Clinical guidelines recommend orthogeriatric care to improve older hip fracture patients’ outcomes, but few studies have been conducted in China. This study evaluated the effects of an orthogeriatric co-management care model in six Chinese hospitals. This non-randomised controlled study was designed as an exploratory trial and was conducted in 3 urban and 3 suburban hospitals. Eligible patients were aged ≥ 65 years with X-ray confirmed hip fracture and admitted to hospital within 21 days of injury. All patients received three times follow-ups within one year (1-month, 4-month and 12-month post admission). Co-management care was implemented in 1 urban hospital, while usual care continued in 5 urban and suburban hospitals. Patient demographics, pre-, peri- and post-operative information, complications and mortality were collected at baseline and follow-ups. The primary outcome was proportion of patients receiving surgery within 48 hours from ward arrival. Secondary outcomes included osteoporosis assessment, in-hospital rehabilitation, length of hospital stay, in-hospital mortality and one-year cumulative mortality. There were 2,071 eligible patients enrolled (1,110 intervention, 961 control). Compared to usual care, a significantly higher proportion of intervention patients received surgery within 48 hours (75% vs 27%, p<0.0001), osteoporosis assessment (99.9% vs 60.6%, p<0.0001), rehabilitation (99.1% vs 3.9%, p<0.0001) and shorter length of hospital stay (6.1 days vs 12.0 days, p<0.0001). The intervention group saw a significant lower in-hospital mortality rate than the control group (adjusted relative risk 0.021, 95% CI 0.001 to 0.45, P=0.01). One-year cumulative mortality was also significantly reduced in the intervention group (hazard ratio 0.59, 95% CI 0.38 to 0.80, p=0.01). Co-management care of older hip fracture patients resulted in better outcomes, including decreased time to surgery, improved clinical management, and reduced one-year mortality. A randomised controlled trial is needed to provide definitive evidence. The study is supported by Capital's Funds for Health Improvement and Research (2018-1-2071).

Mobile and tablet apps, ubiquitous and pervasive computing, wearable computing and domotics for health.

Background: Chest examination by auscultation is essential in patients with COVID-19, especially those with poor respiratory conditions, such as severe pneumonia and respiratory dysfunction, and intensive cases who are intubated and whose breathing is assisted with a ventilator. However, proper auscultation of these patients is difficult when medical workers wear personal protective equipment and when it is necessary to minimize contact with patients. Objective: The objective of our study was to design and develop a low-cost electronic stethoscope enabling ear-contactless auscultation and digital storage of data for further analysis. The clinical feasibility of our device was assessed in comparison to a standard electronic stethoscope. Methods: We developed a prototype of the ear-contactless electronic stethoscope, called Auscul Pi, powered by Raspberry Pi and Python. Our device enables real-time capture of auscultation sounds with a microspeaker instead of an earpiece, and it can store data files for later analysis. We assessed the feasibility of using this stethoscope by detecting abnormal heart and respiratory sounds from 8 patients with heart failure or structural heart diseases and from 2 healthy volunteers and by comparing the results with those from a 3M Littmann electronic stethoscope. Results: We were able to conveniently operate Auscul Pi and precisely record the patients’ auscultation sounds. Auscul Pi showed similar real-time recording and playback performance to the Littmann stethoscope. The phonocardiograms of data obtained with the two stethoscopes were consistent and could be aligned with the cardiac cycles of the corresponding electrocardiograms. Pearson correlation analysis of amplitude data from the two types of phonocardiograms showed that Auscul Pi was correlated with the Littmann stethoscope with coefficients of 0.3245-0.5570 for healthy participants (PP<.001). Conclusions: Auscul Pi can be used for auscultation in clinical practice by applying real-time ear-contactless playback followed by quantitative analysis. Auscul Pi may allow accurate auscultation when medical workers are wearing protective suits and have difficulties in examining patients with COVID-19. Clinical Trial: ChiCTR.org.cn ChiCTR2000033830; http://www.chictr.org.cn/showproj.aspx?proj=54971.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet

