Decision difficulties of long-term-care facility nurses in transferring residents to the emergency department: A cross-sectional nationwide study.

AIMS: To examine the level of decision difficulties of long-term-care facility (LTCF) nurses when transferring residents to the emergency department (ED) and associated influencing factors. DESIGN: A cross-sectional nationwide study. METHODS: The LTCFs were selected through random stratified sampling across the whole Taiwan during February 2018 to January 2019. LTCF nurses who met the selection criteria were invited to participate with two or three nurses selected from each LTCF. The Patient Transfer Decision Difficulty Scale (PTDDS) was used to measure the level of difficulty in making decisions related to the transfer of residents to the ED. Data were collected by mailing the questionnaires and asking the nurses to return the completed form in 2 weeks. Data were analysed using simple linear regression and multiple regression with stepwise methods. RESULTS: In total, 618 valid questionnaires with an 85.32% response rate from 319 LTCFs were used for the data analysis. Decision difficulties that LTCF nurses experienced were moderate, the nursing personnel-bed ratio, LTCF professional training and basic life support training were predictive factors of the level of difficulty experience (scores of PTDDS) for the LTCF nurse (F = 6.81, p < .001). CONCLUSIONS: Enhancing emergency training in LTCF can improve nurses' decision-making ability to refer LTCF residents to emergency treatment. IMPACT: What problem did the study address? The study addressed the difficult decision LTCF nurses may experience when transferring a resident to the emergency department. What were the main findings? All LTCF nurses faced a moderate level of difficulty in decision-making. 'Transfer timing' was most often considered in the decision-making process when a resident was transferred to the ED. Where and on whom will the research have impact? Results of this study have considerable reference value for LTCF managers and nurses in the decision-making ability and suitability of transferring residents for emergency treatment.

Clinical observation of the effect of prophylaxis on allodynia in patients with migraine.

OBJECTIVE: The clinical characteristics of migraine with and without allodynia were compared to evaluate the risk factors of cutaneous allodynia in migraine. The effects of prophylactic therapy on allodynia in patients with migraine were assessed based on the change in pain threshold after therapy. PATIENTS AND METHODS: A total of 71 patients with migraine admitted to the Department of Neurology of Shandong Provincial Hospital were recruited in this study. The included patients were aged 18-70 years and did not present positive symptoms according to the nervous system examination. The variation in cutaneous allodynia was assessed for the role of classic prophylactic therapy in migraine-related allodynia, also termed as central sensitization (CS). Patients with migraine were randomized into two groups (topiramate and flunarizine groups), and the effect of drugs was evaluated by the change in cutaneous pain threshold between the two groups. Fifty-five patients were tested for pain threshold due to instrument failure. Pressure allodynia was measured with a force gage, and pricking was measured with Electronic von Frey Anesthesiometer. The pain threshold was measured every 3 months for 6 months. The variations in pain threshold after treatment were compared using t-test and χ 2 test. RESULTS: Allodynia was seen in 70.4% of the patients; of these, 76.3% were females. Female gender, duration of illness, and frequency of migraine attacks per month were significantly associated with allodynia. The rate of allodynia and frequency of headache declined significantly, the number of patients with allodynia was reduced, and the pain threshold improved dramatically after treatment. The composite adverse events were low after treatment with topiramate and flunarizine. CONCLUSION: Allodynia was observed, especially in females who experienced frequent migraine attacks for a prolonged period. Gender, duration of illness, and number of migraine attacks per month were the major predictors of allodynia. Topiramate and flunarizine administered orally for a short duration can effectively improve the pain threshold and CS of patients with migraine, and efficiently relieve allodynia.

Effects of Background Lighting Color and Movement Distance on Reaching Times Among Participants With Low Vision, Myopia, and Normal Vision.

This study investigated the effects of target distance (30, 35, and 40 cm) and the color of background lighting (red, green, blue, and yellow) on the duration of movements made by participants with low vision, myopia, and normal vision while performing a reaching task; 48 students (21 women, 27 men; M age = 21.8 year, SD = 2.4) participated in the study. Participants reached for a target (a white LED light) whose vertical position varied randomly across trials, ranging in distance from 30 to 40 cm. Movement time was analyzed using a 3 (participant group) × [4 (color of background lighting) × 3 (movement distance)] mixed-design ANOVA model. Results indicated longer times for completing a reaching movement when: participants belonged to the low vision group; the target distance between the starting position and the target position was longer (40 cm); and the reaching movement occurred in the red-background lighting condition. These results are particularly relevant for situations in which a user is required to respond to a signal by reaching toward a button or an icon.

Protective effect of neovibsanin B on spatial cognitive functions of rats with cerebrovascular hypoperfusion.

