The Effectiveness of a Critical Appraisal Skills Workshop 6 Months After Nurses' Participation.

Background The aim of this study was to explore whether nursing staff retained knowledge, self-confidence, and attitudes 6 months after participating in a critical appraisal skills workshop. Method A retrospective matched case-control study was conducted to ascertain the effects of this training on the ability to appraise literature. Results Mean scores on the critical appraisal knowledge test, self-confidence, and attitudes were significantly higher in the case group compared to the control group (p < .001, p < .05, and p = .031, respectively). Conclusion Six months after the workshop, critical appraisal knowledge, self-confidence, and attitudes remained improved among the nursing staff who participated. This indicates that the workshop was effective for learning and can be used for clinical training. [J Contin Educ Nurs. 2022;53(8):372-378.].

Phycoerythrin from Colaconema sp. Has Immunostimulatory Effects on the Whiteleg Shrimp Litopenaeus vannamei and Increases Resistance to Vibrio parahaemolyticus and White Spot Syndrome Virus.

We investigated whether phycoerythrin (PE), a pigment sourced from marine algae, could act as an immunomodulatory agent in whiteleg shrimp (Litopenaeus vannamei). To this end, PE was extracted and purified from a PE-rich macroalgae, Colaconema sp. Our in vitro analysis demonstrated that PE enhanced prophenoloxidase and phagocytosis activity but inhibited the production of reactive oxygen species in hemocytes. Additionally, the PE signal could be detected using an in vivo imaging system after its injection into the ventral sinus of the cephalothorax of whiteleg shrimp. The expression profiles of fourteen immune-related genes were monitored in hemocytes from whiteleg shrimp injected with 0.30 µg of PE per gram of body weight, and crustin, lysozyme, penaiedin 4, and anti-lipopolysaccharide factor showed up-regulated post-stimulation. The induction of immune genes and enhancement of innate immune parameters by PE may explain the higher survival rates for shrimp that received different doses of PE prior to being challenged with Vibrio parahaemolyticus or white spot syndrome virus compared to controls. Combined, these results show that PE from Colaconema sp. can differentially stimulate the immune response of whiteleg shrimp in vitro and in vivo and could potentially be used as an immunomodulator in shrimp culture.

Effectiveness of mindfulness-based interventions on quality of life and menopausal symptoms in menopausal women: A meta-analysis.

OBJECTIVE: Menopause is a normal physiological process experienced by women, but it is often accompanied by physical and emotional symptoms that may negatively affect quality of life. This meta-analysis aimed to evaluate the effectiveness of mindfulness-based interventions on quality of life and menopausal symptoms by examining randomized controlled trials. METHODS: A systematic search was conducted across six electronic databases to collect relevant articles published up to June 30, 2020. The articles' quality was assessed using the modified Jadad scale. We performed a meta-analysis with Review Manager 5.3, calculating 95% confidence intervals and standardized mean differences, and conducted sensitivity analyses. RESULTS: The meta-analysis of five randomized controlled trials included 475 participants. The results indicated that the mindfulness-based intervention groups showed significant improvements in total quality of life and vasomotor and physical quality of life, compared to control groups (standardized mean differences range: from -0.48 to -0.68, all ps < 0.05). After the sensitivity analyses, evidence of heterogeneity remained. Insufficient data prevented conducting a meta-analysis with the sexual subscale of MENQOL or on vasomotor symptoms of menopause. CONCLUSION: For menopausal women, mindfulness-based interventions may improve quality of life (except for psychological and sexual subscales). However, there is insufficient evidence to analyze whether such interventions can reduce vasomotor-related menopausal symptoms. Although heterogeneity should be carefully assessed, mindfulness-based interventions may be a novel approach for improving women's overall quality of life during menopause. However, further research is needed to verify these effects.

Effects of mindfulness-based stress reduction on sleep quality and mental health for insomnia patients: A meta-analysis.

