Lithium toxicity with prolonged neurologic sequelae following sleeve gastrectomy: A case report and review of literature.

RATIONALE: Lithium is the first-line medication for bipolar disorder, given a narrow therapeutic window of 0.8 to 1.2 mEq/L. Change of lithium pharmacokinetics following bariatric surgery may lead to lithium toxicity, which is particularly concerned. PATIENT CONCERNS: We presented a 39-year-old man with morbid obesity and bipolar affective disorder for 20 years, who was treated with lithium. He developed serious lithium toxicity following sleeve gastrectomy and prolonged neurologic sequelae. DIAGNOSES: He suffered from persistent watery diarrhea, general weakness, and then drowsy consciousness. Lithium level was checked immediately to be 3.42 mEq/L and lithium toxicity was diagnosed. INTERVENTIONS: After 3 courses of hemodialysis, his serum lithium level subsequently declined to 0.63 mEq/L, while his consciousness returned normal. Lithium was replaced by lamotrigine. OUTCOMES: The patient was discharged thirty-five days after admission, while his serum lithium declined to 0.06 mEq/L. Neurologic sequelae were noted by muscle weakness and pain sensation in both feet. The nerve conduction test revealed sensorimotor polyneuropathy with conduction block. He was advised to keep a passive range of motion exercise. LESSONS: Although the consensus guideline remains lacking, our report reviewed cases of relevance in the literature and highlighted the awareness of the potential risk of lithium toxicity following bariatric surgery. We suggest close monitoring of the lithium levels and perhaps a dosage adjustment for the postoperative period.

Validation of the Smoking Cessation Counseling Scale Chinese Version in Taiwan.

BACKGROUND: Providing tobacco control (TC) and smoking cessation (SC) counseling is an important part of healthcare. An assessment tool to understand healthcare providers' experiences in providing SC counseling may enhance TC. OBJECTIVE: The aims of this study were to (1) translate and develop the Smoking Cessation Counseling Scale-Chinese version (SCCS-C) and (2) evaluate its psychometric properties in Taiwan. METHODS: This is a 2-phase instrument testing study. In the first phase, the SCCS-C was developed and translated. In the second phase, 2 groups of participants were recruited. First, 292 SC educator trainees completed the psychometric assessment measures (internal consistency reliability and construct validity). The 2-week test-retest reliability was assessed in certified TC instructors. RESULTS: The results showed that (1) the SCCS-C has satisfactory content validity and internal consistency reliability with a Cronbach's α of .96; (2) the overall 2-week test-retest reliability was 0.70; (3) instead of the 4-factor structure of the original scale, a 3-factor structure of the SCCS-C was identified by exploratory factor analysis to explain 65.37%; (4) construct validity was supported by significant negative correlations between SCCS-C and barriers regarding TC and positive correlations with counseling, responsibility, and self-efficacy; and (5) discriminant validity was supported by significant differences between SC educator trainees and the certified TC instructors, as well as between those living with or without smokers. CONCLUSIONS: The SCCS-C has satisfactory reliability, test-retest reliability, and construct validity. IMPLICATIONS FOR PRACTICE: The SCCS-C is a valid, reliable instrument for assessing healthcare counseling activities for SC in Taiwan.

Transtheoretical model-based passive smoking prevention programme among pregnant women and mothers of young children.

BACKGROUND: We evaluated the effectiveness of a transtheoretical model (TTM)-based passive smoking prevention programme developed to enhance passive smoking avoidance among pregnant women and women with young children in Taiwan. METHODS: Subjects were pregnant women recruited from the obstetrics/gynaecology department and women with children younger than age 3 recruited from the paediatrics department of four hospitals in Taiwan. Participants were randomly assigned to a group receiving a TTM-based intervention programme or a comparison group receiving routine care. The intervention programme consisted of educational materials and phone counselling. Baseline assessment and post-test data were collected from both groups using a self-reported questionnaire developed based on stages of change related to readiness for passive smoking avoidance. RESULTS: Determinants of change, post-test scores of knowledge, experiential and behavioural processes and self-efficacy were significantly different between the intervention group and comparison group among both pregnant women and mothers. Among pregnant women, the intervention group had significantly higher post-test scores than the comparison group. The distribution of percentages in three stages of change (Precontemplation, Contemplation/Preparation and Action/Maintenance) was significantly different between the two groups among both pregnant women and mothers. However, a higher percentage of mothers made progress in stages of change compared with pregnant women. CONCLUSION: A TTM-based intervention programme was potentially effective in passive smoking prevention by improving knowledge, experiential and behavioural processes and self-efficacy among pregnant women and women with young children. A higher percentage of mothers with young children had progressed in stages of change post-intervention compared with pregnant women.

Stage of adoption for preventive behaviour against passive smoking among pregnant women and women with young children in Taiwan.

AIMS: This study assessed the applicability of the transtheoretical model to prevent exposure to passive smoking among pregnant women and women with young children in Taiwan. We examined whether women in different stages of change had different knowledge, processes of change, decisional balance and self-efficacy. BACKGROUND: Although previous studies have found a positive association between the presence of children and a mother's readiness to prevent exposure to passive smoking, a few studies have systematically examined the mothers' stage of adoption for preventive behaviour against passive smoking. METHODS: A cross-sectional survey based on self-reported data was conducted in 2005-2006. A total of 315 women was recruited from perinatal and paediatric clinics at four hospitals. The transtheoretical model measures included knowledge, stages of change, processes of change, decisional balance and self-efficacy towards passive smoking. RESULTS: Of the 315 women in the study, 17·1% were at the precontemplation stage, 7·9% were at the contemplation/preparation stage and 74·9% were at the action/maintenance stage. Women at the action/maintenance stage scored the highest in knowledge, process of change, pros of decisional balance and self-efficacy, followed by the women at the contemplation/preparation stage and the women at the precontemplation stage. CONCLUSIONS: This study supported the applicability of the transtheoretical model theory for adoption of preventive behaviour against passive smoking among pregnant women and women with young children. RELEVANCE TO CLINICAL PRACTICE: Nurses could educate pregnant women and women with young children to adopt preventive behaviours against passive smoking using stage-matched intervention strategies, targeting the transtheoretical model constructs, to promote behavioural change.