Neovibsanins are believed to be promising candidates for the development of novel therapeutic agents to treat neurological diseases like Alzheimer's disease. It has been shown that chronic cerebral hypoperfusion is linked to neurodegenerative disorders and their subsequent cognitive impairment. In the present study effect of neovibsanin B (NVB) on spatial cognitive functions of rats with lobal cerebrovascular hypoperfusion was investigated. The cerebrovascular hypoperfusion rat model was prepared by bilateral common carotid arteries occlusion (2VO). Morris water maze (MWM) test was employed to examine the effect of NVB on spatial cognitive function before and after 2VO intervention. The animals were divided into two groups; long-term memory (LTM) and short-term memory (STM) groups. Each of the groups was subdivided into 3 subgroups: control, untreated and NVB treated groups. After ten weeks of the surgery, all the subgroups were tested with MWM. The results of working memory test for both control and NVB treated groups revealed that escape latency time and total distance travelled were significantly lower compared to untreated group. Similarly, the maze test performance was observed to be significantly improved for control and NVB treated groups. Moreover, the probe memory test performance for control and NVB treated groups was markedly better than untreated group. Thus NVB has a significant effect on the spatial cognitive preservation in rats with chronic cerebral hypoperfusion. Thus NVB can be a promising agent for the spatial cognitive functions improvement.

Effects of pregabalin on central sensitization in patients with migraine.

PURPOSE: Despite the fact that the most recently articulated theory of migraine is the central sensitization hypothesis, few basic and clinical research studies on central sensitization have been conducted in patients with migraine. Here, we aim to reveal the risk factors of migraine with allodynia and to illustrate the effects of pregabalin on alleviating allodynia. METHODS: 63 migraine patients meeting the International Headache Society criteria were prospectively included. The cutaneous allodynia (CA) symptoms that occurred during headache attacks were examined with the Allodynia Symptom Checklist (ASC). The risk factors of allodynia were determined using logistic regression analysis. 41 patients with allodynia were treated with pregabalin (150 - 600 mg/d) for 12 weeks. The improvements in allodynia and headache severity as well as the side effects of the drug were recorded at 1 and 3 months following drug administration. RESULTS: Among the 63 patients, there were 41 cases (65.1%) of allodynia, including 35 cases (85.4%) of thermal allodynia, 12 cases (29.4%) of static mechanical allodynia, and 9 cases (22.0%) of dynamic mechanical allodynia. The allodynia appeared to be associated with gender (female), disease duration, and medication overuse. Compared with baseline, both the ASC scores in the three types of CA and the number of patients with allodynia were significantly decreased (p < 0.05) in patients treated with pregabalin. The frequency, severity, and duration of headache as well as the migraine disability assessment (MIDAS) and headache impact test (HIT-6) scores were significantly decreased (p < 0.05) when compared with baseline. The overall efficiency of drug therapy was 85.4% among all patients who received pregabalin. There were few side effects detected, and the patients showed good tolerability to drug therapy. CONCLUSIONS: Our results showed that 65.1% of patients with migraine had allodynia and that migraine with allodynia was related to the patient gender (female), disease duration, and medication overuse. Pregabalin was effective at relieving allodynia in migraine.

Automatic cell segmentation and nuclear-to-cytoplasmic ratio analysis for third harmonic generated microscopy medical images.

Traditional biopsy procedures require invasive tissue removal from a living subject, followed by time-consuming and complicated processes, so noninvasive in vivo virtual biopsy, which possesses the ability to obtain exhaustive tissue images without removing tissues, is highly desired. Some sets of in vivo virtual biopsy images provided by healthy volunteers were processed by the proposed cell segmentation approach, which is based on the watershed-based approach and the concept of convergence index filter for automatic cell segmentation. Experimental results suggest that the proposed algorithm not only reveals high accuracy for cell segmentation but also has dramatic potential for noninvasive analysis of cell nuclear-to-cytoplasmic ratio (NC ratio), which is important in identifying or detecting early symptoms of diseases with abnormal NC ratios, such as skin cancers during clinical diagnosis via medical imaging analysis.

[Comparative study of mannitol-induced acute kidney impairments in patients of different ages suffering from subarachnoid hemorrhage].

