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《Journal of the American Medical Directors Association》2022,23(11):1861-1867
ObjectivesOlder adults' prior health status can influence their recovery after a major illness. We investigated the association between older adults’ independence in self-care tasks prior to a skilled nursing facility (SNF) stay and their self-care function at SNF admission, discharge, and the change in self-care function during an SNF stay.DesignRetrospective study of 100% national CMS data files from October 1, 2018, to December 31, 2019.Settings and ParticipantsThe sample included 616,073 Medicare fee-for-service beneficiaries who were discharged from an SNF between October 1, 2018, and December 31, 2019.MethodsThe admission Minimum Data Set (MDS) was used to determine residents’ prior ability (independent, some help, dependent) to complete self-care tasks before the current illness, exacerbation, or injury. Seven self-care tasks from MDS Section GG were used to calculate total scores (range 7-42 points) for self-care at admission, discharge, and the change in self-care between admission and discharge.ResultsMost residents (62.0%) were independent, 35.3% needed some help, and 2.64% were dependent in self-care prior to SNF admission. Nearly 25% of residents with urinary incontinence, 28.8% with bowel incontinence, and 31.7% with moderate-severe cognitive impairment were independent in self-care prior to SNF admission compared with approximately 70% of residents without these conditions. Compared with residents who were dependent in self-care prior to SNF admission, those who were independent or needed some help had significantly higher self-care total scores at admission (5.67 vs 4.21 points, respectively) and discharge (6.44 vs 3.82 points, respectively) and exhibited greater improvement in self-care (3.48 vs 1.62 points, respectively).Conclusions and ImplicationsOur findings are evidence that the new MDS item for a resident's independence in self-care tasks before SNF admission is a valid measure of their prior self-care function. This is clinically useful information and should be considered when developing rehabilitation goals. 相似文献
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Ovarian cancer is one of the leading causes of cancer-related death among women worldwide and accounts for 4% of all cancer cases in female patients. To date, ovarian cancer has the poorest prognosis among all types of gynecological cancer; thus, it is necessary to identify prospective therapeutic options. Previous studies have demonstrated the involvement of reactive oxygen species (ROS) in the cytotoxicity of various anticancer drugs against several types of carcinoma, including ovarian cancer. The present study aimed to investigate the anticancer effects of Siomycin A, a thiopeptide antibiotic, on the ovarian cancer cell lines PA1 and OVCAR3. To determine the viability of these cells following exposure to Siomycin A, the MTT assay was used, and apoptosis was determined by ELISA. In addition, mitochondrial membrane potential was determined by JC1 staining, and cellular ROS levels were assessed by dichlorodihydrofluorescein diacetate staining in the presence and absence of antioxidant NAC. The subsequent levels of antioxidant enzymes and glutathione were also determined following Siomycin A treatment in the two cell lines. A combination study with Siomycin A and cisplatin indicated enhanced efficiency of the drugs on ovarian cancer cell viability. The results of the present study also demonstrated that Siomycin A induced ROS production, inhibited the major antioxidant enzymes, including catalase, superoxide dismutase, glutathione peroxidase, glutathione reductase and intracellular GSH in PA1 and OVCAR3 cells, and inhibited the cell viability with an IC50 of ~5.0 and 2.5 µM after 72 h respectively compared with the untreated controls. Additionally, the Siomycin A-induced ROS production further targeted apoptotic cell death by impairing the mitochondrial membrane potential and modulating the levels of pro- and antiapoptotic proteins compared with those in the corresponding control groups. The administration of the antioxidant N-acetylcysteine significantly abrogated the cytotoxic effects of Siomycin A. In conclusion, the results of the present study demonstrated the role of ROS in Siomycin A-mediated cytotoxicity in ovarian cancer cells. 相似文献
