A new in situ magnetic method to indicate the source and seasonal diffusion of heavy metal contamination at Qingdao Beach, China.

The accumulation of heavy metals from sewage and garbage dumping can seriously impact beach tourism and thus the local economy, but it is difficult to quickly and accurately determine the pollution location and source of heavy metals and clarify their diffusion range. This study investigates a new in situ magnetic testing method to address this issue. (1) The in situ method can be used to effectively and quickly evaluate heavy metal sources and diffusion ranges based on the distribution of κ values. (2) According to chemical experiments, the specific elements polluting a beach can be determined, such as the Cr, Ni, Zn, and Fe pollution of Beach No. 3. (3) Although κ values for assessing heavy metal pollution on different beaches vary, metal pollution occurs when the higher κ value is more than 50 times the lower κ value on the same beach. (4) The κ values vary in different seasons due to the influence of natural factors and urban seasonal sewage policies.

Association of Blood Pressure Indices with Right and Left Cardio-Ankle Vascular Index (CAVI) and Its Mathematically Corrected Form (CAVI0) for the Evaluation of Atherosclerosis.

BACKGROUND AND OBJECTIVES: The cardio-ankle vascular index (CAVI) is an index for arterial stiffness that is theoretically independent of blood pressure. CAVI0 is the mathematically corrected formula of CAVI that has been claimed to be less dependent on blood pressure changes. The association of right and left CAVI and CAVI0 with blood pressure indices can reveal the importance of considering the blood pressure of the patient despite their theoretical independency. In this study, we assessed the right and left CAVI and CAVI0 and evaluated the main effect of blood pressure indices on them with respect to age. MATERIALS AND METHODS: We collected the following data of 136 community-dwelling individuals: age; sex; weight; height; body mass index; right and left CAVI and CAVI0; and systolic (SBP), diastolic (DBP), and mean blood pressure (MBP). The association of right and left CAVI and CAVI0 with blood pressure indices was evaluated using regression analysis. RESULTS: Regression analysis revealed that SBP, DBP, and MBP were associated with right and left CAVI (independent of age). Moreover, SBP was associated with both right and left CAVI0 (independent of age), whereas DBP was not associated with right or left CAVI0. CONCLUSION: Right and left arterial stiffness measured using CAVI has no different associations with SBP, DBP, and MBP. Both right and left CAVI0 were independently associated with SBP, whereas neither left nor right CAVI0 was independently associated with DBP. MBP was only associated with the right-side CAVI0 in community-dwelling individuals.

PPARα agonist fenofibrate relieves acquired resistance to gefitinib in non-small cell lung cancer by promoting apoptosis via PPARα/AMPK/AKT/FoxO1 pathway.

Recent studies show that intracellular accumulation of cholesterol leads to acquired resistance to gefitinib in non-small cell lung cancer (NSCLC) cells. In this study we investigated how to regulate the cholesterol levels in gefitinib-resistant NSCLC cells. We showed that intracellular cholesterol levels in gefitinib-resistant cell lines (PC-9/GR, H1975, H1650, and A549) were significantly higher than that in gefitinib-sensitive cell line (PC-9). Treatment with gefitinib (5 µM) significantly increased intracellular cholesterol levels in PC-9/GR, H1975, and H1650 cells. Gefitinib treatment downregulated the expression of PPARα, LXRα, and ABCA1, leading to dysregulation of cholesterol efflux pathway. We found that a lipid-lowering drug fenofibrate (20, 40 µM) dose-dependently increased the expression of PPARα, LXRα, and ABCA1, decreased the intracellular cholesterol levels, and enhanced the antiproliferative effects of gefitinib in PC-9/GR, H1975, and H1650 cells. We revealed that fenofibrate increased the gefitinib-induced apoptosis via regulating the key proteins involved in the intrinsic apoptosis pathway. In PC-9/GR, H1975 and H1650 cells, fenofibrate dose-dependently increased the expression of AMPK, FoxO1, and decreased the expression of AKT, which were remarkably weakened by knockdown of PPARα. In PC-9/GR cell xenograft mice, combined administration of gefitinib (25 mg · kg-1 · d-1) and fenofibrate (100 mg · kg-1 · d-1) caused remarkable inhibition on tumor growth as compared to treatment with either drug alone. All the results suggest that fenofibrate relieves acquired resistance to gefitinib in NSCLC by promoting apoptosis via regulating PPARα/AMPK/AKT/FoxO1 pathway. We propose that combination of gefitinib and fenofibrate is a potential strategy for overcoming the gefitinib resistance in NSCLC.

