ObjectiveStroke is a leading cause of disability and mortality in older adults. Post-stroke cognitive frailty (CF) increases the risk of adverse outcomes. However, evidence regarding the prevalence of CF remains limited and inconsistent. This study aims to systematically evaluate the prevalence of CF among older adults with stroke in China and identifies factors associated with variation in prevalence, thereby informing future research directions and potential clinical considerations.MethodsWe searched PubMed, Embase, Web of Science, Cochrane Library, China Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), VIP Database, and Wanfang Database for relevant studies reporting the prevalence of CF in Chinese older adults with stroke. The search covered the period from each database’s inception to November 2024. Eligible studies were assessed for quality, and data were extracted. All analyses were performed using Stata 18.0 software.ResultsFour Chinese studies involving 1,337 participants were included. Meta-analysis revealed a pooled prevalence of CF among older adults with stroke of 33% (95% CI: 28–39%). Subgroup analysis indicated a significantly higher prevalence of CF in stroke patients aged ≥80 years compared to those aged 60–79 years (p < 0.05). Furthermore, the prevalence was significantly higher among those who consumed alcohol than among non-consumers (p < 0.05). Notably, subgroup estimates for patients with malnutrition and depression were markedly high, at 47% (95% CI: 34–60%) and 62% (95% CI: 53–71%), respectively.ConclusionAvailable evidence suggests that the prevalence of CF among older adults with stroke in China appears to be substantial, with significant variations associated with alcohol consumption and advanced age. The particularly high prevalence estimates in patients with malnutrition or depression warrant increased clinical attention and further investigation into their relationship with post-stroke CF. Caution is warranted given the limited evidence base (n = 4), high heterogeneity, and exclusively hospital-based Chinese setting; larger studies are needed to confirm these observations. Early identification and evidence-based interventions targeting CF in this population may be crucial to mitigating adverse health outcomes pending further validation.Systematic review registrationThis systematic review was prospectively registered with PROSPERO (registration number: CRD42025643159).

This article synthesized the status quo of genetic specialist nurse training abroad,and in combination with advancements in the field of genetic nursing in China,provided targeted insights.The aim was to clarify the role positioning of genetic specialist nurses,strengthen the cultivation of their specialist nursing competencies,establish standardized training processes and certification criteria,and plan for their continued education.These efforts were intended to promote the development of the genetic specialist nursing workforce in China.

Frailty is a prevalent geriatric syndrome in older adults, characterized by reduced physiological reserves and increased vulnerability to adverse health outcomes. Physical inactivity is a key modifiable risk factor that accelerates frailty progression. Nudge-based interventions, which subtly guide behavior through choice architecture, offer a promising, low-cost approach to promoting physical activity and improving health outcomes in this population A systematic search was conducted in PubMed, EMBASE, Cochrane Library, Web of Science, PsycINFO, and EconLit from inception to May 20, 2025, for randomized controlled trials (RCTs) on nudge-based physical activity interventions in frail older adults. Two reviewers independently performed study selection, data extraction, and quality assessment using the Cochrane risk-of-bias tool. Pooled effect sizes were calculated using random- or fixed-effects models as appropriate, with standardized mean difference (SMD) or mean difference (MD) reported for continuous outcomes. Statistical heterogeneity was assessed using I² and Cochran’s Q tests. A total of 16 studies involving 2,730 participants were included. Meta-analysis indicated that physical activity interventions based on nudge strategies significantly improved depressive symptoms [SMD = − 0.30, 95

