Objective:To investigate the longitudinal stability of the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and the Activity of Daily Living Scale (ADL).Methods:The longitudinal cognitive assessment results of 68 dementia patients admitted to the Dementia and Leukoencephalopathy Outpatient Clinic, Department of Neurology, Peking Union Medical College Hospital, from January 2021 to January 2024, were retrospectively analyzed, including the total and sub-items scores of the MMSE, MoCA, and ADL. Two different rules were applied to analyze the abnormality rates: rule 1, where the current test result being better than the previous one was considered an abnormality; rule 2, where the current test result being better than the previous average score was considered an abnormality (If a patient had only 2 cognitive assessments, rule 2 was considered the same as rule 1). Two rules were used to analyze the abnormality rates of the scales. The statistical analyses were repeated after excluding patients with possible anxiety and depression status.Results:In assessing the total score stability, MMSE showed the lowest abnormality rates [27.2% (31/114) under rule 1 and 29.8% (34/114) under rule 2], while MoCA had the highest abnormality rates [41.3% (26/63) and 46.0% (29/63), respectively]. The ADL abnormality rates were 27.7% (23/83) and 33.7% (28/83), respectively. Among MoCA sub-items, category cue, multiple choice cue, second memory trial, orientation, and clock showed higher abnormality rates [31.7%(20/63), 30.2%(19/63), 23.8%(15/63), 22.2%(14/63), 22.2%(14/63), respectively]. After excluding population with possible anxiety and depression status, the relative abnormality rates of MMSE and ADL sub-items did not significantly change, while the abnormality rate of orientation in MoCA sub-items decreased relatively.Conclusion:The MMSE and ADL exhibit good stability in long-term monitoring of dementia patients, serving as essential tools for assessing and following up cognitive changes.

BACKGROUND: While emotional distress, encompassing anxiety and depression, has been associated with negative clinical outcomes, its impact across various clinical departments and general hospitals has been less explored. Previous studies with limited sample sizes have examined the effectiveness of specific treatments (e.g., antidepressants) rather than a systemic management strategy for outcome improvement in non-psychiatric inpatients. To enhance the understanding of the importance of addressing mental health care needs among non-psychiatric patients in general hospitals, this study retrospectively investigated the impacts of emotional distress and the effects of early detection and management of depression and anxiety on hospital length of stay (LOS) and rate of long LOS (LLOS, i.e., LOS >30 days) in a large sample of non-psychiatric inpatients. METHODS: This retrospective cohort study included 487,871 inpatients from 20 non-psychiatric departments of a general hospital. They were divided, according to whether they underwent a novel strategy to manage emotional distress which deployed the Huaxi Emotional Distress Index (HEI) for brief screening with grading psychological services (BS-GPS), into BS-GPS ( n = 178,883) and non-BS-GPS ( n = 308,988) cohorts. The LOS and rate of LLOS between the BS-GPS and non-BS-GPS cohorts and between subcohorts with and without clinically significant anxiety and/or depression (CSAD, i.e., HEI score ≥11 on admission to the hospital) in the BS-GPS cohort were compared using univariable analyses, multilevel analyses, and/or propensity score-matched analyses, respectively. RESULTS: The detection rate of CSAD in the BS-GPS cohort varied from 2.64% (95% confidence interval [CI]: 2.49%-2.81%) to 20.50% (95% CI: 19.43%-21.62%) across the 20 departments, with a average rate of 5.36%. Significant differences were observed in both the LOS and LLOS rates between the subcohorts with CSAD (12.7 days, 535/9590) and without CSAD (9.5 days, 3800/169,293) and between the BS-GPS (9.6 days, 4335/178,883) and non-BS-GPS (10.8 days, 11,483/308,988) cohorts. These differences remained significant after controlling for confounders using propensity score-matched comparisons. A multilevel analysis indicated that BS-GPS was negatively associated with both LOS and LLOS after controlling for sociodemographics and the departments of patient discharge and remained negatively associated with LLOS after controlling additionally for the year of patient discharge. CONCLUSION Emotional distress significantly prolonged the LOS and increased the LLOS of non-psychiatric inpatients across most departments and general hospitals. These impacts were moderated by the implementation of BS-GPS. Thus, BS-GPS has the potential as an effective, resource-saving strategy for enhancing mental health care and optimizing medical resources in general hospitals.
Humans ; Retrospective Studies ; Male ; Length of Stay/statistics & numerical data* ; Female ; Middle Aged ; Adult ; Psychological Distress ; Inpatients/psychology* ; Aged ; Anxiety/diagnosis* ; Depression/diagnosis*

