Enhancing tube feeding method for neurosurgery: the application of improved PICC technique.

BACKGROUND AND PURPOSE: Peripherally inserted central catheter (PICC) used in neurosurgical patients requires changes in patients' head positions. However, such changes can worsen pressure on the brain tissue, lead to sudden acute brain herniation and respiratory arrest, resulting in a higher chance of patient death. This paper addresses the aforementioned problems by introducing a new PICC catheterization method. METHOD: In a retrospective study, the records of patients with PICC from April 2020 to April 2023 were reviewed, and they were divided into three groups based on the methods employed. The first group as the conventional group, involved changing patients' body positions during catheterization. The second group, as the intracavitary electrocardiographic (IECG) group, utilized intracavitary electrocardiographic monitoring and involved changing patients' body positions during catheterization. The third group as the intracavitary electrocardiographic with improved body positioning (IECG-IBP) group, catheterization was performed with guidance from intracavitary electrocardiographs and without changing the patients' body positions. The ECG changes among patients undergoing different catheter delivery methods were then compared, as well as the rate of catheter tip misplacement. RESULT: The study encompassed a total of 354 cases. Our findings reveal distinct P wave amplitude percentages among the groups: 0% in the conventional group, 88.46% in the IECG group, and 91.78% in the IECG-IBP group. Furthermore, the following catheter tip misplacement rates were recorded: 11.54% for the conventional group, 5.39% for the IECG group, and 5.47% for the IECG-IBP group. Significantly notable differences were observed in these two key indicators between the conventional group and the IECG-IBP group. Notably, the IECG-IBP group demonstrated a more favorable outcome compared to the IECG group. CONCLUSION: In patients with neurosurgical diseases, especially those with tracheostomy and nuchal stiffness, the IECG-IBP PICC catheter insertion method can effectively reduce the patient's neck resistance, does not increase the patient's headache and dizziness symptoms, and does not reduce the success of one-time catheterization. Rate and does not increase the incidence of jugular venous ectopia.

Prevention of hospital-acquired transnasal tube-related pressure injuries: a quality improvement project.

BACKGROUND: Nurses certified in wound, ostomy, and continence (WOC) monitored an increasing incidence of hospital-acquired transnasal tube-related pressure injuries (TTPIs) in a tertiary hospital. Hospital-acquired pressure injuries are one of the most common preventable complications of hospitalization; however, the significance of TTPI prevention must be considered alongside the safety of tube fixation to prevent unplanned extubations (UEs), which are serious adverse events. Thus, exploring a quality improvement (QI) project to effectively reduce the risk of TTPIs while safeguarding tube safety is urgently needed. PURPOSE: To decrease the incidence of TTPIs. METHODS: Inpatients from 2017 to 2018 were set as the control group, using routine precautions. Inpatients from 2019 to 2020 were set as the experimental group, and a bundle of training and clinical practice interventions was implemented to compare the incidence of TTPIs and UEs between the 2 groups. RESULTS: After improvement, the incidence of TTPIs reduced from 1.20% to 0.69%, the incidence of UEs reduced from 2.40% to 1.63%, and the differences were both statistically significant (P < .05). CONCLUSION: The QI project reduced the incidence of TTPIs and UEs, thereby protecting the nasal skin/mucosal surfaces, safeguarding tube fixation, and ultimately improving the quality of clinical care.

Corrigendum: Development and initial validation of a clinical measure to assess symptoms of post-stroke depression in stroke patients at the rehabilitation stage.

[This corrects the article DOI: 10.3389/fpsyg.2022.928257.].

Development and initial validation of a clinical measure to assess symptoms of post-stroke depression in stroke patients at the rehabilitation stage.

Background: The high incidence of post-stroke depression (PSD) during rehabilitation exerts a negative effect on the treatment and functional recovery of patients with stroke and increases the risk of mortality. It is necessary to screen PSD in the rehabilitation stage and thus provide effective intervention strategies. However, existing measurements used to assess PSD in the rehabilitation stage in patients with stroke lack specificity. This study aimed to develop a clinical measure to assess symptoms of PSD in the rehabilitation stage. Methods: The research team created the initial items through a literature review and semi-structured interviews of patients with stroke. Then, the symptom-related items were estimated by three panels: healthcare professionals (N = 41), Delphi experts (N = 15), and patients with stroke in the rehabilitation stage (N = 30). Results: The literature review and semi-structured interview produced 51 symptom-related items including six domains, and the items were reduced to 47 by the healthcare professionals. The symptom-related items were further reduced to 33 items by a two-round Delphi consultation. The initiative coefficients of the two Delphi rounds were 71.4 and 100%, the expert authority coefficients were both 0.85, Kendall's W were 0.152 and 0.408 (p < 0.01), and the coefficient of variation (CV) were 0.05-0.32 and 0.00-0.18, respectively. The item-level content validity index (I-CVI) was 0.53-1.00, the scale-level CVI/universal agreement (S-CVI/UA) was 0.26, and the S-CVI/average (S -CVI/Ave) was 0.85 for the first found Delphi consultation; the I-CVI was 0.67-1.00, the S-CVI/UA was 0.61, and the S-CVI/Ave was 0.97 for the second round Delphi consultation. All content validity indicators have been significantly improved compared with the first round. Using mean ≥ 4 and full score ≥ 0.5, combined with CV ≤ 0.16 as the item criteria, a clinical measure of PSD with 33 items and 6 dimensions (cognition, sleep, behavior, emotion, body, and guilt) was finally formed after two rounds. The patients with stroke made no further revisions after evaluation. Conclusion: The research team developed a specific tool with good content validity to assess the symptoms of PSD in the rehabilitation stage.