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Jessica E. Rabski Ashirbani Saha Michael D. Cusimano 《American journal of surgery》2021,221(2):388-393
BackgroundCompetency-based medical education requires evaluations of residents’ performances of tasks of the discipline (ie. entrustable professional activities (EPAs)). Using neurosurgical Faculty perspectives, this study investigated whether a sample of neurosurgical EPAs accurately reflected the expectations of general neurosurgical practice.MethodA questionnaire was sent to all Canadian neurosurgery Faculty using a SurveyMonkey® platform.ResultsThe proportion of respondents who believed the EPAs were representative of general neurosurgery competences varied significantly across all EPAs [47%–100%] (p < 0.0001). For 9/15 proposed EPAs, ≥75% agreed they were appropriate for general neurosurgery training and expected residents to attain the highest standard of performance. However, a range of 27–53% of the respondents felt the other six EPAs would be more appropriate for fellowship training and thus, require a lower standard of performance from graduating residents.ConclusionThe shift towards subspecialization in neurosurgery has implications for curriculum design, delivery and certification of graduating residents. 相似文献
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目的 建立早期卒中后抑郁风险列线图预测模型,为临床医护人员筛查卒中后抑郁高危患者提供工具。
方法 对建模组259例卒中患者在卒中后第7~14天收集10项相关危险因素,于卒中后8~10周采用汉密尔顿抑郁量表和蒙哥马利抑郁量表测评卒中患者抑郁状况。利用χ2检验、Lasso回归及logistic回归筛选危险因素建立列线图预测模型,对模型进行内部及外部验证(验证组有82例患者)。
结果 卒中后抑郁检出率为39.38%;性别、婚姻状况、并存疾病数目、卒中部位、神经功能受损程度、日常生活活动能力是卒中后抑郁的独立危险因素(均P<0.05)。基于上述6个独立危险因素建立的列线图预测模型具有较好的区分度(AUC值:内部验证为0.883,外部验证为0.849)和准确度(Hosmer-Lemeshow检验:内部验证χ2=7.939,P=0.439,外部验证χ2=3.538,P=0.896);决策曲线分析显示预测模型曲线在大于10%的阈值概率区间具有临床实用价值。
结论 卒中患者发作后8~10周即有较高的卒中后抑郁发生率,构建的列线图模型能够有效预测早期卒中后抑郁风险,利于临床给予针对性干预。 相似文献
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目的:分析在校大学生预防自杀意念的外在保护因素。方法:采用分层抽样、三阶段抽样等方法,应用NCS-R自杀意念量表,对某北京高校两个学年的大学生(n=1256)的学习与生活状况进行调查,并进行logistic回归分析。结果:在校大学生有自杀意念的有173人(占13.77%);积极参加班级活动、经常参加体育锻炼等则是大学生群体减少自杀意念的保护因素,差异有统计学意义(均P<0.05)。结论:积极参加班级课外活动及体育锻炼对预防自杀意念有正向影响,建议作为大学生自杀预防的外在保护因素而加以重视。 相似文献
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Jipeng Wang Tianqi Wang Weifang Ding Jitao Wu Gang Wu Yongqiang Wang Zhongbao Zhou Ling Xu Yuanshan Cui 《Andrologia》2019,51(10)
Antioxidants were proved to be efficient to improve the quality of spermatozoa after varicocelectomy. We carried out a systematic review and performed a meta‐analysis to evaluate the efficacy of antioxidant therapy in sperm parameters' quality after varicocelectomy during 3 or 6 months' treatment cycle. During research, randomised controlled trials were searched by MEDLINE, EMBASE and the Cochrane Controlled Trials Register, and necessary parameters were compared between two groups after varicocelectomy. Finally, six studies including 576 patients were included in our meta‐analysis. As for sperm parameters, significant improvements of sperm concentration (p < .0001), sperm motility (p = .03), progressive sperm motility (p < .00001) and sperm morphology (p < .00001) were existed in antioxidant group 3 months after varicocelectomy. With regard to the 6 months' outcomes, sperm parameters were improved as well except sperm motility (p = .72) and progressive sperm motility (p = .57). Referring to pregnancy rate, no significant difference was existed between two groups (p = .36), and the FSH level of antioxidant group was lower than placebo group 3 or 6 months after varicocelectomy (3 months, p = .02; 6 months, p = .03). In conclusion, compared with the placebo, the antioxidant therapy after varicocelectomy can improve the quality of sperm parameters and construct a favourable living condition for spermatozoa by reducing FSH level. 相似文献
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