Objective:To evaluate the effect of long-term full-dose cognitive digital therapy on improving and maintaining cognitive function in patients with cognitive disorders, and to provide basis for nursing management of patients with cognitive disorders.Methods:This study adopted three parallel randomized control trial design. By adopting the method of continuous grouping and convenient sampling, from January 2020 to January 2023, 90 patients with cognitive disorders who were treated in the neurology outpatient department of Beijing Xuanwu Hospital of Capital Medical University were selected as the study objects. These patients were divided into the control group, outpatient group and home group with 30 patients in each group by using the random digit table method. The control group received routine nursing, patients in the outpatient group received cognitive digital therapy in clinic based on routine nursing, and patients in the home group received cognitive digital therapy at home based on routine. Before intervention, 6 and 12 months after intervention, Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) were compared among three groups.Results:A total of 85 patients were enrolled in three groups. There were 28 cases in the control group, including 12 males and 16 females, aged (64.68±11.26) years. There were 30 patients in the outpatient group, including 19 males and 11 females, aged (65.74 ± 8.44) years. There were 27 cases in the home group, including 14 males and 13 females, aged (66.81 ± 11.18) years. The MMSE scores of the control group before intervention, 6 and 12 months after intervention were (22.00 ± 4.82), (17.25 ± 5.15), (14.25 ± 4.54) points respectively, and those of the outpatient group were (22.26 ± 3.46), (22.93 ± 3.77), (22.30 ± 3.57) points, while those of the home group were (22.40 ± 3.72), (22.03 ± 3.76), (21.90 ± 4.08) points respectively. The analysis of variance of repeated measurements showed that the intergroup, time and interaction effects were statistically significant ( Fbetween-group=15.30, Ftime=4.10, Finteraction=20.25, all P<0.05). The total scores of MoCA in the control group were (16.50 ± 4.87), (12.64 ± 4.94), (9.89 ± 4.01) points before intervention, 6 and 12 months after intervention, (18.74 ± 4.22), (18.96 ± 4.31), (18.41 ± 4.34) points in the outpatient group, (17.20 ± 5.12), (16.93 ± 3.67), (16.93 ± 4.10) points in the home group respectively. The analysis of variance of repeated measurements showed that the intergroup, time and interaction effects were statistically significant ( Fbetween-group=16.30, Ftime=5.74, Finteraction=12.08, all P<0.05). Conclusions:Long-term adequate outpatient and in-home cognitive digital therapy can effectively improve and maintain cognitive function in patients with cognitive disorders. It optimizes the management scheme of cognitive function training and provides evidence-based basis for non-drug intervention of patients with cognitive disorders.

Objective:To develop an expert consensus on safety management of inpatients with Alzheimer's disease (AD) (referred to as the " Consensus") and standardize safety management strategies for AD inpatients. Methods:The evidence on safety management of AD inpatients was searched, evaluated, and summarized, with a search period from database establishment to July 31, 2023. This study conducted methodological quality evaluation and evidence extraction on the included article to form a consensus draft. A total of 24 experts from 15 hospitals across the country were selected for two rounds of Delphi expert consultation to analyze, revise, and improve their opinions, forming the final draft of the Consensus. Results:The positive coefficients for both rounds of expert consultation were 100.00% (24/24). In the second round of consultation, the expert judgment basis coefficient was 0.925, familiarity level was 0.846, authority coefficient was 0.886, Kendall harmony coefficient was 0.044 ( P<0.01). The Consensus elaborated on five common safety problems (loss, falling, aspiration/choking, self-injury/other injury, and medication errors in AD inpatients) from three aspects (assessment, identification of risk factors, and nursing strategies) . Conclusions:The Consensus is scientific and practical to a certain extent, providing guidance and reference for the safety management practice of AD inpatients.

