Identifying High-Quality Non-Instrumental Dysphagia Screening Tools for Detection of Adult Dysphagia Case in Acute-Care Settings: A Systematic Review.

INTRODUCTION: As patients nowadays tend to have multiple diseases and complex medical histories, our aim was to identify high-quality, non-instrumental dysphagia screening tools used for the detection of adult dysphagia cases in all disease categories in acute-care settings. METHOD: A literature search was conducted in five databases from each database's earliest inception to 31 July 2021 and guided by five keywords: 'dysphagia', 'deglutition', 'screening', 'test' and 'measure'. Without limiting the search in any specific disease category, reviewers assessed original studies and identified tools if they had been validated against instrumental evaluations and if they had been designed as a pass-fail procedure to screen whether dysphagia is absent or present. We further excluded any tool if it was (1) for pediatric focus, or (2) a patient self-report questionnaire. All final tool candidates underwent a methodological quality appraisal using the Revised Tool for the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). RESULT: Out of 195 studies with 165 tools identified, 20 tool candidates underwent QUADAS-2 review. We found six high-quality, non-instrumental screening tools for detecting adult dysphagia cases in acute-care settings, including the Yale Swallow Protocol, Gugging Swallowing Screen, Toronto Bedside Swallowing Screening Test (both English and Portuguese versions), Sapienza Global Bedside Evaluation of Swallowing and Two-Step Thickened Water Test. These high-quality tools were developed primarily for patients with stroke. Only Yale Swallow Protocol was originally tested for heterogeneous populations with stroke, multiple sclerosis, traumatic brain injury, oesophageal surgery, neurosurgery and head-and-neck cancer. CONCLUSIONS: The results highlight the gap in the unavailability of high-quality dysphagia screening tool in several emerged high-risk populations including elderly inpatients, or patients following endotracheal extubation. Further research is needed to determine whether these six tools can be effectively applied across different high-risk populations in acute-care settings to screen for cases finding.

[Nursing Care of Patients With Carotid Artery Stenosis Who Receive Carotid Artery Stent].

Atherosclerosis, a major cause of carotid artery stenosis, has a high correlation to stroke, which may induce transient ischemic attack (TIA) and/or permanent brain damage. The main treatment of carotid artery stenosis includes medication, carotid endarterectomy (CEA), and carotid artery stenting (CAS). However, when artery stenosis becomes severe, CEA or CAS is the most-often recommended intervention. CAS, a type of revascularization, is considered less invasive than CEA and is associated with a higher successful rate. CAS not only treats carotid stenosis effectively and reduces the incidence of stroke and myocardial infarction but also may increase the survival rate. Because CAS may lead to in-stent restenosis, an eluting stent has been developed to prevent this adverse event. However, the effectiveness of the eluting stent has yet to be adequately verified. As patients who receive CAS remain at risk of recurrent stroke, intravascular restenosis, TIA, and mortality, post-procedure medical and nursing care for this population must be appropriately applied in order to maximize the rate of long-term success. Therefore, we recommend that clinical physicians and nurses regularly evaluate and monitor post-CAS patients in order to prevent complications. Moreover, they should educate patients before discharge on post-CAS wound care and medicine-taking regimens as well as on the importance of smoking cessation, controlling blood sugar and blood pressure, exercising regularly, reducing body weight, maintaining a healthy diet, and controlling the risk factors of atherosclerosis in order to prevent the recurrence of complications.

Statistical properties of the rovibrational bound levels for Ar2Kr.

We calculate the rovibrational bound levels with total angular momentum J = 0, 1 of 40Ar284Kr trimer using the slow variable discretization method combined with the finite-element method-discrete variable representation basis. The statistical distributions of the rovibrational levels for JΠ=0e, 1e, and 1o symmetries are presented and the effects of the Axilrod-Teller potential term are considered. For the 0e and 1e symmetries, the Axilrod-Teller term makes the spectra become fully chaotic. However, for the 1o symmetry, statistical properties depend mainly on the coupling between K = 0 and K = 1 and the Axilrod-Teller term has a small effect.