Background Peripheral intravenous therapy is a common and safety-sensitive component of clinical nursing practice. Newly graduated nurses may have insufficient knowledge and operational skills in peripheral intravenous therapy and may lack confidence during the early transition to clinical practice. Theory-informed blended training may provide a structured approach to strengthening peripheral intravenous therapy-related competence, but evidence among newly graduated nurses remains limited. This study aimed to examine whether a Kolb-informed blended training approach was associated with improved peripheral intravenous therapy-related knowledge, PIVC operational skills, and core competence among newly graduated nurses, and to explore participants’ learning experiences. Methods An explanatory sequential mixed-methods study was conducted in a tertiary hospital in China. A total of 228 newly graduated nurses were included. Nurses in the intervention group received eight micro-video sessions and a 90-minute face-to-face workshop, whereas nurses in the historical control group received routine training. Peripheral intravenous therapy-related knowledge, operational skills, and core competence were assessed before and after training. Analysis of covariance was used to compare post-training outcomes between groups after adjustment for baseline scores. Semi-structured group interviews were conducted with 11 participants from the intervention group to explore their perceptions of the blended training approach. Results Compared with routine training, the Kolb-informed blended training approach was associated with significantly higher post-training scores in peripheral intravenous therapy-related knowledge, operational skills, and core competence. After adjustment for baseline scores, the adjusted mean differences were 15.07 points for knowledge, 8.39 points for operational skills, and 5.74 points for core competence. Qualitative findings suggested that micro-videos supported flexible and repeatable learning, while the workshop provided opportunities for hands-on practice, peer observation, instructor feedback, and reflection. Participants perceived improvements in procedural understanding, technical performance, and confidence in performing peripheral intravenous therapy-related procedures. Conclusion A Kolb-informed blended training approach was associated with improved peripheral intravenous therapy-related knowledge, operational skills, and core competence among newly graduated nurses. This approach may be useful for strengthening peripheral intravenous therapy-related competence during hospital-based transition training. Further multicenter studies with randomized designs, longer follow-up, and patient-related outcomes are needed to examine the durability and clinical impact of this training approach.

ObjectivesTo explore independent risk factors for preoperative venous thromboembolism (VTE) and to evaluate the predictive value of D-dimer levels and their interactions with key clinical variables. MethodsIn total, 1,004 elderly patients with hip fractures (≥60 years) admitted between December 2012 and February 2023 were retrospectively analyzed. Routine preoperative lower-extremity venous ultrasonography was performed to screen for deep vein thrombosis (DVT), and computed tomography pulmonary angiography was conducted when pulmonary embolism (PE) was clinically suspected. Multivariable logistic regression identified independent risk factors and interaction analyses assessed modifiers of the D-dimer–VTE association. Model performance was evaluated by ROC curves and AUC. ResultsThe incidence of preoperative VTE was 21.4% (215/1,004, 95% CI: 19.0%–24.1%), comprising 21.2% (213/1,004, 95% CI: 18.8%–23.9%) for DVT and 0.9% (9/1,004, 95% CI: 0.5%–1.7%) for PE, with seven patients having both DVT and PE. Multivariable logistic regression identified the following independent predictors: cardiovascular disease (OR = 2.787, 95% CI: 1.985–3.950, p < 0.001), injury-to-admission time of >1 day (OR = 2.471, 95% CI: 1.483–4.085, p < 0.001), history of VTE (OR = 3.676, 95% CI: 1.285–10.964, p = 0.016), shortened activated partial thromboplastin time (APTT) (OR = 0.941, 95% CI: 0.909–0.972, p < 0.001), and lower hemoglobin (OR = 0.983, 95% CI: 0.975–0.991, p < 0.001). D-dimer alone had poor discrimination for VTE (AUC = 0.533). Interaction analysis showed that sex (p for interaction = 0.018), injury-to-admission time (p for interaction = 0.002), and bedridden time (p for interaction < 0.001) significantly modified the association between D-dimer and preoperative VTE risk. The baseline multivariable model yielded an AUC of 0.728 for predicting VTE, which improved to 0.742 after including D-dimer interaction terms (ΔAUC = 0.013, 95% CI: 0.000–0.027, p < 0.05). ConclusionsCardiovascular disease, injury-to-admission time of >1 day, a history of DVT or PE, shortened APTT, and lower hemoglobin were identified as independent risk factors for preoperative VTE in elderly patients with hip fractures. Although D-dimer alone demonstrated limited discriminatory ability, incorporating its interactions with sex, injury-to-admission time, and bedridden time improved predictive performance.

