Opportunities for Interactive Communication in Mechanically Ventilated Critically Ill Patients: A Video-Based Observational Study.

Background: Mechanically ventilated critically ill patients need the opportunity to communicate their physical and psychosocial concerns to nurses. However, these patients face the unique problem of lacking even the opportunity to communicate. Aims: The study aimed to describe the characteristics of communication opportunities for critically ill mechanically ventilated patients. Methods: The study was designed as a video-based descriptive observational study. Participants included seven mechanically ventilated critically ill patients at the intensive care unit, coronary care unit, or high care unit who were conscious and seven registered nurses (seven pairs). Videos were recorded continuously from 8 am to 4 pm, and the footage was then descriptively analyzed. Data collection took place between July 2019 and June 2020. Results: The total recording time was 668.0 minutes. Of these 668.0 minutes, nurses stayed in the Conversation Area of the Patient for 279.6 minutes, and of these 279.6 minutes, two-way face-to-face communication between nurse and patient occurred for 78.0 minutes. Of these 78.0 minutes, communications were started by nurses for 47.2 minutes (174 scenes) and by patients for 24.2 minutes (36 scenes). The patient-started two-way communication scenes included 37 instances of Patient-Intentional-Action that triggered the start of communication. Actions using the upper limbs were observed in 20 instances and represented the most frequently used body part. The head/face, lower limbs, or trunk were also used in some of the actions. Gestures were the most commonly used action type (14 instances). Other types included lip movement, grimace, leg flex/extension, and cough. Conclusions: We found that nurses tended to start communication more frequently than patients did and that patients demonstrated Patient-Intentional-Action with a variety of actions using various body parts. Communication opportunities for patients were created when nurses took the initiative to start communication or when they noticed and responded to the Patient-Intentional-Action. Our findings demonstrate that nurses need to recognize and always respond to Patient-Intentional-Action and to take the initiative in communicating rather than waiting for the patient to do so.

Association of abdominal obesity with crossing capillaries in the finger nailfold in type 2 diabetes mellitus.

AIM: Increased crossing of finger nailfold capillaries could be a novel visual marker of early microvascular damage among type 2 diabetes mellitus patients. Although abdominal obesity is an important driver of early microvascular damage, its association with an increase in the percentage of crossing capillaries remains uncertain. We investigated the association between abdominal obesity and an increase in the percentage of crossing capillaries in the finger nailfold in patients with type 2 diabetes mellitus. METHODS: This cross-sectional study enrolled 123 type 2 diabetes mellitus patients (age 40-75 years) who visited the outpatient diabetic clinic at Osaka University Hospital between May and October 2019. Abdominal obesity was defined as a waist circumference ≥ 90 cm in women and ≥ 85 cm in men. Capillary morphology was assessed by nailfold capillaroscopy based on the simple capillaroscopic definitions of the European League Against Rheumatism Study Group. The association between abdominal obesity and a high percentage of crossing capillaries in the finger nailfold (defined as the highest tertile of crossing capillaries) was analyzed using multivariable logistic regression. RESULTS: After adjusting for age, sex, smoking status, regular exercise, duration of diabetes, glycated hemoglobin, hypertension, and dyslipidemia, abdominal obesity was significantly associated with a high percentage of crossing capillaries (multivariable-adjusted odds ratios [95% confidence interval] = 2.70 [1.05-6.90], p = 0.038). CONCLUSIONS: Abdominal obesity may play an important role in the increase in the percentage of crossing capillaries in the finger nailfold in patients with type 2 diabetes mellitus.

Differences in the risk of severe falls between patients aged <65 years and patients aged ≥65 years at a psychiatric hospital based on 12-year incident reports.

PURPOSE: This study compared age differences in risk factors for falls requiring treatment in psychiatric patients. DESIGN AND METHODS: An incident database was used to compare fall incidents in patients aged less than 65 years and those aged greater than or equal to 65 years. FINDINGS: Approximately 30% of fallers were less than 65 years. Mental status and medication were the main risk factors. Decreased activities of daily living were associated with the most falls in patients greater than or equal to 65 years. PRACTICE IMPLICATIONS: Fall risk differed between the two age groups. Medication may play a major role in falls among patients less than 65 years.

Association of crossing capillaries in the finger nailfold with diabetic retinopathy in type 2 diabetes mellitus.

AIMS/INTRODUCTION: Crossing capillaries in the finger nailfold might potentially be a novel diabetic retinopathy (DR) biomarker that could be assessed non-invasively in the clinical setting. However, the association between crossing capillaries and DR is controversial. This study aimed to investigate the association between the percentage of crossing capillaries in the finger nailfold and DR in patients with type 2 diabetes mellitus. MATERIALS AND METHODS: This cross-sectional study enrolled 108 type 2 diabetes mellitus patients (aged 40-75 years) who visited the outpatient diabetic clinic at Osaka University Hospital, Osaka, Japan, between May and October 2019. Capillary morphology was assessed using nailfold capillaroscopy based on the simple capillaroscopic definitions of the European League Against Rheumatism Study Group. Details of DR and other laboratory data were obtained from medical records. The association between the tertile of the percentage of the crossing capillary and DR was analyzed using multivariable logistic regression. RESULTS: After adjusting for age, sex, diabetes duration, glycated hemoglobin, systolic blood pressure, body mass index, and use of renin-angiotensin system inhibitor and antihyperlipidemic medication, the percentage of crossing capillaries was significantly associated with DR (multivariable-adjusted odds ratios for increasing tertiles of the percentage of crossing capillary: 1 [reference], 2.05 [95% confidence interval 0.53-7.94], and 4.33 [95% confidence interval 1.16-16.21]; P-trend = 0.028). CONCLUSIONS: A higher percentage of crossing capillaries in the nailfold was associated with a higher risk of DR, independent of traditional risk and inhibiting factors, in patients with type 2 diabetes mellitus.