OBJECTIVE: Mindfulness-based stress reduction (MBSR) is a potentially effective supplement for the treatment of insomnia; however, there is no comprehensive review of its mental health effects among insomnia patients. This study aimed to synthesize relevant quantitative evidence and evaluate MBSR application and effectiveness for insomnia patients' sleep quality and mental health. METHODS: A systematic search through eight databases from the earliest available dates until August 2019 was conducted. Randomized controlled trials assessing the effects of MBSR on sleep quality, anxiety, and depression as outcome measures among insomnia patients comprising patients aged above 18 years were included in this meta-analysis. Each study's quality was assessed using the modified Jadad quality scale. The Review Manager 5.3 software was used to calculate the standardized mean differences (SMD) with 95% confidence intervals (CIs) for the data analyses. RESULTS: In total, data for 497 patients in seven randomized controlled trials were analyzed. The results revealed that compared to the control group, the MBSR group significantly improved in sleep quality (SMD = -0.69, 95% CI: -1.12~ - 0.26, Z = 3.16, p = .002), depression (SMD = -1.83, 95% CI: -2.81-0.84, Z = 3.63, p < .001), and anxiety (SMD = -1.74, 95% CI: -2.90-0.59, Z = 2.96, p = .003). A sensitivity analysis was undertaken. After carefully reviewing included trials, we can reasonably conclude that these heterogeneities did not impair the overall effect size of MBSR in the results. CONCLUSIONS: MBSR significantly improved sleep quality and mental health. Future research is needed using standardized methods examining the long-term effects of MBSR on the mental health of individuals with insomnia.

Community Composition of Photosynthetic Picoeukaryotes in a Subtropical Coastal Ecosystem, with Particular Emphasis on Micromonas.

Photosynthetic picoeukaryotes (PPEs) are important constituents in picoplankton communities in many marine ecosystems. However, little is known about their community composition in the subtropical coastal waters of the Northwestern Pacific Ocean. In order to study their taxonomic composition, this study constructed 18S rRNA gene libraries using flow cytometric sorting during the warm season. The results show that, after diatoms, prasinophyte clones are numerically dominant. Within prasinophytes, Micromonas produced the most common sequences, and included clades II, III, IV, and VI. We are establishing the new Micromonas clade VI based on our phylogenetic analysis. Sequences of this clade have previously been retrieved from the South China Sea and Red Sea, indicating a worldwide distribution, but this is the first study to detect clade VI in the coastal waters of Taiwan. The TSA-FISH results indicated that Micromonas clade VI peaked in the summer (~4 × 102  cells/ml), accounting for one-fifth of Micromonas abundance on average. Overall, Micromonas contributed half of Mamiellophyceae abundance, while Mamiellophyceae contributed 40% of PPE abundance. This study demonstrates the importance of Micromonas within the Mamiellophyceae in a subtropical coastal ecosystem.

Changes in the Synechococcus Assemblage Composition at the Surface of the East China Sea Due to Flooding of the Changjiang River.

The aim of this study was to elucidate how flooding of the Changjiang River affects the assemblage composition of phycoerythrin-rich (PE-rich) Synechococcus at the surface of the East China Sea (ECS). During non-flooding summers (e.g., 2009), PE-rich Synechococcus usually thrive at the outer edge of the Changjiang River diluted water coverage (CDW; salinity ≤31 PSU). In the summer of 2010, a severe flood occurred in the Changjiang River basin. The plentiful freshwater injection resulted in the expansion of the CDW over half of the ECS and caused PE-rich cells to show a uniform distribution pattern, with decreased abundance compared with the non-flooding summer. The phylogenetic diversity of 16S rRNA gene sequences indicated that the flooding event also shifted the picoplankton community composition from being dominated by Synechococcus, mainly attributed to the clade II lineage, to various orders of heterotrophic bacteria, including Actinobacteria, Flavobacteria, α-Proteobacteria, and γ-Proteobacteria. As an increasing number of studies have proposed that global warming might result in more frequent floods, combining this perspective with the information obtained from our previous [1] and this studies yield a more comprehensive understanding of the relationship between the composition of the marine Synechococcus assemblage and global environmental changes.

The effects of systematic educational interventions about nasogastric tube feeding on caregivers' knowledge and skills and the incidence of feeding complications.