Background Pain accelerates physical performance impairment in people with cognitive frailty (CF). Identifying the correlational paths through which pain affects physical performance in this population is crucial, yet the underlying mechanisms remain incompletely understood. Objective This study aimed to examined associations of Instrumental Activities of Daily Living (IADL) and insomnia on the relationship between pain and physical performance in older people with CF, providing clinical insights for preventing and delaying CF. Design A cross-sectional survey was conducted in two communities in Beijing, China (Jan–Jun 2025), involving 524 community-dwelling older adults with CF. Key indicators were assessed using standardized scales: Fried Frailty Phenotype, Montreal Cognitive Assessment (Beijing version), Clinical Dementia Rating Scale, Verbal Rating Scale for pain, Short Physical Performance Battery (SPPB), IADL scale, Athens Insomnia Scale, and a demographic/clinical characteristics questionnaire. Model 6 in SPSS was used to examine the associations. Results Pain was negatively associated with SPPB through two paths: (1) Pain impaired SPPB by reducing IADL capacity (β = -0.084, P < 0.001); and (2)Pain negatively affected SPPB by exacerbating insomnia symptoms (β = -0.009, P ≤ 0.05). In addition, pain exerted a strong direct effect on physical performance (β = -0.201, P < 0.001). Conclusion Pain was associated with physical performance through multiple correlational paths, with IADL and insomnia serving as statistical linking variables. Clinical interventions for older adults with CF should prioritize comprehensive pain management, IADL support, functional training, and insomnia care as an auxiliary strategy. Future research should explore additional correlational factors.

Background Understanding the role of visual impairment and psychosocial health in cognitive frailty can provide new perspectives and ideas for promoting health in the elderly. The study aims to use latent profile analysis to delineate and classify the psychosocial condition of older adults with visual impairment and considering the mediation effects of psychosocial condition sub-group between visual impairment and cognitive frailty. Methods The cross-sectional study enrolled aging people with eye diseases from a hospital in Beijing. Participants’ general demographics, visual acuity, psychosocial condition, and cognitive frailty were collected through questionnaires. Latent profile analysis, mediation analysis, and logistical analysis were utilized to achieve the aims. Results Total 539 elderly people involved and 25.04% has cognitive frailty, the latent profile analysis identified three distinct groups: good (27.8%), middle (31.3%), and poor (40.9%). Elderly people with eye disease have high prevalence of cognitive frailty, they also have greater number of visual impaired. The latent profile analysis based psychosocial condition group significantly mediated the relationship between visual impairment and cognitive frailty. Conclusion The cognitive frailty of the elderly population is influenced by visual impairments and the existence of unsatisfied psychological condition will increase the prevalence. The targeted interventions should be multifaceted, addressing sensory, emotional, and cognitive health simultaneously. The focus and practice on elderly people’s visual health and psychosocial health could promote healthy aging and management of cognitive frailty.

Purpose: In order to provide a foundation for identification and intervention strategies, this study intends to investigate the influencing factors and associative patterns of two subtypes of reversible cognitive frailty (RCF) and potential reversible cognitive frailty (PRCF) in older adults with cognitive frailty (CF) who live in the community. Patients and Methods: From July to December 2023, we conducted a cross-sectional study in a Beijing community to recruit older adults with CF using convenience sampling. We conducted the survey using the General Information Questionnaire, the Montreal Cognitive Assessment, the Clinical Dementia Rating, the Fried Frailty Phenotype, the Geriatric Depression Scale-15, the Generalized Anxiety Disorder-7, the Athens Insomnia Scale, the Barthel index, the Tinetti Performance Oriented Mobility Assessment, and the Lubben social network scale. The participants were separated into two categories: RCF and PRCF, based on frailty and cognitive assessment. After screening variables with a random forest algorithm, we applied association rule analysis to examine the factors influencing CF and the strength of their interactions. Results: The survey was completed by 529 older adults with CF who lived in the community. Among them, 145 participants (27.4%) were classified as PRCF and 384 (72.6%) as RCF. 24 association rules, 12 for each subtype, were developed using the Apriori algorithm and clinical practice experience. These rules identified polypharmacy, multimorbidity, low educational attainment, and high fall risk as significant factors. Furthermore, the association pattern for PRCF is more complex. Conclusion: The influencing factors associative patterns of the two categories of CF differ. In order to better manage elderly individuals with CF in the community, improve the cognitive health of the elderly, and encourage healthy aging, medical professionals should upgrade the community evaluation system for CF.

