[Improvement of Medical Alarm Management Accuracy for Critical Care Nurses in a Continuous Renal Replacement Therapy Unit].

BACKGROUND: Continuous renal replacement therapy (CRRT) is a common medical treatment for critically ill patients. The alarm management component of CRRT is urgent and time sensitive. Patient safety and survival rates are jeopardized if critical care nurses do not handle this situation properly. However, clinical settings cannot provide nurses with the opportunity to practice alarm management, which results in related training difficulties. Based on a survey conducted in May 2018, the rate of proper alarm management for the nurses in our CRRT unit was only 53.1%. An investigation attributed this low rate to inadequacies in standard procedures, resources for reference, opportunities for hands-on experience, professional training at different levels, immediate assistance from industry, and lack of familiarity with the purpose and handling of alarm incidents. These findings motivated our project team to improve alarm management. PURPOSE: To increase the accuracy of alarm management in CRRT critical care nurses to more than 90%. RESOLUTIONS: This project, which was implemented from September 8th, 2018 to August 31st, 2019, adopted a diverse and effective teaching strategy that included establishing standard procedures and technical tests; creating a plan for a case scenario simulation course using flipped teaching; providing scenario simulation videos; and designing online scenario simulation interactive exercises, nursing manuals, and flashcards of simplified procedures. RESULTS: The accuracy rate of proper alarm management for CCRT critical care nurses increased from 53.1% to 98.9%. CONCLUSIONS: Diverse teaching strategies may be used to effectively enhance the care provided by critical care nurses, increase patient safety, and improve the quality of care. The findings and strategies in this study may also be applied to other intensive care units.

Distinctive effects between cognitive stimulation and reminiscence therapy on cognitive function and quality of life for different types of behavioural problems in dementia.

BACKGROUND: Among the various complementary therapies for patients with dementia (PwD), cognitive stimulation therapy (CST) and reminiscence therapy (RT) are frequently used to improve cognitive function and quality of life. However, no studies have examined the use of complementary therapies applied to different types of behavioural and psychological symptoms of dementia in PwD. AIMS: The purpose of this study was to investigate the distinctive effects of CST and RT on cognitive function and quality of life for PwD with three types of behavioural problems - the dispute, return and dissociate types. METHODS: A quasi-experimental design was employed. A total of PwD residing in 10 long-term care institutions participated in the study and were divided into three groups. The CST and RT groups received 50-minute sessions of intervention therapy once a week for 10 continuous weeks, and the control group participated in regular activities. The pretest (week 1), post-test (week 12) and follow-up (week 24) data were collected using the Mini-Mental State Examination and Quality of Life-Alzheimer's Disease. Two-way analysis of variance was used for data analysis. RESULTS: The results of our study revealed CST and RT interventions had positive effects on cognition and quality of life of PwD. For short-term effects on cognitive function, CST was the most positive intervention for the dispute type. With regard to short-term effects on quality of life, CST was greater than RT for PwD. For follow-up effects, CST and RT may have potentially sustained effects. CONCLUSION: This study suggests that CST and RT could be applied to improve the cognitive function and quality of life for PwD, as well as contribute to the effectiveness of nonpharmacological approaches to PwD with certain types of behavioural problems.

Test-retest reliabilities of hand-held dynamometer for lower-limb muscle strength in intellectual disabilities.

The primary purpose of this study was to investigate the test-retest reliabilities of hand-held dynamometer (HDD) for measuring lower-limb muscle strength in intellectual disabilities (ID). The other purposes were to: (1) compare the lower-limb muscle strength between children with and without ID; (2) probe the relationship between the muscle forces and agility performance in ID; and (3) explore the factors associated with muscle strength in ID. Sixty-one participants (30 boys and 31 girls; mean age=14.1 ± 3.3 year) were assessed by the HDD using a "make" test. The comparative group consisted of 63 typically developing children (33 boys and 30 girls; mean age=14.9 ± 2.1 year). The ID group demonstrated lower muscle groups than in typically developing group. Except for the ankle plantarflexors (ICC=0.69, SEM=0.72), test-retest analysis showed good intrarater reliability with ICC ranging from 0.81 to 0.96, and intrarater SEM values ranged from 0.40 to 0.57. The HDD has the potential to be a reliable tool for strength measurement in ID. Muscle strength was positively related to agility performance. Regression analysis indicated that height, weight, BMI, and activity level were significant predictors of muscle strength in ID.