AIMS AND OBJECTIVES: To compare the influence of a systematic nursing intervention on primary caregivers' knowledge and skills about nasogastric tube feeding and the number of nasogastric tube-related complications with that of routine nursing instructions BACKGROUND: To ensure the quality of care and reduce the incidence of complications, it is crucial that primary caregivers receive comprehensive health education about nasogastric tube feeding before hospital discharge. DESIGN: A quasi-experimental research with pretest/post-test evaluations. METHODS: The control group included 127 inpatients whose caregivers received routine education about nasogastric tube feeding, while the experimental group included 106 inpatients whose caregivers received systematic nursing intervention including comprehensive educational pamphlets and video education. The evaluation questionnaire included demographic variables, a nasogastric tube care knowledge scale, and a nasogastric tube skills assessment scale. The post-test was administered after the caregiver performed nasogastric tube feeding for the first time, and complications were noted at follow-up within three months of discharge. RESULTS: In terms of post-test knowledge and skills, the experimental group scored significantly higher than the control group, despite no difference in the pretests. In addition, the incidence rates for constipation, diarrhoea and abdominal distention were lower in the experimental group. CONCLUSIONS: Systematic nursing intervention, including comprehensive educational pamphlets and video education, significantly improved the knowledge and skills of primary caregivers for nasogastric tube feeding. The increased ability of caregivers may have contributed to less incidence of complication. RELEVANCE TO CLINICAL PRACTICE: The results of this study underlined the importance of developing nasogastric tube-related nursing interventions and educational strategies for clinical nurses, home care nurses and caregivers. The research tool used here may serve as a reference for assessing the technical operations of healthcare professionals and the knowledge and skills of caregivers.

Quantitative analysis of respiration-related movement for abdominal artery in multiphase hepatic CT.

OBJECTIVES: Respiration-induced motion in the liver causes potential errors on the measurement of contrast medium in abdominal artery from multiphase hepatic CT scans. In this study, we investigated the use of hepatic CT images to quantitatively estimate the abdominal artery motion due to respiration by optical flow method. MATERIALS AND METHODS: A total of 132 consecutive patients were included in our patient cohort. We apply the optical flow method to compute the motion of the abdominal artery due to respiration. RESULTS: The minimum and maximum displacement of the abdominal artery motion were 0.02 and 30.87 mm by manual delineation, 0.03 and 40.75 mm calculated by optical flow method, respectively. Both high consistency and correlation between the present method and the physicians' manual delineations were acquired with the regression equation of movement, y = 0.81x + 0.25, r = 0.95, p < 0.001. CONCLUSION: We estimated the motion of abdominal artery due to respiration using the optical flow method in multiphase hepatic CT scans and the motion estimations were validated with the visualization of physicians. The quantitative analysis of respiration-related movement of abdominal artery could be used for motion correction in the measurement of contrast medium passing though abdominal artery in multiphase CT liver scans.

Influence of the Changjiang River flood on Synechococcus ecology in the surface waters of the East China Sea.

Synechococcus spp. have been suggested as the primary component of picophytoplankton in the East China Sea (ECS). However, the influences of sudden environmental changes on Synechococcus assemblage composition have not yet been investigated. In the summer of 2010, a disastrous flood occurred in the Changjiang River basin. To improve our understanding of how this flood affected the Synechococcus ecology on the ECS surface, their assemblages and distributions have been described using two-laser flow cytometry and phylogenetic analysis of the phycocyanin operon. During the nonflooding summer of 2009, phycoerythrin-rich (PE-rich) Synechococcus thrived near the outer boundary of the Changjiang River diluted water (CDW) coverage, while phycocyanin-rich (PC-rich) Synechococcus predominated inside the turbid CDW with a transparency of <80%. During the 2010 summer, flooding expanded the CDW coverage area to over half of the ECS. PE-rich cells showed a homogeneous distribution and a decline in abundance, while the spatial pattern of the PC-rich Synechococcus resembled the pattern from 2009. Based on the phycocyanin operon phylogeny, the Synechococcus in the ECS were categorized into five groups, ECS-1 to ECS-4 and ECS-PE, comprising a total of 19 operational taxonomic units. In the summer of 2009, ECS-2 dominated in the coast, and the ECS-3 and ECS-PE clades prevailed in the offshore waters. However, during the summer of 2010, ECS-4 and ECS-PE became the dominant strains. The injection of abundant anthropogenic pollutants and the enhancement of transparency within the CDW expansion area appear to be the factors needed to transiently alter the ecology of Synechococcus after flooding.

