University-affiliated General Hospital Research Articles

Factors predicting proactive work behaviors among nurses: A descriptive predictive study.

This study examined the level of proactive work behavior and predictability of education level, work engagement, transformational leadership of nurse managers, and organizational support on proactive work behaviors among nurses. Nurses face many challenges to provide quality nursing care as numbers of patients increase in particular as a result of COVID-19 and human resource shortages worldwide, this includes Myanmar. Proactive work behavior is a critical factor in providing quality nursing care. We collected data from 183 registered nurses in four university-affiliated general hospitals in Myanmar by using stratified random sampling. Instruments included the Utrecht Work Engagement Scale, the Global Transformational Leadership Scale, the Survey of Perceived Organizational Support, and the Proactive Work Behavior Scale. Descriptive statistics and multiple regression were used to analyze data. Findings are reported according to the STROBE checklist. The overall level of proactive work behavior was perceived as moderate. Transformational leadership and work engagement were significant predictors of proactive work behaviors of nurses, explaining 33.0% of the total variance. Findings provide that both transformational leadership and work engagement are significant predictors of proactive work behaviors which are important for improving the quality of patient care and organizational outcomes. Nurse administrators and hospital directors should encourage nurses to voice ideas for improving the standard of work, provide opportunities for generating ideas, support resources for taking charge and preventing problems whilst also supporting the promotion of nurse managers' transformational leadership and nurses' work engagement.

Antibiogram of Multidrug-Resistant Bacteria Based on Sepsis Onset Location in Korea: A Multicenter Cohort Study.

Administration of adequate antibiotics is crucial for better outcomes in sepsis. Because no uniform tool can accurately assess the risk of multidrug-resistant (MDR) pathogens, a local antibiogram is necessary. We aimed to describe the antibiogram of MDR bacteria based on locations of sepsis onset in South Korea. We performed a prospective observational study of adult patients diagnosed with sepsis according to Sepsis-3 from 19 institutions (13 tertiary referral and 6 university-affiliated general hospitals) in South Korea. Patients were divided into four groups based on the respective location of sepsis onset: community, nursing home, long-term-care hospital, and hospital. Along with the antibiogram, risk factors of MDR bacteria and drug-bug match of empirical antibiotics were analyzed. MDR bacteria were detected in 1,596 (22.7%) of 7,024 patients with gram-negative predominance. MDR gram-negative bacteria were more commonly detected in long-term-care hospital- (30.4%) and nursing home-acquired (26.3%) sepsis, whereas MDR gram-positive bacteria were more prevalent in hospital-acquired (10.9%) sepsis. Such findings were consistent regardless of the location and tier of hospitals throughout South Korea. Patients with long-term-care hospital-acquired sepsis had the highest risk of MDR pathogen, which was even higher than those with hospital-acquired sepsis (adjusted odds ratio, 1.42; 95% confidence interval, 1.15-1.75) after adjustment of risk factors. The drug-bug match was lowest in patients with long-term-care hospital-acquired sepsis (66.8%). Gram-negative MDR bacteria were more common in nursing home- and long-term-care hospital-acquired sepsis, whereas gram-positive MDR bacteria were more common in hospital-acquired settings in South Korea. Patients with long-term-care hospital-acquired sepsis had the highest the risk of MDR bacteria but lowest drug-bug match of initial antibiotics. We suggest that initial antibiotics be carefully selected according to the onset location in each patient.

Evaluation of Psychiatric Counseling for Patients Hospitalized with COVID-19 in a University-Affiliated General Hospital in Tehran, Iran

