The effects of a standardized nursing intervention model on immobile patients with stroke: a multicenter study in China

2023 Guideline for the Management of Patients With Aneurysmal Subarachnoid Hemorrhage: A Guideline From the American Heart Association/American Stroke Association

AIM

The "2023 Guideline for the Management of Patients With Aneurysmal Subarachnoid Hemorrhage" replaces the 2012 "Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage." The 2023 guideline is intended to provide patient-centric recommendations for clinicians to prevent, diagnose, and manage patients with aneurysmal subarachnoid hemorrhage.

METHODS

A comprehensive search for literature published since the 2012 guideline, derived from research principally involving human subjects, published in English, and indexed in MEDLINE, PubMed, Cochrane Library, and other selected databases relevant to this guideline, was conducted between March 2022 and June 2022. In addition, the guideline writing group reviewed documents on related subject matter previously published by the American Heart Association. Newer studies published between July 2022 and November 2022 that affected recommendation content, Class of Recommendation, or Level of Evidence were included if appropriate. Structure: Aneurysmal subarachnoid hemorrhage is a significant global public health threat and a severely morbid and often deadly condition. The 2023 aneurysmal subarachnoid hemorrhage guideline provides recommendations based on current evidence for the treatment of these patients. The recommendations present an evidence-based approach to preventing, diagnosing, and managing patients with aneurysmal subarachnoid hemorrhage, with the intent to improve quality of care and align with patients' and their families' and caregivers' interests. Many recommendations from the previous aneurysmal subarachnoid hemorrhage guidelines have been updated with new evidence, and new recommendations have been created when supported by published data.

Clinical Promotion of Comfort Nursing Combined with Comprehensive Nursing in the Treatment of Severe Stroke Patients with Diabetes in ICU

Objective

To investigate the application value of comprehensive nursing combined with comfort nursing for severe stroke patients with diabetes in the intensive care unit (ICU), as well as its effect on the incidence of pressure ulcers and aspiration.

Methods

Between March 2019 and March 2021, 123 severe stroke patients with diabetes who were treated at our hospital were randomly assigned to one of two groups: the control group (n = 61) or the study group (n = 62). The control group received normal care, but the research group received comprehensive nursing as well as comfort nursing. The two patient groups were compared in terms of the effects of the clinical application.

Results

The two groups did not differ significantly in general data (P > 0.05). The shorter ICU monitoring and extubation times, the lower incidence of pressure ulcers, aspiration, and nosocomial infections, and higher self-rating anxiety scale (SAS) and self-rating depression scale (SDS) scores and a lower MOS 36-item short-form health survey (SF-36) score were all observed in the research group when compared to the control group (P < 0.05).

Conclusion

For severe stroke patients with diabetes in the ICU, comprehensive nursing combined with comfort nursing has a promising effect, significantly, lowering the risk of pressure ulcers, aspiration, and nosocomial infections, accelerating physical recovery, enhancing mental state, and ensuring a better prognosis, deserving general clinical promotion.

Effect of Nursing Outcome-Oriented Intervention on Airway Management in Elderly Long-Term Bedridden Patients

Objective

This study intended to explore the nursing outcome-oriented intervention's effect on airway management in elderly long-term bedridden patients.

Methods

A total of 120 cases of elderly long-term bedridden patients admitted to our hospital from May 2018 to June 2020 were enrolled and randomly divided into the observation group (n = 60) and control group (n = 60). The control group received the routine nursing intervention, while the observation group received the nursing outcome-oriented intervention. Forced expiratory volume (FEV1), forced vital capacity (FVC), and maximal voluntary ventilation (MVV) in the first second were compared between the two groups before and after the intervention. The pulmonary infection of the two groups was observed. Total protein, hemoglobin, albumin, and cholesterol levels were compared between the two groups. Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD) were used to evaluate the two groups' psychological status before and after the intervention. The Generic Quality of Life Inventory-74 (GQOLI-74) assessed the two groups' quality of life.