Effectiveness of the combination of workshops and flipped classroom model to improve tube fixation training for nursing students.

BACKGROUND: Tube indwelling is a key procedure in modern medicine. Careful tube setup is necessary to prevent unplanned extubation. The training for tube fixation is time- and resource-consuming, and optimal modes of training are currently being sought. Previous studies have compared workshops and flipped classroom models separately using conventional teaching strategies, but no study has examined a combination of both teaching models in nursing training. AIM: To compare the effectiveness of workshops vs workshops combined with the flipped classroom model for improving tube fixation training for nursing students. METHODS: This was a prospective cohort study. In this study, 149 nurses who joined our hospital in 2019 underwent training using workshops combined with the flipped classroom model (experimental group), while 159 nurses who joined the hospital in 2018 received only workshop-based training (control group). The combination of workshops with the flipped classroom training model was divided into two modules: pre-class and in-class training. The participation of nurses in the training activities, on-site assessment of training, nurses' evaluation of their training, and related indicators of tube quality management were evaluated. RESULTS: The average age of nurses in the control group was 22.94 ± 0.94 years and that of nurses in the experimental group was 25.42 ± 3.23 years (P < 0.01). The qualified rate of after-class assessments for the experimental and control groups was 100.00% (average score: 94.01 ± 2.78 points) and 91.82% (average score: 84.24 ± 2.94 points), respectively (P < 0.01). Most nurses in the experimental group completely agreed that the combined training was helpful to cultivate clinical thinking and independent learning ability and to master knowledge of tube fixation. In addition, the training content within the pre-class teaching video, pre-class tube atlas, pre-class main instructor guidance, in-class demonstration, and in-class practice was very informative. The experimental group had higher evaluation scores than the control group (4.88 ± 0.38 vs 4.67 ± 0.64; P < 0.01). Comparison of tube quality management before and after training in 2018 to 2019 revealed that the unplanned ureteral tube removal rate dropped from 0.25‰ to 0.06‰, the unplanned chest tube removal rate dropped from 1.07‰ to 0.78‰, and the unplanned gastric tube removal rate dropped from 0.36‰ to 0.17‰. The incidence rate of pressure ulcers caused by the tube decreased from 0.78‰ to 0.45‰. CONCLUSION: The combination of workshop and flipped classroom training is effective in improving tube fixation training of nurses, cultivating nurses' active learning abilities and clinical thinking, and improving the safety of the procedure.

Association of alcohol consumption with prognosis of ischemic stroke by subtype in different follow-up periods: a hospital-based study in China.

OBJECTIVES: Alcohol consumption is a risk factor for stroke. However, there are no available data on the effect of alcohol consumption on the long-term outcome of ischemic stroke in China. Therefore, this study aimed to explore the association of alcohol consumption with the prognosis of ischemic stroke by subtype in different follow-up periods after stroke. METHODS: This 12-month follow-up study recruited 3830 acute ischemic stroke patients from Tianjin, China, between 2016 and 2018. Patients were categorized into two groups according to their consumption of alcohol. Differences in mortality, recurrence, and dependency rates at 3 and 12 months after stroke were compared between both groups. RESULTS: The mortality, recurrence, and dependency rates at 12 months after stroke were significantly higher in patients who previously consumed alcohol than in those without previous alcohol consumption (all P < 0.005). A similar trend was observed for mortality rate at 3 months after stroke (P < 0.001). The risk of death at 3 months after an atherothrombotic stroke decreased by 63.4% (relative risk [RR], 0.366; 95% confidence interval [CI], 0.144-0.935) among patients who previously consumed alcohol compared with those who never consumed alcohol. Moreover, for patients with small artery disease classified according to the Trial of ORG 10,172 in Acute Stroke Treatment (TOAST), the recurrence and dependency rates at 12 months after stroke decreased by 49.2% (RR, 0.508; 95% CI, 0.259-0.996) and 49.5% (RR, 0.505; 95% CI, 0.258-0.990), respectively, among patients who consumed alcohol. CONCLUSIONS: Previous alcohol consumption decreased the risk of death at 3 months after stroke among patients with atherothrombotic stroke according to the TOAST classification. Furthermore, for patients with small artery disease (according to TOAST classification), alcohol consumption significantly decreased the risk of recurrence and dependency at 12 months after stroke. This study highlights an urgent need to quantify the association of alcohol consumption with outcomes after stroke in China to improve stroke prognosis.