Background: Coronavirus disease 2019 (COVID-19) is associated with a number of psychiatric problems in patients; however, mental healthcare in these patients does not appear to be adequate. Objectives: This study aimed to evaluate the extent of psychological care provided to COVID-19 patients admitted to the hospital and the most common reasons for psychiatric counseling. Methods: This study examined the electronic medical records of all COVID-19-positive patients admitted to Rasoul-e-Akram hospital in Tehran, Iran, within April 1 and September 30, 2020 (approximately 2200 cases). Results: Psychiatric consultation was requested for 5.45% of admitted patients with COVID-19 diagnosis based on a positive real-time reverse transcription-polymerase chain reaction. More than half of those who received psychiatric counseling had a previous psychiatric disorder. The most common reason for requesting psychiatric counseling in patients with a previous psychiatric disorder was the patient’s evaluation and management; the most common reason in patients without a psychiatric disorder was agitation and lack of cooperation. The most common diagnosis in patients with a positive history of psychiatric disorder was bipolar disorders (33.9%), followed by opioid use disorder (29%). Adjustment disorder (54%) and delirium (26%) were the most common diagnoses in patients without a history of psychiatric disease. Conclusions: The current study showed that psychiatric counseling in COVID-19 patients was limited to a small number, including those with a positive history of psychiatric illnesses and prominent psychiatric symptoms.

Effects of white noise on procedural pain-related cortical response and pain score in neonates: A randomized controlled trial

ObjectivesTo evaluate the effects of white noise on pain-related cortical response, pain score, and behavioral and physiological parameters in neonates with procedural pain. MethodsA double-blind, randomized controlled trial was conducted. Sixty-six neonates from the Neonatal Intensive Care Unit in a university-affiliated general hospital were randomly assigned to listen to white noise at 50 dB (experimental group) or 0 dB (control group) 2 min before radial artery blood sampling and continued until 5 min after needle withdrawal. Pain-related cortical response was measured by regional cerebral oxygen saturation (rScO2) monitored with near-infrared spectroscopy, and facial expressions and physiological parameters were recorded by two video cameras. Two assessors scored the Premature Infant Pain Profile-Revised (PIPP-R) independently when viewing the videos. Primary outcomes were pain score and rScO2 during arterial puncture and 5 min after needle withdrawal. Secondary outcomes were pulse oximetric oxygen saturation (SpO2) and heart rate (HR) during arterial puncture, and duration of painful expressions. The study was registered at the Chinese Clinical Trial Registry (ChiCTR2200055571). ResultsSixty neonates (experimental group, n = 29; control group, n = 31) were included in the final analysis. The maximum PIPP-R score in the experimental and control groups was 12.00 (9.50, 13.00), 12.50 (10.50, 13.75), respectively (median difference −0.5, 95% CI −2.0 to 0.5), and minimum rScO2 was (61.22 ± 3.07)%, (61.32 ± 2.79)%, respectively (mean difference −0.325, 95% CI −1.382 to 0.732), without significant differences. During arterial puncture, the mean rScO2, HR, and SpO2 did not differ between groups. After needle withdrawal, the trends for rScO2, PIPP-R score, and facial expression returning to baseline were different between the two groups without statistical significance. ConclusionThe white noise intervention did not show beneficial effects on pain-related cortical response as well as pain score, behavioral and physiological parameters in neonates with procedural pain.

Nebulized Amphotericin B in Mechanically Ventilated COVID-19 Patients to Prevent Invasive Pulmonary Aspergillosis: A Retrospective Cohort Study.