Stress and uncertainty in parents of children with tracheobronchial malacia and stenosis.

BACKGROUND: An increasing number of children are undergoing flexible bronchoscopy because of tracheobronchial malacia and stenosis, but there is little research related to their parents' stress and uncertainty. AIM: To explore and identify risk factors associated with stress and uncertainty among Taiwanese parents of children with tracheobronchial malacia and tracheabronchostenosis in a paediatric intensive care unit. METHODS: A cross-sectional study design was implemented using two psychometric scales: Parenting Stress Index and Parents' Perception of Uncertainty Scale. Parents of Taiwanese children (0-18 years/o) with a diagnosis of tracheobronchial malacia or/and tracheabronchostenosis who underwent bronchoscopy in a paediatric intensive care unit were recruited. The analysis used descriptive statistics and multivariable linear regression. RESULTS: Ninety parents who were caring for a total of 51 children were recruited. Stress and uncertainty both scored high and were positively correlated with each other. Four risk factors arising from parental stress were unemployment, parental uncertainty, the child's tracheobronchial malacia and tracheabronchostenosis and use of oxygen. CONCLUSIONS: Identifying likely causes of stress and uncertainty is essential for this parental group, particularly for parents facing unemployment, feelings of uncertainty and caring for children with both tracheobronchial malacia and tracheabronchostenosis and requiring oxygen. RELEVANCE TO CLINICAL PRACTICE: Nursing practice can focus on better parental support for those parents who are unemployed, show feeling of uncertainty and care for children with combined tracheobronchial malacia and tracheabronchostenosis and other medical care, such as breathing symptom management, nasogastric feeding and oxygen therapy.

Children With Inguinal Hernia Repairs: Age and Gender Characteristics.

Objective. This study reports the age and gender characteristics of children with inguinal hernia repairs (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] Operation Codes 530-533). Methods. We used a retrospective cohort study design based on 2 data sources from 2007 to 2011 (the Bureau of National Health Insurance, Department of Health, Taiwan, and a local teaching children's hospital database) and descriptive statistics to analyze the group's age and gender differences as independent variables. Results. The gender ratio was 7 males to 1 female in the general population, whereas the gender ratio in children was 3.5 males to 1 female. Gender difference was found statistically significant in the age subgroup difference: boys (49.1%) were more than girls (39.3%) in ages 1 to 4, while girls (37.8%) were more than boys (23.7%) in ages 5 to 9. Based on the local hospital's data, of those 611 (15%) children born and who received herniorrhaphy, 204 (33.4%) were born as preterm infants and 407 (66.6%) as term infants. The gender ratio among 204 children born prematurely and received herniorrhaphy was 3 males to 1 female. Of those 353 infants under 6 months who received herniorrhaphy, 155 (76%) were preterm infants while 198 (48.6%) were term infants. Conclusion. Early screening of inguinal hernia for children is important and should focus on those born prematurely, particularly those aged <6 months and boys.

Uncertainty of Parents With Children Undergoing Herniorrhaphy.

This study reports the association between parental uncertainty and characteristics of 123 parent-child dyads prior to the child's herniorrhaphy. A cross-sectional study design and Mishel's Parents' Perception of Uncertainty Scale (PPUS) were used. Parent participants were married (98%), had a university degree (45%), identified with a religion (77%), and worked (69%). More boys (76%) than girls (23%) underwent herniorrhaphy (average age = 2.26 years); 60% were the first-born child and 25% were premature. More children presented with unilateral (63.4%; right = 44.7%, left = 18.7%) than bilateral (36.6%) hernias and most were primary (98%). Overall uncertainty was perceived as moderate and ambiguity had the highest score. Religion, birth order (first child), and hernia site (bilateral) explained 20.6% of total variance of uncertainty. Providing information about postoperative symptom and pain management is important for all parents, particularly for parents identified with a religion and whose first-born child had bilateral hernias.

The influence of personality traits and socio-demographic characteristics on paediatric nurses' compassion satisfaction and fatigue.

