Management of Vertebral Fragility Fracture in Older People: Recommendations from a Spanish Consensus of Experts

Vertebral fragility fractures (VFF) pose a challenge for appropriate care. The aim of this study was to develop consensus recommendations for the management of VFF in older people from a multidisciplinary approach. Specialists in osteoporosis belonging to different scientific societies reviewed the main clinical practice guidelines published in Spain in 2014. Thirty-five recommendations for the management of VFF were evaluated by seven experts using an anonymous survey. Consensus was defined as 80% of responses of 8 (agree) and 9 (strongly agree) on a Likert scale. Consensus was achieved in 22 recommendations (62.8%). The experts agreed on the need for anamnesis, clinical assessment, and laboratory tests, including erythrocyte sedimentation rate, proteinography, and the assessment of levels of calcium, vitamin D, alkaline phosphatase, and thyroid-stimulating hormone. Optional tests, such as bone turnover markers (BTMs), magnetic resonance imaging, bone scintigraphy, or using a fracture risk assessment tool (FRAX®), did not achieve an agreed consensus. Also, there was consensus regarding the administration of calcium/vitamin D supplements, the withdrawal of toxic habits, and personalized physical exercise. Participants agreed on the administration of teriparatide for 24 months and then a switch to denosumab or bisphosphonates in patients at high risk of fracture. Specialists in osteoporosis, primary care physicians, and geriatricians should be involved in the follow-up of patients with VFF. Although there was multidisciplinary agreement on diagnostic tests and non-pharmacological and pharmacological treatment in frail older people, therapeutic objectives should be individualized for every patient. In addition to the specific recommendations, close collaboration between the geriatrician and the primary care physician is essential for the optimal chronic management of frail patients with fragility fractures.

Comprehensive, continuous, and compulsory monitoring of frailty in elderly

Background

The increasing elderly population makes frailty an increasing concern in society with vulnerability to stress and functional decline. Unrecognised comorbidities are common among the elderly due to lack of mention by the patients. Physicians should be equipped with effective interviewing skills along with the use of screening tools to assess any impairments in activities of daily living, cognition and signs of depression.

Objectives

To measure the degree of independence or dependence using scales and stratify patients based on Clinical Frailty Scale (CFS) so as to recommend it as a routinely usable tool.

Materials and Methods

In total, 191 elderly subjects above the age of 65 years were recruited for geriatric assessment. Tools that assess performance in daily living activities and cognition were used. The prevalidated CFS was used to score frailty to stratify patients into frail and non-frail groups, and the parameters were compared.

Results

Mean age of the study population was 69.54 years with 53.4% males and 46.6% females. Mean Katz index and mean Lawton score were >5. The mean Global Deterioration Scale (GDS) score was 1.5, and the mean clinical frailty score was 3.55. Significantly high number of male individuals were found in the frailty group. Hypertension was significantly higher in the frail group. The mean Katz scores were significantly lower, and mean GDS scores were significantly higher in the frailty group. Multivariable logistic regression has shown gender to be an important determinant of frailty with an odds ratio of 0.05 (CI-0.01-0.20). The higher Lawton score and GDS scores were significantly associated with frailty with an odds ratio of 0.33 (CI: 0.21-0.52) and 2.62 (CI: 1.14-6.02), respectively.

Conclusion

Men are more frail than women and co-morbidities like hypertension and coronary artery disease contribute to frailty with cognitive decline and decreased autonomy. A comprehensive assessment to identify frailty will provide a holistic view of well being among the elderly.

[Analysis and Research on Comprehensive Evaluation Method of Operation Performance of Hospital Valuable Equipment]

OBJECTIVE

To study the effective method of comprehensive evaluation and analysis of hospital valuable medical equipment performance.

METHODS

The operation performance of 6 valuable equipment was evaluated by cost-benefit method, comprehensive index method and public evaluation method.

RESULTS

Utilize equipment information management methods for data collection and evaluation, and construct an assessment data model based on evaluation indicators from three aspects: equipment operation status, profitability status, and scientific research contribution.

CONCLUSIONS

Through the performance analysis of different types of valuable medical equipment, a more real and comprehensive quantitative analysis is carried out, which plays a key role in the reasonable purchase, efficient operation and avoiding idling.

[Translocation, Accumulation, and Comprehensive Risk Assessment of Heavy Metals in Soil-Crop Systems in an Old Industrial City, Shizuishan, Ningxia, Northwest China]

In order to explore the environmental geochemistry characteristics of heavy metals (HMs) in soil-crop systems in an old industrial city, the concentration and fraction of HMs in the paddy, wheat, and maize root soil and their seeds were detected and analyzed. Subsequently, statistical methods, risk assessment coding (RAC), the bio-enrichment coefficient factor (BCF), influence index of comprehensive quality (IICQ), and ArcGIS spatial interpolation were used to conduct the translocation, accumulation, and comprehensive risk assessment of HMs in soil-crop systems. The results showed that the average concentrations of As, Cd, Cr, Cu, Hg, Ni, Pb, and Zn in root soil were ranked respectively as follows:12.56, 0.19, 63.48, 23.52, 0.038, 28.86, 21.68, and 69.47 mg·kg-1. HMs in root soil were accumulated to some extent in comparison with the soil background value in Ningxia, especially Cd and Hg, but did not exceed the soil environmental pollution screening value (GB 14618-2018). The average concentrations of the eight aforementioned elements in supporting crop seeds were 0.0149, 0.0112, 0.075, 6.7, 0.0015, 0.67, 0.0427, and 20.48 mg·kg-1 in turn. The over-limit ratio of As, Pb, and Cr in crop seeds was 4%, 3%, and 1%, respectively, relative to the national food safety standards (GB 2762-2017), whereas the other five elements were within the allowable range. In comparison to those in paddy and wheat, HMs hardly tended to translocate to maize seeds from root soil. According to the results of IICQ in soil-crop systems, the cultivated soil was in the state of slight sub-contamination regionally, and only 10% of sampling points showed slight (sub-)contamination-submoderate contamination, where we could replant maize to reduce HMs contamination risk.

