Objective To explore the factors influencing cognitive frailty in elderly inpatients with chronic heart failure(CHF)during hospitalisation,8 prediction models were developed with various machine learning algorithms to identify the best model as a guidance for medical staff on clinical interventions.Methods Convenience sampling method was used to select 650 elderly CHF inpatients who stayed in our hospital between September 2023 and June 2024 as the study objects in the cross-sectional investigation.A total of 607 patients had completed the study.The patients were divided into a cognitive frailty group and a non-cognitive frailty group according to the presence or absence of cognitive frailty.Variables were initially screened using univariate analysis and stepwise Logistic regression.The total sample was then randomly divided into a training set(n=424)and a testing set(n=183)of a 7:3 ratio.Eight predictive models were created using the algorithms of neural network(NN),k-nearest neighbour(KNN),linear discriminant analysis(LDA),support vector machine(SVM),naive Bayes(NB),logistic regression,decision tree(DT)and random forest(RF)on the training set.The predictive performance of the models was compared using the data of the testing set.Results The prevalence of cognitive frailty in elderly CHF inpatients was 48.3%.Results of Logistic regression showed that age,marital status,education,body mass index,multi-morbidity,nutritional status,medication,frequency of weekly exercise and the living conditions were the key factors(P<0.05).The overall accuracy in classification of the eight predictive models ranged from 0.803 to 0.847,with F1-values of 0.778 to 0.833,precision of 0.848 to 0.897,and recall rate of 0.700 to 0.778.The area under the receiver operating characteristic curve was 0.820 to 0.901.Conclusion Of the eight predictive models,the prediction model created with LDA shows the best performance and prediction in terms of comprehensive prediction metrics,while the prediction model created with NN shows the worst performance in comprehensive prediction.

Objective To explore the relationship between the risk of falls and the prolonged hospital stay in elderly patients with acute pancreatitis and to provide evidences for the decision-making of nursing and patient management.Methods A total of 232 elderly patients with acute pancreatitis admitted to our hospital from October 2021 to May 2024 were included as the study objects.General information questionnaire and revised Morse fall scale(MFS)were used for investigation.The patients were divided into a prolonged group and a non-prolonged group according to the length of hospital stay.Logistic regression was used to identify the factors that influenced the prolonged hospital stay.The effect of a risk of falls on prolonged hospital stay was analysed by Logistic regression with controlled variables.Results A total of 229 patients completed the study.The average hospital stay of the 229 patients was(9.8±5.5)days,with a median of 9 days(interquartile range:6,12 days).A total of 53 patients(23.14%)had a prolonged hospital stay.The average score of the risk of falls was(5.9±3.0),with a median score of 6(interquartile range:4,8).Multivariate Logistic regression analysis showed that the factors influencing the prolonged hospital stay were diabetes(OR=3.005,95%CI=1.380-6.542),nutritional risk(OR=2.393,95%CI=1.220-4.695),risk of falls(OR=1.233,95%CI=1.098-1.385)(all P<0.05).Further logistic regression analysis was conducted using multiple models and controlled variables,including gender,age,body mass index,history of smoking,history of alcohol consumption,hypertension,diabetes,education,lifestyle,primary disease,time from morbidity to admission,payment method for medical care,and nutritional risk.The results showed that the risk of falls was associated with prolonged hospital stay even after the adjustment of variables(OR=1.278,95%CI=1.126-1.451,P<0.001).Restricted cubic spline(RCS)curve analysis demonstrated that there was a nonlinear relationship between the risk of falls and the prolonged hospital stay(Pfor overall<0.001,Pfor nonlinear<0.05).Threshold effect analysis indicated that while the score of risk of falls was≥8,then per additional increase in the score was associated with a 2.3-fold of increase in the risk of prolonged hospital stay(OR=2.300,95%CI=1.454-3.637,P<0.001).Conclusion The risk of falls,in conjunction with diabetes and a nutritional risk,affects the prolonged hospital stay in elderly patients with acute pancreatitis.The risk of falls also affect independently on a prolonged hospital stay.When the score of risk of falls is≥8,the risk of prolonged hospital stay increases with the increment of the fall risk score.

Objective To investigate the post-intervention experiences in elderly stroke patients who received the group-based acceptance and commitment therapy(ACT)and to provide a reference to improve the group-based ACT intervention strategies for the patients.Methods With the descriptive phenomenological research,the semi-structured in-depth interviews were conducted with 15 elderly stroke patients who had received the group-based ACT intervention for 6 months in a Tier-IIIA hospital in Hunan Province between May and July 2023.The data acquired from the interviews were analysed using the Colaizzi method.Results The experiences in elderly stroke patients with the group-based ACT intervention were categorised into three main themes and ten sub-themes:(1)The impact of intervention on the psychology and spirit(change cognition and accept oneself;enhance awareness and reflect on oneself;clarify values and adapt to oneself;disengage from suffering and achieve dissociation;understand suffering and discover a sense of meaning in life);(2)Behavioural changes brought by the intervention(change approaches to improve health;engage in rehabilitation exercises and build confidence;enhance social interactions and integrate into life);(3)Suggestions for the intervention program(tailor to the physiological characteristics of the elderly;adapt to the psychological characteristics of the elderly).Conclusion The group-based ACT intervention has a beneficial effect on the psychological,spiritual and behavioural changes in the elderly stroke patients.The intervention programs should be improved according to the physical and mental characteristics therefore to improve the mental health of elderly stroke patients.

