Cut Points of Chair Stand Test for Poor Physical Function and Its Association With Adverse Health Outcomes in Community-Dwelling Older Adults: A Cross-Sectional and Longitudinal Study

ObjectivesTo identify the optimal cutoff points for poor physical function [measured by a 5-times sit-to-stand (5-STS) test] associated with slowness in community-dwelling older adults and to validate the 5-STS cut points by determining whether they predicted future slowness and clinically relevant health outcomes over a 2-year-follow-up period.DesignCross-sectional and longitudinal analyses of a cohort study.Setting and ParticipantsWe conducted cross-sectional (n = 2977) and prospective 2-year follow-up analyses (n = 2515) among participants aged 70-84 years enrolled in the nationwide Korean Frailty and Aging Cohort Study (KFACS).MethodsClassification and regression tree (CART) analysis was used to identify the 5-STS cut points for poor performance in terms of slowness (eg, gait speed ≥1.0 m/s, gait speed >0.8 m/s and <1.0 m/s, gait speed ≤0.8 m/s) at baseline. Multinomial logistic regression models were used to evaluate the prevalence and incidence of slowness and clinical outcomes according to the three 5-STS categories (normal, intermediate, and poor) in the cross-sectional and longitudinal analyses.ResultsThe overall prevalence of slowness in our study sample was 9.0% for a gait speed of ≤0.8 m/s and 32.1% for a gait speed of <1.0 m/s. The CART model identified 5-STS cut points of 10.8 seconds and 12.8 seconds for intermediate and poor physical function, respectively. In the adjusted model, the cut point of 12.8 seconds had a significantly increased likelihood of incident slowness and clinically relevant health outcomes (ie, mobility limitation, disability, frailty, sarcopenia risk, and falls) over the 2-year-follow-up period (all, P < .05).Conclusions and ImplicationsOur study established 5-STS test cutoff points for poor physical function. Thresholds of 10.8 and 12.8 seconds (intermediate and poor physical function, respectively) for a 5-STS test might help identify individuals at risk of physical function impairments and, thus, help design preventive interventions in community health care settings.     

课程思政融入《口腔生物学》课堂教学的探索

立德树人作为我国高等学校的育人的方向,是高校的立身之本。育人先育德,教师理应把立德树人作为一种教育理念贯穿于课堂教学中,做到育人育才有机结合,在专业课授课过程中注重对思想政治教育元素的提炼和融入,加强对学生的思想政治教育,注重对学生世界观、人生观和价值观的正确引导和塑造,为我国社会主义建设培养合格的建设者和接班人。文章以《口腔生物学》课堂教学为例,探讨了课程思政教育背景下新型课堂教学的设计思路与理念,课堂教学中思政元素的提炼和融入的措施和方法。通过将思政教育元素有机融入课堂教学各环节,既提升了课堂教学的效果,又圆满实现了育人目标。     

《中医内科临床诊疗指南——头痛》制定中患者偏好与价值观的调查研究

目的:研究原发性头痛患者偏好与价值观,为形成推荐意见强度分级共识时提供参考。方法:采用横断面网络调查,通过半开放式电子问卷形式,使用视觉模拟评分(VAS)测量影响患者选择治疗措施的考虑因素重要性、总体治疗措施方向、头痛辨证汤剂治疗、原发性头痛的中成药及非药物治疗措施等方面的偏好与价值观。结果:调查共纳入研究对象217人。影响患者选择治疗措施的考虑因素重要性评分、总体治疗措施方向的偏好评分、偏头痛及紧张型头痛治疗措施的偏好评分差异具有统计学意义(P<0.01)。患者在选择治疗措施时最关注疗效,总体偏好于选择非药物疗法。在偏头痛治疗中,患者对针刺治疗偏好程度最高;在治疗紧张型头痛时,患者对推拿治疗的偏好程度最高;在治疗丛集性头痛时,患者对不同干预措施没有表现出明显偏好。结论:总体上,不良反应少的非药物疗法,如针灸、推拿等在原发性头痛治疗中更受患者欢迎,临床实践指南的制定应该考虑头痛患者的这一偏好与价值观结果。     