Aortic Dissection and Hypotension Without Cardiac Tamponade: A Case Report

Ascending aortic dissection is typically characterized by severe chest or back pain. However, its presentation can be atypical, leading to diagnostic challenges, especially in settings where classic symptomatology may not be evident. In this report, we described the case of a 74-year-old woman who presented to the emergency room of a rural community hospital with chief complaints of vertigo, nausea, and vomiting, without the classic symptoms of chest or back pain associated with aortic dissection. Despite initial treatment for autonomic dysregulation, the patient's symptoms persisted. Subsequent comprehensive assessments, including computed tomography angiography, revealed an ascending aortic dissection extending to the bilateral common carotid arteries. This atypical presentation, characterized by cerebral hypoperfusion and systemic hypotension without tachycardia, emphasizes the need to maintain a high suspicion index, even in the absence of hallmark symptoms. This case underscores the importance of considering the possibility of ascending aortic dissection in patients with nontraditional symptoms. Recognizing these atypical presentations is crucial for timely intervention, especially in rural settings with limited advanced diagnostic tools. This case also highlights potential sex disparities in symptom presentation, emphasizing the need for clinicians to recognize nontraditional symptoms in women. Rapid identification, evaluation, and management are imperative to prevent severe outcomes, and a multidisciplinary approach has proven to be the most effective in such cases.

ANPELA: Significantly Enhanced Quantification Tool for Cytometry-Based Single-Cell Proteomics

ANPELA is widely used for quantifying traditional bulk proteomic data. Recently, there is a clear shift from bulk proteomics to the single-cell ones (SCP), for which powerful cytometry techniques demonstrate the fantastic capacity of capturing cellular heterogeneity that is completely overlooked by traditional bulk profiling. However, the in-depth and high-quality quantification of SCP data is still challenging and severely affected by the large numbers of quantification workflows and extreme performance dependence on the studied datasets. In other words, the proper selection of well-performing workflow(s) for any studied dataset is elusory, and it is urgently needed to have a significantly enhanced and accelerated tool to address this issue. However, no such tool is developed yet. Herein, ANPELA is therefore updated to its 2.0 version (https://idrblab.org/anpela/), which is unique in providing the most comprehensive set of quantification alternatives (>1000 workflows) among all existing tools, enabling systematic performance evaluation from multiple perspectives based on machine learning, and identifying the optimal workflow(s) using overall performance ranking together with the parallel computation. Extensive validation on different benchmark datasets and representative application scenarios suggest the great application potential of ANPELA in current SCP research for gaining more accurate and reliable biological insights.

Evaluating the Resources and Environmental Carrying Capacity in Laos Using a Three-Dimensional Tetrahedron Model

(1) Background: The quantitative evaluation and comprehensive measurement of resources and environmental carrying capacity (RECC) are key links in the study of RECC from classification to synthesis. Laos, as the only landlocked country of Mainland Southeast Asia (MSEA), is an important economic corridor (i.e., China-MSEA Economic Corridor) of the Belt and Road Initiative (BRI). (2) Methods: Based on the human settlements index (HSI), resource carrying index (RCI), and socio-economic development index (SDI), here, a three-dimensional tetrahedron model for the comprehensive assessment of RECC with equilibrium significance was constructed, including HSI-based suitability classification, RCI-based restrictive classification, and SDI-based adaptability classification. Taking provinces as the basic unit, we quantitatively assessed and comprehensively evaluated RECC in Laos using a three-dimensional tetrahedron model. (3) Results: The human settlement environment in Laos is mainly characterized by the moderate suitable category (85%), while the high suitability area (merely 5%) supports more than 30% of the total population. Laos had over 90% of its area in good condition in resources and environmental carrying status (surplus or balanced state), translating into more than 95% of the population. The social and economic development level is mainly characterized by low-level development (43%), with nearly 30% of the population living in these low-level areas. The comprehensive bearing state of resources and environment is characterized by surplus, and 85% of the population is distributed in the surplus area, which occupies 63% of the land. (4) Conclusions: It is possible to better explore the adaptation strategies and countermeasures for enhancing RECC in Laos and provide a scientific reference for regional sustainable development. We believe that the three-dimensional tetrahedron method can be applied to quantitatively evaluate and comprehensively measure RECC at larger scale, e.g., the BRI regions.

Soil Quality Assessment in Farmland of a Rapidly Industrializing Area in the Yangtze Delta, China

The comprehensive quality assessment of farmland soil is critical for agricultural production and soil ecological protection. Currently, there is no systematic method for conducting a comprehensive quality assessment of farmland soil; subsequently, as the most developed economic area in China, the comprehensive quality assessment of farmland soil in the Yangtze River Delta is lacking. We chose the farmland soil of Suzhou city as the research object. The soil fertility index (SFI) and soil environment index (SEI) were calculated with the membership function and Nemerow index. Finally, the comprehensive assessment of soil quality was achieved with the TOPSIS model. The results showed that the average values of soil pH, SOM, TN, AHN, AP, and AK were 6.44 (slightly acidic), 28.17 g/kg (medium), 1.63 g/kg (rich), 118.16 mg/kg (medium), 38.31 mg/kg (rich), and 160.63 mg/kg (rich), respectively. For the concentrations of heavy metals, including Cr, Ni, Cu, Zn, Cd, and Pb, in 122 soil samples, the percentages exceeding the background values of Jiangsu province were 5.74%, 8.20%, 8.20%, 10.66%, 86.07%, and 84.43%, respectively. Cd and Pb were the main heavy metal pollutants on farmlands. The soil samples with SFI values below the medium level (SFI < 0.6) accounted for 44.26%, and samples with SEI values below the medium level (SEI < 0.6) accounted for 13.12%. The values of the soil quality index (SQI) ranged from 0.171 to 0.996, with an average SQI value of 0.586 (very poor-V), and approximately half of the farmland soil quality in Suzhou city needed to be further improved. In a word, this study provides a theoretical basis and scientific support for the quality assessment and rational utilization of farmland soil.