A Hot-Polymer Fiber Fabry-Perot Interferometer Anemometer for Sensing Airflow.

This work proposes the first hot-polymer fiber Fabry-Perot interferometer (HPFFPI) anemometer for sensing airflow. The proposed HPFFPI is based on a single-mode fiber (SMF) endface that is attached to a UV-cured polymer to form an ultracompact fiber Fabry-Perot microcavity. The proposed polymer microcavity was heated using a low-cost chip resistor with a controllable dc driving power to achieve a desired polymer's steady-state temperature (T) that exceeds the T of the surrounding environment. The polymer is highly sensitive to variations of T with high repeatability. When the hot polymer was cooled by the measured flowing air, the wavelength fringes of its optical spectra shifted. The HPFFPI anemometers have been experimentally evaluated for different cavity lengths and heating power values. Experimental results demonstrate that the proposed HPFFPI responses well in terms of airflow measurement. A high sensitivity of 1.139 nm/(m/s) and a good resolution of 0.0088 m/s over the 0~2.54 m/s range of airflow were achieved with a cavity length of 10 µm and a heating power of 0.402 W.

Hyperspherical coupled channel calculations of energy and structure of (4)He-(4)He-Li(+) and its isotopic combinations.

The ground state vibrational energy and spatial features of (4)He-(4)He-Li(+) and its triatomic isotopic complexes are studied using the slow variable discretization (SVD) method in the hyperspherical coordinates for the zero total angular momentum. Our results show that the dominant structure of the system is an isosceles triangle with the shorter side associated with the two Li(+)-He distances using the sum-of-potential approximation. Corrections caused by the induced dipole-induced dipole interactions on the He atoms are also investigated. The effects are seen to be small and have a minor influence on the binding energy and the structure of present system. The results are also compared with the full ab initio calculations including all the three-body interactions and information of three-body corrections is obtained.

[Nursing Care of Lumbar Spine Fusion Surgery Using a Semi-Rigid Device (ISOBAR)].

Aging frequently induces degenerative changes in the spine. Patients who suffer from lumbar degenerative disease tend to have lower back pain, neurological claudication, and neuropathy. Furthermore, incontinence may be an increasing issue as symptoms become severe. Lumbar spine fusion surgery is necessary if clinical symptoms continue to worsen or if the patient fails to respond to medication, physical therapy, or alternative treatments. However, this surgical procedure frequently induces adjacent segment disease (ASD), which is evidenced by the appearance of pathological changes in the upper and lower sections of the spinal surgical sites. In 1997, ISOBAR TTL dynamic rod stabilization was developed for application in spinal fusion surgery to prevent ASD-related complications. The device has proven effective in reducing pain in the lower back and legs, decreasing functional disability, improving quality of life, and retarding disc degeneration. However, the effectiveness of this intervention in decreasing the incidence of ASD requires further research investigation, and relevant literature and research in Taiwan is still lacking. This article discusses lumbar degenerative disease, its indications, the contraindications of lumbar spine fusion surgery using ISOBAR, and related postoperative nursing care. We hope this article provides proper and new knowledge to clinical nurses for the care of patients undergoing lumbar spine fusion surgery with ISOBAR.

Arrhythmia Perception and Quality of Life in Bradyarrhythmia Patients Following Permanent Pacemaker Implantation.