Results

After the intervention, the levels of FEV1, FVC, and MVV; total protein, hemoglobin, albumin, and cholesterol; and scores of physical function, psychological function, social function, and material life function in the observation group were higher than those in the control group. Pulmonary infection, secondary infection, the infection rate is more than 3%, HAMA, and HAMD scores, and the incidence of pressure ulcers, aspiration, constipation, and the falling bed was lower than those in the control group, with statistical significance (all P < 0.05).

Conclusion

Nursing outcome-oriented intervention can effectively improve lung function, pulmonary infection, nutritional status, negative mood, and quality of life of long-term bedridden elderly patients.

Length of Stay, Hospital Costs and Mortality Associated With Comorbidity According to the Charlson Comorbidity Index in Immobile Patients After Ischemic Stroke in China: A National Study

BACKGROUND

In this study, we examined the length of stay (LoS)-predictive comorbidities, hospital costs-predictive comorbidities, and mortality-predictive comorbidities in immobile ischemic stroke (IS) patients; second, we used the Charlson Comorbidity Index (CCI) to assess the association between comorbidity and the LoS and hospitalization costs of stroke; third, we assessed the magnitude of excess IS mortality related to comorbidities.

METHODS

Between November 2015 and July 2017, 5114 patients hospitalized for IS in 25 general hospitals from six provinces in eastern, western, and central China were evaluated. LoS was the period from the date of admission to the date of discharge or date of death. Costs were collected from the hospital information system (HIS) after the enrolled patients were discharged or died in hospital. The HIS belongs to the hospital's financial system, which records all the expenses of the patient during the hospital stay. Cause of death was recorded in the HIS for 90 days after admission regardless of whether death occurred before or after discharge. Using the CCI, a comorbidity index was categorized as zero, one, two, and three or more CCI diseases. A generalized linear model with a gamma distribution and a log link was used to assess the association of LoS and hospital costs with the comorbidity index. Kaplan-Meier survival curves was used to examine overall survival rates.

RESULTS

We found that 55.2% of IS patients had a comorbidity. Prevalence of peripheral vascular disease (21.7%) and diabetes without end-organ damage (18.8%) were the major comorbidities. A high CCI=3+ score was an effective predictor of a high risk of longer LoS and death compared with a low CCI score; and CCI=2 score and CCI=3+ score were efficient predictors of a high risk of elevated hospital costs. Specifically, the most notable LoS-specific comorbidities, and cost-specific comorbidities was dementia, while the most notable mortality-specific comorbidities was moderate or severe renal disease.

CONCLUSION

CCI has significant predictive value for clinical outcomes in IS. Due to population aging, the CCI should be used to identify, monitor and manage chronic comorbidities among immobile IS populations.

Effect of the Age-Adjusted Charlson Comorbidity Index on All-Cause Mortality and Readmission in Older Surgical Patients: A National Multicenter, Prospective Cohort Study

Background

Identifying a high-risk group of older people before surgical procedures is very important. The study aimed to explore the association between the age-adjusted Charlson comorbidity index (ACCI) and all-cause mortality and readmission among older Chinese surgical patients (age ≥65 years).

Methods

A large-scale cohort study was performed in 25 general public hospitals from six different geographic regions of China. Trained registered nurses gathered data on clinical and sociodemographic characteristics. All-cause mortality was recorded when patients died during hospitalization or during the 90-day follow-up period. Readmission was also tracked from hospital discharge to the 90-day follow-up. The ACCI, in assessing comorbidities, was categorized into two groups (≥5 vs. &lt;5). A multiple regression model was used to examine the association between the ACCI and all-cause mortality and readmission.

