Factors associated with facial pressure injury in patients receiving non-invasive positive pressure ventilation mask: A retrospective case-control study.

AIMS AND OBJECTIVES: This study aimed to investigate factors associated with facial pressure injury (FPI) in patients receiving non-invasive positive pressure ventilation (NIPPV) during hospitalisation in the intensive care unit (ICU) and to identify predictors of FPI. BACKGROUND: Non-invasive positive pressure ventilation is a method of treating patients with acute and chronic respiratory failure. However, FPI may occur due to unsuitable nasal-oral NIPPV masks and discomfort in contact with the skin surface. DESIGN: A retrospective case-control study. METHODS: From January 2018 to October 2020, a total of 397 patients admitted to a national hospital in Taiwan were enrolled. Patients received NIPPV and routinely used under-mask prophylactic dressings during hospitalisation. Patients were divided into the non-FPI group (n = 357) and the FPI group (n = 40). Demographic, clinical characteristics, acute physiology and chronic health evaluation II scores, and Braden Scale scores were collected from medical records. Logistic regression analysis was performed to examine the contribution of each factor to the FPI, and odds ratios were reported. The STROBE checklist was used in this retrospective case-control study. RESULTS: There were significant differences between the groups in age, serum albumin, C-reactive protein, body mass index (BMI), disease severity, Braden Scale score, length of stay, duration of mechanical ventilation and use of corticosteroids. Logistic regression analysis revealed that the risk factor for FPI was the Braden Scale score [OR = 1.630 (1.176-2.260)], BMI [OR = 0.396 (0.210-1.784)] and corticosteroids [OR = 0.394 (0.159-1.811)], which were predictors of FPI in patients with NIPPV. CONCLUSIONS: Facial pressure injury may still occur in patients who routinely use prophylactic dressings under NIPPV masks. This study provides information on continuing education training for FPI to more accurately identify high-risk and timely preventive measures to reduce FPI. RELEVANCE TO CLINICAL PRACTICE: Addressing FPI-related factors to prevent facial skin damage and reduce comorbidities in patients using NIPPV masks.

Epigallocatechin Gallate Modulates Essential Elements, Zn/Cu Ratio, Hazardous Metal, Lipid Peroxidation, and Antioxidant Activity in the Brain Cortex during Cerebral Ischemia.

Cerebral ischemia induces oxidative brain injury via increased oxidative stress. Epigallocatechin gallate (EGCG) exerts anti-oxidant, anti-inflammatory, and metal chelation effects through its active polyphenol constituent. This study investigates whether EGCG protection against cerebral ischemia-induced brain cortex injury occurs through modulating lipid peroxidation, antioxidant activity, the essential elements of selenium (Se), zinc (Zn), magnesium (Mg), copper (Cu), iron (Fe), and copper (Cu), Zn/Cu ratio, and the hazardous metal lead (Pb). Experimentally, assessment of the ligation group was performed by occlusion of the right common carotid artery and the right middle cerebral artery for 1 h. The prevention group was intraperitoneally injected with EGCG (50 mg/kg) once daily for 10 days before cerebral ischemia. The brain cortex tissues were homogenized and the supernatants were harvested for biochemical analysis. Results indicated that cerebral ischemia markedly decreased SOD, CAT, Mg, Zn, Se, and Zn/Cu ratio and increased malondialdehyde (MDA), Fe, Cu, and Pb in the ischemic brain cortex. Notably, pretreating rats with EGCG before ischemic injury significantly reversed these biochemical results. Our findings suggest that the neuroprotection of EGCG in the ischemic brain cortex during cerebral ischemia involves attenuating oxidative injury. Notably, this neuroprotective mechanism is associated with regulating lipid peroxidation, antioxidant activity, essential elements, Zn/Cu ratio, and hazardous metal Pb.

Neuroprotective Effect of Quercetin during Cerebral Ischemic Injury Involves Regulation of Essential Elements, Transition Metals, Cu/Zn Ratio, and Antioxidant Activity.