ObjectiveThis study aimed to identify social isolation profiles among older adults in China using latent profile analysis and to explore their associations with demographic and health factors.MethodsA cross-sectional study was conducted between July and December 2023 in the Chaoyang and Dongcheng districts of Beijing, China. Participants aged 60 years or older were recruited through convenience sampling from six communities. Latent profile analysis was used to classify social isolation patterns, and multivariate logistic regression models to assess associated factors.Results529 participants were included. Three social isolation profiles were identified: the mild social isolation subgroup (n = 239, 45.2%), the moderate social isolation subgroup (n = 213, 40.3%), and the severe social isolation subgroup (n = 77, 14.5%). Comparing mild to severe social isolation, multivariate analysis revealed that older adults living alone without caregiver had significantly higher odds of severe social isolation compared to those living with children (OR = 0.099, 95% CI: 0.034–0.377, P < 0.001). Frailty (OR = 0.141, 95% CI: 0.039–0.588, P = 0.033), severe ADL dependence (OR = 0.249, 95% CI: 0.145–0.454, P = 0.048), and moderate to severe IADL dependence (OR = 0.448 to 0.307, P = 0.046, P = 0.017) were also significantly associated with severe social isolation. Similarly, in the comparison between the moderate and severe subgroups, compared to those living with children, older adults living alone without caregiver were more likely to experience severe social isolation (OR = 0.199, 95% CI: 0.078–0.328, P = 0.001). In terms of functional status, severe ADL dependence (OR = 0.152, 95% CI: 0.061–0.505, P = 0.015) and moderate to severe IADL dependence (OR = 0.231 to 0.128, P = 0.045, P = 0.033) were significantly associated with severe social isolation.ConclusionOlder adults living alone without caregiver, with frailty, and with functional dependence are at significantly higher risk of severe social isolation. Family network integrity emerged as the primary dimension differentiating severe social isolation from mild-to-moderate isolation, which may be linked to a quantitative gradient of overall network restriction. Understanding the specific factors contributing to different profiles could inform tailored support strategies to enhance social engagement and quality of life in this population.

Objective To analyze the research hotspots and development trends in the field of social frailty of the elderly,thus providing reference for further research in this field. Methods The literature related to social frailty was retrieved from CNKI and Web of Science core collection and analyzed in terms of authors,institutions,countries,keywords,and burst terms by CiteSpace. Results A total of 165 articles in both Chinese and English were included.The annual number of papers published in the field of social frailty showed an increasing trend year by year.The authors,institutions,and countries with the largest number of papers were from Japan.The available studies of social frailty mainly focused on the causes and mechanisms,assessment methods,occurrence status,and adverse health outcomes.The social frailty of patients with heart failure and the survival status of patients with social frailty are major research trends in this field. Conclusions The research on social frailty is in the preliminary stage of exploration.The research focus is on the occurrence status and adverse effects of social frailty.In the future,the causes and mechanisms of social frailty in different populations and different contexts can be further explored,and targeted prevention,intervention,and management can be carried out.