Although studies have evaluated the quality of life (QoL) of patients undergoing permanent pacemaker (PPM) placement, their results are inconsistent. To assess arrhythmia perceptions and QoL in bradyarrhythmia patients following PPM implantation, 137 patients completed demographic, arrhythmia perception, and QoL questionnaires before and six months after implantation. Before implantation, they reported fatigue (74.1%), dizziness (72.9%), dyspnea (64.7%), chest pain (62.4%), and heart fluttering (54.1%). After implantation, arrhythmia perceptions and QoL showed significant improvement (p < .05), except vitality (p > .05). However, patients with arrhythmia for more than three years, three or more PPM implants, two or more comorbidities, or were 41-50 years showed no significant QoL improvement. Doctors and hospital educators, rather than nurses, provided the most PPM information to patients. Since nurses provide primary in-hospital care to PPM patients, they should impart more patient education while considering individual characteristics in caring situations to enhance patients' QoL.

Effects of Lumbar Fusion Surgery with ISOBAR Devices Versus Posterior Lumbar Interbody Fusion Surgery on Pain and Disability in Patients with Lumbar Degenerative Diseases: A Meta-Analysis.

Purpose/Aim: Lumbar degenerative diseases (LDDs) cause pain and disability and are treated with lumbar fusion surgery. The aim of this study was to evaluate the efficacy of lumbar fusion surgery with ISOBAR devices versus posterior lumbar interbody fusion (PLIF) surgery for alleviating LDD-associated pain and disability. Materials and Methods: We performed a literature review and meta-analysis conducted in accordance with Cochrane methodology. The analysis included Group Reading Assessment and Diagnostic Evaluation assessments, Jadad Quality Score evaluations, and Risk of Bias in Non-randomized Studies of Interventions assessments. We searched PubMed, MEDLINE, the Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, ProQuest, the Airiti Library, and the China Academic Journals Full-text Database for relevant randomized controlled trials and cohort studies published in English or Chinese between 1997 and 2017. Outcome measures of interest included general pain, lower back pain, and disability. Results: Of the 18 studies that met the inclusion criteria, 16 examined general pain (802 patients), 5 examined lower back pain (274 patients), and 15 examined disability (734 patients). General pain, lower back pain, and disability scores were significantly lower after lumbar fusion surgery with ISOBAR devices compared to presurgery. Moreover, lumbar fusion surgery with ISOBAR devices was more effective than PLIF for decreasing postoperative disability, although it did not provide any benefit in terms of general pain or lower back pain. Conclusions: Lumbar fusion surgery with ISOBAR devices alleviates general pain, lower back pain, and disability in LDD patients and is superior to PLIF for reducing postoperative disability. Given possible publication bias, we recommend further large-scale studies.

Safety and efficacy of using vascular closure devices for hemostasis on sheath removal after a transfemoral artery percutaneous coronary intervention.

AIM: To determine the efficacy of vascular closure devices (VCDs) for hemostasis following transfemoral percutaneous coronary interventions (PCIs). METHODS: This two-group pre-post-test observational study with purposive sampling enrolled 73 patients between January, 2014 and February, 2015. The patients were allocated to either the intervention (vascular closure devices group, n = 34) or the control group (manual compression [MC] group, n = 39). Questionnaires were used to assess their demographic and clinical characteristics, vascular complications, visual analogue scale score for pain, and discomfort levels. Pain and discomfort were measured before and after the PCI. RESULTS: Vascular complications were observed in 15 (44.1%) VCD patients and 13 (33.3%) MC patients, with no significant between-group difference. However, the VCD patients had a higher relative risk of bruising, hematomas, and need for further treatment. After the PCI, the pain scores and discomfort levels increased significantly in both groups, but the VCD patients had more successful hemostasis, less pain, and less physical and psychological discomfort (lower-limb numbness, shoulder pain, restlessness, and worrying about walking ability, being unable to lift heavy objects in the future, and taking time off from work). CONCLUSION: The VCDs seem to be superior to the MCs, providing more successful hemostasis, less pain and discomfort, and earlier ambulation after a transfemoral PCI. These findings aid clinical nurses in understanding the risk of vascular complications, discomfort, and pain that are associated with VCD use for improving the quality of clinical care and help clinicians in determining the appropriate hemostatic method for patients undergoing a transfemoral PCI, particularly in the Chinese population.