AIMS: To explore the level of and the association between, compassion satisfaction and fatigue of paediatric nurses; to determine the association between personality traits and compassion satisfaction and fatigue; to identify the determinants of compassion satisfaction and fatigue. BACKGROUND: Paediatric nurses are prone to experiencing compassion fatigue associated with caring for children with illness and their families, yet its connection with nurses' personality traits remains unknown. DESIGN: A cross-sectional descriptive study design was used. METHODS: The data collection used three instruments measuring socio-demography, responses to the compassion satisfaction and fatigue test and the revised NEO personality inventory. The study used descriptive, correlation and multiple regression analysis for the data collected between April - July 2014. RESULTS: From 173 female paediatric nurses, two-thirds worked in critical care units and indicated a satisfactory level of compassion satisfaction and a low level of compassion fatigue, despite a lack of association between the two concepts. Four determinants-agreeableness, extraversion, conscientiousness and engaging with outdoor activities-were predictive and explained 43.6% of total variance of compassion satisfaction. Two risk factors of compassion fatigue identified were less emotional stability and singlehood (marital status) and these explained 26.1% of total variance of compassion fatigue. CONCLUSION: Support for improving agreeableness and emotional stability in paediatric nurses' workplaces including involvement in the outdoor activities and an increase in social connection may enhance compassion satisfaction and prevent exhaustive compassion fatigue.

Verapamil Use Is Associated With Reduction of Newly Diagnosed Diabetes Mellitus.

Objective: The mechanism of the beneficial effect of calcium-channel blockers (CCBs), especially verapamil, on the development of type 2 diabetes mellitus (T2DM) has been described. This study compared the incidence of T2DM in adults prescribed oral verapamil and propensity score-matched adults prescribed other oral CCBs. Methods: This retrospective population-based cohort study used Taiwan's National Health Insurance Research Database from 2000 to 2011. T2DM was defined according to the International Classification of Diseases, Ninth Revision, Clinical Modification. Results: During follow-up periods of 41,958 and 42,118 person-years, 269 of 4930 patients in the verapamil cohort and 340 of 4930 patients in the matched cohort, respectively, developed T2DM. The incidence rates were 6.41 and 8.07 per 1000 population per year among verapamil and other CCB users, respectively. The adjusted hazard ratio (HR) for T2DM associated with use of verapamil (vs. other CCBs) was 0.80 [95% confidence interval (CI), 0.68 to 0.94; P = 0.006]. After exclusion of patients followed for <180 days or <365 days (to avoid bias derived from delayed diagnosis), adjusted HRs remained significant [0.79 (95% CI, 0.67 to 0.93; P = 0.005) and 0.77 (95% CI, 0.65 to 0.91; P = 0.002), respectively]. Only the interaction term for age was significant (P = 0.009). Verapamil had a more prominent effect on patients aged older than 65 years (P < 0.001). Conclusions: In patients with no known history of diabetes mellitus, oral verapamil use was associated with a decreased incidence of T2DM compared with other CCBs.

Primary caregivers of in-home oxygen-dependent children: predictors of stress based on characteristics, needs and social support.

AIM: To identify the predictors of primary caregivers' stress in caring for in-home oxygen-dependent children by examining the association between their levels of stress, caregiver needs and social support. BACKGROUND: Increasing numbers of primary caregivers of oxygen-dependent children experience caregiving stress that warrants investigation. DESIGN: The study used a cross-sectional design with three psychometric scales - Modified-Parenting Stress Index, Caregiver Needs Scale and Social Support Index. METHODS: The data collected during 2010-2011 were from participants who were responsible for their child's care that included oxygen therapy for ≧6 hours/day; the children's ages ranged from 3 months-16 years. Descriptive statistics and multivariable linear regression were used. RESULTS: A total of 104 participants (M = 34, F = 70) were recruited, with an average age of 39·7 years. The average age of the oxygen-dependent children was 6·68 years and their daily use of oxygen averaged 11·39 hours. The caregivers' overall levels of stress were scored as high and information needs were scored as the highest. The most available support from family and friends was emotional support. Informational support was mostly received from health professionals, but both instrumental and emotional support were important. Levels of stress and caregiver needs were significantly correlated. Multivariable linear regression analyses identified three risk factors predicting stress, namely, the caregiver's poor health status, the child's male gender and the caregiver's greater financial need. CONCLUSION: To support these caregivers, health professionals can maintain their health status and provide instrumental, emotional, informational and financial support.