Objective:To explore the application effect of Internet-based hospital-institution linkage care management model in elderly care for the elderly of dementia.Methods:The research was a quasi-experiment study. A total of 80 elderly people of dementia from three combined medical and nursing institutions, Beijing Fangshan District Mental Health Care Hospital, Beijing Jinhai Hospital of Traditional Chinese Medicine, and Beijing Yiciyuan Nursing Care Center, were selected as the research objects by convenient sampling. The elderly people of dementia enrolled from May to August 2021 served as the control group, and elderly people of dementia enrolled from September to December 2021 served as the experimental group, with 40 cases in each group. Conventional management methods were taken in the control group, while Internet-based hospital-institution linkage care management model was taken in the experimental group. Before the intervention, at 3 months of intervention, the Mini-Mental State Examination (MMSE), Barthel index (BI) and Cohen Mansfield agitation behavior inventory (CMAI) were used to evaluate the cognitive function, activities of daily living and agitation behavior of two groups.Results:A total of 78 cases were included, including 39 cases in the experimental group and 39 cases in the control group, respectively. Before intervention, there was no significant difference in scores of MMSE, BI, and CMAI in the two groups of elderly people with dementia ( P>0.05). After 3 months of intervention, the score of MMSE in the experimental group was (17.36±5.67) points, which was higher than (15.05 ± 2.70) points of the control group, and the difference was statistically significant ( t=2.13, P<0.05). The score of CMAI in the experimental group was (34.18 ± 4.37) points, which was lower than (37.13 ± 5.06) points of the control group, and the difference was statistically significant ( t=2.76, P<0.05). There was no significant difference in BI scores ( t=0.13, P>0.05). Conclusions:The Internet-based hospital-institution linkage care management model improves the cognitive function and agitated behavior of the elderly with dementia in medical-nursing institutions.

Objective:To evaluate the efficacy and safety of transhepatic arterial chemoembolization (TACE) combined with tyrosine kinase inhibitors (TKI) and programmed death-1 (PD-1) inhibitors in the treatment of patients with initially unresectable hepatocellular carcinoma.Methods:The clinical data of 42 patients with initially unresectable hepatocellular carcinoma who were admitted to the Department of Hepatobiliary and Pancreatic Surgery of the First Affiliated Hospital of Zhengzhou University from January 2020 to December 2022 were included. There were 31 males and 11 females, with a median age of 56 years old (range, 45-72 years old). All patients received TACE+ TKI+ PD-1 inhibitor combined treatment. The systemic treatment cycles were calculated by the regimen of immunotherapy. The timing of local treatment depends on tumor size, blood supply and treatment response. Patients were followed up through hospitalization, outpatient visits and telephone review. The Kaplan-Meier curves were obtained for survival analysis.Results:The dosing cycle to achieve optimal imaging response in the patients was 4 (3, 7) [ M( Q1, Q3)], with a systemic treatment time of 141 (65, 194) d [ M( Q1, Q3)] and 2 (1, 3) times [ M( Q1, Q3)] of local treatments. All patients were evaluated by modified response evaluation criteria in solid tumors criteria after treatment, including nine patients with complete response (CR), 21 with partial response, eight with stable disease, and four with progressive disease. Objective response rate and disease control rate were 71.4% (30/42) and 90.5% (38/42), respectively. Treatment-related adverse reactions occurred in 85.7% (36/42) of patients and grade Ⅲ or Ⅳ adverse reactions occurred in 16.7% (7/42). There was no level Ⅳ adverse reactions. All adverse reactions were controlled after dose reduction and symptomatic treatment. Thirteen patients (31.0%, 13/42) redeemed resectable after treatment and underwent radical surgery. Seven patients had pathological CR after surgery. In two patients, the pathological residual cancer tissue was less than 10%. The cumulative overall survival rates of the 42 patients at 6 months, 1 year, 1.5 years after treatment were 100%, 91.7%, and 65.0%, respectively. The postoperative 1-year survival rate of patients undergoing surgery after successful conversion was 83.3%. Conclusion:This study preliminarily showed the safety and efficacy of TACE, TKI, and PD-1 inhibitor combined therapy in patients with initially unresectable hepatocellular carcinoma.