OBJECTIVE: To analyze and compare the clinical characteristics of mannitol-induced acute renal function impairment in treatment of patients of different ages suffering from subarachnoid hemorrhage (SAH) for the first time. METHODS: This study was a review of 1 361 patients with available hospital records admitted to the division of neurology due to SAH from February 1989 to December 2005. Among them, 94 patients had acute renal function impairment as a result of mannitol administration. Of these patients, 35 patients were middle-aged (<60 years old) and 59 patients of old age (>60 years old). The study included the time of appearance of renal function impairment after mannitol medication, its prognosis, the administration of nephrotoxic drugs, and the dose and duration of mannitol therapy. RESULTS: In old age group, abnormal renal function and urine routine appeared in 5 days (median), and 4 days (median) respectively, and acute renal failure (ARF) was diagnosed in 5 days, and the incidence rate of ARF was 20.3% after treatment with mannitol. The respective event appeared 7 days, 11 days, 9 days and 2.8% (P<0.05 or P<0.01) respectively, in middle-aged group. The data indicated the elderly patients had poorer tolerance to mannitol, with earlier occurrence of mannitol nephrosis, poorer outcome of kidney impairment and worse prognosis. Forty-three patients (72.9%) were treated with katlex (with a median of total dosage of 400 mg) in old-aged group, 35 patients (100.0%) were treated with katlex (with a median of total dosage of 800 mg) in middle-aged group, and there was a significant difference between two groups (P<0.01). The data indicated the incidence of mannitol nephrosis was lower in patients treated with large dosage of mannitol and katlex. The mortality was 3.4% (2/59 cases) and 0% (0/35 cases) in old-aged and middle-aged groups respectively (P=0.528). CONCLUSION: The elderly patients have higher rate of mannitol-induced impairment of renal function after SAH than middle-aged patients. The data emphasize that proper combination therapy of mannitol with katlex is an effective measure in preventing renal failure.

Use of the WHOQOL-BREF for evaluating persons with traumatic brain injury.

This study examined psychometric properties of a brief version of the World Health Organization Quality of Life questionnaire (WHOQOL-BREF) among persons with traumatic brain injury (TBI) and the relations of the WHOQOL-BREF domains, including physical capacity, psychological wellbeing, social relationships, and environment, to different indicators of TBI severity. Of the 354 eligible and available subjects from 22 hospitals in northern Taiwan over a 6-month period, 199 completed telephone interviews during data collection. Three indicators of TBI severity were used: the Glasgow Coma Scale, the presence of post-traumatic amnesia, and the abbreviated injury scale to the head. All domain scores of the WHOQOL-BREF had nearly symmetrical distributions: low percentages of ceiling and floor values (0-3%), low missing rates (0-0.5%) for all but one item (43.2%), and very good internal consistency (0.75-0.89) and test-retest reliability (0.74-0.95). The WHOQOL-BREF also exhibited excellent known-groups validity, as well as very good responsiveness and convergent validity with regard to employment, independence in daily life activities, social support, and depression. After adjustment for potential confounders, almost none of the domain scores of the WHOQOL-BREF significantly differed in the severity levels of the three severity indicators. In conclusion, the WHOQOL-BREF is an appropriate health-related quality of life (HRQL) instrument for persons with TBI. Furthermore, the initial severity of the TBI might not be suitable for predicting levels of HRQL in persons with TBI.

Current experiences in the use of the severe head-injury guidelines in Taiwan.

BACKGROUND: Head injury is the leading cause of death and disability for patients who experienced a major accident. It has been suggested that a well-planned neurointensive care management can effectively reduce the secondary brain insults. The BTF and the AANS proposed the Guidelines for the Management of Severe Head Injury in 1995. The purpose of this study was to obtain a consensus on whether the guidelines are suitable for treating patients with severe head injury in Taiwan. METHODS: Data from patients with severe head injury were collected from 6 different medical centers in Taiwan. The methods for controlling ICP, CPP, and hyperventilation, and the medical treatment with vasopressors and sedatives have been analyzed. RESULTS: Ninety-four patients with severe head injury (GCS

[Correlation of changes of peripheral benzodiazepine receptors in hippocampus synaptosomes with cognitive impairment: experiment with D-galactose-induced senescent rats].