IMPORTANCE:Despite high mortality rates of COVID-19-associated pulmonary aspergillosis (CAPA) in the ICU, antifungal prophylaxis remains a subject of debate. We initiated nebulized conventional amphotericin B (c-AmB) as antifungal prophylaxis in COVID-19 patients on invasive mechanical ventilation (IMV).OBJECTIVES:To assess the CAPA incidence in COVID-19 patients on IMV treated with and without nebulized c-AmB as antifungal prophylaxis.DESIGN, SETTING, AND PARTICIPANTS:Retrospective cohort study of consecutive COVID-19 patients admitted to our adult 17-bed ICU in a university-affiliated general hospital in Ede, The Netherlands, between January 25, 2021, and July 9, 2021. Patients not requiring IMV or transferred from or to another ICU were excluded. From April 9, 2021, daily nebulized amphotericin B in all patients on IMV was initiated.MAIN OUTCOMES AND MEASURES:Bronchoscopy with bronchoalveolar lavage (BAL) was performed in case of positive cultures for Aspergillus from the respiratory tract and/or unexplained respiratory deterioration. Incidence of probable and proven CAPA was compared between patients treated with and without nebulized antifungal prophylaxis using Pearson chi-square test.RESULTS:A total of 39 intubated COVID-19 patients could be analyzed, of which 16 were treated with antifungal prophylaxis and 23 were not. Twenty-six patients underwent bronchoscopy with BAL. In patients treated with antifungal prophylaxis, the incidence of probable/proven CAPA was significantly lower when compared with no antifungal prophylaxis (27% vs 67%; p = 0.047). Incidence of tracheobronchial lesions and positive Aspergillus cultures and BAL-galactomannan was significantly lower in patients treated with antifungal prophylaxis (9% vs 47%; p = 0.040, 9% vs 53%; p = 0.044, and 20% vs 60%; p = 0.047, respectively). No treatment-related adverse events and no case of proven CAPA were encountered in patients receiving antifungal prophylaxis.CONCLUSIONS AND RELEVANCE:Nebulization of c-AmB in critically ill COVID-19 patients on IMV is safe and may be considered as antifungal prophylaxis to prevent CAPA. However, a randomized controlled trial to confirm this is warranted.

Incidence and correlates of insomnia and its impact on health-related quality of life among Chinese pregnant women: a cross-sectional study

ABSTRACT Objective The aims of this study were to examine the incidence and correlates of insomnia and its impact on health-related quality of life among Chinese pregnant women. Method A cross-sectional study was performed from November 2018 to April 2019 in a university-affiliated general hospital in Guangzhou, China. Seven hundred and seventeen pregnant women completed the 36-item Short-Form Health Survey (SF-36), the Self-Rating Anxiety Scale (SAS), the Self-Rating Depression Scale (SDS), and the obstetric and sociodemographic data sheet. Findings 24.3% of the pregnant women suffered from insomnia. Compared with women without insomnia, those with insomnia had a significantly lower health-related quality of life during pregnancy. Maternal age, educational level, occupation, economic status, insurance coverage, gestational age, the woman’s relationship with her mother-in-law and anxiety were significantly associated with insomnia among pregnant women. Conclusion The incidence of insomnia among pregnant women is high, and insomnia is negatively correlated with health-related quality of life. Appropriate measures and practical therapeutic programmes should be provided to prevent the adverse effects of insomnia in pregnant women with advanced maternal age, lower education, lower economic status, unemployment, lack of insurance coverage, unsatisfied with their relationships with their mothers-in-law, and suffering from anxiety symptoms, especially in the third trimester.

Screening for Depressive Disorder in Elderly Patients with Chronic Physical Diseases Using the Patient Health Questionnaire-9.

ObjectiveWe aimed to identify depressive symptom profiles that indicated the presence of depressive disorder and present optimal cut-off sub-scores for depressive symptom profiles for detecting depressive disorder in elderly subjects with chronic physical diseases including diabetes, chronic obstructive pulmonary disease/asthma, and coronary artery disease, using the Patient Health Questionnaire-9 (PHQ-9).MethodsTwo hundred and thirty-one elderly patients with chronic physical diseases were recruited consecutively from a university-affiliated general hospital in South Korea.ResultsGreater severities of all 9 depressive symptoms in the PHQ-9 were presented in those with depressive disorder rather than those without depressive disorder. A binary logistic regression modeling presented that little interest [adjusted odds ratio (aOR)=4.648, p<0.001], reduced/increased sleep (aOR=3.269, p<0.001), psychomotor retardation/agitation (aOR=2.243, p=0.004), and concentration problem (aOR=16.116, p<0.001) were independently associated with increased likelihood of having depressive disorder. Receiver operating characteristics (ROC) curve analysis presented that the optimal cut-off value of score on the items for little interest, reduced/increased sleep, psychomotor retardation/agitation and concentration problem (PHQ-9) for detecting depressive disorder was 4 with 61.9% of sensitivity and 91.5% of specificity [area under curve (AUC)=0.937, p<0.001].ConclusionOur findings suggested that the diagnostic weighting of little interest, reduced/increased sleep, psychomotor retardation/agitation, and concentration problem is needed to detect depressive disorder among the elderly patients with chronic physical diseases.