Female patients with thyroid cancer have a greater desire for not only curing the disease but also leaving an inconspicuous scar. Systematic nursing has a comprehensive effect on reducing scar formation. However, comprehensive nursing guidance for postoperative scar management are not usually available for patients with thyroid cancer. This study aimed to compare the comprehensive effect of systematic nursing compared to traditional nursing measures on postoperative scar management in patients with thyroid cancer. One hundred patients who underwent radical thyroidectomy between January 2019 and June 2019 were selected and randomly assigned to two groups. Patients in the experimental group (n = 50) received nursing care under systematic nursing guidance, while those in the control group (n = 50) received traditional nursing care. In the 3rd, 6th, and 12th months after surgery, all patients returned to the general surgery department for scar evaluation. Scarring was evaluated using the Vancouver Scar Scale (VSS). Patients’ self-evaluated satisfaction scores for scar appearance and nursing guidance were also collected. Compared with the control group, scars in the experimental group were less inconspicuous. At the 6th and 12th months after surgery, the total VSS score in the experimental group was significantly lower than that in the control group (P < 0.001). By the 12th month after surgery, patients in the experimental group were more satisfied with the final scar appearance (experimental group: 4.69 ± 0.48; control group: 4.06 ± 0.57; P < 0.01) and nursing care (experimental group: 4.88 ± 0.34; control group: 4.50 ± 0.52; P < 0.05). Systematic nursing guidance had positive effects on reducing scar formation and enhancing patient satisfaction.

Objective:This study aims to investigate the effects of exercise-cognitive dual-task training on frailty status, cognitive function, physical performance, and dual-task cognitive load in older adults with Cognitive frailty (CF) over a 16-week intervention period. Methods:This randomized controlled trial enrolled older adults with CF at community health service center in Chaoyang District, Beijing, between February and March 2024. Participants were randomly assigned to either the dual-task training group or the health education group in a 1:1 ratio. The dual-task training group received an exercise-cognitive dual-task training program, while the health education group received information on CF, including its symptoms, risk factors, and non-pharmacological prevention and treatment strategies. The primary outcomes were frailty status, while the secondary outcomes included cognitive function, balance and gait function, walking ability, and dual-task cognitive load. Results:A total of 72 participants (35 males) were enrolled, including 36 individuals (mean age: 74.81 ± 8.23 years, 17 males, mean BMI: 21.38 ± 2.83 kg/m2) in the dual-task training group, and 36 individuals (mean age: 76.50 ± 7.75 years, 18 males, mean BMI: 22.18 ± 2.12 kg/m2) in the health education group. Participants (n = 72) were 75.66 ± 7.9 years old; 48.6% (35/72) were male and 51.4% (37/72) were female. Following the intervention, the dual-task training group exhibited significant improvements compared to the health education group in the Tilburg Frailty Index (5.14 ± 0.99 vs. 7.36 ± 1.07, p < 0.001) and Montreal Cognitive Assessment scores (27.25 ± 2.41 vs. 23.47 ± 1.87, p < 0.001). Additionally, the dual-task training group demonstrated superior outcomes in the Performance-Oriented Mobility Assessment (POMA) scores (24.64 ± 5.50 vs. 17.39 ± 4.38, p < 0.001), Time Up and Go Test (TUGT) indicators (10.66 ± 1.76 vs. 12.01 ± 2.21, p < 0.05), and cognitive load measures (all p < 0.05). Conclusion:Exercise-cognitive dual-task training may effectively improve frailty status, cognitive function, physical performance, and dual-task cognitive load in older adults with CF, suggesting its potential for broader application in this population. Clinical trial registration:http://www.chictr.org.cn/, ChiCTR2400080105.

The identification of depression and loneliness among people with cognitive frailty (CF) could prevent negative psychological and physical health outcomes. Few studies have focused on physical and mental health together, and little is known about the role of daily activity in the association between depression and loneliness among elderly individuals with CF. To determine the positive effect of loneliness on depression among community-dwelling older adults with CF as well as the moderating effect of instrumental activities of daily living (IADL) on this association. This cross-sectional study included 529 adults aged 65 years and older from a community-dwelling population who were screened for CF and was conducted from July 2023 to December 2023. The participants were assessed via validation instruments for the following main variables: Short-form Geriatric Depression Scale, Loneliness Questionnaire, Athens Insomnia Scale, Instrumental Activities of Daily Living (IADL), Social Support Scale, and sociodemographic characteristics. The participants were classified as having reversable CF (RCF) or potentially reversable CF (PRCF). The IADL, depression, insomnia, and loneliness scores were lower among individuals with RCF than among individuals PRCF. The moderating effect of IADL scores shows that the relationship between loneliness and depression has a steeper and positive slope when lower levels of IADL exist, compared with a straight line when there are higher levels of IADL, for this case, the line is less steep and showed negative association. The integrity of physical and social connections has a protective effect on the mental health of elderly people with CF. It is necessary to pay attention to disability and loneliness among elderly individuals. Targeted interventions for improving physical activity and social participation seem to be practical and feasible solutions to alleviate depressive symptoms.