Results

There were 3,911 older surgical patients (mean = 72.46, SD = 6.22) in our study, with 1,934 (49.45%) males. The average ACCI score was 4.77 (SD = 1.99), and all-cause mortality was 2.51% (high ACCI = 5.06% vs. low ACCI = 0.66%, P &lt; 0.001). After controlling for all potential confounders, the ACCI score was an independent risk factor for 90-day hospital readmission (OR = 1.18, 95% CI: 1.14, 1.23) and 90-day all-cause mortality (OR = 1.26, 95% CI: 1.16–1.36). Furthermore, older surgical patients with a high ACCI (≥5) had an increased risk of all-cause mortality (OR = 6.13, 95% CI: 3.17, 11.85) and readmission (OR = 2.13, 95% CI: 1.78, 2.56) compared to those with a low ACCI (&lt;5). The discrimination performance of the ACCI was moderate for mortality (AUC:0.758, 95% CI: 0.715–0.80; specificity = 0.591, sensitivity = 0.846) but poor for readmission (AUC: 0.627, 95% CI: 0.605–0.648; specificity = 0.620; sensitivity = 0.590).

Conclusions

The ACCI is an independent risk factor for all-cause mortality and hospital readmission among older Chinese surgical patients and could be a potential risk assessment tool to stratify high-risk older patients for surgical procedures.

Effect of Nursing Intervention on Coronary CT Angiography in Elderly Patients

To investigate the clinical benefits of coronary CT angiography in older adults. The results of this trial were 110 patients who underwent CT angiography (selected from 20 March 2016 to 20 March 2017). Use computer group mode. The control group received health care, including 50 patients, and the control group received usual care, including 60 patients. Then, the best and best image quality, time-consuming analysis, and satisfaction were compared between the two groups. The experimental results showed that the best and best image quality (83.00%), examination time (5.72 ± 1.81) minutes, and patient satisfaction (100.00%) of the experimental group were better than those of the control group (P < 0.05). Targeted healthcare for patients undergoing coronary CT angiography can improve the patient's ability to receive a diagnosis with a consistent attitude, reduce work hours, reduce adverse factors, and improve patient satisfaction with care.

Nutritional Status According to the Short-Form Mini Nutritional Assessment (MNA-SF) and Clinical Characteristics as Predictors of Length of Stay, Mortality, and Readmissions Among Older Inpatients in China: A National Study

Background

Studies are scarce in China that explore the association of nutritional status, measured using the Short-Form Mini Nutritional Assessment (MNA-SF) and biochemical data, on adverse clinical outcomes among older inpatients. In this study, we aimed to determine the prevalence of malnutrition in tertiary hospitals of China and the associations between malnutrition and adverse clinical outcomes.

Methods

This prospective study involved 5,516 older inpatients (mean age 72.47 ± 5.77 years) hospitalized in tertiary hospitals between October 2018 and February 2019. The tertiary hospitals refer to the hospital with more than 500 beds and can provide complex medical care services. The MNA-SF was used to assess nutritional status. Multiple logistic regression and negative binomial regression were used to analyze the relationship between nutritional parameters and risk of hospital length of stay (LoS), mortality, and rehospitalization.

Results

We found that 46.19% of hospitalized patients had malnutrition or malnutrition risk, according to the MNA-SF. Death occurred in 3.45% of patients. MNA-SF scores 0–7 (odds ratio [OR] 5.738, 95% confidence interval [CI] 3.473 to 9.48) were associated with a six-fold higher likelihood of death, and scores 8–11 (OR 3.283, 95% CI 2.126–5.069) with a three-fold higher likelihood of death, compared with MNA-SF scores 12–14 in the logistic regression model, after adjusting for potential confounders. A low MNA-SF score of 0–7 (regression coefficient 0.2807, 95% CI 0.0294–0.5320; P < 0.05) and a score of 8–11 (0.2574, 95% CI 0.0863–0.4285; P < 0.01) was associated with a significantly higher (28.07 and 25.74%, respectively) likelihood of increased LoS, compared with MNA-SF score 12–14. MNA-SF scores 0–7 (OR 1.393, 95% CI 1.052–1.843) and 8–11 (OR 1.356, 95% CI 1.124–1.636) were associated with a nearly 1.5-fold higher likelihood of 90-day readmission compared with MNA-SF scores 12–14 in the logistic regression model. Moreover, hemoglobin level, female sex, education level, former smoking, BMI 24–27.9 kg/m², age 75 years and above, and current alcohol consumption were the main factors influencing clinical outcomes in this population.

