Postoperative delirium screening tools for post-anaesthetic adult patients in non-intensive care units: A systematic review and meta-analysis.

AIMS AND OBJECTIVES: To identify the most accurate postoperative delirium screening tools for detecting postoperative delirium among patients who underwent general anaesthesia surgery in general wards. BACKGROUND: The lack of detection of postoperative delirium can negatively affect the patient's condition, along with their postoperative treatment and rehabilitation, and it can prolong their hospitalisation, persists cognitive dysfunction and increases mortality. Screening for postoperative delirium in hospitalised patients as nursing assessment is routine clinical practice for early detection. DESIGN: A systematic review and meta-analysis. METHODS: MEDLINE, Embase, CINAHL, KoreaMed and Cochrane electronic databases were searched using the key words delirium, postoperative, assessment or screening, and adult for articles published up to April 2020, with no limit on the year of publishing. Only prospective cohort studies reporting sensitivity and specificity values were included. We followed the recommendations of the Cochrane Handbook of Diagnostic Test Accuracy Reviews and the PRISMA checklist. The Quality Assessment of the Diagnostic Accuracy Studies-2 tool was used for data extraction and quality assessment, while a bivariate random-effects meta-analysis model was used for pooling and comparing diagnostic accuracy and providing a summary of evidence. RESULTS: Six delirium assessment tools were evaluated from nine papers including 3088 patients. Due to the limited number of papers, the meta-analysis included the Confusion Assessment Method (CAM) and its variants, Delirium Detection Score (DDS) and Nurses' Delirium Screening Checklist (NuDESC). Overall, NuDESC demonstrated higher sensitivity than CAM or DDS, while all showed high specificity (0.90 or greater). CONCLUSION: This review suggested that NuDESC can be employed as an accurate screening tool with high specificity for assessing postoperative delirium during routine checkups. However, it is necessary to consider suitable cut-off values, which is the reference point, in accordance with the clinical setting and the patients' condition. RELEVANCE TO CLINICAL PRACTICE: NuDESC reported the best evidence of diagnostic accuracy, and we recommend clinical nurses to employ this easy-to-use and validated tool for daily screening of postoperative delirium in general wards to facilitate its early detection and the accurate estimation of its prevalence.

Measuring patient acuity and nursing care needs in South Korea: application of a new patient classification system.

BACKGROUND: An accurate and reliable patient classification system (PCS) can help inform decisions regarding adequate assignments for nurse staffing. This study aimed to evaluate the criterion validity of the Asan Patient Classification System (APCS), a new tertiary hospital-specific PCS, by comparing its rating and total scores with those of KPCS-1 and KPCS-GW for measuring patient activity and nursing needs. METHODS: We performed a retrospective analysis of the medical records of 50,314 inpatients admitted to the general wards of a tertiary teaching hospital in Seoul, South Korea in March, June, September, and December 2019. Spearman's correlation and Kappa statistics according to quartiles were calculated to examine the criterion validity of the APCS compared with the KPCS-1 and KPCS-GW. RESULTS: The average patient classification score was 28.3 points for APCS, 25.7 points for KPCS-1, and 21.6 points for KPCS-GW. The kappa value between APCS and KPCS-1 was 0.91 (95% CI:0.9072, 0.9119) and that between APCS and KPCS-GW was 0.88 (95% CI:0.8757, 0.8810). Additionally, Spearman's correlation coefficients among APCS, KPCS-1, and KPCS-GW showed a very strong correlation. However, 10.8% of the participants' results were inconsistent, and KPCS-1 tended to classify patients into groups with lower nursing needs compared to APCS. CONCLUSION: This study showed that electronic health record-generated APCS can provide useful information on patients' severity and nursing activities to measure workload estimation. Additional research is needed to develop and implement a real-world EHR-based PCS system to accommodate for direct and indirect nursing care while considering diverse population and dynamic healthcare system.

Development of Critical Reflection Competency Scale for Clinical Nurses.

Critical reflection develops nurses' critical thinking and clinical reasoning competency. It is necessary to develop a validated scale to measure critical reflection competency considering the clinical situation and nursing context. Therefore, this study analyzed the concept of critical reflection, developed a scale to measure critical reflection competency, and verified its validity and reliability. The concept of critical reflection and components of the scale were confirmed through literature review and results of previous studies on content analysis. A total of 64 preliminary items were derived on a 5-point Likert scale. The adequacy of vocabulary and expression was checked, and a content validity test was conducted. An I-CVI value of 0.88-1.00 was computed. Construct validity was conducted through an exploratory factor analysis, and data collected from 296 clinical nurses were analyzed. Five factors and nineteen items were derived, and the explanatory power was found to be 53.02%. Cronbach's α of the scale was 0.853. Future studies need to develop a critical reflection education program and utilize this concept as an educational strategy. We propose a study to verify the effect of applying an educational program using the critical reflection competency scale developed in this study.

Development and evaluation of an advanced National Air Quality Forecasting Capability using the NOAA Global Forecast System version 16.

