Factors Associated with Return Visits by Elders within 72 Hours of Discharge from the Emergency Department.

Elders have a higher rate of return visits to the emergency department (ED) than other patients. It is critical to understand the risk factors for return visits to the ED by elders. The aim of this study was to determine the factors associated with return visits to the ED by elders. This study retrospectively reviewed the hospital charts of elders who returned to the ED within 72 h after discharge from ED. The risk factors identified in the Triage Risk Screening Tool were applied in this study. Of the elders discharged from the ED, 8.64% made a return visit to the ED within 72 h. The highest revisit rate occurred within 24 h after discharge. Factors associated with return ED visits within 24 h by elders were difficulty walking and having discharge care needs. The factor associated with ED return visits within 24-48 h was polypharmacy. Difficulty walking, having discharge care needs, and hospitalization within the past 120 days were associated with return visits made within 48-72 h following discharge. Identifying the reasons for return visits to the ED and providing a continuous review of geriatric assessment and discharge planning could reduce unnecessary revisits.

Enantioselective Synthesis of Axially Chiral Figure-Eight Spirocycloparaphenylenes via Rh-Catalyzed Intermolecular [2 + 2 + 2] Cycloaddition.

We have achieved the enantioselective synthesis of axially chiral figure-eight spiro[9.9]cycloparaphenylene (CPP) tetracarboxylates with up to 75:25 er via the cationic Rh(I)/(R)-H8-BINAP complex-catalyzed chemo-, regio-, and enantioselective intermolecular double [2 + 2 + 2] cycloaddition of an achiral symmetric tetrayne with dialkyl acetylenedicarboxylates followed by reductive aromatization. The spiro[9.9]CPP tetracarboxylates are highly distorted at the phthalate moieties with large dihedral and boat angles and exhibit weak aggregation-induced emission enhancement behavior.

The Outcomes of an Interprofessional Simulation Program for New Graduate Nurses.

This study explored the learning outcomes of an interprofessional simulation program for new graduate nurses during their training program. It was a single-group, pre-test and post-test research design. Ninety-three new graduate nurses participated in the study. The Nursing Competence Instrument and program satisfaction survey questionnaires were used to evaluate the learning outcomes of the program. Data were collected between 1 July 2019 and 30 June 2020 in a medical center in Taiwan. It was found that four nursing core competencies were significantly higher after the simulation, including advancing career talents (t = 10.12, p < 0.0001), integrating care abilities (t = 10.19, p < 0.001), dealing with tension (t = 6.87, p < 0.0001), and leading humanity concerns (t = 6.86, p < 0.001). The average satisfaction score for the interprofessional simulation training among nurses was 4.42 out of 5. In conclusion, interprofessional simulation education can help novice nurses improve their nursing core competencies. The results of this study provide an important indicator for hospitals and governments when making policy and training programs for new graduate nurses.

Curbing COVID-19 progression and mortality with traditional Chinese medicine among hospitalized patients with COVID-19: A propensity score-matched analysis.

BACKGROUND: Viral- and host-targeted traditional Chinese medicine (TCM) formulae NRICM101 and NRICM102 were administered to hospitalized patients with COVID-19 during the mid-2021 outbreak in Taiwan. We report the outcomes by measuring the risks of intubation or admission to intensive care unit (ICU) for patients requiring no oxygen support, and death for those requiring oxygen therapy. METHODS: This multicenter retrospective study retrieved data of 840 patients admitted to 9 hospitals between May 1 and July 26, 2021. After propensity score matching, 302 patients (151 received NRICM101 and 151 did not) and 246 patients (123 received NRICM102 and 123 did not) were included in the analysis to assess relative risks. RESULTS: During the 30-day observation period, no endpoint occurred in the patients receiving NRICM101 plus usual care while 14 (9.27%) in the group receiving only usual care were intubated or admitted to ICU. The numbers of deceased patients were 7 (5.69%) in the group receiving NRICM102 plus usual care and 27 (21.95%) in the usual care group. No patients receiving NRICM101 transitioned to a more severe status; NRICM102 users were 74.07% less likely to die than non-users (relative risk= 25.93%, 95% confidence interval 11.73%-57.29%). CONCLUSION: NRICM101 and NRICM102 were significantly associated with a lower risk of intubation/ICU admission or death among patients with mild-to-severe COVID-19. This study provides real-world evidence of adopting broad-spectrum oral therapeutics and shortening the gap between outbreak and effective response. It offers a new vision in our preparation for future pandemics.

