Incidence and risk factors of subsyndromal delirium after curative resection of gastric cancer

Background: Subsyndromal delirium, a condition in which patients exhibit some, but not all, of the symptoms of delirium, can negatively affect the outcomes of patients with cancer. However, the incidence of subsyndromal delirium in patients with gastric cancer is unknown. Here, we investigated the incidence and risk factors of subsyndromal delirium after curative resection of gastric cancer. Methods: We recruited consecutive patients with gastric cancer who were scheduled for curative resection at a tertiary hospital. Patients' subsyndromal delirium symptoms were serially assessed preoperatively and 1, 2, 3, and 7 days postoperatively using the Delirium Rating Scale-Revised-98 (DRS-R-98). A DRS-R-98 score of 8-14 at any postoperative assessment was considered to indicate subsyndromal delirium. Sociodemographic and pre-/intraoperative clinical data were also assessed. Logistic regression analyses were used to determine the associated risk factors. Results: Data were analysed from 163 out of 217 eligible patients. Postoperative delirium occurred in one patient (0.6%) and subsyndromal delirium occurred in 19 patients (11.7%). Age >= 70 years (odds ratio, [OR] 3.85; 95% confidence interval [0], 136-10.92; p = 0.011) and education level <= 9 years (OR, 3.98; 95% CI, 139-11.41; p= 0.010) were independent risk factors of subsyndromal delirium after adjusting for preoperative cognitive function. Other pre-/intra-operative variables including anxiety/depression, poor sleep quality, and anaesthesia duration were not associated with subsyndromal delirium. Conclusions: In contrast to the low incidence of delirium among patients undergoing curative resection of gastric cancer, a substantial proportion of such patients experienced subsyndromal delirium. Considering the prognostic implications, more careful detection and management of subsyndromal delirium may be warranted in patients with gastric cance

Facilitating student learning with critical reflective journaling in psychiatric mental health nursing clinical education: A qualitative study

Backgrounth Critical reflective journaling has been used to facilitate student learning in various disciplines; however, there is only limited data available on its application in clinical education in the area of psychiatric mental health nursing. Objectives: The aims of the study were to: 1) explore types of events or issues that senior nursing students chose to reflect upon in their critical reflective journals during their 5-week psychiatric mental health nursing clinical practicum; and 2) assess students' evaluations of critical reflective journaling. Design & Methods: For this qualitative study, we collected data from senior nursing students who were enrolled in the mental health clinical practicum from March to June 2016 and agreed to participate in the study. During the 5-week psychiatric mental health nursing clinical practicum, students completed four weeks of clinical rotations in two units and submitted one journal entry each week reflecting upon an instance they selected and completed a survey to evaluate critical reflective journaling. De-identified data were analyzed using qualitative content analysis. Results: We analyzed 236 journal entries and survey results completed by 59 students. Students chose to reflect upon the following issues: boundaries of therapeutic relationships, responses to patient symptoms, and own attitudes and biases toward mental illness. They reported that critical reflective journaling provided them opportunities for self-reflection and self-emancipation, which led to increased motivation for full engagement in the clinical practicum and increased understanding of patients' perspectives as well as mental health nursing competency. Overall, students were satisfied with critical reflective journaling but also identified areas for improvement in regard to its application in clinical education. Conclusions: Through critical reflective joumaling, nursing students are able to self-reflect on issues arisen during their clinical rotation, which leads to improvement of their competency in psychiatric mental health nursing and full engagement in the clinical practicum.OAIID:RECH_ACHV_DSTSH_NO:T201822306RECH_ACHV_FG:RR00200001ADJUST_YN:EMP_ID:A077287CITE_RATE:2.067DEPT_NM:간호학과EMAIL:[email protected]_YN:YN

Pre-treatment anxiety is associated with persistent chemotherapy-induced peripheral neuropathy in women treated with neoadjuvant chemotherapy for breast cancer