Conclusions

Malnutrition increases the risk of hospital LoS, mortality, and 90-day readmission. The use of nutritional assessment tools in all hospitalized patients in China is needed. The MNA-SF combined with hemoglobin level may be used to identify older inpatients with a high risk of adverse clinical outcomes. These findings may have important implications for the planning of hospital services.

Prediction of Poststroke Urinary Tract Infection Risk in Immobile Patients Using Machine Learning: a observational cohort study

BACKGROUND

Urinary tract infection (UTI) is one of major nosocomial infections significantly affecting the outcomes of immobile stroke patients. Previous studies have identified several risk factors, but it's still challenging to accurately estimate personal UTI risk.

OBJECTIVES

We aimed to develop predictive models for UTI risk identification for immobile stroke patients.

METHODS

Research data were collected from our previous multi-centre study. Derivation cohort included 3982 immobile stroke patients collected from November 1, 2015 to June 30, 2016; external validation cohort included 3837 patients collected from November 1, 2016 to July 30, 2017. 6 machine learning models and an ensemble learning model were derived based on 80% of derivation cohort and effectiveness was evaluated with the remaining 20%. We used Shapley additive explanation values to determine feature importance and examine the clinical significance of prediction models.

RESULTS

2.59% (103/3982) patients were diagnosed with UTI in derivation cohort, 1.38% (53/3837) in external cohort. The ensemble learning model performed the best in area under the receiver operating characteristic (ROC) curve in internal validation (82.2%); second best in external validation (80.8%). In addition, the ensemble learning model performed the best sensitivity in both internal and external validation sets (80.9% and 81.1%, respectively). We also identified seven UTI risk factors (pneumonia, glucocorticoid use, female sex, mixed cerebrovascular disease, increased age, prolonged length of stay, and duration of catheterization).

CONCLUSIONS

Our ensemble learning model demonstrated promising performance. Future work should continue to develop a more concise scoring tool based on machine learning models and prospectively examining the model in practical use, thus improving clinical outcomes.

Nutritional Risk, Health Outcomes, and Hospital Costs Among Chinese Immobile Older Inpatients: A National Study

Purpose: Evidence of the impact of nutritional risk on health outcomes and hospital costs among Chinese older inpatients is limited. Relatively few studies have investigated the association between clinical and cost outcomes and nutritional risk in immobile older inpatients, particularly those with neoplasms, injury, digestive, cardiac, and respiratory conditions.

Methods: This China-wide prospective observational cohort study comprised 5,386 immobile older inpatients hospitalized at 25 hospitals. All patients were screened for nutritional risk using the Nutrition Risk Screening (NRS 2002). A descriptive analysis of baseline variables was followed by multivariate analysis (Cox proportional hazards models and generalized linear model) to compare the health and economic outcomes, namely, mortality, length of hospital stay (LoS), and hospital costs associated with a positive NRS 2002 result.

Results: The prevalence of a positive NRS 2002 result was 65.3% (n = 3,517). The prevalence of “at-risk” patients (NRS 2002 scores of 3+) was highest in patients with cardiac conditions (31.5%) and lowest in patients with diseases of the respiratory system (6.9%). Controlling for sex, age, education, type of insurance, smoking status, the main diagnosed disease, and Charlson comorbidity index (CCI), the multivariate analysis showed that the NRS 2002 score = 3 [hazard ratio (HR): 1.376, 95% CI: 1.031–1.836] were associated with approximately a 1.5-fold higher likelihood of death. NRS 2002 scores = 4 (HR: 1.982, 95% CI: 1.491–2.633) and NRS scores ≥ 5 (HR: 1.982, 95% CI: 1.498–2.622) were associated with a 2-fold higher likelihood of death, compared with NRS 2002 scores <3. An NRS 2002 score of 3 (percentage change: 16.4, 95% CI: 9.6–23.6), score of 4 (32.4, 95% CI: 24–41.4), and scores of ≥ 5 (36.8, 95% CI 28.3–45.8) were associated with a significantly (16.4, 32.4, and 36.8%, respectively) higher likelihood of increased LoS compared with an NRS 2002 scores <3. The NRS 2002 score = 3 group (17.8, 95% CI: 8.6–27.7) was associated with a 17.8%, the NRS 2002 score = 4 group (31.1, 95% CI: 19.8–43.5) a 31.1%, and the NRS 2002 score ≥ 5 group (44.3, 95% CI: 32.3–57.4) a 44.3%, higher likelihood of increased hospital costs compared with a NRS 2002 scores <3 group. Specifically, the most notable mortality-specific comorbidity and LoS-specific comorbidity was injury, while the most notable cost-specific comorbidity was diseases of the digestive system.

