Predictors of success in the registered nurse licensure exam for nursing graduates whose education was affected by the COVID-19 pandemic.

The Coronavirus disease 2019 (COVID-19) pandemic has had an unprecedented impact on health-care education. However, the relationship between changes in nursing internships in Taiwan during the COVID-19 pandemic and outcome in the national registered nurse (RN) licensure exam for new nursing graduates is underexplored. The study was to explore the predictors of first-attempt success in the RN licensure exam in 2022. A retrospective review of secondary data was employed in this study. Adjusted binary logistic regression was used to analyze data. A convenience sample of 78 new graduates attempted the exam. Of these graduates, 87.2% passed the RN licensure exam. Age was the main predictor of exam success, followed by grand mean academic score and total alternative (nontraditional in-person) internship hours. Compared with those who failed the exam, the graduates who passed the exam were significantly more likely to be younger, have better academic performance, and have engaged in more alternative internship hours. Nursing faculties should consider implementing supportive strategies early for students who are underperforming or those who are older than their classmates on average to help them pass the RN exam on the first attempt. The optimal duration and long-term consequences of alternative nursing internships must be analyzed in further detail.

Various configuration types of the foveal avascular zone with related factors in normal Chinese adults with or without myopia assessed by swept-source OCT angiography.

AIM: To describe the morphological characteristics of foveal avascular zone (FAZ) in normal Chinese adults with or without myopia by swept-source optical coherence tomography angiography (SS-OCTA) and analyze the possible associated factors. METHODS: Normal Chinese adults with or without myopia aged between 18 and 60y were recruited into the study. One eye in each individual was randomly selected for scanning using SS-OCTA. FAZ parameters, central retinal thickness (CRT) and central choroidal thickness (CCT) were then analyzed. Correlations between systemic and ocular variables and FAZ parameters were subsequently evaluated. The subgroup analysis based on refractive error was also carried out. RESULTS: In total, 127 eyes out of 127 normal subjects were finally included in the study (mean age 29.5±8.22y, 61 males and 66 females). The pattern of FAZ was variable: round configuration in 28 eyes (22%), quadrilateral configuration in 23 eyes (18%), pentagonal configuration in 20 eyes (16%), oval configuration in 15 eyes (12%), triangular configuration in 6 eyes (5%) and irregular configuration in 35 eyes (28%). The mean area of FAZ was 0.37±0.12 mm2. Females had a larger FAZ (0.41±0.11 mm2 vs 0.32±0.11 mm2) compared with that of males (P<0.01). All myopic individuals showed smaller FAZ area and perimeter compared with that of normal individuals (P<0.01). There was no obvious correlation between age and FAZ. In the univariate regression analysis, both axial length (AL) and refractive error were significantly related to FAZ parameters. However, only CRT showed negative correlation with FAZ in the multivariate regression analysis. CONCLUSION: The pattern of FAZ configuration in normal Chinese adults with or without myopia is highly variable. Establishing quantitative parameters of FAZ would not only provide details of macular pathophysiology but could possibly contribute as a biomarker in disease staging.

The association of the optimal bolus of dexmedetomidine with its favourable haemodynamic outcomes in adult surgical patients under general anaesthesia.

AIMS: Dexmedetomidine is highly specific α2-adrenoceptor agonist. A single bolus of dexmedetomidine can achieve clinical therapeutic effect. Therefore, it is essential to know the safety margin between the clinical effectiveness dosages of dexmedetomidine and its side effect. METHODS: A total of 42 patients who underwent elective thyroidectomy were enrolled in this study. Dexmedetomidine was given as a single bolus injection 30 min towards the end of surgery. The up-and-down sequential schedule was used in this study. The starting dose of dexmedetomidine was set at 0.1 µg/kg in the first patient and the next patient would then receive a dose of dexmedetomidine decremented by 0.05 µg/kg if the prior patient's baseline heart rate (HR) had a decrease of ≥20% and/or mean arterial blood pressure (MAP) increase or decrease of ≥20%, otherwise, the following patient would receive an incremental 0.05 µg/kg dose of dexmedetomidine. The analytic techniques of linear, linear-logarithmic, exponential regressions and centred isotonic regression were used to determine the ED50 of dexmedetomidine and the residual standard errors were calculated for the comparison of goodness of fit among the different models. RESULTS: The median (interquartile range [range]) lowest HR was 57 beats/min (53-63.3[46-76]) with an average HR decrease of 8.0 beats/min (5-13 [4 to 23]). The median (interquartile range [range]) highest MAP was 98 mmHg (91.8-105 [83-126]) with a MAP increase of 10.0 mmHg (6.8-18.0 [2-24]). The ED50 (95% confidence interval) from 4 different statistical approaches (linear, linear-logarithmic, exponential regressions and centred isotonic regression) were 0.262 µg/kg (0.243, 0.306), 0.252 µg/kg (0.238, 0.307), 0.283 µg/kg (0.238, 0.307), and 0.278 µg/kg, respectively. Among the 4 models, the exponential regression had the least residual standard error (0.03618). CONCLUSION: The ED50 derived from 4 statistical models for an intravenous bolus of dexmedetomidine without significant haemodynamic effects was distributed in a narrow range of 0.252-0.283 µg/kg, and the exponential regression was the model to best match the study data.

Bezold-Jarisch reflex occurred in a pediatric patient with giant intra-abdominal teratoma during induction of anesthesia: A case report.

RATIONALE: Bezold-Jarisch reflex (BJR) occurs when the cardioinhibitory receptors in the walls of ventricles are activated by various stimuli, with typical features of bradycardia, vasorelaxation, and hypotension. This reflex usually happens in parturient intrathecal anesthesia, as a result of decreased venous return by compression of inferior vena cava, but it is only rarely reported during general anesthesia. PATIENT CONCERNS: Severe bradycardia and hypotension, indicating BJR, occurred during the induction of general anesthesia in a 3-month-old female child with giant intra-abdominal teratoma. DIAGNOSES: A giant intra-abdominal teratoma was detected by computed tomography scanning. The decreased left ventricular ejection faction along with increased troponin I and N-terminal pro-B-type natriuretic peptide indicated a preoperative mild cardiac dysfunction. BJR was diagnosed on the basis of the severe bradycardia and hypotension observed during the induction of general anesthesia, INTERVENTIONS:: Atropine failed to increase heart rate. Cardiopulmonary resuscitation was initiated immediately and epinephrine was injected intravenously because of sudden circulatory collapse. Soon after the return of spontaneous circulation, a central venous line was placed and invasive blood pressure was monitored. Vital signs and homeostasis were kept stable during teratoma resection. OUTCOMES: The child was extubated after emergence from anesthesia in the operating room. Eleven days later, she had recovered without complications and was discharged. LESSONS: General anesthesia should be induced with great care in patients with giant intra-abdominal masses, and the patient should be kept in the left-lateral table tilt position before induction.

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.