OBJECTIVES: To explore the relationship between the Observer's Assessment of Alertness/Sedation (OAAS) score and the bispectral index (BIS) during propofol titration for general anesthesia induction and analyze the impact of BIS monitoring delay on anesthetic depth assessment. METHODS: This study was conducted among 90 patients (ASA class I-II) undergoing elective surgery under general anesthesia. For anesthesia induction, the patients received propofol titration at the rate of 0.5 mg·kg^-1·min^-1 till OAAS scores of 4, 3, 2, and 1 were reached. After achieving an OAAS score of 1, remifentanil (2 μg·kg⁻¹) and rocuronium (0.6 mg·kg⁻¹) were administered, and tracheal intubation was performed 2 min later. BIS values, mean arterial pressure (MAP), heart rate (HR), and propofol dosage at each OAAS score were recorded, and the correlation between OAAS scores and BIS values was analyzed. The diagnostic performance of BIS values for determining when the OAAS score reaches 1 was analyzed using ROC curve. RESULTS: All the patients successfully completed tracheal intubation. BIS values of the patients at each of the OAAS scores differed significantly (P<0.01), and the mean BIS value decreased by 4.08, 8.32, 5.43 and 5.24 as the OAAS score decreased from 5 to 4, from 4 to 3, from 3 to 2, and from 2 to 1, respectively. There was a significant correlation between the OAAS score and BIS values (ρ=0.775, P<0.001). The median BIS value for an OAAS score of 1 was 76, at which point 83.33% of the patients had BIS values exceeding 60. ROC curve analysis showed that for determining an OAAS score of 1, BIS value, at the optimal cutoff value of 84, had a sensitivity of 88.9%, a specificity of 73.3%, and an area under the curve of 0.842 (0.803-0.881). CONCLUSIONS OAAS score during induction of general anesthesia is strongly correlated with BIS value and is a highly sensitive and timely indicator to compensate for the delay in BIS monitoring.
Humans ; Propofol/administration & dosage* ; Male ; Female ; Middle Aged ; Anesthesia, General/methods* ; Adult ; Consciousness Monitors ; Aged ; Young Adult ; Monitoring, Intraoperative/methods* ; Electroencephalography

The Rainbow Model of Integrated Care(RMIC)is a new conceptual framework that integrates primary care principles,integrated care characteristics,and a triple aim framework based on the Rainbow Model,which helps researchers better understand the concept of integrated care from a primary care perspective and thus scientifically conduct integrated care practice programs.This paper reviews the emergence and development of RMIC,its conceptual framework,and its application in integrated care,with the aim of providing a guiding basis for improving the quality of integrated care and positively transforming the health care delivery model in China.

Objective:To explore the trajectory of social vulnerability in first-episode stroke patients and analyze its influencing factors.Methods:Using convenience sampling, 210 stroke patients admitted to the Department of Cerebrovascular Diseases in The 3 rd Affiliated Hospital of CCUCM from January to December 2023 were selected as study subjects. The General Information Questionnaire, the Chinese version of the Social Vulnerability Index (SVI), Nutritional Risk Screening 2002, and the Social Support Rating Scale were used to conduct surveys at admission (T 1), 2 weeks post-onset (T 2), 1 month post-onset (T 3), 3 months post-onset (T 4), and 6 months post-onset (T 5). Latent Class Growth Model (LCGM) and univariate analysis were used for data processing. Results:A total of 176 valid consecutive questionnaires were collected, with an effective response rate of 83.81% (176/210). The SVI scores at T 1 to T 5 were (18.64±5.82), (19.97±6.42), (16.19±5.34), (15.98±5.61), and (16.12±4.42), respectively. Three latent classes of social vulnerability trajectories were identified among first-episode stroke patients, with average probabilities of 0.942, 0.956, and 0.932 for patients belonging to each latent class. The three classes were the high-level worsening group (30.1%, 53/176), the moderate-level improving group (52.3%, 92/176), and the low-to-moderate-level stable group (17.6%, 31/176). Age, living arrangement, self-rated personality type, activities of daily living after illness, presence of malnutrition, and social support were influencing factors for grouping the trajectories of social vulnerability in first-episode stroke patients ( P<0.05) . Conclusions:First-episode stroke patients exhibit three distinct trajectory types of social vulnerability from admission to 6 months post-onset, with variations in their social vulnerability trajectories. Age, living arrangements, self-rated personality types, activities of daily living after illness, presence of malnutrition, and social support are influencing factors for grouping social vulnerability trajectories in first-episode stroke patients. Clinical staff should closely monitor stroke patients in the high-level worsening group, promptly identify high-risk patients with social frailty, in order to reduce the impact of social vulnerability and provide proactive and targeted protective care.