[Nursing Digital Transformation: An Example of an Electronic Whiteboard in a Regional Hospital in Central Taiwan].

The electronic whiteboard system is an important part of smart medical care. This system has been digitized and upgraded gradually over time, and now functions as a dashboard, incorporating sound effects, touch control, image display, face recognition, and other functions that maximize usage efficiency. In hospitals, electronic whiteboards are specialized for dedicated use in one of two areas: nursing stations and wards. Those used in nursing stations may upload data into the medical information system based on departmental and institutional requirements. Systems are built to the specific needs of different clinical departments and thus differ widely in terms of settings and functionality. Therefore, hospitals should promote regular communication among doctors, nurses, and patients.

Simplifying and Testing the Psychometric Psychiatric Patients' Fall Risk Scale: An Analysis of One-Year Admissions.

This study aimed to simplify the number of items evaluated by fall risk assessment scales for psychiatric patients, conduct associated reliability, validity, and receiver operating characteristic analyses, and determine fall predictors for psychiatric patients. This methodological study was conducted in a hospital specializing in psychiatry, using data from 1101 patients who were hospitalized in 2018. This fall risk assessment scale was modified by the hospital for use in psychiatric patients. The mean age of the sample population was 44.88 (SD = 12.05) years, and the mean duration of hospital stay was 44.04 (SD = 48.14) days. Men comprised 66% of the study population, and women were 34%. Item reduction, psychometric testing for validity and reliability, and receiver operating characteristic analyses were conducted. Logistic regressions were used to analyze fall predictors, including "having anti-epileptic drugs", "need for walking aids", and "having experienced fall occurrence within one year". This study successfully reduced the number of items assessed by the previous scale. The optimal cutoff point was reduced, and the sensitivity and accuracy of the newly revised scale were good. Three fall predictors for psychiatric patients were identified. The revised scale can facilitate the rapid and accurate identification of high-risk, fall-prone psychiatric patients by psychiatric nurses. Hospital information screening should include each patient's fall history.

A Novel Microfluidic Chip for Fast, Sensitive Quantification of Plasma Extracellular Vesicles as Biomarkers in Patients With Osteosarcoma.

Plasma circulating extracellular vesicle (EV) has emerged as a promising biomarker for diagnosis and prognosis of various epithelial tumors. However, fast and efficient capture of EVs with microfluidic chip in sarcoma remains to be established. Herein, we reported a ZnO-nanorods integrated (ZNI) microfluidic chip, where EV capture antibody was uniformly grafted to the surface of the ZnO-nanorods of the chip to enhance the plasma turbulence formation and the capture efficiency at the micro-scale. Based on osteosarcoma (OS) cell line, we demonstrated that a combination of CD81 and CD63 antibody on ZNI chip yielded the greatest amount of total EVs, with an extra sensitive limit of detection (LOD) of ~104 particles mL-1. Furthermore, the addition of fluorescent labeling of Vimentin (VIM), a previously reported sarcoma cell surface biomarker, could enabled the dual visualization of total plasma EVs and VIM-positive EVs from OS patients' plasma. Based on our ZNI chip, we found that the amount of plasma total EVs was significantly different between OS and healthy donors (1562 a.u. versus 639 a.u., p< 0.05), but not between metastatic and nonmetastatic OS (p> 0.05). Interestingly, patients with metastatic disease had a significantly greater amount of VIM-positive EVs (1411 a.u. versus 231 a.u.., p< 0.05) and increased VIM-positive/total EVs ratio (0.943 versus 0.211, p< 0.05) in comparison with the nonmetastatic counterpart. Therefore, our ZNI microfluidic chip has great potential for the fast quantification of plasma EVs, and the microfluidic-based quantification of total and VIM-positive EVs might serve as a promising biomarker for the diagnosis and surveillance in OS patients.

[Using Healthcare Failure Mode and Effects Analysis to Reduce Intra-Arterial Thrombectomy Preoperative Preparation Error Rates in the Emergency Room].