Promoting continence in older people

The prevalence of urinary incontinence (UI) is strongly associated with increasing age. Twenty five percent of women over 80 years of age have clinically significant symptoms in population surveys, but prevalence is as high as 70% in older hospital in-patients and residents of care homes with nursing. UI substantially affects quality of life and well-being, and generates significant economic burden for health and social care. Sadly, UI is considered as taboo by society, leading to isolation, depression and reluctance to seek help. As with all aspects of care of older people, a multi-modal approach to assessment and management is needed. Key to effective management of incontinence is recognition. As a minimum, clinicians should actively ask patients about continence, especially in older adults living with frailty. Careful evaluation and establishment of any underpinning diagnosis and aetiological factors requires comprehensive, multimodal, usually multidisciplinary, assessment. A lack of awareness of the problem and what can be done about it exists in both laypeople and clinicians, this needs correcting. An interdisciplinary approach to research and management must be the way into the future.

Health-related quality of life in older people with functional independence or mild dependence

BACKGROUND

The concept of Health-Related Quality of Life (HRQOL) has grown in importance in the elderly population (PM), which is due to the increase in life expectancy of contemporary societies and the desire of people to live the most advanced years in good condition.

OBJECTIVE

To know the effect of the epidemiological dimensions, functional capacity, social and psychological well-being on the HRQL of a group of senior people from the Borough of Puente Alto intervened by the multidimensional model of the Integral Center for Happy Aging, CIEF, Universidad de los Andes.

RESULTS

Correlation was observed between the dimensions mentioned above, as well as the improvement in the predictive models of HRQL in the extent to which social and psychological variables are incorporated into the morbidity and functional capacity dimension, the latter strongly related to HRQL according to the scientific literature.

CONCLUSION

The study shows the relevance of incorporating measures of social and psychological well-being in the evaluation of HRQL, especially with a view to the design of multidimensional interventions that encompass individual content and the environment in which seniors develop.

[Establishment of an indicator system for comprehensive assessment on terrestrial biodiversity in China]

The comprehensive evaluation of terrestrial biodiversity is a key basic work for biodiversity protection. Clarifying the status, trend, and driving factors of biodiversity is premise and necessary for formulating policies and measures of biodiversity protection. At present, there is no unified indicator system for the comprehensive assessment of terrestrial biodiversity in China. We constructed a comprehensive assessment indicator system of terrestrial biodiversity in China, by combining the Aichi biodiversity targets of the Convention on Biological Diversity and the sustainable development goals of the United Nations, learning from the development trend of biodiversity assessment in the world, and following the Pressure-State-Response framework. A total of 22 indicators were obtained, including eight status indicators, seven pressure indicators, and seven response indicators. The correlation and accessibility of the indicators were analyzed. These indicators could be applied to not only an independent assessment for biodiversity status, threatened and protection effectiveness, but also for the comprehensive assessment of terrestrial biodiversity to optimize and adjust priority protection areas and protection measures. Our results would provide a technical support for calculating green GDP and formulating regional ecological compensation policies.

Psychological and neuropsychological underpinnings of attention-deficit/hyperactivity disorder assessment

The identification and diagnosis of attention-deficit/hyperactivity disorder (ADHD) is extremely important in order to help change the trajectory of an individual's life outcomes. A review of the current state of evidence-based assessment of ADHD is dominated by the DSM-5's conceptualization of behaviorally-oriented diagnostic criteria. This assumption that the DSM-5's method for identifying ADHD is the gold standard underlies the research base that evaluates the incremental validity of measures and methods for diagnosing it. That is, when evaluating whether a measure is useful in the identification of ADHD, the 'right answer' is based on the DSM-5's behaviorally-oriented definition. An alternative model for considering the fact that ADHD is a neurodevelopmental disorder, with its roots in executive dysfunction, is proposed. Using neuropsychological and cognitive tests to identify executive functioning problems can be combined with rating scales and interviews to diagnose ADHD in a way that does not ascribe entirely to a behavioral definition of the disorder.

Assessing the Pilot Implementation of the Integrated Multimorbidity Care Model in Five European Settings: Results from the Joint Action CHRODIS-PLUS

Multimorbidity, the coexistence of several chronic conditions in a patient, represents a great challenge for healthcare systems and society. The Integrated Multimorbidity Care Model (IMCM) was recently designed within the Joint Action on chronic diseases and promoting healthy ageing across the life cycle (CHRODIS) to ensure the continuity of care for patients with multimorbidity. The IMCM was implemented in five European pilot sites in Spain, Italy, and Lithuania, within the Joint Action CHRODIS-PLUS. The effect of these pilot interventions was assessed pre- and post-implementation by 17 healthcare managers, using the Assessment of Chronic Illness Care (ACIC) measure, and by 226 patients with the Patient Assessment of Care for Chronic Conditions (PACIC+) survey. The ACIC total score significantly increased (5.23 to 6.71, p = 0.022) after the intervention, with differences across sites. A significant increase in the PACIC+ summary score was found ranging from 3.25 at baseline to 4.03 after the intervention (p < 0.001), and 58% of the sample perceived an improvement in care. Higher PACIC+ scores after the intervention were associated to lower baseline values in the respective PACIC+ dimension and to greater changes in ACIC Part 1 (delivery system organization). The IMCM implementation can help improve the quality of care for patients with multimorbidity.