Knowledge and Attitude of 851 Nursing Personnel toward Depression in General Hospitals of Korea.

Our study aimed to examine the knowledge and attitude of nursing personnel toward depression in general hospitals of Korea. A total of 851 nursing personnel enrolled at four university-affiliated general hospitals completed self-report questionnaires. Chi-square tests were used to compare the knowledge and attitude of registered or assistant nurses toward depression. In addition, binary logistic regression analysis was used to adjust for the following confounders: age-group and workplace. Registered and assistant nurses differed in their knowledge and attitude toward depression. The proportion of rational and/or correct responses were higher in registered nurses than assistant nurses for the following: constellation of depressive symptoms defined by DSM-IV (adjusted odds ratio [aOR], 3.876; P<0.001); suicide risk in depression recovery (aOR, 3.223; P=0.001) and psychological stress as a cause of depression (aOR, 4.370; P<0.001); the relationship between chronic physical disease and depression (aOR, 8.984; P<0.001); and other items. Our results suggest that in terms of the biological model of depression, the understanding of registered nurses is greater than that of assistant nurses. Moreover, specific psychiatric education programs for nursing personnel need to be developed in Korea. Our findings can contribute to the development of a general hospital-based model for early detection of depression in patients with chronic medical diseases.

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Szakmany, Tamas1; Ellis, Gemma2; Lundin, Robert2; Pignatelli, Llaria2; Hall, Judith3; Morgan, Paul4 Author Information

Pediatric Scoliosis Surgery—Is Postoperative Intensive Care Unit Admission Really Necessary?

Abu-Kishk, Ibrahim*†; Kozer, Eran*†; Hod-Feins, Roei†‡; Anekstein, Yoram†‡; Mirovsky, Yigal†‡; Klin, Baruch†§; Eshel, Gideon*† Author Information

Use of complementary and alternative medicine across the childbirth spectrum in China

Over the last decade, complementary and alternative medicine (CAM) has been widely used in maternity practice all over the world. Women from different cultural backgrounds prefer the use of specific CAM modalities. The objectives of this study were to explore the use of CAM, the types of CAM practitioners consulted, and perceptions of the efficacy of CAM among a sample of Chinese postpartum women. The study's second objective was to investigate common patterns of CAM provided and the reasons for a CAM recommendation to childbearing women, from the perspective of obstetric staff. This cross-sectional survey was undertaken at a university-affiliated general hospital and a maternity and child health hospital in Guangzhou, China. Patients were approached from both the postnatal wards and the postnatal outpatient departments, and healthcare professionals were obstetric staff, including doctors, midwives and nurses who work in the department of obstetrics. A total of 306 patients and 225 obstetric staff completed the questionnaire. The mean age of these patients and obstetric staff was 29.28 (SD 4.31), and 31.01 (SD 6.97) years old, respectively. Questionnaire data revealed the prevalence of CAM use among patients was 42.8%. Common types of CAM used and provided by the studied hospitals include acupressure (43.5%), massage therapy (32.0%), reflexology (30.2%), acupuncture (23.5%), and herbal medicine (20.0%). Most Chinese women used CAM therapies during the postnatal period (30.9%). These women mainly used CAM for pain relief (22.2%) and relaxation (18.3%). The most common reasons for health professionals to recommend CAM to patients, were patient demand (81.3%) and CAM's proven efficacy (81.3%). In order to communicate effectively about CAM, health professionals should undertake continuing professional development on updated perspectives of CAM use in obstetrics, and equip themselves with updated knowledge about the evidence-base for CAM, in order to provide efficient and qualified care to potential CAM users.