Conclusions: This study demonstrated the high burden of undernutrition at the time of hospital admission on the health and hospital cost outcomes for older immobile inpatients. These findings underscore the need for nutritional risk screening in all Chinese hospitalized patients, and improved diagnosis, treatment, and nutritional support to improve immobile patient outcomes and to reduce healthcare costs.

Remote Diagnosis System of Uremia Complicated with Sleep Disorder and Effectiveness of Nursing Intervention

This study aimed to analyze the related factors and remote diagnosis of sleep disorders in patients with uremia and to provide the basis for clinical intervention measures. The Pittsburgh Sleep Quality Index (PSQI) was used to evaluate the sleep quality of 100 patients with uremia. The experimental results show that among 100 patients with uremia, 83 patients (83%) were complicated with sleep disorder, and the average PSQI score was (10.73 ± 1.36). The PSQI score was significantly higher in the elderly, patients with long duration of dialysis, patients with elevated CRP, patients with substandard anemia, and patients with substandard calcium and phosphorus, with statistical significance (P < 0.05). The sleep quality of patients with uremia is correlated with depression, age, and penetration age. The worse the sleep quality is, the more severe the depression is. It proved that the sleep quality of dialysis patients is an important factor. Conclusion. Sleep disorder is a common complication in patients with uremia. Age, anemia, calcium and phosphorus abnormality, permeation age, and inflammatory status are important factors affecting sleep quality in dialysis patients.

Nurses' Awareness and Actual Nursing Practice Situation of Stroke Care in Acute Stroke Units: A Japanese Cross-Sectional Web-Based Questionnaire Survey

The awareness of care provided by stroke care unit (SCU) nurses in Japan to patients with an acute cerebrovascular accident (CVA) and the characteristic differences in their actual nursing practice were evaluated. A cross-sectional web-based questionnaire survey was administered to 1040 SCU nurses. Data collection and reporting procedures followed the STROBE Statement Checklist for cross-sectional studies. Exploratory factor analysis, using 52 observation items, identified eight factors with a factor loading > 0.4. For all factors, the actual practice was significantly lower than the awareness of the importance of nursing care for patients with acute CVA. Awareness and actual practice of recognition of patients' physical changes (RPPCs) were high. The actual practice of RPPCs and preventing the worsening of acute stroke and related symptoms varied, depending on years of experience in acute phase stroke care. RPPCs in actual practice had a significantly higher score among certified nurses or certified nurse specialists. Their awareness of the importance of collaborating with therapists was low. On-the-job training can improve nurses' competence and prevent worsening conditions in patients with CVA. An emphasis on enhancing practice experience toward patients with acute CVA and facilitating the deployment of certified nurses in SCUs can improve nursing care practice.

An early predictive model of frailty for older inpatients according to nutritional risk: protocol for a cohort study in China

BACKGROUND

Previous reports suggest that the attributes of frailty are multidimensional and include nutrition, cognition, mentality, and other aspects. We aim to develop an early warning model of frailty based on nutritional risk screening and apply the frailty early warning model in the clinic to screen high-risk patients and provide corresponding intervention target information.