Semi-Prone Position Can Influence Variability in Respiratory Rate of Premature Infants Using Nasal CPAP.

UNLABELLED: To determine the effect of positions (supine, lateral, semiprone) on the physiological parameters (HR, RR, SpO2) of premature infants receiving NCPAP who were non-oxygen-dependent and non-BPD, and to identify significant clinical changes associated with these variables. METHODS: A crossover study design with three different positions in the assigned sequence (supine-supine, supine-lateral and supine-semiprone) was used, and each position was maintained for 1h. The subjects' vital signs were recorded 30 min after initiation of each position and measured for 30 min. RESULTS: Forty-seven infants with a median GA of 28.6 weeks (range 26-35) were studied, and their median BW was 1210g (range 776-2920). Overall, position-related effects showed significant difference in the variability in RR (OR=0.68; CI 0.51-0.89), with the variability in RR being significantly lower in the semiprone position. The lateral position was associated with increased RR (B=2.9; p=0.02). Previous use of ventilator (PUV) was associated with increased HR, whereas BW and GA were negatively associated with higher HR. Cesarean birth, use of surfactant and PUV were associated with lower SpO2, whereas BW and GA were correlated with higher SpO2. GA was identified as a protective factor, while PUV was a risk factor for the variability in both HR and SpO2. CONCLUSIONS: Premature infants receiving NCPAP sleeping in the semiprone position may have more stable RR, while the lateral position did not improve RR. Thus, the semiprone and supine positions may be considered preferable when positioning the monitored premature infants with NCPAP.

The desire to survive: the adaptation process of adult cancer patients undergoing radiotherapy.

AIM: Radiotherapy is one of the primary treatment strategies for cancer. However, patients not only deal with the side-effects of radiotherapy, but they must also endure the psychological distress caused by cancer. This study explores how cancer patients adapt to the treatment process when receiving radiotherapy. METHODS: This study used a grounded theory approach, and eight in-depth interviews were conducted with newly diagnosed cancer patients who received radiotherapy as a primary treatment. RESULTS: The core category that emerged from this study was "the desire to survive". The categories and subcategories that emerged from the data include facing unknown situations (e.g. searching for relevant information and decision-making considerations, and listening to healthcare professionals' suggestions), experiencing the pain of treatment (e.g. tolerating side-effects, tolerating inconvenience during the treatment, accepting support during the treatment, and adjusting lifestyles), and chances to extend life (e.g. accepting fate, determination to undergo the treatment, and adjusting negative emotions). CONCLUSION: The study results provide a better understanding of the experiences of cancer patients undergoing radiotherapy. Healthcare professionals should provide effective medical management for side-effects and psychological support to cancer patients during the journey of radiotherapy.

A correlational study of illness knowledge, self-care behaviors, and quality of life in elderly patients with heart failure.

BACKGROUND: Patients with heart failure experience adverse physical symptoms that affect quality of life. The number of patients with heart failure in Taiwan has been growing in recent years. PURPOSE: This article examines correlations among illness knowledge, self-care behaviors, and quality of life in elderly patients with heart failure. METHODS: A cross-sectional research design using three questionnaires was adopted. The study was undertaken in an outpatient department of a teaching hospital in Taiwan from January to June 2008. Potential participants aged 65 years or older were selected by a physician based on several diagnostic findings of heart failure that included an International Classification of Diseases' code 4280 or 4289. Patients who were bedridden or had a prognosis of less than 6 months were excluded from consideration. RESULTS: One hundred forty-one patients with heart failure were recruited. Most participants were men (51.8%), older adults (49.6% older than 71 years old), and either educated to an elementary school level or illiterate (69.5%) and have New York Heart Association class II (61.0%). Participants had an average left ventricular ejection fraction of 41.1%. The illness knowledge of participants was poor (accuracy rate: 29.3%), and most were unaware of the significance of self-care. Illness knowledge correlated with both self-care behaviors (r = -.42, p < .01) and quality of life (r = -.22, p < .01). Illness knowledge and age were identified as significant correlated factors of self-care behaviors (R = .22); and functional class, living independently, and age were identified as significant correlated factors of quality of life (R = .41). CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Participants in this study with higher self-reported self-care behaviors and quality of life were younger in age and had better illness knowledge. Furthermore, physical function and independence in daily living significantly affected quality of life. Care for patients with heart failure, particularly older adults, should focus on teaching these patients about heart failure illness and symptom management. Assisting elderly patients with heart failure to promote and maintain physical functions to handle activities of daily living independently is critical to improving patient quality of life.