Rhodium-Catalyzed Intermolecular Cycloaromatization Route to Cycloparaphenylenes that Exhibit Aggregation-Induced Emission.

A high-yielding new route to substituted cycloparaphenylenes has been developed via reductive aromatization of a diyne bearing two cyclohexadiene units giving a cyclophenylene-ethynylene (CPE) followed by the cationic rhodium(I)/dppe complex-catalyzed intermolecular [2+2+2] cycloaddition (cycloaromatization) of the CPE with monoynes. The thus-obtained products, substituted [8]cycloparaphenylene-triphenylenes ([8]CPPTs), exhibited definite aggregation-induced emission (AIE). This molecule is noteworthy as a novel AIE-active cycloarylene that does not have well-known AIE luminogens, such as tetraphenylethene and 1,2,4,5-tetraphenylbenzene skeletons. The single-crystal X-ray diffraction analyses of the AIE-active [8]CPPTs revealed their highly ordered packing structures in which the rotation of the triphenylene moieties is restricted.

Anticancer Effects of Taraxacum via Cell Cycle Arrest, Necrosis, Apoptosis, and Endoplasmic Reticulum Stress.

Dandelion (Taraxacum species) is a wild plant with over 2500 species. Flavonoids, phenolic compounds, saponins, sesquiterpenes, and sugars have been detected in the organs of Taraxacum, and for centuries it has been used in traditional medicine for the relief and treatment of various diseases. However, details of its working mechanism remain unclear. Bioactive compounds in herbal extracts generally have low yields, which makes their isolation and purification intensive in terms of time and cost. Here, to assess their versatility and safety, we applied aqueous extracts of two species of Taraxacum, T. mongolicum and T. formosanum, including extracts of both fresh and dried T. formosanum, to compare their potential antitumor effects on HeLa human cervical cancer cells, three liver cancer cell lines, and one normal liver cell line. After being treated with a lower dose of Taraxacum, the upregulation of subG1 and S populations, as well as increased levels of p-eIF2[Formula: see text]-to-eIF2[Formula: see text] ratio, were observed in HeLa cells, whereas the downregulation of S population and the absence of mRNA expressions were detected in HeLa cells when being treated with a higher dose of Taraxacum. These results indicated that Taraxacumcould induce apoptosis and endoplasmic reticulum stress while suppressing proliferation, transcription, colony formation, migration, and invasion. What's more, we also found that the effects of fresh T. formosanum were much stronger than that of T. mongolicumin HeLa cells. Based on these results, we suggest that T. formosanum may contain specific compound(s) that are potentially useful for cancer therapy. However, much work remains to identify these effective compounds for the future application of Taraxacumto cancer therapy.

Standard risk assessment forms help reduce preventable harm in older adult inpatients: A retrospective chart review study.