Digital health interventions can potentially improve the integration of the health care systems. Hip fracture is a serious injury for older people and integrated post-surgery care is vital for good recovery. We aimed to characterise digital health interventions used for hip fracture post-surgery care, and further to examine the extent to which of these interventions address the World Health Organisation (WHO) integrated care for older people (ICOPE) framework. A scoping review was conducted, by searching the literature from English and Chinese databases and trial registries. Keywords included hip fracture, post-surgery care and digital health interventions. Interventional, observational, qualitative studies and case reports were included. We used a combined framework, WHO ICOPE and WHO digital health intervention classifications, to support data synthesis. A total of 4,542 articles were identified, of which 39 studies were included in the analysis. We identified only six randomised controlled trials. Digital health interventions were mainly used to help doctors provide clinical care and facilitate service delivery between the patients and healthcare providers. No studies focused on health workforce, financial policy or the development of infrastructure. The primary users were healthcare providers and patients, without healthcare managers or the use of data services. Most digital health interventions focused on physical therapy, bone protection and falls prevention. Limited interventions were implemented in low-and middle-income countries. A stronger evidence base is needed to expand the use of digital health for post-surgery care of hip fracture patients, including high-quality larger-scale studies, more focus in resource-constrained settings, expanding to more users and capabilities of interventions, and exploring the role of digital health for the integrated care model to mitigate health system challenges.

Background: With rapid economic development and lifestyle changes, diet-related diseases have become a major public health concern globally. China is experiencing significant dietary transitions. From 2001 to 2021, the intake of staple foods declined, while the consumption of animal-based foods and ultraprocessed foods increased significantly. But comprehensive assessments of major dietary risk factors and the long-term health impacts of shifting dietary patterns in China remain unclear. Objective: This study aims to assess the disease burden attributable to dietary risk factors in China using data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021 (GBD 2021), and to examine long-term trends over the past 3 decades. In addition, it provides an in-depth analysis of the 3 major diet-related disease categories in China: cardiovascular diseases, neoplasms, and diabetes and kidney diseases. Methods: We extracted data from GBD 2021, focusing on diet-related health outcomes in China across 33 provinces and regions. Measures included deaths, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs), stratified by age, sex, and region. Age-standardized rates (ASRs) were calculated, and temporal trends were analyzed using estimated annual percentage change (EAPC). Results: In 2021, dietary risk factors accounted for 1.70 million deaths and 38.39 million DALYs among Chinese adults aged 25 years and older. The leading contributors were high sodium intake, low fruit consumption, and low whole grain intake. Cardiovascular diseases were the largest contributors to diet-related DALYs. The burden was more pronounced in males than in females and highest among older adults aged 80 years and older. Substantial regional variation was observed, with the Northeastern and Western regions showing higher burden. From 1990 to 2021, overall disease burden due to dietary risks declined steadily, as reflected by decreasing ASR-DALYs (EAPC= -1.76), YLLs, and death rates. In contrast, YLDs showed a slight upward trend (EAPC=0.75), indicating a shift toward increased years lived with disability. In addition, the relative contributions of specific dietary risk factors changed considerably. Low vegetable intake, once ranked the third in 1990, dropped to the 12 ^th by 2021, while high red meat consumption rose from the 15 ^th to 7 ^th place. Although the ranking of high-sugar beverage consumption did not change, the ASR-DALYs rate increased significantly, with a percentage change of 689.14% between 1990 and 2021. Conclusions: In China, the burden of diet-related diseases remains substantial. While the overall age-standardized disease burden has declined, marked regional and demographic disparities persist. Certain dietary risks, such as high red meat and sugar-sweetened beverage consumption, are rising, and high sodium intake remains a serious concern. These trends highlight the urgent need for comprehensive, adaptable, and evidence-based nutrition policies to be implemented to address the evolving diet-related disease burden across diverse populations in China.