Strength and agility training in adolescents with Down syndrome: a randomized controlled trial.

The purpose of this study was to investigate the effects of a proposed strength and agility training program of adolescents with Down syndrome. Ninety-two adolescents were recruited and evenly randomized to two intervention groups (exercise group vs. control group). The mean age for the exercise and the control group was 10.6±3.2 and 11.2±3.5 respectively. The exercise training program consisted of a 5-min treadmill exercise and one 20-min virtual-reality based activity administered three times a week for 6 weeks. Pre- and post-test measures were taken for muscle strength and agility performance. The measured muscle included hip extensor, hip flexor, knee extensor, knee flexors, hip abductors, and ankle plantarflexor. A handheld dynamometer was used to measure the lower extremities muscle strength, and agility performance was assessed by the strength and agility subtests of the Bruininks-Oseretsky Test of Motor Proficiency-Second Edition. The exercise group had significant improvements in agility (p=0.02, d=0.80) and muscle strength of all muscle group (all p's<0.05, d=0.51-0.89) assessed in comparison to the control group after the 6-week intervention. Knee muscle groups including both flexors and extensors had the greatest gains among all the muscles measured. A short-term exercise training program used in this study is capable of improving muscle strength and agility performance of adolescents with DS.

Resveratrol helps recovery from fatty liver and protects against hepatocellular carcinoma induced by hepatitis B virus X protein in a mouse model.

Resveratrol is a natural polyphenol that has beneficial effects across species and various disease models. Here, we investigate whether resveratrol is effective against hepatitis B virus (HBV)-associated hepatocellular carcinoma (HCC) using HBV X protein (HBx) transgenic mice. We found that resveratrol (30 mg/kg/d) has a therapeutic effect on HBx-induced fatty liver and the early stages of liver damage. Resveratrol decreased intracellular reactive oxygen species and transiently stimulated hepatocyte proliferation. Interestingly, resveratrol inhibited LXRα and downregulated the expression of the lipogenic genes, Srebp1-c and PPARγ. The decrease in Srebp1-c seems to further downregulate the expression of its target genes, Acc and Fas. In addition, resveratrol stimulated the activity of Ampk and SirT1. Thus, resveratrol has a pleiotropic effect on HBx transgenic mice in terms of the downregulation of lipogenesis, the promotion of transient liver regeneration, and the stimulation of antioxidant activity. Furthermore, at the later precancerous stages, resveratrol delayed HBx-mediated hepatocarcinogenesis and reduced HCC incidence from 80% to 15%, a 5.3-fold reduction. Resveratrol should be considered as a potential chemopreventive agent for HBV-associated HCC.

Antioxidant properties of several medicinal mushrooms.

Three species of medicinal mushrooms are commercially available in Taiwan, namely, Ganoderma lucidum (Ling-chih), Ganoderma tsugae (Sung-shan-ling-chih), and Coriolus versicolor (Yun-chih). Methanolic extracts were prepared from these medicinal mushrooms and their antioxidant properties studied. At 0.6 mg/mL, G. lucidum, G. lucidum antler, and G. tsugae showed an excellent antioxidant activity (2.30-6.41% of lipid peroxidation), whereas C. versicolor showed only 58.56%. At 4 mg/mL, reducing powers were in the order G. tsugae (2.38) approximately G. lucidum antler (2.28) > G. lucidum (1.62) > C. versicolor (0.79). At 0.64 mg/mL, scavenging effects on the 1,1-diphenyl-2-picrylhydrazyl radical were 67.6-74.4% for Ganoderma and 24.6% for C. versicolor. The scavenging effect of methanolic extracts from G. lucidum and G. lucidum antler on hydroxyl radical was the highest (51.2 and 52.6%) at 16 mg/mL, respectively. At 2.4 mg/mL, chelating effects on ferrous ion were in the order G. lucidum antler (67.7%) > G. lucidum (55.5%) > G. tsugae (44.8%) > C. versicolor (13.2%). Total phenols were the major naturally occurring antioxidant components found in methanolic extracts from medicinal mushrooms. Overall, G. lucidum and G. tsugae were higher in antioxidant activity, reducing power, scavenging and chelating abilities, and total phenol content.