AIMS: To examine nurse documentation of assessments using standard risk assessment forms in older inpatients, and to determine the value of such assessment. DESIGN: Cross-sectional retrospective chart review. METHODS: This retrospective review of risk evaluation documentation in patients' medical records focused on skin, continence, medical complications, nutrition, cognition, mobility, medications and pain. RESULTS: A total of 1000 medical records from Taiwan hospitals were reviewed from January 2016 to December 2017, and 379 from Australian hospitals were reviewed from March 2011 to February 2012. Taiwanese patients with documented assessment of skin (aOR =2.94, 95%CI =1.88-4.54), nutrition (aOR =3.22, 95%CI =1.08-9.59), cognition (aOR =2.61, 95%CI =1.32-5.16) and pain (aOR =5.01, 95%CI=1.63-15.38) had significantly higher odds of developing new problems; while Australian patients with documented assessments of continence (aOR =11.55, 95%CI =1.48-90.45) and nutrition (aOR =12.90, 95%CI =1.67-99.06) had significantly higher odds of developing new problems. DISCUSSION: Nursing assessments and interventions documented in standard risk assessment forms help clinical nurses detect new preventable problems and prevent harm in older hospital inpatients across geographic locations and hospital types. Standard nursing forms can be used in clinical practice to guide proactive care by nurses to prevent harm during hospitalisation. IMPACT: Older inpatients are at risk of preventable harm and new health problems. The present study found that incorporating eight factors sensitive to nursing care into standard risk assessment forms can help reduce preventable harm in older inpatients. In addition, these forms guide assessment and intervention effectively in different countries.

Enhancing reflection on medical and surgical nursing among nursing students: A participatory action research study.

BACKGROUND: Medical and Surgical Nursing (MSN) is a core course in baccalaureate nursing programs that requires active and effective teaching and learning strategies to enhance students' engagement. OBJECTIVE: To develop and implement an effective learning process for students undertaking the MSN course. DESIGN: This participatory action research study used reflection as the center of action in the cycle of planning, acting, observing and reflecting and re-planning. SETTING: The study was conducted at a University in southern Taiwan. PARTICIPANTS: Thirty nursing students in their second year of a bachelor program in nursing, aged 19 to 20 years, were recruited via email and completed the study. METHODS: The data were collected from February to June 2019 through reflective workshops, group discussions, individual interviews, and field notes. A qualitative content analysis was performed. Four criteria were considered to ensure the trustworthiness of the study process: reliability, validity, transferability, and authentic citations. RESULTS: Four key themes - two challenges and two adaptive strategies - emerged in relation to the spiral process of improving teaching and learning in the MSN course. Participants experienced two main challenges: the large amount of multidisciplinary knowledge expected, and the rapid pace of the course. The two adaptive strategies were: recognizing their own unique way of learning and becoming an active learner and achiever. CONCLUSIONS: The project helped students to identify their own learning challenges, recognize the need to modify their attitudes and approaches to learning, improve teaching and learning in the MSN course, and identify the characteristics relevant to becoming an active learner and achiever.

Synthesis, Structures, and Properties of Highly Strained Cyclophenylene-Ethynylenes with Axial and Helical Chirality.

Single and double cyclophenylene-ethynylenes (CPEs) with axial and helical chirality have been synthesized by the Sonogashira cross-coupling of di- and tetraethynyl biphenyls with a U-shaped prearomatic diiodoparaphenylene followed by reductive aromatization. X-ray crystallographic analyses and DFT calculations revealed that the CPEs possess highly twisted bent structures. Bend angles on the edge of the paraphenylene units were close to the value of [5]cycloparaphenylene (CPP)-the smallest CPP to date. The double and single CPEs possessed stable chirality despite flexible biphenyl structures because of the high strain in the diethynyl-paraphenylene moiety. In both the single and double CPEs, orbital interactions along the biphenyl axis were observed by DFT calculations in LUMO and LUMO+2 of the single CPE and LUMO+1 of the double CPE, which likely cause lowering of these orbital energies. Concerning chiroptical properties: boosting of the gabs value was observed in the biphenyl-based double CPE, as well as the binaphthyl-based single CPE, compared to the biphenyl-based single CPE.

What Do Adolescents Learn from a 50 Minute Cardiopulmonary Resuscitation/Automated External Defibrillator Education in a Rural Area: A Pre-Post Design.

