[A Reappraisal of Pain Using a Nurses' Professional Study Circle].

BACKGROUND: Pain relates to the highly personal and subjective experience of feelings and emotions. Patients are often misunderstood because of language-related limitations and the conditions of their disease. PURPOSE: In this research, a professional study circle was held to help nurses reconstruct their understanding of patient pain to enhance their awareness / empathy for differences in pain perception between others and themselves and to improve their ability to provide professional, individualized care. METHODS: Nine nurses were invited from the urology department to join the developed professional study circle. We spent one year and a half reading "Listening to Pain: Finding Words, Compassion, and Relief" and held a sharing and discussion roundtable meeting every month. The study circle included: (1) assigned reading and the appointment of a leader on rotation to direct the sharing and discussion, (2) presentation of clinical cases related to the reading, (3) discussions of how to apply what they had learned in clinical practice, and (4) an interview of study circle members and a full analysis of their reflections and changes of view regarding pain perceptions. RESULTS: After a close reading and guided discussions, these nine nurses began to change their perceptions of pain and, in general, passed through three stages, including: (1) cast doubt on the authenticity of patient expressions of pain because of stereotyped biases; (2) develop a new empathy based on careful listening; (3) providing individualized care and experiencing professional growth. After successfully transiting through these stages, the nurses held a more profound understanding of their patients, practiced a more sensitive use of language, and reflected an enhanced professional ability to assess pain. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: This professional study circle successfully helped the nurses internalize a more empathetic understanding of pain and exhibit greater skill in designing individualized care for their patients.

[Three-Step Interdisciplinary Team Program for Nasogastric Tube Care].

Patients with chewing disorders and dysphagia often take nutrition via nasogastric tube feeding. Patients with indwelling nasogastric tubes often experience discomfort, resulting in increased incidences of self-extubation and slippage. Frequent changes or misplacement of the nasogastric tube may also cause patient safety issues such as aspiration pneumonia, gastrointestinal trauma, and pneumothorax. Collaboration within the interdisciplinary team is needed to provide proper nasogastric tube care prior to placement, during the indwelling process, and during the removal of the nasogastric tube. Interdisciplinary teams should develop standardized procedures for nasogastric tube care, initiate swallow screening, oral care and training early, and develop a care plan for nasogastric tube removal. An evidence-based, practical example of nasogastric tube care implemented by an interdisciplinary team in a neurology unit is presented in this article. Interdisciplinary teams may assist patients to prepare to return to a normal tube-free life using individualized, safe, and dignified nasogastric tube care to improve quality of life.

Gender difference in the association of dietary patterns and metabolic parameters with obesity in young and middle-aged adults with dyslipidemia and abnormal fasting plasma glucose in Taiwan.

BACKGROUND: The increasing prevalence of obesity has become a pandemic problem, and dietary patterns are one of the important factors causing obesity. Although the correlation between dietary patterns and obesity has been well explored, the gender difference on the association between dietary patterns and obesity remains unclear. The objective of this study examined whether gender difference existed in the relationship of dietary patterns with metabolic parameters and specific indices of adiposity among young and middle-aged adults with dyslipidemia and abnormal fasting plasma glucose (FPG) in Taiwan. METHODS: A total of 14,087 subjects aged between 20 and 50 years with dyslipidemia and abnormal FPG were recruited in Taiwan between 2001 and 2010 for a cross-sectional study. Dyslipidemia was defined primarily according to the National Cholesterol Education Program Adult Treatment Panel III guidelines with minor modification. Abnormal FPG level was defined by the American Diabetes Association. Principal component analysis was conducted to identify dietary patterns. Multivariate logistic regression analysis was performed to evaluate the association of dietary patterns and metabolic parameters with different indices of adiposity including general obesity, central obesity, and high body fat, stratified by gender. RESULTS: Two dietary patterns derived from principal component analysis were the prudent dietary pattern and the western dietary pattern. Both men and women in the highest quartile of the western dietary pattern had a significantly increased odds ratio of general obesity, central obesity, and high body fat. However, only male subjects in the higher quartiles of the prudent dietary pattern had a significantly decreased odds ratio of all indices of obesity. Both men and women with higher high-density lipoprotein cholesterol and total cholesterol levels had a significantly reduced odds ratio of general and central obesity, while those with higher triglycerides and FPG levels had a significantly increased odds ratio of general and central obesity. Higher low-density lipoprotein cholesterol level was significantly associated with an elevated odds ratio of high body fat, while higher total cholesterol level was significantly correlated with a reduced odds ratio of high body fat only in women. CONCLUSIONS: Gender difference exists in the association of dietary patterns and metabolic parameters with obesity and body fat in young and middle-aged adults with dyslipidemia and abnormal FPG in Taiwan.

