted by three of four researchers using 13 electronic databases and snowballing method. The COSMIN was used to assess the methodological quality of the studies and the quality of measurement properties. Out of the 11,338 retrieved studies, only seven studies that concerned five instruments were eventually included. The methodological quality of one-fourth of the included studies was doubtful and three-seventh was very good, while only four measurement properties from two instruments were supported by high-quality evidence. Overall, current studies and evidence for selecting cognitive reserve instruments suitable for older adults were insufficient. All included instruments have the potential to be recommended, while none of the identified cognitive reserve instruments for older adults appears to be generally superior to the others. Therefore, further studies are recommended to validate the measurement properties of existing cognitive reserve instruments for older adults, especially the content validity as guided by COSMIN.Systematic Review Registration numbers: CRD42022309399 (PROSPERO).

Diagnostic Accuracy of Mobile Health-Based Audiometry for the Screening of Hearing Loss in Adults: A Systematic Review and Meta-Analysis.

Background: Hearing loss is one of the most prevalent chronic health conditions. Traditional pure tone audiometry (PTA) is the gold standard for hearing loss screening, but is not widely available outside specialized clinical centers. Mobile health (mHealth)-based audiometry could improve access and cost-effectiveness, but its diagnostic accuracy varies widely between studies. Therefore, we aimed to evaluate the diagnostic accuracy of mHealth-based audiometry for hearing loss screening in adults compared with traditional PTA. Methods: Ten English and Chinese databases were searched from inception until April 30, 2022. Two researchers independently selected studies, extracted data, and appraised methodological quality. The bivariate random-effects model was adopted to estimate the pooled sensitivity and specificity for each common threshold (i.e., the threshold to define mild or moderate hearing loss). The hierarchical summary receiver operating characteristic model was used to assess the area under the receiver operating characteristic curve (AUC) across all thresholds. Results: Twenty cohort studies were included. Only one study (n = 109) used the mHealth-based speech recognition test (SRT) as the index test. Nineteen studies (n = 1,656) used mHealth-based PTA as the index test, and all of them were included in the meta-analysis. For detecting mild hearing loss, the pooled sensitivity and specificity were 0.91 (95% confidence interval [CI] 0.80-0.96) and 0.90 (95% CI 0.82-0.94), respectively. For detecting moderate hearing loss, the pooled sensitivity and specificity were 0.94 (95% CI 0.87-0.98) and 0.87 (95% CI 0.79-0.93), respectively. For all PTA thresholds, the AUC was 0.96 (95% CI 0.40-1.00). Conclusions: mHealth-based audiometry provided good diagnostic accuracy for screening both mild and moderate hearing loss in adults. Given its high diagnostic accuracy, accessibility, convenience, and cost-effectiveness, it shows enormous potential for hearing loss screening, particularly in primary care sites, low-income regions, and settings with in-person visit limitations. Further work should evaluate the diagnostic accuracy of the mHealth-based SRT tests.

The Relationship Between Sleep Disturbance and Apolipoprotein E ε4 in Adults With Mild Cognitive Impairment and Alzheimer's Disease Dementia: An Integrative Review.

BACKGROUND: Apolipoprotein E ε4 (APOE ε4) was shown to be a risk factor for mild cognitive impairment (MCI) and Alzheimer's disease (AD) dementia. When coupled with sleep disturbance, APOE ε4 posed additional risks to cognitive impairment. But the literature on the association between sleep disturbance and the APOE ε4 status of persons who are cognitively impaired has not yet been systematically examined. OBJECTIVES: To explore and synthesize the relationship between sleep disturbance and APOE ε4 status of adults with MCI and AD. METHODS: An integrative review was guided by Whittemore and Knafl's methodology. Systematic searches identified studies with multiple sources published before May 20, 2021. A matrix and narrative synthesis was employed to organize and synthesize the findings. Joanna Briggs Institute (JBI) Critical Appraisal tools (2020) were used to evaluate the quality of the selected studies. RESULTS: A total of 7 studies were included. APOE ε4 was associated with poor sleep quality in terms of the deterioration of nighttime total sleep time, 24-hour total sleep time, rapid eye movement, sleep efficiency, sleep latency, and wake after sleep onset in a population with MCI or AD. The interacted and adjusted relationship between sleep disturbance and APOE ε4 on the progression of cognitive decline was inconsistent. CONCLUSIONS: There is evidence to support an association between sleep disturbance and APOE ε4 in individuals with cognitive impairment, but a further examination of the relationship between sleep parameters and APOE ε4 is warranted, especially as the causal or dose-response relationship remains unclear.