Evaluation of nurses' knowledge and understanding of obstacles encountered when administering resuscitation medications.

AIM: The aim of the study was to develop and validate an instrument to evaluate nurses' knowledge and to understand the obstacles that they encounter when administering resuscitation medications. BACKGROUND: Insufficient knowledge is a major factor in nurses' drug administration errors. Resuscitation involves situations in which doctors issue oral orders, and is inherently highly stressful. Sufficient knowledge is vital for nurses if they are to respond quickly and accurately when administering resuscitation medications. METHODS: A cross-sectional study was conducted. A questionnaire (20 true-false questions) developed from literature and expert input, and validated by subject experts and one pilot study, was used to evaluate nurses' knowledge of resuscitation medications. Stratified sampling and descriptive statistics were applied. RESULTS: A total of 188 nurses participated. The overall correct answer rate was 70.5% and the greater the nurse's work experience the higher the score. Only 8% of nurses considered themselves to have sufficient knowledge and 73.9% hoped to gain more training about resuscitation medications. The leading obstacle reported was "interruption of the drug administration procedure on resuscitation" (62.8%). Seventeen out of 20 questions achieved a discriminatory power of over 0.36, indicating good to excellent questions. In the study, a total of 16 resuscitation medication errors were reported by the participants, in which the errors involved atropine (five cases), epinephrine (three cases) and others (eight cases). The errors mainly involved misinterpretation of orders, insufficient knowledge and confusing certain drugs for other look-alike drugs. CONCLUSION: Evidence-based results strongly suggest that nurses have insufficient knowledge and could benefit from longer working experience and additional training about resuscitation medications. Further research to validate the instrument is needed and the education of nurses regarding resuscitation medications is recommended.

Medication errors in pediatric nursing: assessment of nurses' knowledge and analysis of the consequences of errors.

AIM: The purposes of this study were (i) to evaluate pediatric nurses' knowledge of pharmacology, and (ii) to analyze known pediatric administration errors. BACKGROUND: Medication errors occur frequently and ubiquitously, but medication errors involving pediatric patients attract special attention for their high incidence and injury rates. METHODS: A cross-sectional study was conducted. A questionnaire with 20 true-false questions regarding pharmacology was used to evaluate nurses' knowledge, and the known pediatric administration errors were reported by nurses. FINDINGS: The overall correct answer rate on the knowledge of pharmacology was 72.9% (n=262). Insufficient knowledge (61.5%) was the leading obstacle nurses encountered when administering medications. Of 141 pediatric medication errors, more than 60% (61.0%) of which were wrong doses, 9.2% of the children involved suffered serious consequences. CONCLUSIONS: Evidence-based results demonstrate that pediatric nurses have insufficient knowledge of pharmacology. Such strategies as providing continuing education and double-checking dosages are suggested.

Evaluating nurses' knowledge of chemotherapy.

BACKGROUND: The characteristics of the drugs that are used in chemotherapy have given rise to many issues, one of which is whether nurses are competent when working with chemotherapy. METHODS: Nurses' knowledge of chemotherapy was evaluated with a questionnaire that included 20 true-or-false questions. The questionnaire was developed from literature and expert input and validated by subject experts (content validity). A pilot study (contrasted-groups approach) was also conducted. RESULTS: A total of 203 nurses participated in the study and achieved an average overall correct answer rate of 60.9%. Most of the respondents, 63.5% (129 of 203), had a score of less than 70, and 77.3% (157 of 203) hoped to undergo more training on chemotherapy. Their knowledge of chemotherapy came mainly from consultation with colleagues (4.0 ± 0.8) and in-hospital continuing education (3.9 ± 0.8). CONCLUSION: The evidence-based results suggested that nurses have insufficient knowledge about chemotherapy. More fundamentally, however, nurses need more education about chemotherapy in nursing school and through in-hospital continuing education.

The experiences of adult ventilator-dependent patients: a meta-synthesis review.