A new dynamical core, known as the Finite-Volume Cubed-Sphere (FV3) and developed at both NASA and NOAA, is used in NOAA's Global Forecast System (GFS) and in limited-area models for regional weather and air quality applications. NOAA has also upgraded the operational FV3GFS to version 16 (GFSv16), which includes a number of significant developmental advances to the model configuration, data assimilation, and underlying model physics, particularly for atmospheric composition to weather feedback. Concurrent with the GFSv16 upgrade, we couple the GFSv16 with the Community Multiscale Air Quality (CMAQ) model to form an advanced version of the National Air Quality Forecasting Capability (NAQFC) that will continue to protect human and ecosystem health in the US. Here we describe the development of the FV3GFSv16 coupling with a "state-of-the-science" CMAQ model version 5.3.1. The GFS-CMAQ coupling is made possible by the seminal version of the NOAA-EPA Atmosphere-Chemistry Coupler (NACC), which became a major piece of the next operational NAQFC system (i.e., NACC-CMAQ) on 20 July 2021. NACC-CMAQ has a number of scientific advancements that include satellite-based data acquisition technology to improve land cover and soil characteristics and inline wildfire smoke and dust predictions that are vital to predictions of fine particulate matter (PM2.5) concentrations during hazardous events affecting society, ecosystems, and human health. The GFS-driven NACC-CMAQ model has significantly different meteorological and chemical predictions compared to the previous operational NAQFC, where evaluation of NACC-CMAQ shows generally improved near-surface ozone and PM2.5 predictions and diurnal patterns, both of which are extended to a 72 h (3 d) forecast with this system.

Non-Pharmacological Nursing Interventions for Prevention and Treatment of Delirium in Hospitalized Adult Patients: Systematic Review of Randomized Controlled Trials.

Delirium is a common neurobehavioral complication in hospitalized patients that can occur in the acute phase and lead to poor long-term outcomes. The purpose of this study was to identify non-pharmacological nursing interventions for the prevention and treatment of delirium in hospitalized adult patients. We conducted a systematic review to synthesize the findings of published studies. We searched the PubMed, EMBASE, CINAHL, and Cochrane Library CENTRAL databases for randomized controlled trials in January 2021. We report this systematic review according to the PRISMA 2009 checklist. The study was registered on PROSPERO (CRD42021226538). Nine studies were systematically reviewed for non-pharmacological nursing interventions for the prevention and treatment of delirium. The types of non-pharmacological nursing interventions included multicomponent intervention, multidisciplinary care, multimedia education, music listening, mentoring of family caregivers concerning delirium management, bright light exposure, ear plugs, and interventions for simulated family presence using pre-recorded video messages. These results could help nurses select and utilize non-pharmacological nursing interventions for the prevention and treatment of delirium in clinical nursing practice.

Primary Shewanella algae bacteremia mimicking Vibrio septicemia.

Shewanella algae infections are rare in humans. Previously reported cases of S. algae have mainly been associated with direct contact with seawater. We report a case of primary S. algae bacteremia occurring after the ingestion of raw seafood in a patient with liver cirrhosis that presented a fulminent course of necrotizing fasciitis.

Experience with extrarenal manifestations of hemorrhagic fever with renal syndrome in a tertiary care hospital in South Korea.

Reports on the clinical entity of hemorrhagic fever with renal syndrome (HFRS) have focused on acute renal failure. Data on the extrarenal manifestations are limited primarily to case reports. In this study, protean extrarenal manifestations involving the major organs occurred in one-third of patients with HFRS during various stages (i.e., febrile phase through diuretic phase). Pancreatobiliary manifestations and major bleeding occurred in 11% and 10% of patients, respectively. Cardiovascular and central nervous system manifestations developed during the febrile or oliguric phase, whereas pancreatobiliary manifestations and major bleeding were detected even in the diuretic phase. Thus, close monitoring of and additional knowledge about various extrarenal manifestations are needed.

Marine bacteria as a leading cause of necrotizing fasciitis in coastal areas of South Korea.

Necrotizing fasciitis is a life-threatening soft-tissue infection. It is useful to know the etiology of this disease in each community and region because this information can facilitate early diagnosis and treatment. We reviewed medical records of 217 consecutive patients with necrotizing fasciitis in South Korea. Etiologic organisms were documented in 171 (78.8%) patients. Gram-negative marine bacteria were the most common organisms (68.4%). Seasonal variation in incidence occurred during warmer periods. Liver cirrhosis and alcoholism were common underlying illnesses. Gastrointestinal symptoms were more common in persons infected with gram-negative marine bacteria (56.4% versus 29.6%). Gram-negative bacteria were the predominant pathogens in multiple site involvement. Acute Physiology and Chronic Health Evaluation II scores, marine bacteria, and medical treatment without surgery affected mortality. When necrotic areas included less than three extremities, fasciotomy improved the survival rate. In coastal areas, gram-negative marine bacteria are the most common pathogens associated with necrotizing fasciitis. Fasciotomy can improve survival of patients with necrotic areas that involve less than three sites in necrotizing fasciitis.