Management of Idiopathic Intracranial Hypertension: A Case Report.

ABSTRACT: BACKGROUND: Idiopathic intracranial hypertension (IIH) is a neurological disorder characterized by elevated intracranial pressure, affecting predominantly obese women of childbearing age. Early recognition and comprehensive management are vital for preventing severe complications, particularly vision loss. METHODS: This study reports a case of a 27-year-old woman who presented with chronic headaches and blurred vision. Notable findings included headaches that were intensified upon waking and exacerbated by activities that elevated intracranial pressure. The patient also reported nausea, vomiting, transient visual obscurations, and pulsatile tinnitus. After a clinical examination, she was given a diagnosis of IIH. RESULTS: The patient underwent a lumbar-peritoneal shunt procedure to alleviate her symptoms in conjunction with medication treatment. This case study highlights the importance of a multidisciplinary approach in diagnosing and treating IIH. In particular, weight management emerged as a crucial preventive measure against IIH recurrence. CONCLUSION: A multidisciplinary team strategy can enhance outcomes and quality of life, accentuating the need for continued research into IIH recurrence, treatments, and wider implications.

Subthalamic deep brain stimulation in Parkinson's disease under different anesthetic modalities: a comparative cohort study.

BACKGROUND: The efficacy and feasibility of bilateral subthalamic deep brain stimulation (STN-DBS) for Parkinson's disease (PD) under general anesthesia (GA) has not been evaluated. OBJECTIVE: We compared the outcome of patients under GA with those who were operated on under local anesthesia (LA). MATERIAL AND METHODS: Thirty-three patients were assigned to the GA group (desflurane) and 19 patients were assigned to the LA group. Microelectrode recording (MER) was performed in both groups. The surgical outcomes of the patients were evaluated using the Unified Parkinson's Disease Rating Scale (UPDRS) after at least 12 months after surgery. RESULTS: Postoperatively, there was no significant difference on the UPDRS scores in either groups. A significant deterioration in cognitive function in the GA group was observed (p = 0.017). The recorded electrode coordinates, the average tracts for the MER, and STN depth were comparable in both groups. The overall incidence of adverse effects did not show any difference except that the incidence of sialorrhea and dysarthria was significantly higher in the GA group. CONCLUSION: Desflurane GA was shown to be a good alternative anesthetic method for PD patients undergoing DBS. Although the motor outcomes were comparable, a significant cognitive decline may be seen in the GA group with a higher occurrence of stimulation side effects.

Sleep disorder in Taiwanese nurses: a random sample survey.

This study determined the prevalence of and factors associated with insomnia in rotating-shift nurses. A two-stage, cross-sectional, hospital-based study was conducted in eastern Taiwan. Participants were randomly-sampled, rotating-shift nurses (n=661), ranging in age from 21 to 62 years, with a mean age of 31.86 (standard deviation=8.09). Insomnia disorder was identified using the Pittsburgh Sleep Quality Index. Nurses completed the self-reported Index, together with other questionnaires designed by the researchers for the purpose of the study. The prevalence of insomnia disorder was 59% (n=390). Multivariate logistic regression analyses revealed that poor sleepers are more likely to have higher anxiety, feelings of depression, and a poor working atmosphere. Anxiety, depression, and working atmosphere are independent predictors of insomnia. These results suggest that it is crucial to implement a more appropriate shift system and to develop prevention programs for nurses with insomnia to improve their occupational health.

Evaluation of the Chinese version of the swallowing screen in stroke patients with dysphagia.

