Sakurakai Takahashi Hospital, Japan
Background: Development of delirium in intensive care unit (ICU) is associated with increased mortality, prolonged ICU stay and development of post-ICU cognitive impairment. Although several patient-baseline characteristics contributing to the development of delirium such as preexisting dementia, history of hypertension and alcoholism have been established, there is paucity of data on factors contributing to the development of delirium in patients with acute coronary syndrome (ACS), who usually have several comorbidities and are subjected to various treatment-related risk factors with impaired cardiac function.
Objective: This study aimed to identify factors contributing to delirium among patients with ACS.
Methods: We retrospectively investigated 231 patients with ACS who were consecutively hospitalized in coronary care units (CCU) of a hospital between January 2017 and March 2019. Of those, 24 patients with cardiopulmonary arrest on arrival, 8 undergoing mechanical ventilation, 8 preexisting dementia and 6 transferred to general ward until next day were excluded from the study. We divided the remaining 185 patients into two groups (delirium and non-delirium) according to the presence or absence of delirium. Delirium was defined as experiencingany one of following symptoms: 1) contradictory conversation, 2) self-removal of drip infusion, 3) impaired orientation, 4) restlessness, 5) delusions and hallucinations and 6) inability to stay quiet.
Results: Compared to the non-delirium group, the delirium group was older (80.2 ± 8.8 vs. 65.8 ± 11.0 years old, p < 0.001); more likely to be living alone, having cerebrovascular disease and lower left ventricular ejection fraction (43.2 vs. 22.7 %, p = 0.008; 25.0 vs. 10.6 %, p = 0.017; 49.8 ± 11.7 vs. 54.7 ± 13.4 %, p = 0.022, respectively); and more likely to have any one of the central lines, including central venous line, intra-aortic balloon pump, arterial line and temporary pacing (31.8 vs. 12.8 %, p = 0.004). Multivariate logistic regression analyses indicated that age and living alone were independent predictors of delirium (OR 1.16, 95% CI 1.10 – 1.23, p < 0.001 and OR 2.68, 95% CI 1.05 – 6.85, p = 0.04, respectively).
Conclusion: In this study, 23.8% patients with ACS who were hospitalized in CCU suffered from delirium. Results revealed that age and living alone were independent predictors of delirium. However, more attention must be focused on not only physical factors but also social factors to prevent delirium in hospitalized patients with ACS.
Sakurakai Takahashi Hospital, Japan
Background: Nursing support is necessary for reducing the physical and mental stress of the patients undergoing cardiac catheterization. However, there is a paucity of data with regard to nursing support evaluation based on patientsʼ satisfaction because there are few opportunities to obtain such data from patients.
Methods: Fifty patients who underwent cardiac catheterization in our hospital from October to November 2018 were enrolled in the study. Data were collected using a questionnaire comprising 13 items across the following 3 subscales: 1) the environment of the catheterization room, 2) the medical staff ʼs response and 3) the experience at the catheterization room. Each item was rated using a 5-point scale ranging from 1 (“I was not satisfied”) to 5 (“I was satisfied”). The collected data were analyzed using Customer Satisfaction (CS) analysis.
Results: The mean age of the participants was 70.6 ± 10.1 years and 29 of them were male (59%). The CS analysis revealed the need to address the flowing problems: 1) distress pertaining to maintaining a fixed posture (mean score 3.4), 2) sense of insecurity during moving onto the operation table (mean score 3.3) and 3) catheterization room temperature (mean score 4.1).
Conclusions: Medical staff should give careful consideration to the patients from entering to leaving the catheterization room. It is especially important to improve transportation measures, ensure a comfortable posture and improve the catheterization room environment for old patients.
Columbia University, USA
Colorectal cancer is one of the most prevalent causes of cancer related deaths secondary to lung cancer in the United States. A number of factors have been shown to reduce the risk of colorectal cancer development; it has been postulated that there is a strong association between an individualʼs serum vitamin D level and colorectal cancer risk. Active vitamin D, 25-hydroxyvitamin D induces transcriptional regulation that targets anticancer genes, lowering cancer risk through antiproliferative, pro-apoptotic and antiangiogenic properties. There is a worldwide prevalence of vitamin D deficiency and the Institute of Medicine and the Endocrine Society has defined three thresholds, deficiency at a level of < 20 n /ml, insufficiency at a range between 21-29 ng/ml and sufficiency measuring > 30 ng/ml. Studies have shown inconsistent results on the effects of increased vitamin D concentration and reduced colorectal cancer risk. Current recommendations for achieving adequate vitamin D consumption are particularly for maintaining bone health. Sixteen studies were examined and ten of the studies including one systematic review and two metanalysis were able to infer an inverse association between increased circulating 25-hydroxyvitamin D levels and reduced colorectal cancer risk. Considering the results of this review and previous studies, there is a strong consideration for the potential benefits of maintaining the populations serum 25-hydroxyvitamin D concentration in adults to a target of > 30 ng/ml or higher for the prevention of colorectal cancer. The Endocrine Society currently recommends a daily supplementation of at least 1500-2000 IU to maintain a concentration of > 30 ng/ml. The effects of optimal vitamin D status on health outcomes other than for bone health should be evaluated and integrated into public health guidance.
Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taiwan
Objectives: We would like to present a case with lethal complication of esophageal perforation after anterior cervical spine fusion for cervical spondylosis and to inform the medical staff the symptoms and signs of such life-threatening condition, which may be masked by administration of steroids.