OBJECTIVE: To investigate the effects of peripheral benzodiazepine receptor (PBR) in hippocampus synaptosomes on spatial learning and memory. METHODS: Twenty-four Sprague-Dawley rats of both sexes were randomly divided into 2 equal groups: D-galactose-treated group, receiving subcutaneous injection of D-galactose 100 mg/kg once a day for 56 days, and normal saline (NS) control group, receiving comparable injections of NS. Spatial learning and memory were assessed by Morris water maze test for 5 days. After the behavioral testing all rats were decapitated and the hippocampus was removed immediately. Then, the synaptosomes in hippocampus were purified by density gradient centrifugation. The PBR binding parameters, maximal binding site density (B(max)) and equilibrium dissociation constant (KD), were estimated by radioligand [(3)H] PK11195 binding assays. RESULTS: Two weeks after the beginning of experiment the D-galactose-treated rats began to show symptoms of aging. On the 5th day of behavioral testing the D-galactose-induced aging rats presented significant impairment in water maze performance compared with the NS controls (P < 0.001). The decrease in specific [(3)H] PK11195 binding in the hippocampus synaptosomes of the D-galactose-treated group was 67.3 +/- 18.6 fmol/mg, significantly lower than that of the saline control group (127.9 +/- 20.1 fmol/mg, P < 0.01). The Scatchard analysis revealed that the B(max) of the D-galactose-treated group was 177.2 +/- 26.7 fmol/mg, significantly lower than that of the saline group (296.7 +/- 33.5 fmol/mg, P < 0.01), and the K(D) of the D-galactose-treated group was 0.503 +/- 0.06 nmol/L, not significantly different from that of the saline control group (0.502 +/- 0.05 nmol/L). Correlation analysis showed that the specific [(3)H] PK11195 binding in hippocampus synaptosomes was closely related to the escaping latency (r = -0.854), swimming time (r = 0.845), and distance (r = 0.851) in platform quadrant in Morris water maze in all rats (all P < 0.001). CONCLUSION: The decreased expression of PBR in hippocampus synaptosomes is possibly associated with the spatial learning-memory impairments induced by D-galactose.

Sociodemographic, knowledge, and attitudinal factors related to meat consumption in the United States.

OBJECTIVE: To provide information about meat consumption and factors that explain differences among subpopulations, and to evaluate how knowledge and attitudes about nutrition and awareness of diet and health influence meat consumption. DESIGN: The 1994-1996 Continuing Survey of Food Intakes by Individuals provided two nonconsecutive 24-hour recalls. The Diet and Health Knowledge Survey was administered at least 1 week after the last 24-hour recall. Meat subgroups (chicken, beef, pork, and processed pork products) were calculated from Food Guide Pyramid meat groups by using recipe ingredients. SUBJECTS: The study sample included 4,802 children and 9,460 adults from the Continuing Survey of Food Intakes by Individuals and 5,649 adults from the Diet and Health Knowledge Survey. STATISTICS: Weighted percentages and means described the food intake and self-assessed dietary characteristics. Relationships among types of meat intake, dietary characteristics, and demographics were evaluated using a two-stage, multivariate regression model. RESULTS: Individuals in higher income households consumed relatively more chicken; those in low-income households consumed more processed pork products. Those consuming no beef and smaller amounts of chicken had the lowest discretionary fat intakes. Beef and pork consumers were more likely to think that their diets were too high in fat, but less likely to believe it is important to eat a low-fat diet. Region of residence affected the probability of consuming most meats. Having a high level of education was associated with a lower likelihood of consuming beef and pork. CONCLUSIONS: Sociodemographic factors are strong predictors of the probability of choosing particular types of meat and of the amounts eaten. Knowledge and attitudes about diet and meat products also influence choices.

Intranasal delivery of nerve growth factor to protect the central nervous system against acute cerebral infarction.

OBJECTIVE: To confirmed reliability and feasibility of intranasal nerve growth factor (NGF) bypassing the blood-brain barrier and its potential neuroprotective effects on acute cerebral ischemia. METHODS: (1) To assay NGF concentrations in different brain regions after middle cerebral artery occlusion (MCAO). Rats were randomly divided into intranasal (i.n.) NGF, intravenous (i.v.) NGF, and untreated group (n = 4). The concentrations of NGF of different brain regions in the three groups after MCAO were measured by ELISA. (2) To observe neuroprotective action of NGF on focal cerebral ischemic damage. Rats were randomly assigned to 4 groups: i.n. vehicle, i.n. NGF, i.v. vehicle, i.v. NGF (n = 8). Treatment was initiated 30 minutes after onset of MCAO and given again 24 hours later. Three neurologic behavioral tests were performed 24 and 48 hours following onset of MCAO. Corrected infarct volumes were determined 48 hours after onset of MCAO. RESULTS: The olfactory bulb in i.n. NGF group obtained the highest concentration (3252 pg/g) of NGF among all regions, followed by the hippocampus. The NGF concentrations in the olfactory bulb and hippocampus in i.n. NGF group were markedly higher than that in i.v. NGF and control groups. The infarct volume in i.n. NGF group was markedly reduced by 38.8% compared with i.n. vehicle group. I.n. NGF group vestibulum function markedly improved compared with i.n. vehicle group at 24 and 48 hours after onset of MCAO (P24h = 0.02 and P48h = 0.04, respectively). CONCLUSION: Intranasal NGF could pass through the blood-brain barrier, reach the central nervous system, reduce infarct volume, and improve neurologic function in rats following MCAO. Intranasal delivery of NGF may be a promising treatment for stroke.