BACKGROUND & PROBLEMS: Intra-arterial thrombectomy (IAT) is a novel surgery that may restore cerebral blood flow in patients with ischemic stroke and lower the risks of permanent brain damage and disability. Because the process of preoperative preparation for IAT is complicated, error rates for this process have been reported in previous studies to be as high as 100%. Although these errors did not result in serious damage to patients, the risk to patient safety remains. Therefore, reducing the error rate for IAT preoperative preparation is necessary to improve patient safety. PURPOSE: To reduce the rate of IAT preoperative preparation error in an emergency room. RESOLUTION: This project applied healthcare failure mode and effect analysis (HFMEA) to evaluate the potential risks of IAT preoperative preparation in an emergency room. Based on the resultant hazard score, critical preventive measures were adopted, including creating a quick response code consent form, designing order packages, developing a checklist form, modifying stroke operating procedures and policies, planning suitable education content for staffs, developing criteria for evaluating preoperative preparation procedures, and installing vital signs equipment. RESULTS: After implementation of these measures, the hazard scores of 13 out of the 16 potential failure causes decreased to < 8, and the progress rate was 81.3%. The follow-up error rate for preoperative preparation was 0% in October 2019, which fulfilled the goal of this project. CONCLUSIONS: Preoperative preparation for IAT is complicated and time-consuming. In this project, HFMEA was introduced to ensure that preoperative preparation was accomplished in a complete and timely manner. Based on the results, after implementation, preparation work was effectively completed and operations were performed on schedule. Other hospitals may consider using this tool to evaluate potential risks to patient safety and to develop solutions to improve the quality of healthcare processes.

[The Spiritual Health Status and Spiritual Care Behaviors of Nurses in Intensive Care Units and Related Factors].

BACKGROUND: Patients suffer sudden and life-threatening conditions in intensive care units (ICU), which frequently result in traumatic changes in physical, mental, and spiritual health. Little research has been conducted on the spiritual health and spiritual care behaviors of nurses in ICU. PURPOSE: To explore the relationship among demographic characteristics, spiritual health, and spiritual care behaviors in ICU nurses. METHODS: A descriptive correlational research was used and 219 nurses from three teaching hospitals were enrolled as study participants. A structured questionnaire consisting of a demographic datasheet, a spiritual health scale, and a spiritual care behavior scale was used for data collection. SPSS for Windows version 22.0 was used for statistical analysis. RESULTS: The participants received few hours of spiritual-care education. The highest scored item for spiritual health was "connecting with people". The highest scored item for spiritual care behavior was "helping the patient out of adversity". Participants who were older in age and who had more years of clinical experience exhibited spiritual care behaviors such as "helping the patient out of adversity" and "retaining hope" more frequently with their ICU patients. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The older and more clinically experienced nurses in this study performed spiritual care behaviors at a higher frequency than their younger, less experienced counterparts. Therefore, it is recommended that hospitals retain more-experienced nursing staff to elevate the level of holistic health care. Concurrently, training in spiritual care skills should be provided to younger and less experienced nurses in order to facilitate more spiritual care behaviors. The results of this study provide a reference for providing spiritual care behaviors to patients.

mTORC1 maintains the tumorigenicity of SSEA-4(+) high-grade osteosarcoma.

Inactivation of p53 and/or Rb pathways restrains osteoblasts from cell-cycle exit and terminal differentiation, which underpins osteosarcoma formation coupled with dedifferentiation. Recently, the level of p-S6K was shown to independently predict the prognosis for osteosarcomas, while the reason behind this is not understood. Here we show that in certain high-grade osteosarcomas, immature SSEA-4(+) tumor cells represent a subset of tumor-initiating cells (TICs) whose pool size is maintained by mTORC1 activity. mTORC1 supports not only SSEA-4(+) cell self-renewal through S6K but also the regeneration of SSEA-4(+) TICs by SSEA-4(-) osteosarcoma cell dedifferentiation. Mechanistically, active mTORC1 is required to prevent a likely upregulation of the cell-cycle inhibitor p27 independently of p53 or Rb activation, which otherwise effectively drives the terminal differentiation of SSEA-4(-) osteosarcoma cells at the expense of dedifferentiation. Thus, mTORC1 is shown to critically regulate the retention of tumorigenicity versus differentiation in discrete differentiation phases in SSEA-4(+) TICs and their progeny.