Chronic diseases in the elderly are characterised by high incidence rates and prolonged duration.Regular participation in multi-component exercise programs promotes both the physical and mental health of the elderly with chronic diseases and reduces the risk of morbidity,making it the key to prevent chronic diseases in the elderly.This review introduces the concepts of multi-component exercise,elucidates the mechanism in improvement of physical and cognitive functions and evaluates the applications as well as the advantages and disadvantages in the management of chronic diseases in the elderly.This review intends to provide references for clinicians who undertake management role of the chronic diseases in elderly populations.

Objective To identify predictive indicators for unscheduled rehospitalisation within 3 months in patients of oral endotracheal intubation(OEI)with ultrasound gray level co-occurrence matrix(GLCM)and develop a corresponding risk assessment system for the purpose to reduce the event of unscheduled rehospitalisation.Methods A total of 260 OEI patients who underwent extubation in a Tier-IIIA hospital between October 2023 and May 2024 were enrolled by convenience sampling.Patients were divided into a rehospitalisation group and a non-rehospitalisation group according to the event of unscheduled rehospitalisation within 3 months after discharge.Demographic data and laboratory test report,ultrasound morphological indicators and GLCM of rectus femoris muscle were collected on day-1 and day-7 after extubation.Multivariate logistic regression analysis and Framingham risk function were used to identify independent risk factors for unscheduled rehospitalisation within 3 months.A risk assessment system for unscheduled rehospitalisation within 3 months was subsequently developed.Predictive accuracy were evaluated using receiver operating characteristic(ROC)curve and area under the curve(AUC),and Hosmer-Lemeshow test.Results Toally 224 patients were included.The incidence of unplanned rehospitalization within 3 months in patients with oral tracheal intubation was 35.71%(80/224).The independent risk factors for unscheduled rehospitalisation within 3 months in OEI patients were identified as age≥60,nutrition risk screening2002≥3,shock index≥1.0,duration of mechanical ventilation≥251 hours,rectus femoris cross-sectional area≤1.41cm2,angular second moment≤0.71,the proportion change rate of ratio of rectus femoris on quadriceps femoeis for 0 on day-7 after extubation.The risk assessment system exhibited an AUC of 0.791(95%CI:0.707～0.875,P<0.001),with a sensitivity of 75.02%and a specificity of 67.33%.The Hosmer-Lemeshow value was 2.581(P=0.630),and the optimal cut-off value was determined at 3.Conclusion The developed risk assessment system demonstrates a satisfactory predictive performance.It provides a valuable reference for clinical assessment of the patients who had unscheduled rehospitalisation within 3 months in OEI patients.

Objective To investigate the effects of preoperative multidimensional pre-rehabilitation based on the concept of accelerated rehabilitation surgery(ERAS)on postoperative gastrointestinal function and psychological status in patients who received gastrointestinal surgery.Methods A total of 110 patients who underwent gastrointestinal surgery in our hospital from January 2022 to January 2024 were enrolled in this study.Patients who underwent gastrointestinal surgery from January 2022 to June 2023(n=55)were assigned into control group and offered with routine intervention,while patients from July 2023 to January 2024(n=55)were assigned into trial group and offered with postoperative multidimensional rehabilitation interventions based on ERAS.The two groups were compared in terms of recovery of gastrointestinal function,psychological state,cognitive function and the incidence of postoperative complication.Results The trial group demonstrated earlier recovery of bowel sound,flatus passage,first defecation,off-bed ambulation and nasogastric extubation than that of the control group.The trial group had significantly higher difference values of total protein,prealbumin and albumin of blood test between day-3 after surgery and the day of admission(all P<0.001).The trial group exhibited significantly difference values of scores on the patient health questionnaire-9(PHQ-9)and higher scores on the mini-mental state examination(MMSE)between day-3 after surgery and the day of admission than those in the control group(all P<0.001).The trial group was significantly lower than that of the control group(P<0.001).Conclusion Multi-dimensional pre-rehabilitation based on the ERAS can promote a rapid recovery of gastrointestinal function,improve mental status and cognitive function,and reduce complications in the patients with gastrointestinal surgery.