Objective: Chemotherapy-induced peripheral neuropathy (CIPN) is a frequent adverse reaction caused by chemotherapeutic agents, especially the taxanes. CIPN can persist from months to years after completion of chemotherapy, decreasing quality of life for cancer survivors. The aim of this study was to explore the incidence and risk factors of persistent CIPN among women with breast cancer receiving neoadjuvant chemotherapy. Methods: In this prospective study, we recruited women with breast cancer receiving neoadjuvant chemotherapy, including four cycles of docetaxel. Participants reported neuropathic symptoms of tingling/numbness at baseline, at the end of chemotherapy treatment, and at 8 months after completion of chemotherapy. Candidate factors associated with CIPN were assessed before chemotherapy. Results: Among 111 participants, 50 (45.0%) experienced CIPN during chemotherapy, and 21 (18.9%) reported persistent CIPN after chemotherapy. Univariate logistic regression analysis revealed that development of CIPN was significantly associated with pre-treatment numbness (odds ratio [OR], 4.02; 95% confidence interval [CI], 1.09-7.40; p =.033), and persistent CIPN was significantly associated with pre-treatment numbness (OR, 3.60; 95% CI, 1.12-11.61; p =.032) and pre-treatment anxiety (OR, 5.02; 95% CI, 1.84-13.70; p =.002). Multivariate analysis indicated that pre-treatment anxiety remained significantly associated with persistent CIPN (OR, 4.01; 95% CI, 1.25-12.87; p =.020). Conclusion: Our results suggested that pre-treatment anxiety might be related to a patient's risk for persistent CIPN in women with breast cancer undergoing neoadjuvant chemotherapy. Further research is required to investigate if interventions targeting pre-treatment anxiety could provide prevention and management for persistent CIPN

Morning chronotype is a protective factor against chemotherapy-induced hot flashes in premenopausal women with breast cancer

Purpose Adjuvant chemotherapy in patients with breast cancer often causes hot flashes, impairing quality of life. However, the chronobiological or psychiatric factors associated with the development of chemotherapy-induced hot flashes (CIHFs) remain undetermined. The purpose of this study was to investigate whether chronotype was associated with the incidence of CIHFs. Methods A total of 119 premenopausal women with non-metastatic breast cancer awaiting adjuvant chemotherapy after surgery without hot flashes were included. The presence of CIHF was defined as having moderate to severe hot flashes, as measured by the subscale of hot flashes in the Menopause Rating Scale, at 4 weeks after the completion of chemotherapy. Chronotype (Morning/Intermediate/Evening) was assessed with the Composite Scale of Morningness before adjuvant chemotherapy. To examine the association between chronotype and CIHF, we built logistic regression models, adjusting for age, body mass index, sleep quality, and radiation therapy. Results CIHF occurred in 50.4% of participants. Morning type was inversely associated with CIHF (reference: Intermediate type, odds ratio [OR], 0.37; 95% confidence interval [CI], 0.16-0.94; p = 0.040) in the univariate model, and the association remained significant (OR, 0.37; CI, 0.13-0.96; p = 0.045) after adjusting for age, body mass index, sleep quality, and radiation therapy. Conclusions Morning chronotype is a protective factor against the development of CIHF in patients with breast cancer. Chronotypes should be assessed and considered in the prediction and management of CIHF

Can the rigid stylet from an intravenous catheter be an alternative vascular access device for intraosseous catheterisation?