OBJECTIVE: The purpose of this study was to validate a Chinese version of the modified Standardized Swallowing Assessment (SSA) instrument used by nurses in stroke patients with dysphagia and explore the feasibility of the simplified instrument. MATERIALS AND METHODS: This study involved a cross-sectional design. Nurses independently applied the modified SSA to 127 patients with stroke before a complete dysphagia evaluation conducted by a speech-language pathologist. Factor analysis of eight dysphagia variables in the modified SSA was performed to evaluate construct validity. The accuracy of the screening instrument was assessed through receiver operating characteristic (ROC) analysis. RESULTS: The comprehensive swallowing assessment revealed that 49.6% of the stroke patients had dysphagia. The modified SSA had an acceptable internal consistency coefficient. The inter-rater agreement between nurses using the modified SSA showed a Kappa coefficient of 0.509. All items had a communality loading of >0.5, and two factors accounted for 73.89% of the response variance. The area under the ROC curve was 0.79 (95% confidence interval: 0.71-0.87). The sensitivity and specificity derived for dysphagia detection were satisfactory according to the results obtained from the original 8-item and simplified 6-item scales (sensitivities = 82.50% and 81.00% and specificities = 59.40% and 64.10%, respectively; accuracy = 70.87% and 72.44%, respectively). CONCLUSION: This preliminary study suggests that the modified SSA is a potentially reliable and valid nurse-administered screening instrument for dysphagia detection in patients with stroke.

Dietary Patterns in Relation to Components of Dyslipidemia and Fasting Plasma Glucose in Adults with Dyslipidemia and Elevated Fasting Plasma Glucose in Taiwan.

Dietary patterns have been proposed to be related to dyslipidemia and hyperglycemia. This study investigated the correlation of dietary patterns with components of dyslipidemia and fasting plasma glucose (FPG) among young and middle-aged adults (aged between 20 and 50 years) with dyslipidemia and abnormal FPG in Taiwan. This cross-sectional study used the database compiled in Taiwan between 2001 to 2010. A total of 13,609 subjects aged between 20 and 50 years were selected. Dyslipidemia was defined primarily according to the National Cholesterol Education Program Adult Treatment Panel III guidelines with minor modification. Elevated FPG level was defined according to the American Diabetes Association. The factor analysis was conducted to identify three dietary patterns. Higher scores of the meat-convenience dietary pattern (high intake of deep-fried and processed food, sauces, sugar-added beverages, meat and organ meats, instant noodles, rice or flour cooked in oil, and eggs) had no association with components of dyslipidemia and abnormal FPG. Higher scores of the vegetables-fruits-seafood dietary pattern (high intake of vegetables, vegetables with oil or dressing, fruits, seafood, legumes, soy products, and rice or flour products) was inversely associated with hypercholesterolemia and positively associated with hyperglycemia. Higher scores of the dairy-complex carbohydrate dietary pattern (high intake of dairy products, milk, root crops, jam or honey, and whole grains) was inversely correlated with hypertriglycemia and low high-density lipoprotein cholesterol level. Our results support that the dietary pattern may have a role in the prevention and management of dyslipidemia and abnormal fasting plasma glucose.

Validity and reliability of swallowing screening tools used by nurses for dysphagia: A systematic review.

Dysphagia following neurological impairment increases the risk of dehydration, malnutrition, aspiration pneumonia, and even death. Screening for dysphagia has been reported to change negative outcomes. This review evaluated the validity and reliability of measurement tools for screening dysphagia in patients with neurological disorders to identify a feasible tool that can be used by nurses. Electronic databases were searched for studies from 1992 to 2015 related to dysphagia screening measurements. The search was applied to the Pubmed, CINAHL, Cochrane, Medline, EBSCO host, and CEPS + CETD databases. A checklist was used to evaluate the psychometric quality. The tools were evaluated for their feasibility for incorporation into routine care by nurses in hospitals. A total of 104 papers were retrieved, and eight articles finally met the inclusion criteria. The sensitivity and specificity of the screening tools ranged from 29% to 100% and from 65% to 100%, respectively. The interrater reliability ranged from good to excellent agreement. On the basis of quality evaluations, all the included studies had a risk of bias because of inadequate methodological characteristics. The Standardized Swallowing Assessment is the most suitable tool for detecting dysphagia because its psychometric properties and feasibility are higher than those of other screening tools that can be administered by nurses.