Comprehensive Assessment of Water Quality and Pollution Source Apportionment in Wuliangsuhai Lake, Inner Mongolia, China

Water quality is a key indicator of human health. Wuliangsuhai Lake plays an important role in maintaining the ecological balance of the region, protecting the local species diversity and maintaining agricultural development. However, it is also facing a greater risk of water quality deterioration. The 24 water quality factors that this study focused on were analyzed in water samples collected during the irrigation period and non-irrigation period from 19 different sites in Wuliangsuhai Lake, Inner Mongolia, China. Principal component analysis (PCA) and hierarchical cluster analysis (HCA) were conducted to evaluate complex water quality data and to explore the sources of pollution. The results showed that, during the irrigation period, sites in the middle part of the lake (clusters 1 and 3) had higher pollution levels due to receiving most of the agricultural and some industrial wastewater from the Hetao irrigation area. During the non-irrigation period, the distribution of the comprehensive pollution index was the opposite of that seen during the irrigation period, and the degree of pollutant index was reduced significantly. Thus, run-off from the Hetao irrigation area is likely to be the main source of pollution.

Is China Moving toward Healthy Aging? A Tracking Study Based on 5 Phases of CLHLS Data

Health is the key to the aging problem, and “healthy aging” depicts the overall changing trends in the health of all elderly individuals in a society. Based on the Chinese Longitudinal Healthy Longevity Survey (CLHLS) data from the years 2002, 2005, 2008, 2011 and 2014, this article investigates whether there is a trend of “healthy aging” in China. A second-order factor model including four dimensions of physical health, functional status, mental health and social health was constructed to measure a latent variable, “Health_elders”. The further multigroup comparison results by structural equation modeling showed that, with the exception of 2008, the Health_elders in 2002, 2005, 2011 and 2014 displayed an upward trend, and the mean differences in Health_elders across five periods were significant. These findings indicate that on the whole, compared with older people in the past, older people in more recent periods are healthier, which supports the trend of “healthy aging” in China. In terms of cohorts, the average health levels of male, town-residing elderly populations are higher, while the healthy aging trends among female, rural and urban elderly populations are stronger. Moreover, the physical health levels of the 60–74 years-old cohort are decreasing, and the participation of elderly individuals in social activities is low, which are the weaknesses in the healthy aging process in China.

[Comprehensive Assessment and Treatment of Cataracts]

Cataract is a global disease that may cause blindness. Due to the slow pace of disease progression, patients often presume incorrectly that their blurred vision is caused by excessive fatigue or lack of sleep. In addition to their role in causing blindness, cataracts that are diagnosed late into their progression are more difficult to treat with corrective surgery. Furthermore, many older individuals believe incorrectly that declines in vision are part of the natural course of aging and accept these declines as inevitable. Reduced vision has a significant and negative effect on quality of life. Although aging is one of the main causes of cataracts, other major factors include common chronic diseases and the side effects of drugs. In addition, lifestyle factors such as diet, activity, and environmental exposure to ultraviolet rays and radiation are factors in cataract development. Surgery is the only treatment for cataracts currently available. Healthcare professionals not only consider a patient's background but also whether surgery may promote quality of life. While preoperative evaluation requires a holistic and comprehensive approach, postoperative care is also important to the overall success of cataract surgery. For example, instructions in topical-drop application, wound assessment, and symptoms of comorbidities are crucial for patients. Therefore, a critical literature review was used in this article to establish a strategy for the holistic evaluation of and perioperative nursing care and prevention strategies for cataracts. In addition, recommendations for the comprehensive assessment of and nursing care for patients with cataracts are provided to healthcare professionals article in hopes of improving the quality of care provided to patients with cataracts.

Proactive and systematic multidimensional needs assessment in patients with advanced cancer approaching palliative care: a study protocol

INTRODUCTION

The benefits of palliative care rely on how healthcare professionals assess patients' needs in the initial encounter/s; crucial to the design of a personalised therapeutic plan. However, there is currently no evidence-based guideline to perform this needs assessment. We aim to design and evaluate a proactive and systematic method for the needs assessment using quality guidelines for developing complex interventions. This will involve patients, their relatives and healthcare professionals in all phases of the study and its communication to offer clinical practice a reliable approach to address the palliative needs of patients.

METHODS AND ANALYSIS

To design and assess the feasibility of an evidence-based, proactive and systematic Multidimensional needs Assessment in Palliative care (MAP) as a semistructured clinical interview guide for initial palliative care encounter/s in patients with advanced cancer. This is a two-phase multisite project conducted over 36 months between May 2019 and May 2022. Phase I includes a systematic review, discussions with stakeholders and Delphi consensus. The evidence gathered from phase I will be the basis for the initial versions of the MAP, then submitted to Delphi consensus to develop a preliminary guide of the MAP for the training of clinicians in the feasibility phase. Phase II is a mixed-methods multicenter feasibility study that will assess the MAP's acceptability, participation, practicality, adaptation and implementation. A nested qualitative study will purposively sample a subset of participants to add preliminary clues about the benefits and barriers of the MAP. The evidence gathered from phase II will build a MAP user guide and educational programme for use in clinical practice.

ETHICS AND DISSEMINATION

Ethical approval for this study has been granted by the university research ethics committee where the study will be carried out (approval reference MED-2018-10). Dissemination will be informed by the results obtained and communication will occur throughout.