Cerebral ischemia results in increased oxidative stress in the affected brain. Accumulating evidence suggests that quercetin possesses anti-oxidant and anti-inflammatory properties. The essential elements magnesium (Mg), zinc (Zn), selenium (Se), and transition metal iron (Fe), copper (Cu), and antioxidants superoxide dismutase (SOD) and catalase (CAT) are required for brain functions. This study investigates whether the neuroprotective effects of quercetin on the ipsilateral brain cortex involve altered levels of essential trace metals, the Cu/Zn ratio, and antioxidant activity. Rats were intraperitoneally administered quercetin (20 mg/kg) once daily for 10 days before ischemic surgery. Cerebral ischemia was induced by ligation of the right middle cerebral artery and the right common carotid artery for 1 h. The ipsilateral brain cortex was homogenized and the supernatant was collected for biochemical analysis. Results show that rats pretreated with quercetin before ischemia significantly increased Mg, Zn, Se, SOD, and CAT levels, while the malondialdehyde, Fe, Cu, and the Cu/Zn ratio clearly decreased as compared to the untreated ligation subject. Taken together, our findings suggest that the mechanisms underlying the neuroprotective effects of quercetin during cerebral ischemic injury involve the modulation of essential elements, transition metals, Cu/Zn ratio, and antioxidant activity.

Resveratrol Protects against Cerebral Ischemic Injury via Restraining Lipid Peroxidation, Transition Elements, and Toxic Metal Levels, but Enhancing Anti-Oxidant Activity.

Cerebral ischemia is related to increased oxidative stress. Resveratrol displays anti-oxidant and anti-inflammatory properties. The transition elements iron (Fe) and copper (Cu) are indispensable for the brain but overload is deleterious to brain function. Aluminum (Al) and arsenic (As) are toxic metals that seriously threaten brain health. This study was conducted to elucidate the correlation of the neuroprotective mechanism of resveratrol to protect cerebral ischemic damage with modulation of the levels of lipid peroxidation, anti-oxidants, transition elements, and toxic metals. Experimentally, 20 mg/kg of resveratrol was given once daily for 10 days. The cerebral ischemic operation was performed via occlusion of the right common carotid artery together with the right middle cerebral artery for 60 min followed by homogenization of the brain cortex and collection of supernatants for biochemical analysis. In the ligation group, levels of malondialdehyde, Fe, Cu, Al, and As increased but those of the anti-oxidants superoxide dismutase and catalase decreased. Pretreating rats with resveratrol before ischemia significantly reversed these effects. Our findings highlight the association of overload of Fe, Cu, As, and Al with the pathophysiology of cerebral ischemia. In conclusion, resveratrol protects against cerebral ischemic injury via restraining lipid peroxidation, transition elements, and toxic metals, but increasing anti-oxidant activity.

Development and evaluation of a physical examination and health assessment course.

BACKGROUND: Physical examination and health assessment skills are essential components of nursing practice, and the critical elements to be taught merit further investigation. OBJECTIVES: To develop and evaluate a physical examination and health assessment course based on a self-directed learning framework. DESIGN: An action research design was employed. SETTINGS: A baccalaureate nursing program of the university of science and technology in central Taiwan. PARTICIPANTS: A convenience sample comprising 23 teaching faculty members and 41 enrolled second-year students was recruited. METHODS: Structured questionnaires were developed for data collection. A paired t-test and the Kruskal-Wallis test were used for data analysis. RESULTS: The course consisted of four parts: health history taking from a holistic perspective, examination skills in diverse systems, case exercise and discussion, and final objective structured clinical examination. Statistical significance was found in the areas of physical examination skills, critical thinking, and case analysis. Participants with mid-to high-level self-directed learning had significantly higher scores than those with low-level self-directed learning on physical examination skills and problem assessment. Internal and discriminant validity were supported. CONCLUSION: The study results provide evidence supporting the use of self-directed learning framework in curriculum design. The course integrated necessary knowledge and skills enabled students to practice physical examination, and assessment skills may enhance student confidence in approaching patients in clinical encounters. However, the study was a descriptive design. The generalization of the results needs to be further validated by an experimental study.