Evaluation of a critical appraisal program for clinical nurses: a controlled before-and-after study.

BACKGROUND: Evidence-based practice is important to.clinical health care professionals. Clinical nurses can make informed decisions by applying the best evidence to their care. However, standardized curricula on evidence-based medicine are lacking in nursing education programs. This study evaluated a critical appraisal education program and assessed its value in increasing nurses' knowledge of critical appraisal and confidence in their critical appraisal skills. METHODS: A controlled before-and-after study design was used. The education program integrated lectures,practice, and group discussion. A questionnaire was used to evaluate participants' knowledge and confidence in critical appraisal pre- and postintervention. RESULTS: Participants' knowledge and confidence in critical appraisal improved significantly postintervention(both p < .001 ). CONCLUSION: A 1-day, small group discussion education program can effectively improve nurses' knowledge and confidence in critical appraisal. Educators and administrators may replicate this education program to improve the quality of nursing care

Discriminant analysis of serum inflammatory biomarkers which differentiate pediatric appendicitis from other acute abdominal diseases.

BACKGROUND: Other acute abdominal diseases in children can confound the signs and symptoms of appendicitis, resulting in misdiagnosis and unnecessary appendectomy. In this study, we used discriminant analysis of serum inflammatory biomarkers to determine which acute abdominal diseases could mimic appendicitis, and further analyzed these diseases based on different age groups. METHODS: We prospectively collected 417 patients aged from 4 to 18 years with clinically suspected acute appendicitis in the pediatric emergency department. We selected the significantly higher serum biomarkers for appendicitis as the discriminating variables. Furthermore, we analyzed the definitive diagnoses of patients with normal appendices who could not be predicted by discriminant analysis. RESULTS: Patients with acute appendicitis had significantly higher leukocyte counts (p < 0.01), neutrophil counts, (p < 0.01) and C-reactive protein concentrations (p < 0.01 ) than those with normal appendices. The discriminant power of these three serum biomarkers in acute appendicitis was 76 percent. Acute abdominal diseases which mimicked appendicitis included acute gastroenteritis, nonspecific abdominal pain, urinary tract infection, and upper respiratory infection with gastrointestinal upset. CONCLUSIONS: Serum biomarkers may serve as helpful discriminators to predict the presence of pediatric appendicitis. But, some acute abdominal diseases mimicking appendicitis should be considered during differential diagnosis of acute appendicitis to avoid making misdiagnosis and performing unnecessary appendectomy.

Significant factors in predicting sustained ROSC in paediatric patients with traumatic out-of-hospital cardiac arrest admitted to the emergency department.

BACKGROUND: Paediatric patients with out-of-hospital cardiac arrest (OHCA) due to trauma pose difficult challenges in resuscitation. Trauma is a major cause of OHCA in children. The aim of this study was to determine which factors were related to predicting a sustained return of spontaneous circulation (ROSC) in paediatric OHCA patients with trauma. METHOD: This retrospective study comprised 115 paediatric patients (56 traumatic and 59 non-traumatic OHCA patients) aged younger than 18 years who had been admitted to the emergency department (ED) from January 2000 to December 2004. We analysed the demographic data and the factors that may have influenced sustained ROSC in the group of OHCA paediatric patients with trauma. The non-trauma group was established as a control group. Survival analysis was used to compare differences in survival rate between trauma and non-trauma OHCA patients. Receiver operating characteristic (ROC) analysis was used to determine the significant in-hospital CPR duration related to sustained ROSC. RESULTS: Initial cardiac rhythm on arrival (P=0.005) and the duration of in-hospital CPR (P<0.001) were significant factors. Patients with PEA or VF had higher rate of sustained ROSC than those with asystole (PEA: P=0.003, VF: P=0.03). In the survival analysis, OHCA children with trauma had a lower chance of survival than non-trauma children as the interval from the scene to the ER increased (P=0.008). Based on the ROC analysis, the cut-off values of in-hospital CPR duration were 25min in OHCA paediatric patients with trauma. CONCLUSION: Several significant factors relating to sustained ROSC were determined in the OHCA paediatric patients with trauma; most importantly, we found that in-hospital CPR may have to be performed for at least 25min to enable a spontaneous circulation to return.

