[Using Multiple Strategies to Reduce the Incidence of Delirium in Older Adult Patients Receiving Surgery].

BACKGROUND & PROBLEMS: Older adult patients receiving surgery experience a relatively high rate of developing acute delirium due to factors related to the environment, surgery and anesthesia, pain, and indwelling line, which puts these patients at higher risk of patient safety incidents. The incidence of delirium among older patients receiving surgery in our ward was 12.3%. Moreover, in our ward, delirium-attributed self-extraction accounted for 84.2% of the "tubing events" reported via the Taiwan Patient-safety Reporting System and delirium-attributed falls accounted for 33.3% of the "fall events". Thus, delirium in this patient population had a serious effect on patient safety and increased medical expenses. PURPOSE: Reduce the incidence of delirium in older adult patients receiving surgery from 12.3% to 6.6%. METHODS: Strategies used included providing delirium care education and training to improve the delivery of delirium preventive treatments and the care implementation rate by care teams; formulating a surgical delirium high-risk factor assessment scale for the early screening of high-risk patients; adopting the "RADAR" delirium identification method for the rapid identification of cognition changes; establishing delirium prevention and treatment care guidelines for quality-of-care improvement; introducing bedside exercise equipment to increase patient mobility; and designating a dedicated delirium ward for these patients to provide high-quality delirium care services. RESULTS: The incidence rate of delirium in older adult patients receiving surgery was reduced to 6.5%. In addition, the implementation rate of delirium prevention treatment was increased to 98% in physicians and 100% in nurses. CONCLUSIONS: This project resulted in significantly improved outcomes and was expanded to the other surgical wards. The innovative concept of incorporating a designated delirium ward for older patients receiving surgery into other wards may be referenced in future ward planning and strategies for improving the quality of medical care.

[Using Creative Thinking Teaching to Improve Abdominal Drainage Tube Care Integrity Among Two-Year Post Graduate Nurses (PGNs)].

BACKGROUND & PROBLEMS: The abdominal drainage tube is an important device used in disease treatment and life maintenance. Drainage tube slippage leads to complications that increase both length of stay and costs of care. Four and seven cases of drainage tube slippage were reported, respectively, in 2018 and 2019 in our trauma wards. Among these, 9 cases were under the care of nurses in their post graduate year (PGY) training program. PURPOSE: To increase to 94% the abdominal drainage tube care-completeness rate of nurses in the PGY program. METHODS: Methods used included: establishing a standardized care module for abdominal drainage tube in the trauma wards, using the "drainage tube model" and multimedia teaching material in education to enhance skill proficiency, flexibly adjusting education schedules, using a creative-thinking teaching model in education, employing direct observation to evaluate PGY nurses' abdominal drainage tube skills; and establishing a drainage tube skill proficiency audit mechanism. RESULTS: After the intervention, the rate of care completeness for the abdominal drainage tube rose to 98.1%, participant awareness rose to 100%, and the rate of abdominal drainage tube slippage reduced to 0%. CONCLUSIONS: This project achieved good outcomes that may be expanded horizontally to other surgical wards. The use of the creative-thinking teaching model in training activities received good feedback from the nurse participants and will be incorporated into in-service education standards along with the computerized direct observation of procedural skills in the PGY e-learning passport to strengthen the completeness of learning processes.

Suppression of Carnosine on Adhesion and Extravasation of Human Colorectal Cancer Cells.

AIM: To investigate the effect of carnosine, an active compound of dietary beef, fish and chicken, on the regulation of cell adhesion and extravasation during metastasis. MATERIALS AND METHODS: Cell adhesion and extravasation abilities, and related regulating molecular mechanisms were analyzed in human colorectal cancer cells (HCT-116) and human umbilical vein cells (EA.hy926). RESULTS: Carnosine reduced the ability of HCT-116 cells to adhere to EA.hy926 cells. The expression levels of integrin-ß1 in HCT-116 cells, as well as of intercellular adhesion molecule-1 and E-selectin in EA.hy926 cells, were reduced after carnosine treatment. After EA.hy926 cells were treated with carnosine, phosphorylation of vascular endothelia-cadherin (VE-cadherin), protein levels of Ras homologous (RHO) and RHO-associated coiled-coil containing protein kinase, and levels of reactive oxygen species were reduced. After treating EA.hy926 cells with carnosine, phosphorylation of inhibitor of kappa B (IκB) and DNA binding activity of nuclear factor-κB (NF-κB) were reduced. CONCLUSION: Carnosine inhibits metastatic cell adhesion and extravasation by suppressing NF-κB signaling activation.

Fabrication optimisation of carbon fiber electrode with Taguchi method.

In this study, we describe an optimised procedure for fabricating carbon fiber electrodes using Taguchi quality engineering method (TQEM). The preliminary results show a S/N ratio improvement from 22 to 30 db (decibel). The optimised parameter was tested by using a glass micropipette (0.3 mm outer/2.5 mm inner length of carbon fiber) dipped into PBS solution under 2.9 V triangle-wave electrochemical processing for 15 s, followed by coating treatment of micropipette on 2.6 V DC for 45 s in 5% Nafion solution. It is thus shown that Taguchi process optimisation can improve cost, manufacture time and quality of carbon fiber electrodes.