Objective:Aimed to investigate the risk factors associated with depression in community-dwelling older adults with cognitive frailty and to examine the mediating role of sleep quality in the relationship between activities of daily living (ADL) and depression. Methods:A cross-sectional study was conducted using convenience sampling, enrolling older adults with cognitive frailty from six communities in Beijing from July 2023 to December 2023. Cognitive frailty was assessed using the Montreal Cognitive Assessment (MoCA) alongside with the Fried Frailty Phenotype, while depressive symptoms were measured with the Geriatric Depression Scale (GDS-15). Multivariate logistic regression analysis was used to identify risk factors influencing depression, and mediation analysis was employed to explore the mediating effect of sleep quality on the relationship between ADL and depression. Results:Among the 529 elderly participants with cognitive frailty, 128 (24.2%) were found to exhibit depressive symptoms. Multivariate logistic regression identified ADL [Mild Dependence: OR = 176.729 (95% CI 32.427-963.172), p < 0.001; Moderate Dependence: OR = 51.769 (95% CI 12.541-213.697), p < 0.001], loneliness [OR = 13.821 (95% CI 6.095-31.338), p < 0.001], and sleep quality [Suspected Insomnia: OR = 7.310 (95% CI 2.316-23.074), p = 0.001] were significantly associated with depression. Sleep quality was found to mediate the relationship between ADL and depression, accounting for 2.82% of the total effect. Conclusion:Dependence in ADL, loneliness, and poor sleep quality are potential risk factors of depression for cognitive frailty in aging adults. Moreover, sleep quality was found to mediate the relationship between ADL dependence and depressive symptoms.

Background:Recent evidence suggests that there is a close correlation of inflammation with depression. Therefore, our study aims to explore the association of Alpha-1-acid glycoprotein (AGP), a highly sensitive inflammatory biomarker, with depression in US adult women. Methods:Data from the National Health and Nutrition Examination Survey (NHANES) from 2021-2023 were selected for this study. Both AGP concentrations and depression levels were assessed using standardized survey instruments. Multivariate logistic and linear regression, and restricted cubic splines models (RCS) were performed to evaluate the relationship of AGP concentrations with depression. Stratified analyses and multiplicative interaction testing were conducted to evaluate the robustness of the observed association across relevant subgroups. Results:AGP concentrations demonstrated a positive linear association with depression among US adult women. Each standardized unit increment in ln-transformed AGP concentrations was associated with significantly higher odds of depression (OR = 2.04, 95% CI: 1.17-3.57) and a 1.47-point increase in PHQ-9 scores (β = 1.47, 95% CI: 0.37-2.56) in the fully adjusted model. Furthermore, compared with participants in the lowest AGP concentration quartile, those in the highest quartile exhibited 72% greater odds of depression (OR = 1.72, 95%CI: 1.03-2.87), and 1.32-point higher PHQ-9 scores (β = 1.32, 95%CI: 0.31-2.34) in the fully adjusted model. This positive association remained consistent across several subgroups and our sensitivity analysis. In addition, compared to C-reactive protein (CRP), AGP had a stronger predictive effect on depression using the ROC curve. Conclusions:AGP exhibited a positive linear association with depression in US adult women. This positive association remained consistent across several subgroups. Furthermore, AGP had a stronger predictive effect on depression compared to CRP.