Objective:To construct an immersive cognitive training intervention scheme for patients with subcortical ischemic vascular cognitive impairment (SIVCI) to provide references for the development of cognitive training.Methods:Through literature research, theoretical analysis, group discussion and clinical investigation, the immersive cognitive training intervention scheme for SIVCI patients was constructed. Using the Delphi expert consultation method, 12 experts were selected to conduct 2 rounds of Delphi expert consultation, and finally an immersive cognitive training intervention scheme for SIVCI patients was established.Results:The recovery rate of the two rounds of expert consultation questionnaire was 100.00% (12/12) . In the second round of consultation, the coefficient of variation of each item was 0 to 0.14, the importance value was 4.67 to 5.00, the expert authority coefficient was 0.92 and Kendall coefficient of concordance was 0.67 ( P<0.05) . Finally, an immersive cognitive training intervention scheme for SIVCI patients was formed. Conclusions:The immersive cognitive training intervention scheme for SIVCI patients constructed in this study is scientific and practical, which can provide a reference for cognitive intervention of patients.

Objective To explore the features of connected speech produced by Chinese mild Alzheimer's disease (AD) patients.Methods Thirty Chinese mild AD patients (eight males and 22 females,and the age was (72.73 ± 7.78) years) and 30 age and education matched normal controls from three communities were recruited in Xuanwu Hospital from January 2018 to May 2018.All subjects completed tasks of picture naming,semantic fluency (animal),and Cookie Theft picture description.Picture description was analyzed for speech production (total word output,speech rate,sound errors),lexical content (number of nouns and verbs,proportion of pronouns and verbs,semantic errors),information content (information unit,idea density,efficiency),syntactic structure and complexity (mean length of utterance,words in sentences,syntactic errors).Differences between groups were calculated.Association between picture naming,semantic fluency,and measures in picture descriptions was analyzed.Results Compared with the controls,mild AD patients achieved lower scores on the picture naming task (74.45±8.04 vs 79.60± 1.73,t=-2.800,P=0.010) as well as on the semantic fluency task (10.35±3.08 vs 18.50±4.66,t=-6.520,P＜0.01) and produced lower speech rate (131.80±36.40 vs 149.64±26.69,t=-2.095,P=0.041),less number of nouns (7.52±2.55 vs 9.67±3.58,t=-2.509,P=-0.015) and verbs (4.40±2.24 vs 5.73±1.92,t=-2.375,P=0.021),increased proportion of pronouns (0.286 (0.319) vs 0.039 (0.122),Z=3.602,P＜0.01) and semantic errors (0.629 (1.396) vs 0 (0.779),Z=2.386,P=0.017),less information units (11.00±3.63 vs 13.70±3.53,t=-2.787,P=0.007),decreased idea density (0.11±0.04 vs 0.16±0.05,t=-3.946,P＜0.01),decreased efficiency (14.23±7.56 vs 22.95±7.14,t=-4.738,P＜0.01),shorter mean length of utterance (6.64± 1.27 vs 8.25± 1.70,t=-3.928,P＜0.01),and less words in sentence (0.84±0.10 vs 0.95±0.06,t=-4.625,P＜0.01).Group differences in total word output,sound errors,proportion of verbs,and syntactic errors did not reach statistical significance.Scores on picture naming task were negatively associated with the proportion of pronouns (r=-0.737,P=0.003),and positively associated with the idea density (r=0.540,P=0.046) and efficiency (r=0.592,P=0.026) in the AD group.Scores on semantic fluency task were negatively associated with the proportion of pronouns (r=-0.554,P=0.011).Conclusions Connected speech in mild AD patients was characterized by decreased naming accuracy,decreased sematic fluency,decreased content words,information units,conciseness,efficiency,and syntactic complexity,but motoric aspects of speech and sentence structure remained relatively preserved.Decreased content words and increased pronouns in mild AD may relate to semantic impairment.