[Inhibitory effect and significance of rapamycin on the mammalian target of rapamycin signaling pathway in osteosarcoma stem cells and osteosarcoma cells].

OBJECTIVE: To observe the effect of rapamycin on the MG-63 osteosarcoma cells (OC), osteosarcoma stem cells (OSC) and on mTOR signaling pathway, and explore the feasibility of rapamycin as a novel therapeutic measure in osteosarcoma chemotherapy regimens. METHODS: OC and OSC were cultured in vitro. Immunofluorescence assay was used to detect the expression of Nanog and Oct4 in OC and OSC. OC and OSC were treated with rapamycin in concentrations of 0, 20, 50 and 100 nmol/L. Semi-quantitative PCR and RT-PCR were used to detect the mTOR mRNA and CCK-8 assay was used to detect cell proliferation, and the cell morphology was observed under an inverted microscope. RESULTS: The cores of MG-63 cellular spheres exhibited embryonic stem cell characteristics such as Nanog and Oct4 expession. The mTOR pathway was activated in the OSC and the expression of mTOR mRNA was higher in OSC (0.761 ± 0.080) than that in OS (0.406 ± 0.090, P < 0.05) by semi-quantitative PCR. RT-PCR showed that the expression of mTOR mRNA was lower in OSCs treated with 100 nmol/L rapamycin (0.961 ± 0.060) than that with 0 nmol/L rapamycin (1.654 ± 0.246, P < 0.05). Cell counting kit-8 (CCK-8) assay showed that the proliferation of OC treated with 20, 50 and 100 nmol/L rapamycin was significantly inhibited, compared with that with 0 nmol/L rapamycin (P < 0.05). Compared with 0 nmol/L rapamycin, the proliferation of OSC treated with 20 and 50 nmol/L rapamycin was not significantly inhibited (P > 0.05), but that with 100 nmol/L rapamycin was significantly inhibited (P < 0.05). The invert microscopic observation revealed that rapamycin inhibited the formation of OSC spheres. CONCLUSIONS: Rapamycin can effectively inhibit cell proliferation and the ability of sphere formation of OSCs. It will provide a basis for a novel therapeutic approach in osteosarcoma chemotherapy regimens.

Biomechanical comparison of internal fixations in osteoporotic intertrochanteric fracture. A finite element analysis.

OBJECTIVE: To compare the biomechanical characteristics of dynamic hip screw (DHS) and proximal femoral nail anti-rotation (PFNA) for the treatment of 3 types of osteoporotic femoral intertrochanteric fracture (OFIF) by modeling, and virtual reduction with finite element analysis, and to provide some theoretical basis and reference to select the best internal fixation for clinical treatment of OFIF. METHODS: The experiment was conducted at the Laboratory of Biomechanics, Shanghai Institute of Orthopedics and Traumatology, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China from February to December 2011. The CT scan was performed in 3 cases with different types of OFIF (Evans-Jensen II, III, and IV). Upon validation, fracture models with different internal fixations were developed to simulate and analyze. Under the conditions of 7 different apparent bone densities and 3 different loads, the Von Mises stresses, and the failure rates were calculated, and the stress distribution patterns were compared. RESULTS: The PFNA internal fixation system has better stress distribution than DHS. The former has smaller maximum Von Mises stress of femur and internal fixation, and the femoral element failure rate, as well. The safety range of osteoporosis in PFNA is wider than the DHS. CONCLUSION: The experiment verifies, from the view of biomechanics, that PFNA should be taken into consideration firstly for OFIF (Evans-Jensen II, III, and IV).