Retrospective analysis of endoscopic management of foreign bodies in the upper gastrointestinal tract of adults.

BACKGROUND: Foreign body impaction in the upper gastrointestinal (UGI) tract is considered an emergency worldwide. This article reports our experience in the endoscopic management of foreign bodies in the UGI tract of adults. METHODS: A retrospective chart review was conducted on adult patients (aged >18 years) who received endoscopic management of foreign bodies in the UGI tract at Shuang Ho Hospital between November 2008 and November 2016. RESULTS: A total of 280 patients (male/female: 107/178; mean age: 56 years) were included. Fish bones were the most common ingested foreign bodies (n = 162; 56.8%), and the esophagus was the most common lodgment site (n = 222; 77.9%). The presence of symptoms indicated that the ingested foreign bodies were lodged in the hypopharynx or esophagus rather than in the stomach or duodenum (p < 0.01). The detection rate of ingested foreign bodies in the UGI tract through plain radiography was 53% (122/230). The average "door-to-scope" was 5.9 hours, and 99.2% of the patients received endoscopic management of the ingested foreign bodies within 24 hours. The complication rate was relatively low (n = 14; 4.9%). No patient received surgical intervention or died of endoscopic management. CONCLUSION: Endoscopic management is a safe and highly effective procedure for extracting ingested foreign bodies. Rapid endoscopic intervention should be provided to reduce the risk of complications.

Validation of a Symptoms Distress Scale in a Cirrhotic Population Using Item Response Theory.

BACKGROUND: The assessment of symptoms distress is an important strategy for symptoms management and treatment of patients with liver cirrhosis (LC); however, appropriate instruments are limited. OBJECTIVE: The objective of this study was to validate a symptoms distress scale (SDS) by confirming the appropriateness of each item using item response theory. METHODS: A cross-sectional and convenience sampling was conducted to recruit eligible cirrhotic outpatients from the gastroenterology outpatient department of a single medical university hospital. In total, 163 patients with LC completed the 21-item SDS. A graded response model with two-parameter (discrimination and difficulty) estimation was used for data analysis. RESULTS: The item response theory model identified the validity of the SDS and found that most of the items in the SDS represented a high level of symptoms distress; moreover, three items of bruising, drowsiness, and dark urine were reported in cirrhotic patients with severe symptom distress. Four items comprising bodily pain, right upper quadrant pain, muscle cramps, and change in appearance can be appropriately represented in cirrhotic patients with mild symptoms distress. Moreover, the amount of test information in the SDS was >0.70, indicating acceptable reliability. DISCUSSION: Items of the SDS can be useful for assessing different levels of symptoms distress; however, using the scale to assess mild symptoms distress in populations with LC should be done with great caution.

Health-promoting behaviors benefit the mental health of cirrhotic outpatients.

PURPOSE: The objectives of this study were to survey the frequency of engaging in a health-promoting lifestyle in patients with liver cirrhosis, and examine the mediating effects of a health-promoting lifestyle on relationships of symptoms and psychological distress with the quality of life (QOL). METHODS: A cross-sectional study was conducted to recruit 148 cirrhotic outpatients from the gastroenterology outpatient department of one medical university hospital. All study participants completed self-administered questionnaires comprising a multidimensional symptoms scale, Hospital Anxiety and Depression Scale, short-form Chinese health-promoting lifestyle profile, and the Taiwanese version of the Short-Form 36. Hierarchical linear regression and mediation models were used to evaluate the effect of a health-promoting lifestyle on the QOL. RESULTS: Results showed these cirrhotic outpatients reported low frequencies of health-promoting behaviors in their daily activities and had poor mental health but superior physical health. The hierarchical linear regression model found that depression, anxiety, and a health-promoting lifestyle were significant determinants of mental health. The mediation analysis further identified that a health-promoting lifestyle acted as a significant mediator which ameliorated the effects of depression and anxiety on the mental health aspect of the QOL. CONCLUSIONS: A health-promoting lifestyle can improve the mental health of the QOL. Healthcare professionals can develop effective health-promoting interventions to manage and improve the mental health of cirrhotic patients.