A Methodological Approach for Implementing an Integrated Multimorbidity Care Model: Results from the Pre-Implementation Stage of Joint Action CHRODIS-PLUS

Patients with multimorbidity (defined as the co-occurrence of multiple chronic diseases) frequently experience fragmented care, which increases the risk of negative outcomes. A recently proposed Integrated Multimorbidity Care Model aims to overcome many issues related to fragmented care. In the context of Joint Action CHRODIS-PLUS, an implementation methodology was developed for the care model, which is being piloted in five sites. We aim to (1) explain the methodology used to implement the care model and (2) describe how the pilot sites have adapted and applied the proposed methodology. The model is being implemented in Spain (Andalusia and Aragon), Lithuania (Vilnius and Kaunas), and Italy (Rome). Local implementation working groups at each site adapted the model to local needs, goals, and resources using the same methodological steps: (1) Scope analysis; (2) situation analysis—“strengths, weaknesses, opportunities, threats” (SWOT) analysis; (3) development and improvement of implementation methodology; and (4) final development of an action plan. This common implementation strategy shows how care models can be adapted according to local and regional specificities. Analysis of the common key outcome indicators at the post-implementation phase will help to demonstrate the clinical effectiveness, as well as highlight any difficulties in adapting a common Integrated Multimorbidity Care Model in different countries and clinical settings.

Interdisciplinary Management of Acute Leukemia Across the Continuum of Care

OBJECTIVE

To describe the interdisciplinary management of acute leukemias across the continuum of care.

DATA SOURCE

Literature review and experiential knowledge.

CONCLUSION

Acute leukemia, including acute myelogenous leukemia, acute promyelocytic leukemia, and acute lymphoblastic leukemia, represent a heterogeneous group of hematologic malignancies with complex diagnostic requirements that drive risk-adapted treatment selection. Involvement of clinicians from a variety of specialties and disciplines is required to ensure safe and effective treatment, mitigate adverse events, and maintain or improve quality of life. Patient-centered communication, shared decision-making, and interdisciplinary communication are integral to patient outcomes.

IMPLICATIONS FOR NURSING PRACTICE

Oncology clinicians play a primary role in coordinating the interdisciplinary team and navigating the patient and caregiver experience across the acute leukemia continuum.

Adults with Down syndrome: a comprehensive approach to manage complexity

BACKGROUND

Down syndrome (DS) is characterised by premature ageing that affects selected organ systems, and persons with this condition can present patterns of co-morbidities and deficits often observed in the older population without DS. However, information on the characteristics of adult persons with DS is limited. The objective of the study is to describe characteristics of adults with DS collected with a standardised, comprehensive assessment instrument.

METHODS

Cross-sectional study. Four hundred thirty adults with DS (age range 18/75 years) from three countries (Italy, n = 95; USA, n = 175; and Canada, n = 160). A standardised assessment instrument (interRAI intellectual disability) was used to assess sample characteristics.

RESULTS

Mean age ranged from 35.2 (standard deviation 12.0) years in the US sample to 48.8 (standard deviation 9.0) years in the Canadian sample. Most participants in the Italian and US sample were living in private homes, while more than half of those in the Canadian sample were institutionalised. Prevalences of geriatric conditions, including cognitive deficits, disability in the common activities of daily living, symptoms of withdrawal or anhedonia, aggressive behaviour, communication problems, falls and hearing problems were high in the study sample. Gastrointestinal symptoms, skin and dental problems and obesity were also frequently observed.

CONCLUSIONS

Adults with DS present with a high level of complexity, which may suggest the need for an approach based on a comprehensive assessment and management that can provide adequate care. Further research is needed to understand better the effectiveness of such an approach in the DS population.

Effects of Different Types of Water and Nitrogen Fertilizer Management on Greenhouse Gas Emissions, Yield, and Water Consumption of Paddy Fields in Cold Region of China

Water management and nitrogen (N) fertilizers are the two main driving factors of greenhouse gas emissions. In this paper, two irrigation modes, controlled irrigation (CI) and flood irrigation (FI), and four nitrogen fertilizer levels (N0: 0, N1:,85, N2:,110, and N3:,135 kg·hm^-2) were set to study the effect of different irrigation modes and N fertilizer amount on greenhouse-gas emissions of paddy fields in cold region by using the static chamber-gas chromatograph method; yield and water consumption were also analyzed. The results showed that, compared with FI, CI significantly reduced CH₄ emissions by 19.42~46.94%, but increased N₂O emissions by 5.66~11.85%. Under the two irrigation modes, N fertilizers could significantly increase N₂O emissions, but the CH₄ emissions of each N treatment showed few differences. Compared with FI, appropriate N application under CI could significantly increase grain number per spike, seed-setting rate, and 1000-grain weight, thus increasing yield. Under the two irrigation modes, water consumption increased with the increase of N application rate, and the total water consumption of CI was significantly lower than that of FI. The global warming potential (GWP) of CI was significantly smaller than that of FI. The trend of GWP in each treatment was similar to that of CH₄. Through comprehensive comparison and analysis of water productivity (WP), gas emission intensity (GHGI), and the yield of each treatment, we found that CI+N2 treatment had the highest WP (2.05 kg·m^-3) and lowest GHGI (0.37 kg CO₂-eq·kg^-1), while maintaining high yield (10224.4 kg·hm^-2). The results of this study provide an important basis for guiding high yield, water-savings, and emission reduction of paddy fields in cold regions.

[Comprehensive assessment of soil fertility characteristics under different long-term conservation tillages of wheat field in Weibei Highland, China.]