A Strategic Plan for the Second Phase (2013–2015) of the Korea Biobank Project

The Korea Biobank Project (KBP) was led by the Ministry of Health and Welfare to establish a network between the National Biobank of Korea and biobanks run by university-affiliated general hospitals (regional biobanks). The Ministry of Health and Welfare started the project to enhance medical and health technology by collecting, managing, and providing researchers with high-quality human bioresources. The National Biobank of Korea, under the leadership of the Ministry of Health and Welfare, collects specimens through various cohorts and regional biobanks within university hospitals gather specimens from patients. The project began in 2008, and the first phase ended in 2012, which meant that there needed to be a plan for the second phase that begins in 2013. Consequently, professionals from within and outside the project were gathered to develop a plan for the second phase. Under the leadership of the planning committee, six working groups were formed to formulate a practical plan. By conducting two workshops with experts in the six working groups and the planning committee and three forums in 2011 and 2012, they have developed a strategic plan for the second phase of the KBP. This document presents a brief report of the second phase of the project based on a discussion with them.During the first phase of the project (2008–2012), a network was set up between the National Biobank of Korea and 17 biobanks at university-affiliated hospitals in an effort to unify informatics and governance among the participating biobanks. The biobanks within the network manage data on their biospecimens with a unified Biobank Information Management System. Continuous efforts are being made to develop a common standard operating procedure for resource collection, management, distribution, and personal information security, and currently, management of these data is carried out in a somewhat unified manner. In addition, the KBP has trained and educated professionals to work within the biobanks, and has also carried out various publicity promotions to the public and researchers. During the first phase, biospecimens from more than 300,000 participants through various cohorts and biospecimens from more than 200,000 patients from hospitals were collected, which were distributed to approximately 600 research projects.The planning committee for the second phase evaluated that the first phase of the KBP was successful. However, the first phase of the project was meant to allow autonomy to the individual biobanks. The biobanks were able to choose the kind of specimens they were going to collect and the amount of specimen they would set as a goal, as well as being allowed to choose their own methods to manage their biobanks (autonomy). Therefore, some biobanks collected resources that were easy to collect and the resources needed by researchers were not strategically collected. In addition, there was also a low distribution rate to researchers outside of hospitals, who do not have as much access to specimens and cases as those in hospitals. There were also many cases in which researchers were not aware of the KBP, and the distribution processes were not set up to be convenient to the demands of researchers.Accordingly, the second phase of the KBP will be focused on increasing the integration and cooperation between the biobanks within the network. The KBP plans to set goals for the strategic collection of the needed human bioresources. Although the main principle of the first phase was to establish infrastructure and resource collection, the key objective of the second phase is the efficient utilization of gathered resources. In order to fully utilize the gathered resources in an efficient way, distribution systems and policies must be improved. Vitalization of distribution, securing of high-value resource and related clinical and laboratory information, international standardization of resource management systems, and establishment of a virtuous cycle between research and development (R&D) and biobanks are the four main strategies. Based on these strategies, 12 related objectives have been set and are planned to be executed.

Pediatric scoliosis surgery – is postoperative intensive care unit admission really necessary?

It is common practice for patients to be admitted to the intensive care unit following scoliosis surgery, because of the prolonged anesthesia, the need for efficient pain control and the known immediate postoperative complications. However, this may be unnecessary in many patients. We aimed to establish possible associations between pre- and perioperative parameters and early postoperative complication rates, in particular the need for prolonged mechanical ventilation (>1day), and the presence of major complications in children undergoing primary spinal fusion by thoracolumbar spine instrumentation. We conducted a retrospective review of children undergoing primary scoliosis surgery at a university-affiliated general hospital from 1998 to 2008. Surgical approaches were as follows: anterior spinal fusion, posterior spinal fusion, and combined anterior and posterior fusion. Prior to mid-2005, anesthesia included morphine; thereafter, remifentanil was used. Major complications correlated significantly with neuromuscular scoliosis (NMS) (OR, 4.94; 95% CI, 1.02-24.05), comorbidity conditions (OR, 3.47; 95% CI, 1.16-10.42), and anterior or combined fusion (OR, 7.81; 95% CI, 2.12-28.57). Late extubation correlated significantly with NMS (OR, 31.25; 95% CI, 1.06-100.00) and morphine use during anesthesia (OR, 17.91; 95% CI, 1.44-222.9). Relatively young, healthy idiopathic scoliosis children receiving intraoperative remifentanil sedation and undergoing posterior fusion can be successfully managed in regular wards in the immediate postoperative period. However, intensive care unit admission should be considered in NMS patients, patients with comorbidity conditions, those undergoing anterior or combined spinal fusion, and patients whose anesthesia involves long-acting opioids.