Objective To constructed a predictive model of gastric adenocarcinoma prognosis-related proteins by using TCPA and UCSC Xena databases to obtain sample information.And its application value was tested in order to provide reference for clinical treatment and related mechanism research.Methods Using R project,univariate Cox analysis and LASSO-Cox regression analysis were used to select the proteins related to the prognosis of gastric adenocarcinoma,and the risk scores were calculated.According to the risk scores,the patients were divided into high risk group and low risk group for survival analysis.At the same time,draw the ROC curve of the risk score and the protein heat map to evaluate the predictive ability of these proteins.Then,risk scores were combined with other clinical phenotype data of the patients,in order to establish a prognostic model through multivariate regression analysis,and draw a nomogram.The accuracy of the prognostic model was evaluated by C-index,ROC curve and decision curve.GO enrichment analysis and KEGG enrichment analysis were carried out to explore the proteins involved in biological processes.Results Fifteen differential proteins(CKIT,CHK1,CLAUDIN7,COLLAGENVI,DVL3,EGFR_pY1173,ERALPHA_pS11,NFKBP65_pS536,SYK,ETS1,MYOSINIIA_pS1943,P21,P90RSK,RAPTOR,XBP1)were selected by univariate Cox analysis and LASSO-Cox analysis,for calculating the protein risk scores.Through multivariate regression analysis,five factors including age,gender,M stage,N stage and risk score were selected to construct a prognostic model.The results of survival analysis showed that there were significant differences in overall survival between high and low risk groups(P＜0.0001).The nomogram can be used to predict 3-year and 5-year survival rate of patients,and it is considered to have good predictive value(C-index=0.7257).The ROC curve showed that the model exhibited stable sensitivity and specificity in prediction(AUC=0.79 and 0.88).Conclusion The prognostic model of gastric adenocarcinoma prognosis-related proteins can be used to predict the clinical prognosis of patients,and the research results will help to further guide clinical treatment,which could provide a reference for personalized treatment and management.

Objective To constructed a predictive model of gastric adenocarcinoma prognosis-related proteins by using TCPA and UCSC Xena databases to obtain sample information.And its application value was tested in order to provide reference for clinical treatment and related mechanism research.Methods Using R project,univariate Cox analysis and LASSO-Cox regression analysis were used to select the proteins related to the prognosis of gastric adenocarcinoma,and the risk scores were calculated.According to the risk scores,the patients were divided into high risk group and low risk group for survival analysis.At the same time,draw the ROC curve of the risk score and the protein heat map to evaluate the predictive ability of these proteins.Then,risk scores were combined with other clinical phenotype data of the patients,in order to establish a prognostic model through multivariate regression analysis,and draw a nomogram.The accuracy of the prognostic model was evaluated by C-index,ROC curve and decision curve.GO enrichment analysis and KEGG enrichment analysis were carried out to explore the proteins involved in biological processes.Results Fifteen differential proteins(CKIT,CHK1,CLAUDIN7,COLLAGENVI,DVL3,EGFR_pY1173,ERALPHA_pS11,NFKBP65_pS536,SYK,ETS1,MYOSINIIA_pS1943,P21,P90RSK,RAPTOR,XBP1)were selected by univariate Cox analysis and LASSO-Cox analysis,for calculating the protein risk scores.Through multivariate regression analysis,five factors including age,gender,M stage,N stage and risk score were selected to construct a prognostic model.The results of survival analysis showed that there were significant differences in overall survival between high and low risk groups(P＜0.0001).The nomogram can be used to predict 3-year and 5-year survival rate of patients,and it is considered to have good predictive value(C-index=0.7257).The ROC curve showed that the model exhibited stable sensitivity and specificity in prediction(AUC=0.79 and 0.88).Conclusion The prognostic model of gastric adenocarcinoma prognosis-related proteins can be used to predict the clinical prognosis of patients,and the research results will help to further guide clinical treatment,which could provide a reference for personalized treatment and management.