Studies exploring the perceptions of patients whose lives are maintained by mechanical ventilation highlight the stressful nature of this type of experience. The objective of this meta-synthesis study was to describe the nature of the experience of adult ventilator-dependent patients. A systematic literature search of English and Chinese databases was undertaken, covering the period between 1970 and 2012. Qualitative research findings were extracted and pooled using the Joanna Briggs Institute Qualitative Assessment and Review Instrument. A total of 1004 papers were identified from various database and hand searches. Nineteen papers were critically appraised and 16 met inclusion criteria. Five meta-synthesis themes emerged from the analysis: (1) the feelings of fear due to being dependent on a ventilator and the loss of control of life; (2) disconnection with reality; (3) impaired embodiment; (4) construction of coping patterns; (5) trust and caring relationship. Suggested implications for practice include enhancing the trust relationship with health professionals, as well as nursing actions throughout the suction procedure relating to release of patient's psychological distress and empowering their resilience factors.

Nurses' knowledge of high-alert medications: a randomized controlled trial.

AIM: This study explores the effectiveness of an educational intervention on nurses' knowledge regarding the administration of high-alert medications. BACKGROUND: Nurses' insufficient knowledge is considered to be one of the most significant factors contributing to medication errors. Most medication errors cause no harm to patients, but the incorrect administration of high-alert medications can result in serious consequences. A previous study by the same authors validated 20 true/false questions concerning high-alert medications and suggested that the topic be taught to nurses (Hsaio, et al., 2010. Nurses' knowledge of high-alert medications: Instrument development and validation. Journal of Advanced Nursing, 66(1), 177-199.). METHODS: A randomized controlled trial was employed in 2009 in Taiwan. Twenty-one hospital wards and 232 nurses were randomized to control and intervention groups. The sixty-minute educational intervention was based on the viewing of a Powerpoint file developed for this study. The results were compared pre-intervention and six weeks post-intervention by means of a test comprising the 20 questions regarding high-alert medications. FINDINGS: The pre-intervention baseline data for correct answer rate was 75.8% (mean; n=232). After the intervention, the post-test showed significant improvement in the intervention group (n=113) (pre vs. post; 77.2±15.5 vs. 94.7±7.6; paired t=10.82, p<0.0001) but not in the control group (n=112) (pre vs. post; 74.3±14.7 vs. 75.5±14.2; paired t=0.60; p=0.247). CONCLUSIONS: Educational intervention appears to be effective in strengthening nurses' knowledge of high-alert medications. The Powerpoint file presented teaching material which is both suitable and feasible for hospital-based continuing education.

Faculties' and nurses' perspectives regarding knowledge of high-alert medications.

The incorrect administration of high-alert medications can have serious consequences. A previous study by the authors of this study developed and validated 20 true-false questions concerning high-alert medications and suggested that the topic be taught to nurses. The perspectives of faculty and nurses, however, needed to be assessed before such teaching could be implemented. The aim of this study was to understand the views of faculty and nurses about training in high-alert medications: its importance, the frequency with which it is provided, and the ideal stage at which it should be provided. A cross-sectional study was conducted in 2008 in Taiwan. A questionnaire was used to determine whether the 20 questions are important, whether its content was being taught, and the ideal time for teaching it. Snowball sampling and descriptive statistics were used. A total of 136 faculty and 199 nurses participated. From the perspectives of faculty and nurses, all 20 questions regarding high-alert medications were important (faculty vs. nurses: 4.65±0.35 vs. 4.45±0.67) but the issues to which they related were insufficiently taught (faculty vs. nurses: 3.88±0.87 vs. 3.06±0.94). Faculty believed that the ideal stage at which to provide training on high-alert medications was during formal, in-school nursing education (94.3%) while nurses believed that the ideal stage was during in-hospital continuing education (48.9%). For training in high-alert medications, the researchers recommended the inclusion of classes on the subject as part of formal, in-school nursing education, as well as of hospital-based continuing education. The instrument's questions highlight the important concepts concerning high-alert medications which should be taught to nurses and nursing students.

Clinical characteristics of Acinetobacter baumannii complex bacteremia in patients receiving total parenteral nutrition.