Background: Literature indicates that patients who receive cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) from bystanders have a greater chance of surviving out-of-hospital cardiac arrest (OHCA). A few evaluative studies involving CPR/AED education programs for rural adolescents have been initiated. This study aimed to examine the impact of a 50 min education program that combined CPR with AED training in two rural campuses. Methods: A quasi-experimental pre-post design was used. The 50 min CPR/AED training and individual performance using a Resusci Anne manikin was implemented with seventh grade students between August and December 2018. Results: A total of 336 participants were included in this study. The findings indicated that the 50 min CPR/AED education program significantly improved participant knowledge of emergency responses (p < 0.001), correct actions at home (p < 0.01) and outside (p < 0.001) during an emergency, and willingness to perform CPR if necessary (p < 0.001). Many participants described that "I felt more confident to perform CPR/AED," and that "It reduces my anxiety and saves the valuable rescue time." Conclusions: The brief education program significantly improved the immediate knowledge of cardiac emergency in participants and empowered them to act as first responders when they witnessed someone experiencing a cardiac arrest. Further studies should consider the study design and explore the effectiveness of such brief programs.

A Study on the Reporting Intention of Medical Incidents: A Nursing Perspective.

Medical incidents threaten patients' lives and health, increase medical costs, and can lead to medical disputes. A high proportion of medical incidents are not reported. The aim of this study was to explore the factors influencing nurses' reporting of medical incidents. The cross-sectional survey design used a self-administered 47-item questionnaire to survey 835 nurses in three hospitals in Taiwan between January and December 2014. The intention among nurses to report medical incidents was high (3.86/5); nurses' intention to report medical incidents was positively correlated ( r = .34, p < .0001) with their attitude about reporting, awareness of reporting ( r = .37, p < .0001), and support from interested parties ( r = .12, p = .001), and was negatively correlated with positive incentives ( r = -.14, p < .0001) and negative incentives ( r = .29, p < .0001). Nurses' awareness and a supportive work environment affect nurses' willingness to voluntarily report medical incidents; hence, they are critical considerations as Taiwan moves toward systems of mandatory reporting.

Waiting and hoping: a phenomenographic study of the experiences of boarded patients in the emergency department.

AIMS AND OBJECTIVES: To understand the experiences and concerns of patients in the emergency department during inpatient boarding. BACKGROUND: Boarding in the emergency department is an increasingly common phenomenon worldwide. Emergency department staff, patients and their families become more stressed as the duration of boarding in the emergency department increases. Yet, there is limited knowledge of the experiences and concerns of boarded patients. DESIGN: The qualitative approach of phenomenography was used in the study. METHODS: The phenomenographic study was conducted in one emergency department that treats approximately 15,000 patients each month. Twenty emergency department boarding patients were recruited between July-September 2014. Semi-structured interviews were used for data collection. The seven steps of qualitative data analysis for a phenomenographic study - familiarisation, articulation, condensation, grouping, comparison, labelling and contrasting - were employed to develop an understanding of participants' experiences and concerns during their inpatient boarding in the emergency department. RESULTS: The perceptions that emerged from the data were collected into four categories of description of the phenomenon of emergency department boarding patients: a helpless choice; loyalty to specific hospitals and doctors; an inevitable challenge of life; and distrust of the healthcare system. The outcome space for the emergency department boarding patients was waiting and hoping for a cure. CONCLUSION: The experiences and concerns of emergency department boarding patients include physical, psychological, spiritual and health system dimensions. It is necessary to develop an integrated model of care for these patients. RELEVANCE TO CLINICAL PRACTICE: Understanding the experiences and concerns of patients who are placed on boarding status in the ED will help emergency healthcare professionals to improve the quality of emergency care. There is a need to develop a care model and associated intervention measures for emergency department patients during the boarding process. The results of this study will help health regulatory authorities to develop an appropriate emergency department boarding system so that patients receive better emergency care.

Is Bladder Training by Clamping Before Removal Necessary for Short-Term Indwelling Urinary Catheter Inpatient? A Systematic Review and Meta-analysis.