Objective:To investigate the longitudinal stability of the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and the Activity of Daily Living Scale (ADL).Methods:The longitudinal cognitive assessment results of 68 dementia patients admitted to the Dementia and Leukoencephalopathy Outpatient Clinic, Department of Neurology, Peking Union Medical College Hospital, from January 2021 to January 2024, were retrospectively analyzed, including the total and sub-items scores of the MMSE, MoCA, and ADL. Two different rules were applied to analyze the abnormality rates: rule 1, where the current test result being better than the previous one was considered an abnormality; rule 2, where the current test result being better than the previous average score was considered an abnormality (If a patient had only 2 cognitive assessments, rule 2 was considered the same as rule 1). Two rules were used to analyze the abnormality rates of the scales. The statistical analyses were repeated after excluding patients with possible anxiety and depression status.Results:In assessing the total score stability, MMSE showed the lowest abnormality rates [27.2% (31/114) under rule 1 and 29.8% (34/114) under rule 2], while MoCA had the highest abnormality rates [41.3% (26/63) and 46.0% (29/63), respectively]. The ADL abnormality rates were 27.7% (23/83) and 33.7% (28/83), respectively. Among MoCA sub-items, category cue, multiple choice cue, second memory trial, orientation, and clock showed higher abnormality rates [31.7%(20/63), 30.2%(19/63), 23.8%(15/63), 22.2%(14/63), 22.2%(14/63), respectively]. After excluding population with possible anxiety and depression status, the relative abnormality rates of MMSE and ADL sub-items did not significantly change, while the abnormality rate of orientation in MoCA sub-items decreased relatively.Conclusion:The MMSE and ADL exhibit good stability in long-term monitoring of dementia patients, serving as essential tools for assessing and following up cognitive changes.

Objective:To systematically review the qualitative research on the care experience of caregivers of palliative care for minors, in order to provide a reference for formulating a care plan that is more in line with the needs of palliative care for minors and their families.Methods:The Cochrane Library, Australia Joanna Briggs Institute Evidence-based Health Care Center Library, Embase, PubMed and Web of Science, CINAHL, China National Knowledge Infrastructure, Wanfang Database, VIP Database and China Biology Medicine Disc were searched by computer for literature on qualitative research on care experience of underage hospice care caregivers from the establishment of the database to December 30, 2023.Results:A total of 11 articles were included and 70 research results were extracted, which were summarized into 7 new categories and formed 2 integrated results: professional caregivers and relative caregivers had multiple care burden, and need multiple care support; professional caregivers and relative caregivers can shoulder the care responsibility of children together, actively respond to the difficulties in care, gain personal care experience and growth.Conclusions:Hospice care for minors has its own characteristics, and caregivers have various care burdens and needs. Special attention should be paid to the emotional experience and care demands of caregivers, and targeted support and protection should be provided to promote the construction of hospice care team for minors in China and improve the level of hospice care for minors in China.

Objective:To analyze the clinical and imaging features of patients with COVID-19-related osmotic demyelination syndrome (ODS).Methods:COVID-19-related ODS cases diagnosed in the Department of Neurology, Peking Union Medical College Hospital from January 2020 to September 2023 were retrospectively reviewed. And their past medical history, possible triggers, clinical manifestations, imaging manifestations, treatment and prognosis were summarized.Results:A total of 5 patients with COVID-19-related ODS were included. Electrolyte disturbances acted as an inducement of ODS in all patients (5/5),4 of whom with hyponatremia. Four of 5 patients first presented with disturbance of consciousness, followed by predominant dystonia. Imaging of all patients (5/5) showed isolated extrapontine myelinolysis (EPM). With the prolongation of the course of disease, such signal intensity could return to normal, and lesions showed atrophic changes in some patients. The patients′ clinical symptoms were partly relieved within a few days to a few months after treatment.Conclusions:COVID-19-related ODS is mostly associated with hyponatremia, and EPM is more common. COVID-19 should be considered as a risk factor for ODS.

Objective:To gain a deep understanding of the current cognition and training needs of nursing undergraduates regarding their emergency response teamwork skills, and to provide reference for the development of courses on emergency response teamwork among nursing undergraduates.Methods:From September to October 2023, purposive sampling was used to select 15 senior nursing undergraduates from Peking Union Medical College, Beijing University of Chinese Medicine, and Beijing City University as subjects for semi-structured interviews. Colazizzi 7-step analysis method was used to summarize and extract themes.Results:Three themes were extracted, including insufficient cognition and skill in emergency response, lack of emergency response teamwork cultivation, and the need for systematic and comprehensive training courses.Conclusions:Universities, hospitals, and other training institutions should work together to develop a systematic emergency response teamwork training course for nursing undergraduates, to cultivate the skills of nursing undergraduates and reserve talents for high-quality emergency response nursing teams.