Results: This was a 57-year-old male who underwent anterior cervical spine surgery due to cervical spondylosis. After the operation, no obvious wound infection was found, but he complained of easy choking and difficulty swallowing liquid diet, nevertheless, he was discharged after achieving symptomatic relief via the use of steroids. He experienced sore throat, local heat and dysphagia a few hours later and returned to emergency room. Imaging studies suggested of esophageal perforation with deep neck infection. He was immediately readmitted for esophageal repair, but leakage was found at the site of repair on the eighth postoperative day and rotational muscle flap coverage was required. With addition of adequate drainage and nutritional support, his condition gradually improved and he was discharged 41 days after rehospitalization.
Discussion: When a patient who has been taking steroids continues to experience dysphagia or burning throat pain after anterior cervical spine surgery, strong consideration must be given to other rare postoperative complication such as esophageal perforation. If such complication is not identified and treated promptly, the patient may potentially face a life-threatening condition. Esophageal perforation is suspected by presentation of air around the surgical site on plain radiographs and definite diagnosis can be confirmed through computed tomography scan. This case study provides description of patient's clinical manifestations, diagnosis and course of treatment. We hope that this article will give a better understanding of the possible postoperative complications and the care needed for patients following anterior cervical spine fusion, facilitating early recognition and prompt treatment of the problems.
Jhih-Yu Lin graduated from the medical college of Yuanpei University of Medical Technology, Taiwan in 2005 and has received full clinical nursing practice training at Taipei Tzu Chi Hospital. She gained her master's degree at National Taipei University of Nursing and Health Sciences, Taiwan in 2015 and held the academic title of the lecturer in 2018. She is currently working at Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation as the head nurse of nursing department and teaching at school of medicine in at St. Maryʼs Medicine, Nursing and Management College, Sanxing Township, Yilan, Taiwan. Shuo-Suei Hung graduated from the medical college of National Taiwan University in 1995 and has received full orthopedic surgical training at the Chang Gung Memorial Hospital in Taiwan. He gained his PhD degree in the Department of Mechanical Engineering at Chang Gung University in 2011 and held the academic title of assistant professor in 2013. He is currently working at Taipei Tzu Chi hospital, Buddhist Tzu Chi Medical Foundation as the chief of orthopedic department and teaching at school of medicine in Tzu Chi University.
1Chulalongkorn University, Thailand
2Cardio surgical unit, Police hospital, Thailand
This research is a descriptive study. Purpose of study is investigated the reliability and exploratory factor analysis of Thai version for the cardiac patients learning needs inventory. It is the evidence base to be used in the context that is suitable for Thai people relying on the standardized translation process. Forward translations from original to Thai version. And then check the content validity by 5 experts. The reliability of translated Thai version was examined by distributing questionnaire to 150 patients with diagnosed with acute myocardial infraction, hospitalized at the coronary intensive care unit of a publish hospital in Bangkok, Thailand. The questionnaire was statistical analysis for the reliability and exploratory factor analysis.
The result of this study found that Internal consistency was estimated based on Cronbachʼs alpha coefficient of the cardiac patients learning needs inventory in Thai version total scale was 0.95, While for each domain were 0.91, 0.95, 0.94, 0.89, 0.92, 0.95, 0.86 and 0.66 in respectively. That itʼs achieved good level of reliability. The results of the exploration factor analysis by using Kaiser-Myer-Olkinʼs measures of sampling adequacy (KMO) was .91Bartlet's test of sphericity statistics showed that the chi-Square (χ2) statistics used in the test of 6346.19, which had a statistically significant level at the level of .05. The elements can be extracted in 7 domains. The Variance Initial Eigen value was 60.47%. All of domains were Factor loading more than 0.5. Finally, the research demonstrated that the translated of the cardiac patients learning needs is suitable for use in Thai patients with cardiovascular disease.
Pachanut Nunthaitaweekul has completed her Ph.D. from Faculty of Nursing, ChulalongkornUniversity, Thailand (2012). She is the Lecturer at the Faculty of Nursing and specific in adult and gerontology nursing (2005-present). She was Adjunct Faculty, school of nursing, University of Minnesota, USA (2009-2012). She has published more than 15 papers in reputed journals and has been serving gas an editorial board member of repute. She is a consultant in Routing two Research (R2R) for Police hospital, Thailand. She has expert and researches interesting focus in Cardiovascular nursing, orthopedic nursing, risk behaviors with NCD patients, pain management concept Alterative and complementary care, innovation care nursing and Emergency and Disaster management
Queens Belfast University, UK
Background: The efficiency of large group teaching (lectures) has long been called into question with much research high lighting low levels of student participation and poor attention spans leading to a lack of engagement with learning which inhibits deep learning. Small group teaching and Enquiry Based Learning (EBL) are methods of teaching that can help promote deep learning. There is also a growing need and demand for Technology Enhanced Learning to suit changing lifestyles. The Labtutor® System is one such piece of software that is designed to incorporate EBL and small group teaching quality into the large group setting.
Aim: To evaluate the Labtutor System from the undergraduate perspective
Methods: The system was used with a September group of students in their life science lectures. At the point of module review a Quantitative survey was employed and data was gathered using PRS system n=115
Results: Participants reported overall that they enjoyed using the system and found it beneficial to their learning specifically:
(a) Increased engagement with material in online learning as a result of using the system.
(b) Increased participation and levels of interactivity in the lecture as a result of using the system.
(c) Increased enhancement of learning as a result of using the system and
(d) Usefulness of the formative assessment facilitated by using the system.
Conclusion: The study concludes that Labtutor® system and other such methods of Technology Enhanced Learning packages if used correctly can enhance learning.
Implications for practice: The days of didactic large group teaching are over educatorʼs must “up their game” to ensure quality teaching