The emerging role of ultrasound in detecting interstitial lung disease in patients with rheumatoid arthritis

ObjectiveTo investigate the potential role of US in the detection of ILD in a cohort of patients with RA.MethodsPatients with diagnosis of RA were consecutively enrolled. All patients underwent pulmonary examination, laboratory data, DLCO measure, chest HRCT and radiographs, and US examination. A healthy group was included as control group. US was performed according the 14-intercostal space scanning protocol using the following semiquantitative scale [0 = normal (≤ 5 B-lines); 1 = slight (≥ 6 and ≤ 15 B-lines); 2 = moderate, (≤ 16 and ≥ 30 B-lines); 3 = severe (≥ 30 B-lines)].ResultsA total of 74 RA patients and 74 healthy controls were included. Thirty of 74 patients (40.5%) showed US signs of ILD with respect to the healthy controls (3 subjects, 4.1%) (P < 0.001); whereas HRCT showed ILD in 27 (36.4%) of 74 patients. Among the 30 patients that showed US findings of ILD, 17 (56.6%) were asymptomatic from respiratory view-point. The sensitivity and specificity of US were 92% and 89% respectively. A positive correlation between US and HRCT findings were found (P < 0.001) whereas no correlation was found with chest radiographs and DLCO findings. Positive association between US findings and DAS28-ESR, anti-CCP and RF (P < 0.01 for each respectively) was found. Feasibility, represented by the mean time spent to perform the pulmonary US assessment was 7.8 minutes (± SD 1.2, range 6 to 10 minutes).ConclusionsOur results support the potential of US in detect accurately ILD in patients with RA and provide a rationale to consider it as a friendly screening tool to be implemented in early phases of the disease.     

Social values and health priority setting in Australia: An analysis applied to the context of health technology assessment

ObjectiveTo describe the role of social values in priority setting related to health technology assessment processes and decision-making in Australia.ApproachThe processes and decision criteria of the Pharmaceutical and Medical Benefits Advisory Committees are described based on literature and policy sources, and analysed using a framework for identifying social values in priority-setting.FindingsTransparency and accountability of processes are apparent. Participation balances inclusiveness and effectiveness of decision-making, but presents an opportunity to enhance priority setting processes. Clinical and cost-effectiveness are important content considerations. Social values related to justice/equity are considered, without quantification of criteria weights for equity relative to other factors. HTA processes support solidarity through subsidising approved technologies for all Australians, whilst retaining autonomy by permitting non-subsidised technologies to be accessed privately, leading to possible tension between the values of solidarity, autonomy and equity.ConclusionsPriority setting related to health technology subsidy incorporates a range of inter-related social values in the processes and content of decision-making. Participation in decision-making could arguably be improved if a patient and public engagement policy were to be formulated alongside more widespread changes across processes to assess social values using approaches such as the Citizens’ Jury.     

Nerve ultrasound reference data in children from two to seven years

ObjectiveWe examined selected peripheral and spinal nerves of children aged between two and seven years.MethodHigh resolution ultrasound was performed in 116 children (2–7 years of age) at 19 predefined landmarks of median, ulnar, tibial, fibular, sural and radial nerves, the vagus as well as cervical spinal nerve 5 and 6. Further, side-to-side measuring and grey-scale analysis was done at selected nerve sites.ResultsNerves of children were on average smaller than those of adults. Nerve growth correlates significantly with age in all nerves, the mean values were similar in the age of two to four years and five to seven years. Body mass index (BMI) and gender showed moderate effect at some nerve sites, however not uniformly in all. A side-to-side difference of up to 30% in median, and up to 20% in tibial nerve can occur in healthy individuals. Grey-scale analysis for echointensity has been performed in median, ulnar and tibial nerves.ConclusionNerve size increases with age, BMI and gender have moderate effect. A side-to-side-difference of up to 30% can exist.SignificanceReference values of nerve cross-sectional area, side-to-side-difference and echo intensity are necessary to detect nerve pathology in children as well as in adults.