Effect of traditional Chinese medicine (TCM) on survival, quality of life, and immune function in patients with ovarian carcinoma: A protocol for systematic review and meta analysis.

BACKGROUND: Traditional Chinese medicine (TCM) has been widely applied as promising adjunctive drugs for ovarian carcinoma (OC) in China and other Asian countries. However, its exact clinical efficacy and safety is still not well investigated. In this study, we aimed to summarize the efficacy of TCM on survival, quality of life (QoL), and immune function in patients with OC through the meta-analysis. METHODS: Relevant clinical trials of TCM for the treatment OC patients will be searched in Cochrane Library, Web of Science, Google Scholar, PubMed, Medline, Embase, China Scientific Journal Database, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, and Wanfang Database from their inception to November 2020. Two researchers will perform data extraction and risk of bias assessment independently. The clinical outcomes, including overall survival (OS), QoL, immune function, tumor markers, and adverse events, were systematically evaluated by using Review Manager 5.3 and Stata 14.0 statistical software. RESULTS: The results of this study will provide high-quality evidence for the effect of TCM on survival, QoL and immune function in patients with OC. CONCLUSION: The conclusions of this meta-analysis will be published in a peer-reviewed journal, and draw an objective conclusion of the efficacy of TCM on survival, QoL, and immune function in patients with OC. TRIAL REGISTRATION NUMBER: INPLASY2020110104.

Home enteral nutrition after esophagectomy for esophageal cancer: A systematic review and meta-analysis.

BACKGROUND: Not only has the placement rate of enteral feeding tubes during operations for esophageal cancer increased, but also has number of patients who choose to continue enteral feeding at home instead of removing the feeding tube at discharge. The impacts of home enteral nutrition (HEN) after esophagectomy in esophageal cancer patients are analyzed. METHODS: A systematic review was conducted in accordance with PRISMA and Cochrane guidelines. English and Chinese databases, including PubMed, Embase, Web of Science, The Cochrane Library, Scopus, CBM, CNKI, and Wan Fang were searched from inception to December 7, 2019. Randomized controlled trials evaluating the short-term outcomes of HEN following esophagectomy in cancer patients were included. The risk of bias of the included studies was appraised according to the Cochrane risk of bias tool. The summary of relative risk/weighted mean difference (WMD) estimates and corresponding 95% confidence interval (95% CI) were calculated using fixed- and random-effects models. RESULTS: Nine randomized controlled trials involving 757 patients were included in the meta-analysis. Compared with oral diet, HEN was associated with significantly increased body weight (WMD 3 kg, 95% CI 2.36-3.63, P < .001), body mass index (WMD 0.97 kg/m, 95% CI 0.74-1.21, P < .001), albumin (WMD 3.43 g/L, 95% CI 2.35-4.52, P < .001), hemoglobin (WMD 7.23 g/L, 95% CI 5.87-8.59, P < .001), and total protein (WMD 5.13 g/L, 95% CI 3.7-6.56, P < .001). No significant differences were observed in prealbumin and gastrointestinal adverse reactions. Physical (WMD 8.82, 95% CI 6.69-10.95, P < .001) and role function (WMD 12.23, 95% CI 2.72-21.74, P = .01) were also significantly better in the HEN group. The nausea/vomiting (WMD -5.43, 95% CI -8.29 to -2.57, P = .002) and fatigue symptoms (WMD -11.76, 95% CI -16.21 to -7.32, P < .001) were significantly reduced. Appetite loss (WMD -8.48, 95% CI -14.27 to -4.88, P = .001), diarrhea (WMD -3.9, 95% CI -7.37 to -0.43, P = .03), and sleep disturbance (WMD -7.64, 95% CI -12.79 to -2.5, P = .004) in the HEN group were also significantly less than the control group. CONCLUSIONS: HEN improved nutrition status, physical and role function, and reduced nausea/vomiting, fatigue, appetite loss, diarrhea, and sleep disturbance compared with an oral diet in esophageal cancer patients postsurgery. HEN did not increase adverse reactions.

[Effects of taking the pingzhi tablets on cellular infiltration in tissues of nasal polyps].

OBJECTIVE: To assess the effects of taking the "Pingzhi Tablets" on infiltration of inflammatory in tissues of chronic sinusitis and nasal polyps. METHOD: Nasal polyps from taking the "Pingzhi Tablets" treated patients (40 cases) and untreated patients (40 cases) were investigated. The samples were stained by HE and SABC-AP immunohistochemical methods. RESULT: Compared with untreated polyps, the polyps treated by taking the "Pingzhi Tablets" contained significantly lower tissue densities of CD 11b+, CD7+ positive cells. Although the densities of CD 19+ positive cells were lower in treated polyps, the differences were not statistically significant. CONCLUSION: The findings demonstrated tissue effects of treatment with taking "Pingzhi Tablets" and the treatment was effective in suppressing the inflammatory cell infiltration.