Soil fertility properties described by four physical indices and seven chemical indices in the 10-year long-term experiment of wheat fields in Weibei Highland were used to investigate the cumulative effect of 11 soil indices under six long-term conservation tillage treatments. The principal component analysis was performed to comprehensively evaluate the cumulative effect of soil fertility under different tillage treatments, so as to provide scientific basis for soil sustainable utilization and management in Weibei Highland. The results showed that, compared with continuous conventional tillage (CT/CT), soil bulk density by no-tillage/subsoiling rotational tillage (NT/ST), subsoiling/conventional tillage rotational tillage (ST/CT) and conventional tillage/no-tillage rotational tillage (CT/NT) decreased by 6.6%, 5.9% and 6.6%, respectively, and no significant difference was found between continuous no-tillage (NT/NT) and CT/CT. NT/NT had the highest content of >0.25 mm mechanical stable aggregate, and no-tillage/subsoiling rotational tillage (NT/ST) had the highest content of >0.25 mm water stable aggregate. Compared with CT/CT, the mechanical stable aggregate contents under other five tillage treatments increased by 1.7%-10.1%, soil organic matter increased by 0.6%-11.2%, and the contents of nitrogen, phosphorus, and potassium contents also increased. By principal component analysis, 11 soil indices were divided into two principal components to comprehensively characterize soil quality. The contribution rate of the first principal component was 75.5%, where the major contributors were soil organic matter, water stable aggregate, total nitrogen, total phosphorus, total potassium, alkaline hydrolysis nitrogen, available phosphorus, available potassium, bulk density and soil porosity. The contribution rate of the second principal component was 13.2%, where the major contributor was mechanical stable aggregate. Together, those two principal components accounted for 88.6% of the original variables. The soil fertility performance was in the sequence of NT/ST>ST/CT>CT/NT>NT/NT>ST/ST>CT/CT after gradually accumulating the effects of long-term conservation tillage. NT/ST was the most appropriate tillage patterns for the wheat fields in Weibei Highland, due to the resulting balanced and high-quality soil environment.

Comparison of the clinical characteristics and comprehensive assessments of the 2011 and 2017 GOLD classifications for patients with COPD in China

Objective

Compared with the 2011 Global Initiative for Chronic Obstructive Lung Disease (GOLD), there have been significant changes in the 2017 GOLD classification. The purpose of this study was to analyze the changes in clinical characteristics of the new A-B-C-D system and to explore its role in comprehensive assessment of COPD.

Subjects and methods

A total of 631 stable COPD patients were included in a cross-sectional survey. Data collected included baseline data and pulmonary function testing results, respiratory muscle strength, symptoms and quality of life, exercise capacity, nutritional status, and anxiety and depression as a comprehensive assessment. Based on the 2011 GOLD and 2017 GOLD classifications, patients were divided into Groups A₁–D₁ and Groups A₂–D₂, respectively.

Results

In the 2011 GOLD, 64 subjects in Group C₁ were reclassified into Group A₂ (41.6%), while 77 subjects in Group D₁ were reclassified into Group B₂ (27.1%). The old and new grading systems were somewhat consistent (Cohen’s kappa=0.6963, P<0.001). Lung function was lower, while the body mass index, airflow obstruction, dyspnea, and exercise capacity index (BODE index) was higher in Group A₂ than in Group A₁ (P<0.001). In Group B₂, lung function, 6-minute walking distance (6MWD), and respiratory muscle strength were significantly lower than in Group B₁ (P<0.001), while the BODE index (P<0.001) was higher. In comprehensive assessment, subjects in Groups B₂ and D₂ had significantly lower lung function, 6MWD, respiratory muscle strength, quality of life, higher symptom scores, and BODE index than subjects in Group A₂ (P<0.001). The differences between Group A₂ and C₂ were small.

Conclusion

Compared with the 2011 GOLD, the 2017 GOLD reclassified more patients into Groups A and B, those with significantly worse lung function and higher BODE index. In the comprehensive assessment of the new classification, Groups B and D may have greater disease severity. However, the effectiveness of the new grading system in predicting patient prognosis, and its guidance on the use of drugs, remains to be explored in future studies.

Comprehensive Assessment of the Relationship Between MicroRNA-124 and the Prognostic Significance of Cancer

BACKGROUND

Numerous studies have demonstrated the presence of microRNA-124 abnormalities involving gene expression, methylation, and single nucleotide polymorphism (SNP) in multiple and diverse cancers, but the prognostic value of these abnormalities in cancer remains inconclusive.

OBJECTIVE

The aim of this study is to determine the prognostic value of miR-124 in cancer.

METHODS

We scrutinized the electronic databases and estimate the association between miR-124 expression, methylation and single nucleotide polymorphisms (SNPs), and prognosis in cancers. The pooled hazard ratios with 95% confidence intervals (CIs) for overall survival (OS), and disease-free survival/recurrence-free survival (RFS)/progression-free survival (PFS) were calculated to estimate the effects of miR-124 expression, methylation, and SNPs on cancer prognosis. The Quality in Prognosis Studies and Newcastle-Ottawa Scale were utilized to assess the quality of included studies.

RESULTS

A total of 20 studies involving 3,574 participants were analyzed in evidence synthesis. Our findings showed that the low expression of miR-124 was significantly associated with poor OS (HR = 2.37, 95% CI: 1.91-2.94, P = 0.00; HR = 3.10, 95% CI: 2.04-4.70, P = 0.00) and PFS/RFS (HR = 2.21, 95% CI: 1.50-3.26, P = 0.00; HR = 2.12, 95% CI: 1.20-3.74, P = 0.00). The hyper-methylation of miR-124 was associated with poor OS (HR = 2.09, 95% CI: 1.48-2.95, P = 0.00) and PFS (HR = 3.70, 95% CI: 1.72-7.97, P = 0.00) (Table 3). The patients carrying with Allele C of miR-124 rs5315649 had a worse OS (HR = 1.50, 95% CI: 1.09-2.07, P = 0.00) and PFS (HR = 1.67, 95% CI: 1.20-2.33, P = 0.00) than the carriers with Allele G.