Age and pain as predictors of discomfort in patients undergoing transfemoral percutaneous coronary interventions.

BACKGROUND: Transfemoral percutaneous coronary intervention (PCI) requires strict bed rest, causing pain and discomfort in patients. However, no studies have investigated this issue. OBJECTIVES: To investigate the predictors of discomfort in transfemoral PCI patients. METHODS: A cross-sectional sample of 110 patients from two coronary care units completed questionnaires on demographic and clinical characteristics, visual analogue pain scale, and discomfort. RESULTS: Eight factors predicted overall discomfort: physiologic pain, physiological discomfort, psychological discomfort, analgesic use after sheath removal, hemostasis method, and bed rest duration. Psychological discomfort was associated with age, chronic obstructive pulmonary disease, analgesic use after sheath removal, successful hemostasis, and hematoma >5 cm. A hierarchical regression model explained 70.5% of the variance in overall discomfort. CONCLUSIONS: Age and physiologic pain are major predictors of overall discomfort, especially in patients aged <60 years having high pain sensitivity. Critical care providers should note patients' physiological and psychological issues throughout the PCI process.

Sex differences in renal transcriptome and programmed hypertension in offspring exposed to prenatal dexamethasone.

Glucocorticoids, predominantly dexamethasone (DEX), are widely used to reduce the risk of prematurity-related chronic lung disease. However, prenatal DEX treatment links to adverse effects in later life, including hypertension. Given that sex differences exist in the blood pressure (BP) control, and that renal transcriptome is sex-specific, thus we intended to elucidate whether prenatal DEX-induced programmed hypertension is in a sex-specific manner and identify candidate genes and pathways using the whole-genome RNA next-generation sequencing (NGS) approach. Offspring were assigned to 4 groups (n=7-8/group): male control (MC), female control (FC), male DEX (MD), and female DEX (FD). Dexamethasone (0.1mg/kg body weight) or vehicle was intraperitoneally administered to pregnant SD rats from gestational day 16-22, to construct a DEX model. Rats were killed at 16weeks of age. Prenatal DEX induced sex-specific increase in BPs in male but not female adult offspring. Prenatal DEX elicited renal programming in a sex-specific fashion as demonstrated by 8 and 18 DEGs in male and female offspring, respectively. Among them, two genes, Hbb and Hba-a2, were shared. The resistance of female offspring to prenatal DEX-induced programmed hypertension is related to a lower Agt expression. Prenatal DEX induced programmed hypertension in adult male but not female offspring, which was related to renal programming affecting sex-biased genes and the RAS. Early identification of sex-specific underlying mechanisms could provide novel deprogramming strategy to reach maximal optimization in both sexes.

Biodiesel production from wet microalgae feedstock using sequential wet extraction/transesterification and direct transesterification processes.

Although producing biodiesel from microalgae seems promising, there is still a lack of technology for the quick and cost-effective conversion of biodiesel from wet microalgae. This study was aimed to develop a novel microalgal biodiesel producing method, consisting of an open system of microwave disruption, partial dewatering (via combination of methanol treatment and low-speed centrifugation), oil extraction, and transesterification without the pre-removal of the co-solvent, using Chlamydomonas sp. JSC4 with 68.7 wt% water content as the feedstock. Direct transesterification with the disrupted wet microalgae was also conducted. The biomass content of the wet microalgae increased to 56.6 and 60.5 wt%, respectively, after microwave disruption and partial dewatering. About 96.2% oil recovery was achieved under the conditions of: extraction temperature, 45°C; hexane/methanol ratio, 3:1; extraction time, 80 min. Transesterification of the extracted oil reached 97.2% conversion within 15 min at 45°C and 6:1 solvent/methanol ratio with simultaneous Chlorophyll removal during the process. Nearly 100% biodiesel conversion was also obtained while conducting direct transesterification of the disrupted oil-bearing microalgal biomass.