METHODS

The proposed study includes two stages. In the first stage, we aim to develop a prediction model of frailty among older inpatients with nutritional risk. Study data were collected from a population-based aging cohort study in China. A prospective cohort study design will be used in the second stage of the study. We will recruit 266 older inpatients (age 65 years or older) with nutritional risk, and we will apply the frailty model in the clinic to explore the predictive ability of the model in participants, assess patients' health outcomes with implementation of the frailty model, and compare the model with existing frailty assessment tools. Patients' health outcomes will be measured at admission and at 30-day follow-up.

DISCUSSION

This project is the first to develop an early prediction model of frailty for older inpatients according to nutritional risk in a nationally representative sample of Chinese older inpatients of tertiary hospitals. The results will hopefully help to promote the development of more detailed frailty assessment tools according to nutritional risk, which may ultimately lead to reduced health care costs and improvement in independence and quality of life among geriatric patients.

TRIAL REGISTRATION

Chinese Clinical Trial Registry, ChiCTR1800017682 , registered August 9, 2018; and ChiCTR2100044148 , registered March 11, 2021.

Propensity weighting: how to minimise comparative bias in non-randomised studies?

Non-randomised study designs are frequently used by researchers in cardiovascular nursing and allied professions. Baseline differences between the groups to be compared may introduce bias in the results. Methods for causal inference address this issue. One such method is propensity weighting, in which two or more treatments/exposure groups are weighted to make the groups as comparable as possible. As such, it mimics a randomised controlled trial design. In this article, the Twang package is presented for propensity weighting, and its use is exemplified in a study on smoking and cannabis consumption in adults with congenital heart disease.

Chinese orthopaedic nurses' knowledge, attitude and venous thromboembolic prophylactic practices: A multicentric cross-sectional survey

BACKGROUND

Venous thromboembolism is a severe preventable complication among orthopaedic surgical patients. Integrating therapeutic guidelines into clinical practice can help improve patient safety and reduce the burden of this pathology. Improving the quality of patient care is important for bridging the gap between the prophylaxis for venous thromboembolism and therapeutic guidelines.

OBJECTIVES

This study aimed at evaluating the knowledge, attitude, and venous thromboembolism and prophylaxis practices of Chinese orthopaedic nurses to guide quality care improvements.

METHODS

The data used in this study are secondary data obtained from a multicentric survey. An anonymous questionnaire was used to measure the attitude and knowledge of venous thromboembolic prophylaxis among orthopaedic nurses. VTE prophylactic practices were extracted from medical records within the electronic case report form immediately after the nurses' investigations. The STROBE statement for observational studies was applied.

RESULTS

Results indicated that although 94.0% of the responding nurses had attended training courses in their wards, a majority of them (68.9%) achieved a median knowledge score of 7 points or below (range 0-9). Knowledge regarding the proper use of prophylaxis, identification of risk factors, signs and symptoms for pulmonary embolism was limited. Self-reported attitudes underestimate the relationships between venous thromboembolism and low-quality nursing care. Pharmacological prophylaxis was highly used (90.9%), while the utilisation of mechanical prophylaxis and its proper use was relatively low.

CONCLUSIONS

Chinese orthopaedic nurses demonstrated enthusiasm for venous thromboembolism and prophylaxis. Their knowledge needs to be improved, including the proper use of prophylaxis, identification of risk factors, signs and symptoms. Mechanical prophylaxis practice for VTE prevention after THA and TKA surgical procedures is not optimistic. Further studies should analyse the causes from multiple perspectives, including the availability of resources, the knowledge and attitude of doctors, nurses and patients.

RELEVANCE TO CLINICAL PRACTICE

The findings from this study can be used to develop and implement interventions for venous thromboembolism after orthopaedic surgery.

Hospitalization costs among immobile patients with hemorrhagic or ischemic stroke in China: a multicenter cross-sectional study

Background

In this study, we aimed to analyze the hospitalization costs for immobile patients with hemorrhagic stroke (IHS) or ischemic stroke (IIS) in China and to determine the factors associated with hospitalization costs.

