Long-Term Effects of Subthalamic Stimulation on Motor Symptoms and Quality of Life in Patients with Parkinson's Disease.

Parkinson's disease (PD) is a progressive neurodegenerative disorder affecting both motor functions and quality of life (QoL). This study compared motor symptoms and QoL in patients with PD before and at 1 and 5 years after subthalamic nucleus deep brain stimulation (STN-DBS) surgery in Taiwan. This study included 53 patients with PD undergoing STN-DBS. The motor symptoms improved by 39.71 ± 26.52% and 18.83 ± 37.15% in the Unified Parkinson's Disease Rating Scale (UPDRS) part II and by 36.83 ± 22.51% and 22.75 ± 36.32% in the UPDRS part III at 1 and 5 years after STN-DBS in the off-medication/on-stimulation state, respectively. The Hoehn and Yahr stage significantly improved at the 1-year follow-up but declined progressively and returned to the baseline stage 5 years post-surgery. The Schwab and England Activities of Daily Living improved and sustained for 5 years following STN-DBS. Levodopa equivalent daily dose decreased by 35.32 ± 35.87% and 15.26 ± 65.76% at 1 and 5 years post-surgery, respectively. The QoL revealed significant improvement at 1 year post-surgery; however, patients regressed to near baseline levels 5 years post-surgery. The long-term effects of STN-DBS on motor symptoms were maintained over 5 years after STN-DBS surgery. At the same time, STN-DBS had no long-lasting effect on QoL. The study findings will enable clinicians to become more aware of visible and invisible manifestations of PD.

The Outcome-Present State Test Model of Clinical Reasoning to Promote Critical Thinking in Psychiatric Nursing Practice among Nursing Students: A Mixed Research Study.

This study determined whether teaching intervention using the outcome-present state test (OPT) clinical reasoning model can effectively improve critical thinking in nursing students during a psychiatry internship. In addition, it evaluates the experiences of the students using this model in clinical practice. METHODS: In this interventional study, 19 students were taught critical thinking skills using the OPT clinical reasoning model during a psychiatry clinical practice. Work-learning forms were used in daily 1 h individual and group discussions with students. The critical thinking disposition scale was completed by every student before and after the intervention. Moreover, the students were asked to the complete reflection experience forms. RESULTS: The average critical thinking disposition pre-intervention score was 95.21, whereas the average post-intervention score was 97.05, indicating an increase of 1.84. There was a significant increase in the fourth dimension of open-mindedness (z = -2.80, p < 0.01). The learning experience has been likened to a process of clearing the fog, and it involves the use of limited known conditions, thinking outside the box, and adaptation to complex care issues. CONCLUSION: Using the OPT clinical reasoning model as a teaching strategy during a psychiatric nursing internship significantly improved the open-mindedness dimension among the students. The student reflective experience of talking to teachers as peers helped students identify clues and reframe problems related to clinical care. Additionally, the students reported that this led to more harmonious interactions with their teachers.

The Relationship between Depressive Symptoms, Rumination, and Suicide Ideation in Patients with Depression.

The relationship between suicide and rumination in depression is a recent topic of attention in mental health. The purpose of this study was to investigate the relationship between demographic variables, depressive symptoms, rumination, and suicide ideation in patients with depression, as well as the predictors of suicide ideation. RESEARCH DESIGN: A cross-sectional study of 95 subjects with depression recruited intentionally from the psychiatric ward of Tzu Chi Hospital. The questionnaire included demographic data, the Beck Depression Inventory-II, the Ruminative Response Scale, and the Beck Scale for Suicide Ideation. Independent sample t-test, Pearson product difference correlation, and the stepwise regression test were adopted for data analysis. RESULTS: Age (r = -0.41, p < 0.01), age at diagnosis (r = -0.34, p < 0.01), and sleep duration (r = -0.25, p < 0.05) were negatively correlated with rumination-reflection. The depressive symptoms (r = 0.72, p < 0.01) were positively correlated with rumination, whereas rumination (r = 0.57, p < 0.01) and suicide ideation were positively correlated. Depressive symptoms and rumination could predict suicide ideation, and the effective explanatory power reached 60%. CONCLUSIONS: If the patient with depression was younger or the patient was diagnosed at a younger age, the depressive symptoms of the reflection subscale of rumination thinking and suicide ideation were more serious. Our results indicate that clinicians who care for patients with depression should be aware of rumination and its impact on suicide ideation, specifically in younger patients.

Auditory Hallucinatory Beliefs in Patients With Schizophrenia: Association of Auditory Hallucinations With Social Interactions, Characteristics and Emotional Behaviors Over 3 Months.

The aims of this study were to explore social interactions, characteristics, and emotional behaviors to detect changes in auditory hallucinatory beliefs in patients with schizophrenia over a 3-month period. Participants (n=189) were evaluated using the Auditory Hallucinations Assessment Scale (AHAS) and the Assessment of Communication and Interaction Skills (ACIS). The characteristics and emotional behaviors measured by the AHAS showed improvements, while auditory hallucinatory beliefs became less influential. Social interaction scores increased regardless of changes in auditory hallucinatory beliefs. Psychiatric professionals need to train those who hear voices to react to them with indifference.

Validity and reliability of swallowing screening tools used by nurses for dysphagia: A systematic review.

Dysphagia following neurological impairment increases the risk of dehydration, malnutrition, aspiration pneumonia, and even death. Screening for dysphagia has been reported to change negative outcomes. This review evaluated the validity and reliability of measurement tools for screening dysphagia in patients with neurological disorders to identify a feasible tool that can be used by nurses. Electronic databases were searched for studies from 1992 to 2015 related to dysphagia screening measurements. The search was applied to the Pubmed, CINAHL, Cochrane, Medline, EBSCO host, and CEPS + CETD databases. A checklist was used to evaluate the psychometric quality. The tools were evaluated for their feasibility for incorporation into routine care by nurses in hospitals. A total of 104 papers were retrieved, and eight articles finally met the inclusion criteria. The sensitivity and specificity of the screening tools ranged from 29% to 100% and from 65% to 100%, respectively. The interrater reliability ranged from good to excellent agreement. On the basis of quality evaluations, all the included studies had a risk of bias because of inadequate methodological characteristics. The Standardized Swallowing Assessment is the most suitable tool for detecting dysphagia because its psychometric properties and feasibility are higher than those of other screening tools that can be administered by nurses.