Clinical comparisons between GlideScope video laryngoscope and Trachlight in simulated cervical spine instability.

STUDY OBJECTIVE: To compare the time taken for tracheal intubation, hemodynamic changes, and perioperative morbidities between the GlideScope (GS) video laryngoscope and the Trachlight (TL) with manual inline stabilization. DESIGN: Prospective, controlled, randomized study. SETTING: Operating room. PATIENTS: 60 ASA physical status I and II patients scheduled for elective surgery with general anesthesia. INTERVENTIONS: Patients were randomly assigned to the GS group or TL group (n = 30 for each group). MEASUREMENTS: Noninvasive blood pressure and heart rate at preinduction; preintubation and one, three, and 5 minutes after successful intubation; grade of face mask ventilation; number of intubation attempts; intubation time; apnea duration; mucosal trauma; lip or dental injury; and presence of hypoxia, were all recorded. MAIN RESULTS: The intubation attempts and perioperative safety data were comparable between the two groups. Intubation time and apnea duration were significantly shorter in the TL group than the GS group. All variables one minute after intubation were greater than baseline values except systolic blood pressure (SBP) in TL group. Both systolic blood pressure (SBP) and the degree of change of SBP from the baseline value one minute after intubation in TL group were significantly less than those of the GS group. CONCLUSIONS: Trachlight offers a faster intubation and a milder hemodynamic response than GS.

[An experience promoting evidence-based nursing at a medical center in central Taiwan].

In the 21st Century, evidence-based nursing (EBN) may provide a mechanism by which nurses can manage the explosion in published information in the literature, introduce new techniques, effectively control healthcare costs, and increase attention on nursing quality and health outcomes. The objective of this paper is to share the experience implementing evidence-based nursing. We had applied strategies to implement evidence-based nursing care in our hospital since 2002. Over a more than three-year period (January 2002 to October 2005), we held 46 basic course sessions (around 1,840 attendees) and 58 advanced course sessions (around 500 attendees). There are 445 clinical questions with answered reports, Most questions related to foley care, central vein care and peripheral intravenous injection. Our nursing department revised three guidelines on nursing care skills related to suction and foley and nasal-gastric feeding to meet local conditions. Based on our subjective experience, promotion and implementation of EBN is feasible and helpful to update knowledge and decrease variance in clinical nursing care. However, further outcome research is needed in the future in order to obtain more objective evidence.

Combination antipsychotic therapy in psychiatric outpatient clinics in Taiwan.

OBJECTIVE: The purpose of this study is to survey the use of combination antipsychotic therapy (CAT) in the psychiatric outpatient clinic of a general hospital. METHODS: Patients who received at least 2 antipsychotics in the psychiatric outpatient clinic of a general hospital in 1 month (August 1-31, 2003) were identified, and their retrospective chart review was performed. Using a questionnaire, we surveyed the clinicians on why 2 antipsychotics were prescribed, why long-term CAT was used, and whether the problems were solved by CAT. RESULTS: We studied 957 patients diagnosed with schizophrenia and related disorders in 1 month. A total of 119 patients (12%) were prescribed at least 2 antipsychotics. Among these 119 patients, 91 (76%) were prescribed 2 types of first-generation antipsychotics (FGAs), and 15 patients (16%) were prescribed a second-generation antipsychotic medication and a low-dose FGA medication. The clinicians' main reasons for CAT were to treat insomnia (84%) and psychotic symptoms (83%). CONCLUSIONS: The results of this study revealed that 12% of the patients received CAT in the clinical practice. Most patients were prescribed 2 FGAs. The clinicians' reasons for prescribing CAT in Taiwan were to treat insomnia and psychotic symptoms.

Use of changes over time in serum inflammatory parameters in patients with equivocal appendicitis.