Methods

We evaluated patients with IHS and IIS hospitalized between November 2015 and July 2016 in six provinces or municipality cities of China. Linear regression analysis was used to examine the association with hospitalization costs and predictors.

Results

In total, 1573 patients with IHS and 3143 with IIS were enrolled and analyzed. For IHS and IIS, the average length of stay (LoS) was 17.40 ± 12.3 and 14.47 ± 11.55 days. The duration of immobility was 12.11 ± 9.98 and 7.36 ± 9.77 days, respectively. Median hospitalization costs were RMB 47000.68 (interquartile range 19,827.37, 91,877.09) for IHS and RMB 16578.44 (IQR 7020.13, 36,357.65) for IIS. In both IHS and IIS groups, medicine fees accounted for more than one-third of hospitalization costs. Materials fees and medical service fees accounted for the second and third largest proportions of hospital charges in both groups. Linear regression analysis showed that LoS, hospital level, and previous surgery were key determinants of hospitalization costs in all immobile patients with stroke. Subgroup analysis indicated that hospital level was highly correlated with hospitalization costs for IHS whereas pneumonia and deep vein thrombosis were key factors associated with hospitalization costs for IIS.

Conclusions

We found that hospitalization costs were notably higher in IHS than IIS, and medicine fees accounted for the largest proportion of hospitalization costs in both patient groups, perhaps because most patients ended up with complications such as pneumonia thereby requiring more medications. LoS and hospital level may greatly affect hospitalization costs. Increasing the reimbursement ratio of medical insurance for patients with IHS is recommended. Decreasing medicine fees and LoS, preventing complications, and improving treatment capability may help to reduce the economic burden of stroke in China.

Potential associated factors of functional disability in Chinese older inpatients: a multicenter cross-sectional study

BACKGROUND

There is still controversy about the relationship between aging and changes in functional ability. This study aims to describe the level of basic activities of daily living (ADL) and higher-level instrumental activities of daily living (IADL) in different age groups and explore the factors associated with functional disability in Chinese older inpatients.

METHODS

This cross-sectional study surveyed 9996 older inpatients aged 65 years and older from six tertiary hospitals in China from October 2018 to February 2019. The levels of ADL and IADL were measured by scores of the Barthel index and Instrumental Activities of Daily Living Scale. A mixed-effect generalized linear model was used to examine the association between functional disability and covariates.

RESULTS

The average ADL score was 89.51 ± 19.29 and the mean IADL score 6.76 ± 2.01 for all participants. There was a trend of decreasing scores along with aging, and significant differences between age groups were also observed (P < 0.001). The most affected ADL and IADL was stair climbing and shopping, respectively. Sociodemographic characteristics (such as age), physical health variables (frailty, emaciation, hearing dysfunction, urinary dysfunction, defecation dysfunction, falling accidents in the past 12 months), and mental health variables (cognitive dysfunction, depression) were associated with functional disability. Patients from the emergency department or transferred from other hospitals and former alcohol drinkers are at risk of ADL disability. Former smoking is a risk factor for IADL disability, whereas current drinking, higher-level education, and residing in a building without elevators were likely to maintain a better IADL performance.

CONCLUSIONS

Functional ability declines with aging, older inpatients are low dependency upon ADL and IADL. There are several associated factors among the participants derived from this investigation of a large-scale, multicenter, nationally representative Chinese older inpatient population. These findings potentially have major importance for the planning of hospital services, discharge planning, and post-discharge care.

TRIAL REGISTRATION

Chinese Clinical Trial Registry, ChiCTR1800017682 , registered August 9, 2018.

Cost-effectiveness of an intervention to improve the quality of nursing care among immobile patients with stroke in China: A multicenter study

BACKGROUND

While a nursing intervention program for immobile patients with stroke can improve clinic outcomes, less is known about the cost-effectiveness of these interventions.