Objective To develop a rehabilitation exercise program for the patients with osteoporotic vertebral compression fractures.Methods An online search was performed across both Chinese and English databases and websites to retrieve literature on rehabilitation exercises and related therapeutic measures for patients with osteoporotic vertebral compression fractures.Two researchers independently screened the retrieved literature,evaluated the quality,and extracted relevant evidence.Semi-structured interviews were conducted among 15 patients at various rehabilitation phases about the requirements of rehabilitation.A preliminary exercise program was developed and verified for the validity and feasibility using Delphi method.Results A rehabilitation exercise program was formulated.The program included five periods of preoperative period,bedridden period after surgery,ambulation period(1 week after surgery),weeks 2-8 after surgery and weeks 9-12 after surgery covering six domains of exercise type,exercise items,exercise duration,exercise frequency,exercise intensity and exercise safety.The response rate and effective rate over the two rounds of expert consultation were both 100.00%,with an authority coefficient of 0.94.The Kendall's W coefficients for secondary indicators in the two rounds of expert consultation were 0.184 and 0.334,respectively(both P<0.001).Conclusion The exercise program developed in this study for the patients with osteoporotic vertebral compression fractures is scientifically reliable and reasonable.The two features of continuity and staged characteristics in rehabilitation process are fully considered,thereby it offers a guidance for clinical healthcare professionals as well as the patients in development of practical and effective rehabilitation exercise plans.

Objective To develop a quality evaluation indicator system for"Internet+indwelling tubes home nursing services"for a standardised evaluation process.Methods Based on the structure-process-outcome(SPO)model,a quality assessment indicator system for"Internet+indwelling tubes home nursing services"was developed.This system was refined via a comprehensive literature review,semi-structured interviews,clinical expertise,and a two-round Delphi consultation involving 20 experts from clinical nursing,nursing management,human resource management,public health and information technology.Results The effective recovery rate from both rounds of Delphi consultation was 100.00%.The authority coefficients for two-rounds of expert consultation were both at 0.785.Kendall's W coefficients for secondary indicators were 0.201 and 0.280,and 0.214 and 0.226 for tertiary indicators,all were statistically significant(P<0.05).After 2 rounds of expert consultation,the system demonstrated strong reliability:mean importance weights for all indicators exceeded 4.0,coefficients of variation were below 0.2,and full score rates included or surpassed 20%.The finalised quality evaluation indicator system for"Internet+indwelling tubes home nursing services"included 3 primary indicators(allocation of pipeline nursing service resources,implementation of pipeline nursing service resources,and feedback on the effectiveness of pipeline nursing service resources),12 secondary indicators,and 70 tertiary indicators.Conclusion The quality evaluation indicator system for"Internet+indwelling tubes home nursing services"developed in this study is scientifically reliable,practical and applicable for evaluation of the quality of"Internet+"pipeline home nursing services.

Objective To systematically evaluate the psychological characteristics of adolescent inflammatory bowel disease(IBD)patients during the transition period and provide evidence-based guidance for healthcare professionals in developing transition management strategies.Methods A systematic search was conducted across The Cochrane Library,PubMed,Web of Science,CINAHL,Embase,SinoMed,CNKI,Wanfang,and VIP databases for qualitative studies on adolescent IBD patients during transition,from database inception to May 2024.Eligible studies were critically appraised,and themes were synthesized using the meta-aggregation approach of meta-synthesis.Results Twelve studies were included,yielding 13 findings that were synthesized into five categories:self-development challenges,healthcare system transition barriers,family support conflicts,social adaptation difficulties,and lack of societal support systems.Conclusion Adolescents with IBD experience complex psychological challenges during transition,characterized by excessive psychological burdens,inadequate healthcare support,and insufficient societal recognition.Targeted interventions are needed to improve psychological outcomes during this critical phase.

Objective To retrieve,evaluate and summarise the best evidence in home nutrition management for patients after gastric cancer surgery,so as to provide a reference for medical staff.Methods According to the"6S"mode of evidence-based resource retrieval,desktop work was conducted to search the databases of UpToDate,PubMed,Embase,Cochrane Library,Web of Science,China National Knowledge Infrastructure(CNKI),VIP database,Wanfang database,Scottish Intercollegiate Guidelines Network(SIGN),the website of National Institute for Health and Care Excellence(NICE),Guidelines International Network(GIN),National Guideline Clearinghouse(NGC),the website of Registered Nurses'Association of Ontario(RNAO),the guidelines website of Chinese Society of Clinical Oncology(CSCO),Physiotherapy Evidence Database(PEDro),National Comprehensive Cancer Network(NCCN),the website of China Medical Association(CMA),the website of American Society for Parenteral and Enteral Nutrition(ASPEN),the website of European Society for Clinical Nutrition and Metabolism(ESPEN),and Yimaitong for clinical guidelines,systematic evaluations,expert consensuses,clinical decisions,evidence summaries and randomised controlled trials(RCTs)in home nutrition management for the patients after gastric cancer surgery.The retrieved data was from 1st January,2014 to 30th June,2024.Two researchers who had systematic training in evidence-based nursing independently screened and evaluated the retrieved literature.Results A total of 13 documents were finally included,covering 5 clinical guidelines,5 expert consensuses,1 clinical decision and 2 RCT studies.Thirty-two pieces of the best evidence were summarised from seven aspects of nutritional follow-up,nutritional risk screening and assessment,health education of oral nutrition,health education of tube-fed enteral nutrition,health education of nutrient requirement,complication management and life management.Conclusion The evidence summarised in this study on home nutrition management for the patients after gastric cancer surgery can be used as a reference for medical staff.