BackgroundThe Caprini risk assessment model (RAM) is widely used to evaluate venous thromboembolism (VTE) risk across diverse patient populations. However, the original risk stratifications may require modification for hip fracture patients to improve predictive accuracy. This study aimed to optimize VTE prediction by refining the Caprini model and integrating additional predictive factors.MethodsThis retrospective cohort study included 1114 elderly hip fracture patients screened at Peking Union Medical College Hospital between May 2012 and February 2023. A modified VTE prediction model was developed by integrating D-dimer levels and injury-to-admission time into the Caprini RAM. The sensitivity, specificity, and the area under the curve (AUC) of the model were determined to assess its predictive performance.ResultsThe revised Caprini model effectively stratified patients into three VTE risk levels on the basis of their scores: 14.0% for ≤9, 24.0% for 10-11, and 39.4% for ≥12. Both the Caprini score and risk level demonstrated better predictive ability than D-dimer did (AUCs: 0.606 and 0.614 vs 0.552). Among patients admitted within one day after injury, the D-dimer levels were significantly higher in VTE patients compared with non-VTE patients from day 3 onwards (p = .012). Incorporating the injury-to-admission time with the Caprini score further improved the AUC from 0.614 to 0.649. Among models maintaining the sensitivity and negative predictive value above 90%, this combination model demonstrated the best performance. In contrast, for patients with delayed admission (>1 day), D-dimer levels were significantly higher in those with VTE than in those without VTE (p < .001). Combining the Caprini score with the D-dimer level provided a more accurate prediction (AUC: 0.681), significantly outperforming the Caprini score alone (AUC: 0.552). When the sensitivity exceeded 95%, the D-dimer threshold model across the three Caprini risk levels outperformed the Caprini risk levels combined with the D-dimer level (AUC: 0.592 vs 0.571) and demonstrated a significant advantage at 100% sensitivity.ConclusionsReclassifying the Caprini score into three risk levels may improve preoperative VTE stratification in elderly hip fracture patients. Integrating the injury-to-admission time and D-dimer level into the Caprini model was associated with improved predictive performance. Standardizing the timing of D-dimer sampling may reduce timing-related variability in VTE assessment. External multicentre validation is warranted.

Introduction Preoperative patients with knee osteoarthritis have a significantly increased risk of venous thromboembolism (VTE). While the Caprini risk assessment model offers some clinical guidance in predicting deep vein thrombosis (DVT), it has a relatively low predictive accuracy. Enhancing the model by integrating biomarkers, such as D-dimers, can potentially improve its accuracy. In this study, we explored the effectiveness of combining the Caprini risk model with D-dimer levels for individualized DVT risk assessment in patients with knee osteoarthritis. Materials and Methods This retrospective cohort study included 1605 knee osteoarthritis patients scheduled for total knee arthroplasty from Peking Union Medical College Hospital, screened between January 2015 and December 2018. A revised Caprini risk stratification model was developed, and a predictive DVT model was developed based on this revised system. The sensitivity, specificity, and the area under the curve (AUC) were used to determine predictive effectiveness of the model. Results In the revised Caprini risk stratification, the incidence of DVT increased with higher risk levels: 2.52% in the low-risk group (scores 0-2), 2.88% in the moderate-risk group (score 3), 6.47% in the high-risk group (score 4), and 9.09% in the highest-risk group (score ≥ 5). The incidence of DVT was 3.869-fold higher in the highest-risk group and 2.676-fold higher in the high-risk group compared to the low-risk group (p = 0.013 and p = 0.014, respectively). Combining the revised Caprini risk stratification with D-dimer level demonstrated an improved AUC of 0.792, compared to D-dimer level alone (AUC 0.774) and the revised Caprini model alone (AUC 0.598). Furthermore, applying specific D-dimer thresholds across the four Caprini risk stratifications outperformed the combination of the revised Caprini model and D-dimer level in terms of AUC, specificity, and reduction in unnecessary ultrasonography. Using the Youden index, the AUC for the threshold-based method was slightly higher (0.775 vs 0.754, p = 0.310), with significantly better specificity (76.8% vs 63.6%, p < 0.001) and a greater reduction in ultrasound use (74.1% vs 61.4%). At a sensitivity of 85.5%, the differences were modest but still favored the threshold-based approach. At a sensitivity of 100%, the specificity (36.0% vs 24.7%, p < 0.001) and ultrasound reduction (34.8% vs 23.9%) were significantly better. Conclusion The revised Caprini risk stratification improves preoperative DVT prediction in patients with knee osteoarthritis. Incorporating specific D-dimer thresholds into the four-level Caprini risk model enhances specificity and reduces unnecessary ultrasonography, outperforming both the use of individual indicators and the combination of the revised Caprini model with D-dimer level.