Factors Related to Care Competence, Workplace Stress, and Intention to Stay among Novice Nurses during the Coronavirus Disease (COVID-19) Pandemic.

The outbreak of coronavirus (COVID-19), a public health emergency of international concern, has made healthcare staff preparation and the nurturing of high-quality and adequate nursing professionals critical issues. This study aimed to explore registered nurses' competence in nursing care and their intention to stay in their current workplace. In this study, participants who had graduated from different nursing education systems were recruited. The results indicated that nurses' level of commitment to the workplace and clinical stress were positively correlated with the experience of working with patients. Stepwise regression analysis revealed the following significant predictors for intention to stay: clinical stress, frequency of caring for people with infections, and taking a course on infectious nursing. The novice nurses' competencies in the areas of pandemic disease care and care for infectious adults depended on the experience of nursing care and nursing competence in their professional careers, which may have impact on the nurses' intention to stay. Therefore, clinical stress, frequency of caring for patients, and taking nursing courses were correlated with novice nurses' intention to stay in their professional careers.

Resveratrol Mitigates Cerebral Ischemic Injury by Altering Levels of Trace Elements, Toxic Metal, Lipid Peroxidation, and Antioxidant Activity.

Cerebral ischemia causes increased oxidative stress due to the overproduction of reactive oxygen species. The polyphenol compound resveratrol exerts neuroprotective effects through its antioxidant and anti-inflammatory abilities. The trace elements magnesium (Mg), zinc (Zn), and selenium (Se) also exert antioxidant properties. This study mainly investigates whether the neuroprotective effect of resveratrol during cerebral ischemia is related to its modulation of the concentrations of trace element and toxic metal lead (Pb). Experimental rats were administered resveratrol (20 mg/kg) once daily for 10 consecutive days. Cerebral ischemia was surgically induced via ligation of the right middle cerebral artery and right common carotid artery for 1 h. Brain cortex tissues were homogenized, and the supernatants were harvested for biochemical analysis. Experimental results showed that rats pretreated with resveratrol before cerebral ischemia had significantly higher trace element concentrations of Mg, Zn, and Se and higher antioxidant activity (superoxide dismutase and catalase) in the brain cortex as compared to untreated cerebral ischemia rats. Conversely, resveratrol pretreatment markedly attenuated lipid peroxidation and concentrations of the toxic metal Pb as compared to untreated cerebral ischemic rats. Altogether, the findings of this study highlight that the mechanism underlying the neuroprotective effect of resveratrol involves modulation of the brain levels of trace elements, toxic metal lead, lipid peroxidation, and antioxidant activity.

Effects of maternal confidence and competence on maternal parenting stress in newborn care.

AIM: This paper is a report of a correlational study of the relations of maternal confidence and maternal competence to maternal parenting stress during newborn care. BACKGROUND: Maternal role development is a cognitive and social process influenced by cultural and family contexts and mother and child characteristics. Most knowledge about maternal role development comes from western society. However, perceptions of the maternal role in contemporary Taiwanese society may be affected by contextual and environmental factors. METHODS: A prospective correlational design was used to recruit 372 postpartum Taiwanese women and their infants from well-child clinics at 16 health centres in central Taiwan. Inclusion criteria for mothers were gestational age >37 weeks, ≥18 years old, and healthy, with infants <4 months old. Data were collected between August 2007 and January 2008 using a self-report questionnaire on mothers' and infants' demographic variables, maternal confidence, maternal competence and self-perceived maternal parenting stress. RESULTS: After controlling for maternal parity and infant temperament, high maternal confidence and competence were associated with low maternal parenting stress. Maternal confidence influenced maternal parenting stress both directly and indirectly via maternal competence. CONCLUSION: To assist postpartum women in infant care programmes achieve positive outcomes, nurses should evaluate and bolster mothers' belief in their own abilities. Likewise, nurses should not only consider mothers' infant care skills, but also mothers' parity and infant temperament. Finally, it is crucial for nurses and researchers to recognize that infant care programmes should be tailored to mothers' specific maternal characteristics.