CONCLUSION

The low expression and hyper-methylation of miR-124 was strongly associated with poor prognosis, and genetic variations of miR-124 rs531564 affected prognosis in cancer patients.

[Chilling damage comprehensive assessment methods for rice.]

Based on the grey correlation analysis method, the chilling damage inducing factors and yield structure traits of rice in different growth stages, and the yield structure traits and final yield of rice were regarded as two grey systems. By seeking the grey relations of the grey systems and using the multi level grey correlation analysis method, the comprehensive assessment model of rice chil-ling damage was constructed, and the comprehensive assessment indices of chilling damages in sepa rate stages were established. The rice chilling damages at 27 stations in Northeast China from 1961 to 2015 were assessed separately. The results showed that there was a good corresponding relationship between the chilling damage and the rice yield. The low temperature during the vegetative growth stage, the vegetative growth and reproductive stage, the pollination stage or the grain filling stage significantly decreased the panicle number per plant, the average panicle grain number or the thousand kernel mass, and increased the empty grain rate. A good correspondence existed between temperature and rice yield in the typical chilling damage years.

Cycle ergometer and inspiratory muscle training offer modest benefit compared with cycle ergometer alone: a comprehensive assessment in stable COPD patients

BACKGROUND

Cycle ergometer training (CET) has been shown to improve exercise performance of the quadriceps muscles in patients with COPD, and inspiratory muscle training (IMT) may improve the pressure-generating capacity of the inspiratory muscles. However, the effects of combined CET and IMT remain unclear and there is a lack of comprehensive assessment.

MATERIALS AND METHODS

Eighty-one patients with COPD were randomly allocated to three groups: 28 received 8 weeks of CET + IMT (combined training group), 27 received 8 weeks of CET alone (CET group), and 26 only received 8 weeks of free walking (control group). Comprehensive assessment including respiratory muscle strength, exercise capacity, pulmonary function, dyspnea, quality of life, emotional status, nutritional status, and body mass index, airflow obstruction, and exercise capacity index were measured before and after the pulmonary rehabilitation program.

RESULTS

Respiratory muscle strength, exercise capacity, inspiratory capacity, dyspnea, quality of life, depression and anxiety, and nutritional status were all improved in the combined training and CET groups when compared with that in the control group (P<0.05) after pulmonary rehabilitation program. Inspiratory muscle strength increased significantly in the combined training group when compared with that in the CET group (ΔPI_max [maximal inspiratory pressure] 5.20±0.89 cmH₂O vs 1.32±0.91 cmH₂O; P<0.05). However, there were no significant differences in the other indices between the two groups (P>0.05). Patients with weakened respiratory muscles in the combined training group derived no greater benefit than those without respiratory muscle weakness (P>0.05). There were no significant differences in these indices between the patients with malnutrition and normal nutrition after pulmonary rehabilitation program (P>0.05).

CONCLUSION

Combined training is more effective than CET alone for increasing inspiratory muscle strength. IMT may not be useful when combined with CET in patients with weakened inspiratory muscles. Nutritional status had slight impact on the effects of pulmonary rehabilitation. A comprehensive assessment approach can be more objective to evaluate the effects of combined CET and IMT.

Landfill mining: Developing a comprehensive assessment method

In Austria, the first basic technological and economic examinations of mass-waste landfills with the purpose to recover secondary raw materials have been carried out by the 'LAMIS - Landfill Mining Österreich' pilot project. A main focus of its research, and the subject of this article, is the first conceptual design of a comprehensive assessment method for landfill mining plans, including not only monetary factors (like costs and proceeds) but also non-monetary ones, such as the concerns of adjoining owners or the environmental impact. Detailed reviews of references, the identification of influences and system boundaries to be included in planning landfill mining, several expert workshops and talks with landfill operators have been performed followed by a division of the whole assessment method into preliminary and main assessment. Preliminary assessment is carried out with a questionnaire to rate juridical feasibility, the risk and the expenditure of a landfill mining project. The results of this questionnaire are compiled in a portfolio chart that is used to recommend, or not, further assessment. If a detailed main assessment is recommended, defined economic criteria are rated by net present value calculations, while ecological and socio-economic criteria are examined in a utility analysis and then transferred into a utility-net present value chart. If this chart does not support making a definite statement on the feasibility of the project, the results must be further examined in a cost-effectiveness analysis. Here, the benefit of the particular landfill mining project per capital unit (utility-net present value ratio) is determined to make a final distinct statement on the general benefit of a landfill mining project.

Development of an integral assessment approach of health status in patients with obstructive airway diseases: the CORONA study

BACKGROUND

Traditional assessment of patients with obstructive lung diseases (asthma and chronic obstructive pulmonary disease; COPD) relies on physiological tests. The COPD and Asthma Rotterdam Integrated Care Approach (CORONA) study aims to develop a diagnostic pathway with a more comprehensive approach to the assessment of patients with asthma and COPD in secondary care.

METHODS

An eight-step method was used to develop and implement the pathway for patients with asthma or COPD referred to an outpatient hospital setting.

RESULTS

The diagnostic pathway consists of an evidence-based set of measurements prioritized by a Delphi procedure. The pathway incorporates three innovative diagnostics: the metronome-paced hyperventilation test to measure dynamic hyperinflation, an activity monitor to objectively evaluate physical activity in daily life, and the Nijmegen Clinical Screening Instrument as a comprehensive assessment tool to acquire detailed insight into symptoms, functional limitations, and quality of life.

CONCLUSION

An innovative diagnostic pathway was developed and implemented for patients with obstructive lung diseases referred to secondary care. As this pathway aims to provide a comprehensive analysis of health status, it focuses on biomedical aspects and also reviews behavioral aspects that further elucidate the patient's health status. The added value of the diagnostic pathway needs to be determined from both an organizational perspective and from the individual patient's viewpoint.