Validation of Eurolung risk models in a Japanese population: a retrospective single-centre analysis of 612 cases.

OBJECTIVES: The objective of this study was to evaluate the validity of Eurolung risk models in a Japanese population and assess their utility as predictive indicators for the prognosis. METHODS: Between 2007 and 2014, 612 anatomic lung resections were performed among 694 lung cancer patients in our institution. We analysed the cardiopulmonary morbidity and mortality and compared them with the predicted results. We also investigated the association between the Eurolung aggregate risk scores and the long-term outcomes using the Kaplan-Meier method and a multivariable analysis. RESULTS: The percentage of cardiopulmonary complications was lower than that predicted by Eurolung 1 (22.4% vs 24.6%). The mortality rate was significantly lower than predicted by Eurolung 2 (0.7% vs 3.0%). The morbidity rate was stratified by Aggregate Eurolung 1. The stratification of the mortality rate by the Eurolung 2 aggregate score was also in line with the increase in score, although the observed number of deaths was quite small (4 cases). The 5-year overall survival was clearly separated according to the stratified Aggregate Eurolung 1 and 2 (P < 0.01 and P < 0.01, respectively). Besides pathological stage, both the Aggregate Eurolung 1 (score 0-7 vs 8-20) and 2 (score 0-8 vs 9-19) scores were shown to be independently associated with overall survival on multivariable. CONCLUSIONS: Eurolung risk models cannot be directly applied to the patients in our institution. However, Eurolung aggregate risk scores were helpful not only for stratifying morbidity and mortality after anatomic lung resection but also for predicting the long-term outcomes.

Indelible distrust: memory bias toward cheaters revealed as high persistence against extinction.

Our ability to learn about the reputations of others-that is, who is likely to cooperate versus cheat-contributes greatly to cooperativeness in society. There has been recent debate whether humans employ memory bias favoring cheaters (i.e., there is an evolved module for the detection of cheaters) or whether no such bias exists (i.e., reputation learning is flexibly modulated by contextual factors). We report 3 experiments that address this issue by comparing persistence against extinction-which is a reliable measure of prepared fear learning (Öhman & Mineka, 2001)-between memories regarding cheaters and cooperators. In all experiments, participants learned to classify unfamiliar persons as either cooperators or cheaters, and, then, they were instructed to disregard those learned associations and told that they had been determined arbitrarily, which simulated a verbal extinction procedure in the fear conditioning paradigm (Hugdahl & Öhman, 1977). The results indicated that while postlearning changes in perceived trustworthiness were modulated by a contextual factor (appearance of the facial stimulus), the persistence of learning exhibited a cheater advantage: Cheaters remained perceived as untrustworthy to a greater extent than cooperators as trustworthy at the extinction period. Thus, there exists a cheater bias in human reputation learning, the proximate and ultimate mechanisms of which warrant further study.

Enhanced memory for the wolf in sheep's clothing: facial trustworthiness modulates face-trait associative memory.

Our decision about whether to trust and cooperate with someone is influenced by the individual's facial appearance despite its limited predictive power. Thus, remembering trustworthy-looking cheaters is more important than remembering untrustworthy-looking cheaters because we are more likely to trust and cooperate with the former, resulting in a higher risk of unreciprocated cooperation. The present study investigated whether our mind adaptively copes with this problem by enhancing memory for trustworthy-looking cheaters. Participants played a debt game, wherein they learned to discriminate among good, neutral, and bad lenders, who respectively charged no, moderate, and high interest on the debt. Each lender had either a trustworthy- or untrustworthy-looking face. A subsequent memory test revealed that participants remembered the bad traits of trustworthy-looking lenders more accurately than those of untrustworthy-looking lenders. The results demonstrate enhanced memory for trustworthy-looking cheaters, or wolves in sheep's clothing, implying that humans are equipped with protective mechanisms against disguised, unfaithful signs of trustworthiness.

Do verbs and adjectives play different roles in different cultures? A cross-linguistic analysis of person representation.

Five studies are reported testing the hypothesis that Westerners (Italians) rely more on trait adjectives and that East Asians (Japanese) rely more on behavior-descriptive verbs in person description and memory. In Studies 1 (N = 80) and 2 (N = 128), Italians used more adjectives and fewer verbs than Japanese to describe individuals and groups. Likewise, Studies 3 (N = 161) and 4 (N = 84) revealed that Italians committed more memory errors indicative of behavior-to-trait inferences, whereas Japanese showed an opposite tendency (Study 3) or no difference (Study 4). Study 5 (N = 64) revealed that in both languages, adjectives were perceived to provide more information about the actor and that verbs were perceived to provide more information about the situation. Yet, Japanese participants found adjectives less predictive of future behavior but facilitative of the process of imagining a concrete situation. These results are interpreted as providing evidence for systematic cultural differences in the elaboration of social information.