Objective To investigate the current status and existing problems in the implementation of stroke care continuity in China, and to collect relevant suggestions for solving these problems. Methods Focus group interviews were used, to survey thirty-six nursing managers and senior nurses in neurology departments or rehabilitation programs in 24 cities of 13 provinces. The interview team members presided over the meetings, with full-time staff taking notes and recordings, and the results of the interviews were summarized and organized in a timely manner after the interview. Results At present, most of the general hospitals surveyed are doing their best to continue supporting nursing care for patients discharged from hospitals in different forms following their rescue of the acute phase. However, they are faced with such challenges as insufficient nursing manpower, and discontinuity between different medical institutions, which result in oversimplified nursing care and fragmented care. Conclusions Stroke nursing practitioners are working on continuous nursing care, with quite some challenges as well. Nursing care continuity is an important step towards establishing and improving a scientific and rational grading nursing care system.

Objective To explore the current status of mental resilience and its influencing factors in caregivers of patients with mild Alzheimer's disease (AD), so as to provide evidence for improving the quality of life and care level of the caregivers.Methods A total of 208 mild AD patients' caregivers in the neurology department of a Class Ⅲ Grade A hospital in Beijing were investigated with general information questionnaire, the Chinese version of the Connor-Davidson Resilience Scale (CD-RISC) and the Caregivers Burden Inventory (CBI).The influencing factors were analyzed with single factor analysis, Pearson correlation analysis and multiple linear regression analysis.Results The total score of the mental resilience of the caregivers of patients with mild AD was lower than the domestic norm. The difference in the mental resilience of caregivers with different genders, ages, duration of care, caring burden and caring assistance was statistically significant (P<0.05). Pearson correlation analysis showed that there was no statistical significance of the correlations between the duration of care and the total score, the tenacity dimension, the self-development dimension, as well as the correlation between gender and the tenacity dimension, the self-development dimension (P>0.05). Otherwise, all of the other factors were correlated with the scores of CD-RISC and all dimensions of it (P<0.05). Regression analysis showed that the influencing factors of caregivers' burden on resilience could explain 54.5％ of the total variation of the resilience.Conclusions The mental resilience of the caregivers of the patients with mild AD is generally low. Nurses should give different interventions according to the different levels of resilience and related factors, especially, more technical guidance and psychological support should be given to the caregivers with heavier burden.

Objective To explore the effect of extracurricular activities based on specialist nursing clinic. Methods Thirty-four undergraduate nursing students of grade 2013 in the Capital Medical University were enrolled in the study. After learning of nursing theories for senile dementia, the extracurricular activities based onspecialist nursing clinicwere carried out. Before and after the second class activities, the caring ability inventory scale and self scale-rating for self-directed learning (SRSSDL) were used to assess 34 students. Result After the activities, students' caring ability and self-directed learning ability were statistically significantly improved (P<0.01). Conclusion The extracurricular activities based onspecialist nursing cliniccan stimulate the learning interest of nursing students and improve their self-directed learning ability and humanistic care ability.

Objective To explore the effect of the second class on improving teaching results in "Geriatric Nursing".Methods A total of 53 junior college nursing students of Capital Medical University were selected by purposive sampling from September 2014 to February 2015. They were randomly divided into observation group (n=28, traditional teaching method + the second class teaching) and control group (n=25, traditional teaching method). The learning effects were evaluated with the self-rating scale for self-sirected learning (SRSSDL) and the theoretical achievements of "Geriatric Nursing".Results The theoretical achievements of "Geriatric Nursing" all improved. The average of the theoretical achievements was (80.28±6.15) in observation group and (72.33±9.78) in control group with a significant difference (t=4.43,P<0.05). The scores of SRSSDL in learning awareness, learning behavior, learning strategy, learning evaluation, interpersonal relations skills in observation group were all better than those in control with significant differences (t=4.198, 8.314, 10.237, 12.639, 5.109;P<0.05).Conclusions The second class in "Geriatric Nursing" provides a platform for innovation, demonstration, practice and knowledge aftertaste. It can effectively inspire students' learning interest in the major, be in favor of cultivation in humanistic concern and improve the self-directed learning capacity of junior college nursing students.