Use of Cumulative Assessments in U.S. Schools and Colleges of Pharmacy

The Accreditation Council of Pharmacy Education (ACPE) has taken a strong stance on assessment in pharmacy education. One available assessment tool is cumulative assessments, which may be administered at various points in the curriculum. This article presents the results of a survey of U.S. schools of pharmacy regarding the use of cumulative assessments within their curriculum. A 20-question survey tool was emailed to 125 schools of pharmacy. A total of 105 out of 125 schools participated (response rate 84%). Of these, 52 schools currently have a cumulative assessment program; 18 have one cumulative exam prior to advanced pharmacy practice experiences (APPEs); 19 have a cumulative exam every didactic year; and seven have accumulative exams every semester, except during APPEs (n = 44). Increased faculty workload emerged as the top challenge faced by schools that have implemented a cumulative assessment program. Eighteen schools indicated that no outcomes are measured to determine the utility of the cumulative assessment. From these results, it appears that almost half of participating U.S. schools have implemented a cumulative assessment plan. However, it is apparent that more research needs to be done to determine which outcomes are expected to improve with the implementation of such an assessment plan.

Comprehensive assessment for autonomic dysfunction in different phases after ischemic stroke

BACKGROUND AND PURPOSE

Studies mostly use the analysis of heart rate variability to measure cardiovascular autonomic regulation in ischemic stroke. Besides power spectral analysis of heart rate variability, this study sought to determine whether autonomic function was impaired during different phases in ischemic stroke by Ewing's battery of autonomic function tests.

METHODS

Ninety-four patients with ischemic stroke (34 patients in acute phase and 60 patients in chronic phase, average six-months after stroke onset) and thirty-seven elderly controls were recruited. Ewing's battery autonomic function tests and power spectral analysis of heart rate variability were performed in all the subjects.

RESULTS

From power spectral analysis of heart rate variability, stroke patients of both acute and chronic phases had significantly lower low frequency power spectral density than controls. From Ewing's battery of autonomic function tests, patients in acute phase showed impairment in two parasympathetic tests (Valsalva ratio: P = 0·002; heart rate response to deep breathing: P < 0·001) and those in chronic phase showed impairment in all parasympathetic tests (all P < 0·05) in comparison with controls.

CONCLUSIONS

The comprehensive assessment indicates that autonomic dysfunction occurs in acute phase of ischemic stroke and may persist up to six-months after stroke. Parasympathetic dysfunction rather than sympathetic dysfunction is predominant after ischemic stroke.

The comprehensive care project: measuring physician performance in ambulatory practice

OBJECTIVE

To investigate the feasibility, reliability, and validity of comprehensively assessing physician-level performance in ambulatory practice.

DATA SOURCES/STUDY SETTING

Ambulatory-based general internists in 13 states participated in the assessment.

STUDY DESIGN

We assessed physician-level performance, adjusted for patient factors, on 46 individual measures, an overall composite measure, and composite measures for chronic, acute, and preventive care. Between- versus within-physician variation was quantified by intraclass correlation coefficients (ICC). External validity was assessed by correlating performance on a certification exam.

DATA COLLECTION/EXTRACTION METHODS

Medical records for 236 physicians were audited for seven chronic and four acute care conditions, and six age- and gender-appropriate preventive services.

PRINCIPAL FINDINGS

Performance on the individual and composite measures varied substantially within (range 5-86 percent compliance on 46 measures) and between physicians (ICC range 0.12-0.88). Reliabilities for the composite measures were robust: 0.88 for chronic care and 0.87 for preventive services. Higher certification exam scores were associated with better performance on the overall (r = 0.19; p<.01), chronic care (r = 0.14, p = .04), and preventive services composites (r = 0.17, p = .01).

CONCLUSIONS

Our results suggest that reliable and valid comprehensive assessment of the quality of chronic and preventive care can be achieved by creating composite measures and by sampling feasible numbers of patients for each condition.

Home care patients in four Nordic capitals - predictors of nursing home admission during one-year followup

The aim was to predict nursing home admission (NHA) for home care patients after a 12-month follow-up study. This Nordic study is derived from the aged in home care (AdHOC) project conducted in 2001–2003 with patients at 11 sites in Europe. The participants in the cohort study were randomly selected individuals, aged 65 years or older, receiving homecare in Oslo, Stockholm, Copenhagen, and Reykjavik. The Resident Assessment Instrument for Home Care (version 2.0) was used. Epidemiological and medical characteristics of patients and service utilization were recorded for 1508 home care patients (participation rate 74%). In this sample 75% were female. The mean age was 82.1 (6.9) years for men and 84.0 (6.6) for women. The most consistent predictor of NHA was receiving skilled nursing procedures at baseline (help with medication and injections, administration or help with oxygen, intravenous, catheter and stoma care, wounds and skin care) (adjusted odds ratio = 3.7, 95% confidence interval: 1.7–7.8; P < 0.001). In this Nordic material, stronger emphasizing on higher qualified nurses in a home care setting could prevent or delay NHA.

Comprehensive assessment of elderly patients

Comprehensive assessment of elderly patients is becoming of increasing importance with our changing demography. This paper discusses the major areas of functional impairment: immobility, falling, incontinence of urine and feces, and confusion. These problems may lead to physician contact because of the strain they impose on care providers, the increased dependency they create, or the social crisis they precipitate. It is important for the family physician to assess patients on the basis of the particular functions related to these problems. Multidisciplinary teams with special training are being developed to cope with the increasing need for assessment of the elderly. It is important that these assessments be made carefully, and that the full rehabilitation potential of each patient be realized. Only in this way can optimum use be made of limited resources and unnecessary suffering reduced.