Analysis of risk factor for pediatric intensive care unit delirium in children: a case-control study.

OBJECTIVE: This study aimed to survey the prevalence of delirium in the pediatric intensive care unit (PICU) and explore the associated risk factors. DESIGN: A retrospective case-control study. SETTING: Two PICUs within a tertiary-A general hospital. PATIENTS: Patients aged from 1 month to 7 years who stayed in either PICU for at least 1 day were included. METHODS: A total of 639 patients admitted to PICU of a tertiary-A general hospital from December 2018 to August 2019 were enrolled. Demographic, clinical, laboratory data and length of stay in the PICU were collected. The patients were screened twice a day with the Chinese version of Cornell Assessment of Pediatric Delirium (CAPD), and were divided into the delirium group and the non-delirium group. A risk factor analysis was conducted, with ICU pediatric delirium as primary outcome, by performing a multivariable logistic regression analysis. RESULTS: Of the 639 patients, the prevalence of ICU pediatric delirium was 31.30%. Of the 200 children with delirium across 3703 study days, 36% children were hyperactive, 41% were hypoactive, and 23% displayed the mixed type of delirium. Univariate analysis and multivariate logistic regression analysis showed that age, PRISM IV score (OR, 2.20; 95% CI, 1.42-3.41), hypoxia (OR, 2.69; 95% CI, 1.53-4.71), metabolic dis-function (OR, 3.73; 95% CI, 2.08-6.71), duration of infection (OR, 1.22; 95% CI, 1.10-1.36), and mechanical ventilation (OR, 3.78; 95% CI, 2.25-6.35) were statistically correlated with ICU pediatric delirium. The ROC curve analysis shows the combination CRP with duration of infection has good predictive performance. CONCLUSIONS: Age, PRISM IV score, ICU retention time, metabolic dis-function, duration of infection, hypoxia, CRP and mechanical ventilation were the independent risk factors for ICU pediatric delirium. We suggest that active preventive measures should be taken to reduce the occurrence of ICU pediatric delirium.

Noma in a boy with septic shock: a case report.

BACKGROUND: Noma is a rare disease, which is characterized by rapid progression and a high rate of mortality; however, relatively few cases of noma infection accompanied by septic shock in children have been described. Further, most health care professionals have no knowledge of this disease or of its clinical significance. CASE PRESENTATION: Herein, we present a case report of a six-year-old male patient who was diagnosed with noma infection at a Chinese pediatric medical intensive care unit (PMICU), at which time, it was discovered that he had septic shock. Following treatment by continuous renal replacement therapy (CRRT) for septic shock arising from noma, the patient was in generally good condition, and the local wound was seen to be essentially healed five weeks post-admission. CONCLUSION: Noma is an opportunistic infectious disease condition. Treatment of the acute phase of noma predominantly focuses on controlling the infection and improving systemic conditions. In addition, CRRT could be considered as a treatment option for cases that present with noma accompanied by septic shock.

Core competencies for nurses in Chinese intensive care units: a cross-sectional study.

BACKGROUND: Core competencies of intensive care unit (ICU) nurses were defined as the essential capability to influence patient safety and interdisciplinary collaboration; however, there has been no research conducted that relates to core competencies of ICU nurses at Chinese tertiary-A hospitals in Shanghai. AIMS AND OBJECTIVES: To investigate the current state of core competencies and the factors that influence this key capability in ICU nurses in Chinese tertiary-A hospitals. DESIGN: This was a multicentre, cross-sectional study. METHODS: A convenient sampling method was used to investigate 451 ICU nurses at five tertiary-A hospitals in Shanghai. Data were collected using self-administered questionnaires. RESULTS: The core competencies of ICU nurses were above average, and the scores of seven dimensions, ranked from first to last, were medical ethics, clinical practice, nurse-nurse co-operation, assessment and decision-making, personal and professional development, teaching and research and nurse-physician co-operation. Multivariate linear regression analysis showed that the factors exerting an influence on the core competencies of ICU nurses were title, role incumbent and ICU department. CONCLUSION: This study showed an above-average level of core competencies among ICU nurses in tertiary-A hospitals in Shanghai; however, competencies related to nurse-physician co-operation and the translation of research into practice were underdeveloped. RELEVANCE TO CLINICAL PRACTICE: Nursing managers should implement targeted interventions to improve nurse-physician co-operation and translate research into practice competencies, such as high-fidelity simulation, inter-professional education, scientific research training and innovative skills tutorials. Moreover, this study demonstrated the influencing factors that can be used to improve core competences of ICU nurses.