BACKGROUND: Acinetobacter baumannii complex (Abc) comprises at least three phenotypically undifferentiated species, including A baumannii, Acinetobacter genomic species 3 (AGS 3) and Acinetobacter genomic species 13TU (AGS 13TU). Abc bacteremia had rarely been described in patients receiving total parenteral nutrition (TPN). In this study, we aimed to determine any differences in the clinical features of patients having TPN and bacteremia due to A baumannii and those due to nonbaumannii Abc (including AGS 3 and AGS 13TU). METHODS: The data of patients who had received TPN and had Abc bacteremia in Taipei Veterans General Hospital between August 1998 and December 2007 were retrospectively reviewed. The Acinetobacter isolates were identified to genomic species level. RESULTS: A total of 23 patients with A baumannii and 23 patients with nonbaumannii Abc (15 AGS 13TU and 8 AGS 3) bacteremia were identified. The two groups of the patients were comparable regarding their gender, age and APACHE II score at the onset of bacteremia. However, several clinical features were different between the two groups of the patients in the univariate analysis. Furthermore, A baumannii isolates were resistant to more classes of antibiotics than nonbaumannii Abc isolates. The multivariate analysis showed that a higher number of patients with A baumannii bacteremia had received TPN for ≥ 15 days before their onset of bacteremia [odds ratio (OR) 7.214, 95% confidence interval (CI) (1.108-46.989), p = 0.039]. Nevertheless, the 14-day (30.4% vs. 21.7%, p = 0.737) and all-cause in-hospital mortality rate (60.9% vs. 39.1%, p = 0.238) did not differ significantly between these two groups. CONCLUSION: The patients with A baumannii bacteremia demonstrated a longer timeframe in the treatment of TPN prior to the onset of bacteremia than those with nonbaumannii Abc bacteremia, however the clinical outcomes between the two groups of the patients did not differ significantly.

Non-nutritive sucking and facilitated tucking relieve preterm infant pain during heel-stick procedures: a prospective, randomised controlled crossover trial.

BACKGROUND: Preterm infants' repeated exposure to painful procedures may contribute to negative consequences. Thus, improving preterm infants' neurodevelopmental outcomes requires prioritising their pain management. OBJECTIVES: To compare the effectiveness of two non-pharmacological pain-relief strategies (non-nutritive sucking and facilitated tucking) with routine care on preterm infants' pain, behavioural, and physiological responses before, during, and after heel-stick procedures. DESIGN: Prospective, randomised controlled crossover trial. SETTING: Level III Neonatal Intensive Care Unit in Taipei. METHOD: Thirty-four preterm infants (gestational age 29-37 weeks) needing three procedural heel sticks were recruited by convenience sampling and randomly assigned to a sequence of three treatments (two pain-relief interventions and the control condition): (1) routine care, non-nutritive sucking, facilitated tucking, (2) non-nutritive sucking, facilitated tucking, routine care, and (3) facilitated tucking, routine care, non-nutritive sucking. Each treatment condition was performed on a different day to avoid any carry-over effect. Pain was measured by the Premature Infant Pain Profile (PIPP), infant behaviour by a behavioural coding scheme, and physiological signals by electrocardiogram monitors. All data were collected 3 min without stimuli (baseline), during heel-stick procedures, and recovery. RESULTS: Infants receiving non-nutritive sucking and facilitated tucking had significantly lower mean (standard deviation) pain scores during heel-stick procedures (6.39 [3.35] and 7.15 [3.88], respectively) than those receiving routine care (9.52 [4.95]). Infants receiving non-nutritive sucking and facilitated tucking had significantly lower odds ratios (0.39, p=0.011 and 0.34, p=0.005, respectively) for pain (PIPP score≥6) than infants receiving routine care after adjusting for time, baseline pain scores, and infants' characteristics. Similarly, infants receiving non-nutritive sucking and facilitated tucking had significantly lower odds ratios (0.23, p<0.001 and 0.28, p=0.03, respectively) for moderate-to-severe pain (PIPP score≥12) than infants receiving routine care. Infants receiving facilitated tucking had lower frequency ratios for stress-related behaviours, abnormal heart rates, and decreased oxygen saturation than infants receiving routine care. CONCLUSIONS: Both non-nutritive sucking and facilitated tucking effectively reduced pain scores more than routine care during heel-stick procedures. Non-nutritive sucking reduced PIPP pain scores more effectively than facilitated tucking. However, facilitated tucking showed broader effects not only on relieving pain, but also on enhancing infants' physiological and behavioural stability during heel-stick procedures.