PURPOSE: Urinary catheterization is a common technique in clinical practice. There is, however, no consensus on management prior to removal of the indwelling catheter for short-term patients. This systematic review examined the necessity of clamping before removal of an indwelling urinary catheter in short-term patients. METHODS: A systematic literature review was conducted using eight databases and predetermined keywords-guided searches. Some 2,515 studies were evaluated. Ten studies that met the inclusion criteria were selected. RESULTS: The quality of the studies was assessed using the Jadad scoring system. Only 40.0% of studies were rated as high quality. This review found that catheter clamping prior to removal was not necessary for the short-term patient. When made a comparison with the unclamping group, there was no significant difference in recatheterization risk, risk of urine retention, patients' subjective perceptions and rate of urinary tract infection. CONCLUSIONS: This review indicated that bladder training by clamping prior to removal of urinary catheters is not necessary in short-term catheter patients. In addition, clamping carries the risk of complications such as prolonging urinary catheter retention and urinary tract injury. Further investigation requires higher quality methodologies and more diverse study designs.

The emergency patient's participation in medical decision-making.

AIMS AND OBJECTIVES: The purpose of this research was to explore the medical decision-making processes of patients in emergency departments. BACKGROUND: Studies indicate that patients should be given enough time to acquire relevant information and receive adequate support when they need to make medical decisions. It is difficult to satisfy these requirements in emergency situations. Limited research has addressed the topic of decision-making among emergency patients. DESIGN: This qualitative study used a broadly defined grounded theory approach to explore decision-making in an emergency department in Taiwan. METHODS: Thirty emergency patients were recruited between June and December 2011 for semi-structured interviews that were audio-taped and transcribed verbatim. RESULTS: The study identified three stages in medical decision-making by emergency patients: predecision (interpreting the problem); decision (a balancing act) and postdecision (reclaiming the self). Transference was identified as the core category and pattern of behaviour through which patients resolved their main concerns. This transference around decision-making represents a type of bricolage. CONCLUSIONS: The findings fill a gap in knowledge about the decision-making process among emergency patients. RELEVANCE TO CLINICAL PRACTICE: The results inform emergency professionals seeking to support patients faced with complex medical decision-making and suggest an emphasis on informed patient decision-making, advocacy, patient-centred care and in-service education of health staff.

Anemia-related hemogram, uterine artery pulsatility index, and blood pressure for the effects of Four-Agents-Decoction (Si Wu Tang) in the treatment of primary dysmenorrhea.

OBJECTIVES: We previously reported pain intensity as the primary outcome of Four-Agents-Decoction (Si Wu Tang) for treating primary dysmenorrhea. We further explored other effects of this formula in accordance with the theory of Traditional Chinese Medicine on anemia-related hemogram parameters for "nourishing blood" and uterine artery pulsatility index (PI) for "blood stagnation." DESIGN: Data were assessed for post-hoc analysis from 76 young women from the Taipei metropolitan area of Taiwan who participated in the randomized double-blind clinical trial. Analysis of variance and t test were used to examine the treatment effect between and within the Four-Agents-Decoction and placebo groups. OUTCOME MEASURES: In addition to pain intensity, anemia-related hemogram parameters, uterine artery PI, menstruation characteristics, and blood pressure were compared. RESULTS: Compared to placebo, biochemical indicators for anemic status did not change differently after the treatment with Four-Agents-Decoction (Si Wu Tang). The changes in uterine artery PI, menstrual pain intensity, and blood pressure were statistically greater in the active treatment group than in the placebo group. In the 25 women receiving ultrasound examination on the same menstruation day, the directions of the changes in both PI and in visual analog scale (VAS) pain intensity aligned well. The changes in the left PI, right PI, and VAS pain intensity in the Four-Agents-Decoction group were -0.391 +/- 0.861, -0.344 +/- 1.03, and -0.251 +/- 2.02 cm; those in the placebo group were 0.208 +/- 1.10, 0.372 +/- 1.06, and 0.438 +/- 2.98 cm, respectively. Inversely, the changes in blood pressure were 11.4 +/- 10.5 mm Hg for systolic blood pressure and 8.36 +/- 8.65 mm Hg for diastolic pressure for the Four-Agents-Decoction group and 6.36 +/- 8.66 and 2.91 +/- 11.2 mm Hg, respectively, for the placebo group. The directions of the changes did not shift, nor did the values change drastically, after adjusting for the level at screening cycle. CONCLUSIONS: The anemia status evaluated in conventional medicine does not readily explain the effect of "nourishing blood" by Four-Agents-Decoction (Si Wu Tang) from this exploratory study. Although we did not find strong statistical significance of treatment effect, the decreased PI and extra blood pressure elevation may indicate an improvement of "blood stagnation" in the Four-Agents-Decoction group. The added information warrants a further larger clinical trial with an increased power to enhance our understanding of the efficacy, the dose-response relationship, and the mode of action of this ancient formula for treating primary dysmenorrhea.