Abstract Background To evaluate the knowledge, attitude and practice of nurses regarding non-pharmacologic therapies for behavioral and psychological symptoms of dementia (BPSD). Methods This cross-sectional, questionnaire-based study enrolled nurses at Peking Union Medical College Hospital (Beijing, China) between September 2022 and October 2022. Correlations between knowledge, attitude and practice scores were evaluated by Pearson correlation analysis. Factors associated with knowledge, attitude and practice scores were identified by multivariable linear regression. Based on a cross-sectional questionnaire survey, this study designed a questionnaire according to the Guidelines for Diagnosis and Treatment of Dementia in China, and randomly selected nurses from Peking Union Medical College Hospital to fill in the questions through the Wen-Juan-Xing online platform from September 2022 to October 2022. Results The analysis included 210 nurses (202 females). The average knowledge, attitude and practice scores were 11.06±2.61 (total score: 18), 53.51±5.81 (total score: 60) and 64.66 ± 10.35 (total score: 80) points, respectively. Knowledge score was positively correlated with attitude score (r = 0.416, P < 0.001) and practice score (r = 0.389, P < 0.001); attitude and practice scores were also positively correlated (r = 0.627, P < 0.001). Multivariable analysis demonstrated that age ≥ 40 years-old (vs. ≤30 years-old) was associated with higher knowledge score (β = 1.48, 95% confidence interval [95%CI] = 0.42–2.54, P = 0.006). Age ≥ 40 years-old (β = 1.43, 95%CI = 0.35–2.51, P = 0.010 vs. ≤30 years-old) and bachelor’s degree or higher (β = 1.11, 95%CI = 0.12–2.10, P = 0.028 vs. college degree or lower) were associated with higher practice score. Conclusions Older age and higher education level were associated with higher knowledge, attitude and/or practice scores. The findings of this study may help guide the development and implementation of education and training programs to improve the management of BPSD by nurses in China.

Background: To promote the collaborative development of CNSs at different levels, it is necessary to have a targeted understanding of the current core capabilities of CNSs at different levels. The study aims to describe and compare the core competencies of clinical nurse specialist (CNS) between two years in China and investigate the differences among three levels of expertise of CNSs: primary, intermediate, and advanced. Methods: This is a cross-sectional study. An online survey was conducted in 5 November, 2021 and 7 November, 2023. The study was conducted in a grade 3A hospital in China. A population sample of clinical nurse specialists from China was recruited. Core competency was assessed through a self-evaluation strategy, and the assessment instrument included five first-level domains and 35 items. The data were analysed based on their level and survey year. Results: A total of 483 clinical nurse specialists, classified into primary, intermediate, and advanced levels of expertise, participated in the study. The average CNS competency scores increased after two years (P=.002). Among the primary-level CNSs, the scores for all five core competencies significantly differed from 2021 to 2023 (P= .032, .009, .031, .006, .047). The competency of intermediate-level CNSs improved throughout the two years, and their scores for ‘consulting and teaching’ and ‘management and leadership’ were significantly different (P< .001). For advanced-level CNSs, self-assessment scores all increased but were not significantly different. Conclusion: After two years of working at the clinic and receiving further education, the overall core abilities of specialized nurses improved. The performance improvement of intermediate specialized nurses is particularly outstanding, and they are the most popular among colleagues in clinical practice and can provide effective care for patients. The core abilities of primary and intermediate clinical nurse specialists need to be further improved to meet the more urgent needs of hospitals and patients in difficult clinical problems, team management, and professional development.