BACKGROUND: The aim of this prospective study was to determine whether the change between the initial and subsequent analysis of serum inflammatory markers measured 6 to 10 hours later could improve diagnostic accuracy in appendicitis. METHODS: The study group comprised 225 patients who presented to hospital with equivocal signs of appendicitis from 2003 to 2004. Based on the period from the onset of symptoms to admission, receiver operating characteristic (ROC) curves were used to determine cutoff values of the changes between primary and repeated laboratory examinations in diagnosing appendicitis. RESULTS: ROC analysis showed that the cutoff values for the change in total percentage neutrophil count on the first day after onset of symptoms (3.2%), and a change of in CRP concentration above the baseline on the second day (9.5 mg/L) and the third day (17.0 mg/L) after onset of symptoms were significant parameters for diagnosing acute appendicitis. CONCLUSION: The cutoff values of the change in total neutrophil count on the first day after onset of symptoms and the change in CRP on the second and third days after onset of symptoms during in-hospital observation may serve as useful parameters to surgeons in differentiating acute appendicitis from other acute abdominal diseases.

Predictors of successful resuscitation in non-trauma dead-on-arrival children.

BACKGROUND: Dead-on-arrival (DOA) children pose difficult challenges in resuscitation because of the very low survival rate. In this study, we aimed to analyze the factors that may be related to predicting successful cardiopulmonary resuscitation (CPR). METHODS: We reviewed the hospital records of 120 DOA children aged younger than 18 years who had been admitted to the emergency department (ED) from 2000 to 2004 and analyzed related factors that may have influenced initial CPR in the non-trauma DOA children. Survival analysis was used to compare differences in survival rate between the non-trauma and trauma DOA children. Receiver operating characteristic (ROC) analysis was used to determine the predictive in-hospital CPR duration related to success of initial CPR. RESULTS: We found the initial cardiac rhythm (P = 0.007), pre-hospital basic life support (BLS) (P < 0.001), mode of transportation (P = 0.019), the period from scene to hospital (P=0.025) and the duration of pre-hospital BLS (P = 0.003) were the significant factors related to initial successful CPR in non-trauma DOA children. Based on the ROC analysis, the cutoff value of in-hospital CPR duration was 23 minutes in non-trauma DOA children. CONCLUSIONS: We found that in-hospital CPR should be performed for at least 23 minutes in nontrauma DOA children for spontaneous circulation to return.

Predictive value of C-reactive protein at different cutoff levels in acute appendicitis.

Determining the different cutoff values of C-reactive protein (CRP) on the basis of how long the patient's symptoms were present can be used to early predict acute appendicitis. We analyzed retrospectively from 2001 to 2004 the hospital records of 568 patients who underwent appendectomies for suspected appendicitis. Receiver operating characteristic analysis has shown that CRP measurement can increase the diagnostic accuracy in acute appendicitis. The cutoff values of CRP concentration taken as the first, second, and third days after onset of symptoms that distinguish acute appendicitis from other acute abdominal diseases were 1.5, 4.0, and 10.5 mg/dL, respectively; the values that distinguish perforated appendicitis from other acute abdominal diseases were 3.3 mg/dL (first day), 8.5 mg/dL (second day), and 12.0 mg/dL (third day). The different cutoff values of CRP concentration may serve as a useful predictive parameter in the early diagnosis of acute appendicitis on the first 3 days after the onset of symptoms.

Enhancements in gene expression by the choice of plasmid DNA formulations containing neutral polymeric excipients.

Formulations containing maltodextrin (2% w/v) were identified to facilitate intramuscular (im) delivery of plasmid DNA in mice using the reporter genes luciferase and chloramphenicol acetyltransferase (CAT) and the therapeutic gene of erythropoietin (EPO) as monitors of transfection efficiency. Even though considerable variability in gene expression was observed in animals, a 5-8-fold enhancement of reporter gene expression was observed with this excipient compared with saline formulations of DNA. In a therapeutically significant experiment, a single im injection of an EPO plasmid formulation containing 2% (w/v) maltodextrin resulted in a significant and prolonged elevation of the hematocrit levels of mice compared with control DNA in saline. Biophysical studies with Fourier transform infrared (FTIR) spectroscopy, isothermal titration, and differential scanning calorimetry (DSC) suggested a weak interaction between DNA and maltodextrin as well as a thermal stabilizing effect on the DNA. These in vivo and biophysical results with maltodextrin are comparable to those reported previously with other nonionic polymers, such as poly(vinyl pyrrolidone) and poloxamers, and indicate that maltodextrin is an additional nonionic excipient that displays the property of gene expression enhancement.