A randomised placebo-controlled trial of a traditional Chinese herbal formula in the treatment of primary dysmenorrhoea.

BACKGROUND: Most traditional Chinese herbal formulas consist of at least four herbs. Four-Agents-Decoction (Si Wu Tang) is a documented eight hundred year old formula containing four herbs and has been widely used to relieve menstrual discomfort in Taiwan. However, no specific effect had been systematically evaluated. We applied Western methodology to assess its effectiveness and safety for primary dysmenorrhoea and to evaluate the compliance and feasibility for a future trial. METHODOLOGY/PRINCIPAL FINDINGS: A randomised, double-blind, placebo-controlled, pilot clinical trial was conducted in an ad hoc clinic setting at a teaching hospital in Taipei, Taiwan. Seventy-eight primary dysmenorrheic young women were enrolled after 326 women with self-reported menstrual discomfort in the Taipei metropolitan area of Taiwan were screened by a questionnaire and subsequently diagnosed by two gynaecologists concurrently with pelvic ultrasonography. A dosage of 15 odorless capsules daily for five days starting from the onset of bleeding or pain was administered. Participants were followed with two to four cycles for an initial washout interval, one to two baseline cycles, three to four treatment cycles, and three follow-up cycles. Study outcome was pain intensity measured by using unmarked horizontal visual analog pain scale in an online daily diary submitted directly by the participants for 5 days starting from the onset of bleeding or pain of each menstrual cycle. Overall-pain was the average pain intensity among days in pain and peak-pain was the maximal single-day pain intensity. At the end of treatment, both the overall-pain and peak-pain decreased in the Four-Agents-Decoction (Si Wu Tang) group and increased in the placebo group; however, the differences between the two groups were not statistically significant. The trends persisted to follow-up phase. Statistically significant differences in both peak-pain and overall-pain appeared in the first follow-up cycle, at which the reduced peak-pain in the Four-Agents-Decoction (Si Wu Tang) group did not differ significantly by treatment length. However, the reduced peak-pain did differ profoundly among women treated for four menstrual cycles (2.69 (2.06) cm, mean (standard deviation), for the 20 women with Four-Agents-Decoction and 4.68 (3.16) for the 22 women with placebo, p = .020.) There was no difference in adverse symptoms between the Four-Agents-Decoction (Si Wu Tang) and placebo groups. CONCLUSION/SIGNIFICANCE: Four-Agents-Decoction (Si Wu Tang) therapy in this pilot post-market clinical trial, while meeting the standards of conventional medicine, showed no statistically significant difference in reducing menstrual pain intensity of primary dysmenorrhoea at the end of treatment. Its use, with our dosage regimen and treatment length, was not associated with adverse reactions. The finding of statistically significant pain-reducing effect in the first follow-up cycle was unexpected and warrants further study. A larger similar trial among primary dysmenorrheic young women with longer treatment phase and multiple batched study products can determine the definitive efficacy of this historically documented formula. TRIAL REGISTRATION: Controlled-Trials.com ISRCTN23374750.