Effects of a nursing intervention program on disabled patients and their caregivers.

This study evaluated a continuous home-visiting program designed for disabled patients. An intervention program was also designed for caregivers that included education and disabled care skills training, and emotional support over a 22-week period. The criteria for the disabled patients were as follows: (1) aged 18 years or older, (2) Barthel activity of daily living (ADL) score of <80 on the first visit, and (3) onset of disability prior to study was less than 2 years. A total of 126 participants were transferred from several hospitals to the community to be cared for by caregivers. Patients were divided into two groups: control group (n=56), and intervention group (n=70). In the control group, caregivers were not provided with any special training and patients were just evaluated at the beginning and end of the program. In the intervention group, caregivers were given intensive training in care for the disabled and completed eight home-visits. The outcomes were measured before and after program using Barthel ADL index, life satisfaction scale (LSS) and caregiver's burnout scale (CBS). The results showed that improvements in ADL, LSS and CBS were significantly greater in the intervention group, compared to the control group. Multiple linear regression models showed that improvements in ADL were higher among patients with early-stage (onset of disability was less than 6 months before the start of the program) disability, patients whose caregivers had good health status, patients in the intervention group and patients who received more daily care hours. For LSS, there was a negative correlation with change in CBS and financial burden. In conclusion, the intervention program significantly improved disabled patients' ADL scores, as well as caregivers' LSS and CBS scores. It is necessary to coordinate medical and public health resources in the community to provide disabled patients and their caregivers with specific training and caregiving skills.

Unmet nursing care needs of home-based disabled patients.

BACKGROUND: In Taiwan, family members care for 80-90% of disabled people, but most have no professional training or knowledge of care for the disabled. Therefore, the adequacy of care received by the disabled needs to be assessed. AIMS: To evaluate the unmet nursing care needs of physically disabled patients and determine the relevant factors. METHODS: All 322 subjects were over 18 years of age, had a Barthel Index of less than 80 and became disabled 2 years prior to the commencement of this study. All subjects were outpatients of hospitals in central Taiwan and were contacted by phone to schedule an interview. Based on activity of daily living (ADL) scores, patients were divided into three groups: complete dependency, severe dependency and moderate dependency. After training, nurses evaluated the patients' ADL and completed the 20-item Assessment of Nursing Activity (ANA) questionnaire. Based on the ANA, subjects' unmet needs and caregivers' knowledge requirements were assessed. FINDINGS: The results showed the mean number of unmet needs was approximately five. Percentage of unmet needs was 44.8%. For complete dependency patients, the unmet needs score of patients and the needs score of caregiver's knowledge was highest, followed by the severe dependency group, and the moderate dependency group. Based on multiple linear regression, the factors that affected unmet need were as follows: age of patient, ADL score, education level of the caregivers, average daily duration of care and need of caregiving knowledge. Our findings indicate that the provision of counseling and educational support for family caregivers is required to promote quality of care for the disabled.

Risk factors of mortality among the home-based disabled patients in central Taiwan.

The objective of this study was to investigate the factors that affected mortality 1 year after an intensive service program among the disabled. Three hundred and twenty-two disabled subjects were selected from communities in central Taiwan. Sixty-six percent of the participants had cerebral vascular accident (CVA) followed by hypertension (28%) and diabetes mellitus (20%). After 1 year, 117 (36.3%) had died. The activities of daily living (ADL) scores of the participants who had died were significantly lower than those in the survival group. Of those who had pressure sores, 60% were in the 'death group' compared with about 40% in the survival group. Overall, mortality rate was 36.3% after the intensive service program. Based on multiple logistic regression, the factors that affected mortality were as follows: age over 65 years compared with less than 64 years (adjust odds ratio (AOR)=1.897), severe ADL dependence (AOR=0.502), incidence of CVA (AOR=0.448), and pressure sores (AOR=1.978). The authors recommend that the factors affecting mortality be evaluated urgently and that medical services and community support systems cooperate to provide disabled patients with adequate health care. In addition, the implementation of the intensive service program provides an opportunity and challenge for nurses to examine their working practices.