Objective:To investigate the dosimetric feasibility of cardiac stereotactic body radiotherapy (CSBRT) using volumetric-modulated arc radiotherapy (VMAT)-like technique on the Unity MR-linac.Methods:A retrospective analysis was conducted on 12 refractory arrhythmia patients who underwent CSBRT at West China Hospital, Sichuan University, from April 2021 to December 2022. Four different treatment plans were designed for each patient based on the average phase of 4DCT: VMAT plan based on a linear accelerator, VMAT-like plan with magnetic field based on Unity, VMAT-like plan without magnetic field based on a Unity, and static intensity-modulated radiation therapy (IMRT) plan with 7 beams based on Unity. The VMAT-like plans used static IMRT beams evenly distributed at 30 angles. Evaluation metrics included conformity index (CI), homogeneity index (HI), gradient index (GI), dosimetric parameters of organs at risk (OAR), optimization time, and monitor unit (MU). These metrics among groups were analyzed using the Wilcoxon paired signed-rank test.Results:The CI of the VMAT plan was better than that of the VMAT-like plan with magnetic field (0.84 vs. 0.81, P=0.005). The GI of the VMAT-like plan without magnetic field was significantly lower than that of VMAT-like plan with magnetic field ( P=0.015). The CI and HI of the IMRT plan were both inferior to VMAT-like plan with magnetic field ( P=0.034). The average dose to the heart and lungs in VMAT-like plan with magnetic field was higher than those in the VMAT plan and VMAT-like plan without magnetic field (both P<0.05). The magnetic field significantly increased the dose to the skin, tissue-lung interface, and outside the margins (all P<0.05). The optimization time of the VMAT-like plan with magnetic field was longer than that of the IMRT plan, but it required fewer MUs ( P=0.001). The quality of the IMRT plans was poor and did not meet clinical requirements. Conclusion:The quality of CSBRT plans based on VMAT-like techniques meets clinical requirements, but attention must be paid to the dosimetric effects of the magnetic field.

Objective:To investigate the screening values of immunocytochemical P16/Ki-67 double staining, P16 INK4α single staining and high-risk human papillomavirus (HR-HPV) testing for high-grade cervical lesions. Methods:The clinical data of 622 patients who underwent cervical thin-layer liquid-based cytology (TCT) and HR-HPV testing in General Hospital of Taiyuan Iron and Steel (Group) Co., Ltd. from March 2019 to July 2021 were retrospectively analyzed. The remaining cytological specimens were detected by P16/Ki-67 double staining and P16 INK4α single staining. Among them, 334 patients with TCT results suggesting atypical squamous cell of undetermined significance (ASCUS) and above and HPV-positive underwent colposcopy pathological biopsy. Using pathological results as reference, the positive predictive value, sensitivity, specificity and accuracy of P16/Ki-67 double staining, P16 INK4α single staining and HR-HPV testing for screening of high-grade squamous intraepithelial neoplasia (HSIL) and cervical cancer were compared. Results:Taking the results of histopathology as references, combined with the results of TCT, 31 of 622 patients were HSIL, of which 22 (71.0%) were positive for P16/Ki-67 double staining, 23 (74.2%) were positive for P16 INK4α single staining, and 25 (80.6%) were positive for HR-HPV testing; 4 cases were cervical cancer, and the positive rates of the three detection methods were all 100.0% (4/4). Among 622 patients, the positive rates of P16/Ki-67 double staining, P16 INK4α single staining and HR-HPV testing for screening of HSIL and cervical cancer were 13.99% (87/622), 25.40% (158/622) and 21.38% (133/622); the positive predictive values were 29.89%, 17.09% and 21.08%; the accuracies were 91.19%, 78.94% and 83.28%; the specificities were 89.77%, 77.98% and 82.46%; the sensitivities were 74.29%, 77.14% and 82.86%. The positive rate, positive predictive value, specificity and accuracy of P16/Ki-67 double staining were higher than those of P16 INK4α single staining and HR-HPV testing, and the differences were statistically significant ( z values were -5.062 and -3.418, 2.328 and 2.450, 5.436 and 3.570, 6.043 and 4.161, all P < 0.05); the sensitivity of HR-HPV testing was higher than that of P16/Ki-67 double staining and P16 INK4α single staining, but the differences were not statistically significant ( z values were -0.890 and 1.017, both P > 0.05). Conclusions:HR-HPV testing is more suitable for primary cervical lesion screening; P16/Ki-67 double staining can be used as a potential combined cell screening tool or an effective triage tool; P16 INK4α single staining has certain limitations.