Abstract Background It may be challenging for practitioners to secure vascular access in animals, especially in a state of shock. Aim This study aimed to evaluate the clinical relevance of commercial 16‐gauge intravenous (IV) catheter stylet vs. 15‐gauge intraosseous (IO) vascular access in emergencies. Methods Six healthy dogs were used in this study. After general anaesthesia, IO catheterisation was performed on both trochanteric fossae of the femurs using a commercial 16‐gauge IV catheter stylet and EZIO 15‐gauge IO needle. The pressures were measured by manual, gravity and mechanical infusion for 5 min each. Additionally, insertion time and success rate were recorded. Results In hand infusion, mean pressure of a 16‐gauge IO (605.06 ± 49.13 mmHg) was statistically lower than that of a 15‐gauge EZIO IO catheterisation (718.84 ± 93.09 mmHg). In gravity infusion, there was no significant difference in pressure during injection between the 16‐gauge IV catheter (52.23 ± 14.48 mmHg) and 15‐gauge EZIO IO catheterisation (50.68 ± 11.89 mmHg). In mechanical infusion, mean pressure of the 15‐gauge EZIO IO catheterisation (128.25 ± 50.16 mmHg) was lower than that of the 16‐gauge IV catheter (152.56 ± 67.23 mmHg). The insertion times of a 16‐gauge IV catheter and 15‐gauge EZIO IO catheterisation were 16.79 ± 0.92 and 11.65 ± 1.70 s, respectively. The success rates of the insertion were similar between both groups. Conclusion This study shows that IO catheterisation with a commercial IV catheter stylet can be an alternative method of IO catheterisation in an emergency, especially for rapid vascular access

Advanced Age as a Predictor of Survival and Weaning in Venoarterial Extracorporeal Oxygenation: A Retrospective Observational Study

Background. In most reports on ECMO treatment, advanced age is classified as a contraindication to VA ECMO. We attempted to investigate whether advanced age would be a main risk factor deciding VA ECMO application and performing VA ECMO support. We determined whether advanced age should be regarded as an absolute or relative contraindication to VA ECMO and could affect weaning and survival rates of VA ECMO patients. Methods. VA ECMO was performed on 135 adult patients with primary cardiogenic shock between January 2010 and December 2014. Successful weaning was defined as weaning from ECMO followed by survival for more than 48 hours. Results. Among the 135 patients, 35 survived and were discharged uneventfully, and the remaining 100 did not survive. There were significant differences in survival between age groups, and older age showed a lower survival rate with statistical significance (P = .01). By multivariate logistic regression analysis, age was not significantly associated with in-hospital mortality (P = .83) and was not significantly associated with VA ECMO weaning (P = .11). Conclusions. Advanced age is an undeniable risk factor for VA ECMO; however, patients of advanced age should not be excluded from the chance of recovery after VA ECMO treatment

Psychometric properties of the Korean version of the medical outcomes study HIV health survey: results from a multicenter survey in Korea

Abstract Background Precise assessment of health-related quality of life (HRQOL) with a reliable and valid measure is a prerequisite to the enhancement of HRQOL. This study examined the psychometric properties of the Korean version of the Medical Outcomes Study HIV Health Survey (K-MOS-HIV). Methods The reliability and validity of the K-MOS-HIV were examined in a multicenter survey involving 201 outpatients with human immunodeficiency virus (HIV)/ acquired immunodeficiency syndrome (AIDS) from four teaching hospitals throughout Korea. Results Ceiling effects were observed in six subscales scores, particularly, for the role functioning (71.1%), social functioning (63.2%), and pain (48.8%) scores. The Cronbach’s α for the physical health summary and mental health summary were 0.90 and 0.94, respectively, and it ranged from 0.78 to 0.95 for the subscales. The results of the exploratory structural equation modeling supported the two-factor structure of the K-MOS-HIV (physical health summary and mental health summary). An examination of the mean square statistics values from the Rasch analysis showed that the information-weighted fit and outlier-sensitive fit statistics were within the acceptable ranges of 0.6–1.4 except for two items in the mental health summary. The convergent validity of the K-MOS-HIV was supported by its significant positive correlations with the World Health Organization Quality of Life-HIV-BREF subscale scores. Its known-group validity was proven with its ability to detect significant differences in several K-MOS-HIV subscale scores among participants with different sociodemographic and clinical characteristics. Conclusions The K-MOS-HIV health survey appears to be a reliable and valid measure of HRQOL

Cyclin Y regulates spatial learning and memory flexibility through distinct control of the actin pathway