OBJECTIVES

The goal of this study was to evaluate the cost-effectiveness of the intervention program for immobile patients with stroke in China.

DESIGN

A cost-effectiveness analysis alongside a pre-test/post-test (before and after) study was undertaken from a health care perspective.

SETTINGS

Participants were recruited from 25 hospitals among six provinces or municipal cities in eastern (Guangdong province, Zhejiang province, and Beijing municipal city), western (Sichuan province), and central (Henan province and Hubei province) China.

PARTICIPANTS

A total of 7,653 immobile stroke patients were included in our sample. Patients in routine care settings were recruited from November 2015 to June 2016, and the recruitment of the intervention group patients was from November 2016 to July 2017.

METHODS

To adjust for potential bias from confounding variables, the 1:1 propensity score matching yielded matched pairs of 2,966 patients in the routine care group and 2,966 patients in the intervention group, with no significant differences in sociodemographic or clinical characteristics between two groups. All patients were followed-up 3 months after enrolment in the study. Total healthcare costs were extracted from the hospital information system, with the health outcome effectiveness of the intervention program measured using the EuroQol five-dimensional questionnaire (EQ-5D) instrument and the cost-effectiveness of the intervention measured by the incremental cost-effectiveness ratio with a time horizon of 3 months.

RESULTS

Compared to routine care, the intervention program decreased the total costs of stroke patients by CN¥4,600 (95% confidence interval [CI]: [-7050, -2151]), while increasing quality-adjusted life year 0.009 (95% CI: [0.005, 0.013]). The incremental cost-effectiveness ratios over 3 months was CN¥-517,011 per quality-adjusted life year (95% CI: [-1,111,442, -203,912]). Subgroup analysis reveals that both the health-related quality of life and cost effectiveness improved significantly for ischemic patients and tertiary hospitals patients while for hemorrhagic patients and non-tertiary hospital patients only the health-related quality of life improved significantly.

CONCLUSIONS

Findings from this first cost-effectiveness analysis in immobile stroke patients provide evidence that an intervention program provided significant cost saving, but mainly in ischemic patients and tertiary hospital patients. Wider adoption of such programs may be a sensible approach to reducing the burden of stroke and for immobile patients more generally.

Effect of Comorbidity Assessed by the Charlson Comorbidity Index on the Length of Stay and Mortality Among Immobile Hemorrhagic Stroke Patients Younger Than 50 Years

Objective: The burden of comorbidity among young patients with hemorrhagic stroke is high. This study examines the effect of comorbidity on the length of stay (LoS) and mortality among immobile hemorrhagic stroke patients younger than 50 years.

Materials and Methods: A retrospective post-hoc analysis study design was used. A total of 767 younger adults (mean age 41.64 ± 8.16 years) hospitalized for hemorrhagic stroke between November 2015 and July 2017 were evaluated. All-cause mortality was recorded for 90 days after admission regardless of whether death occurred before or after discharge. Comorbidity was assessed using the Charlson Comorbidity Index (CCI), categorized as low (0–1) and high (≥2). A multiple linear regression model was applied to examine the association between CCI and LoS. Survival was evaluated with Kaplan–Meier and Cox regression analyses.

Results: The mean CCI of all patients was 1.25 (SD ± 0.79) and median was 1.0 (IQR 1, 1). The average LoS for patients with a low CCI was 17.73 (± 11.59) days compared with 19.49 (± 15.21) days in those with a high CCI (p = 0.142). The mortality rate was 6.0% (12.10% for high CCI vs. 4.82% for low CCI, p = 0.002). After controlling for confounders, high CCI was not associated with longer LoS (regression coefficient 0.825, 95% CI −1.155 to 2.805; p = 0.413), whereas high CCI was associated with greater likelihood of death than a low CCI (hazard ratio 3.417, 95% CI 1.626 to 7.180; p = 0.001).

Conclusions: High global comorbidity was associated with increased short-term mortality but not with LoS. Measures to manage comorbidities aimed at reducing negative clinical impacts of stroke among younger adults are warranted.