© 2022, The Author(s).Spatial learning and memory flexibility are known to require long-term potentiation (LTP) and long-term depression (LTD), respectively, on a cellular basis. We previously showed that cyclin Y (CCNY), a synapse-remodeling cyclin, is a novel actin-binding protein and an inhibitory regulator of functional and structural LTP in vitro. In this study, we report that Ccny knockout (KO) mice exhibit enhanced LTP and weak LTD at Schaffer collateral-CA1 synapses in the hippocampus. In accordance with enhanced LTP, Ccny KO mice showed improved spatial learning and memory. However, although previous studies reported that normal LTD is necessary for memory flexibility, Ccny KO mice intriguingly showed improved memory flexibility, suggesting that weak LTD could exert memory flexibility when combined with enhanced LTP. At the molecular level, CCNY modulated spatial learning and memory flexibility by distinctively affecting the cofilin-actin signaling pathway in the hippocampus. Specifically, CCNY inhibited cofilin activation by original learning, but reversed such inhibition by reversal learning. Furthermore, viral-mediated overexpression of a phosphomimetic cofilin-S3E in hippocampal CA1 regions enhanced LTP, weakened LTD, and improved spatial learning and memory flexibility, thus mirroring the phenotype of Ccny KO mice. In contrast, the overexpression of a non-phosphorylatable cofilin-S3A in hippocampal CA1 regions of Ccny KO mice reversed the synaptic plasticity, spatial learning, and memory flexibility phenotypes observed in Ccny KO mice. Altogether, our findings demonstrate that LTP and LTD cooperatively regulate memory flexibility. Moreover, CCNY suppresses LTP while facilitating LTD in the hippocampus and negatively regulates spatial learning and memory flexibility through the control of cofilin-actin signaling, proposing CCNY as a learning regulator modulating both memorizing and forgetting processes.11Nsciescopu

Late chronotypes are associated with neoadjuvant chemotherapy-induced nausea and vomiting in women with breast cancer

Neoadjuvant chemotherapy, that is, the administration of chemotherapy before surgery, has been commonly used for locally advanced breast cancer to improve the surgical outcomes and increase the opportunity for breast-conserving therapy. Women with breast cancer often receive an anthracycline-based regimen as the neoadjuvant chemotherapy, which is associated with a high risk of emesis. Despite the development of novel antiemetics, chemotherapy-induced nausea and vomiting (CINV) has been commonly reported as a major adverse effect, affecting the quality of life of the patients. However, the factors predicting CINV in women with breast cancer undergoing neoadjuvant chemotherapy remain unclear. In this single-institution, prospective, observational study conducted at an outpatient cancer centre in the Republic of Korea from November 2013 to March 2016, we analysed women with breast cancer who planned to be treated with neoadjuvant chemotherapy before surgery. Candidate factors associated with CINV were assessed before neoadjuvant chemotherapy using the Munich Chronotype Questionnaire, Pittsburgh Sleep Quality Index and Hospital Anxiety and Depression Scale. CINV was assessed after chemotherapy by using the Multinational Association of Supportive Care in Cancer Antiemesis Tool. Of a total of 143 participants, 7 patients were lost to follow-up and 2 patients were excluded due to changes in their treatment plan; thus, 134 patients were finally included in the analyses. Overall, 48.5% of the participants experienced CINV, with delayed CINV prevalence (42.5%) being more common than acute (39.6%). In the univariate analyses, overall CINV was significantly associated with late chronotypes (odds ratio [OR], 3.49; 95% confidence interval [CI], 1.37-8.87; p = 0.009), a history of nausea/vomiting (OR, 2.19; 95% CI, 1.10-4.37; p = 0.026) and anxiety (OR, 2.25; 95% CI, 1.05-4.81; p = 0.036). In the multivariate analyses, late chronotypes (OR, 3.53; 95% CI, 1.27-9.79; p = 0.015) and a history of nausea/vomiting (OR, 2.83; 95% CI, 1.31-6.13; p = 0.008) remained significantly associated with CINV. In conclusion, in women with breast cancer undergoing neoadjuvant chemotherapy before surgery, late chronotypes were found to have an increased risk of CINV; these data suggest that clinicians need to assess and consider the chronotype in the management of CINV.clos