Is Pain Associated With Suicidality in Stroke?

ObjectiveTo evaluate the relation between poststroke pain and suicidality (SI) in Chinese patients with first or recurrent stroke. DesignCross-sectional survey. SettingAcute stroke unit of a university-affiliated general hospital. ParticipantsPatients (N=496) with acute ischemic stroke admitted to the Acute Stroke Unit. InterventionsNot applicable. Main Outcome MeasuresPatients were interviewed 3 months after the index stroke. SI was assessed with the Geriatric Mental State Examination. Pain was evaluated with the Faces Pain Rating Scale-Revised (FPS-R). The association between FPS-R scores and SI was examined and adjusted for potential confounders, including marital status, depression, neurologic deficits assessed by the National Institute of Health Stroke Scale, and functioning measured by the Barthel Index. ResultsThirty-seven (7.5%) of the patients had SI (the SI group). Compared with the non-SI group, patients in the SI group were more likely to experience pain (59.5% vs 37.7%), had a higher mean FPS-R score (6.0±2.5 vs 4.5±2.3), and had an FPS-R score of >4 (43.2% vs 15.9%). After adjustment for possible confounders, the FPS-R score of >4 (odds ratio=2.9) remained a significant predictor of SI in the subsequent forward logistic regression models. ConclusionsThese findings should alert clinicians that the early identification and treatment of pain may reduce suicide risk in patients with stroke.

Suicidal ideation in seropositive patients seen at a South African HIV voluntary counselling and testing clinic

Suicidal behaviour and HIV/AIDS are significant public health concerns. The aim of this study was to investigate suicidal ideation in patients who were referred to a voluntary HIV counselling and testing (VCT) clinic and who were found to be seropositive. This in order to improve suicide prevention and intervention strategies amongst such patients. The sample studied consisted of volunteer adult patients referred over a three-month period to a HIVVCT clinic based at a university-affiliated general state hospital. Patients completed a questionnaire on sociodemographic data. Suicidal ideation was measured using the Beck Hopelessness Scale and the Beck Depression Inventory (BDI), at two time points (within 72 hours after notification and again at a 6 week follow-up). All patients received extensive pre-and post-test counselling. HIV-test results were available for 189 (99.5%) of the original sample of 190 patients studied, with 157 (83.1%) testing positive. More females tested positive as did unemployed and single/divorced patients. The mean age for HIV-positive patients was 33.49 (SD = 9.449), and for HIV-negative patients it was 37.94 (SD = 15.238). Age was a significant factor in that for each year increase in age, the risk of testing HIV-positive decreased by 4.1%. Lower education and traditional beliefs were also significantly associated with testing HIV-positive. At 72 hours suicidal ideation was present in 17.1% (95% confidence interval 12.16% to 23.45%), and at 6 weeks in 24.1% (95% confidence interval 17.26% to 32.39%) of the seropositive patients. Their average BDI scores were 15.20 and 14.23 respectively at the two time points. Suicidal ideation was present in a significant number of the seropositive cohort studied and increased over a six week period among these patients. The average BDI scores at both time points imply a clinical depression. The findings also suggest an association between positive HIV-test results and certain socio-demographic variables that can act as indicators for suicidal ideation in HIV-infected persons, although this requires further research. Although the relationship between suicidal ideation and HIV-infection is complex, it is an important consideration when assessing patient suicide vulnerability at HIV VCT clinics and when implementing suicide prevention and management strategies.

Cerebrospinal Fluid β‐Amyloid and Tau Are Not Associated with Risk of Delirium: A Prospective Cohort Study in Older Adults with Hip Fracture

To examine the association between cerebrospinal fluid (CSF) β-amyloid (Aβ1-42), tau, and hyperphosphorylated tau (Ptau) and risk of delirium in older adults with hip fracture. Prospective cohort study. University-affiliated general hospital in Alkmaar, the Netherlands. Seventy-six participants aged 75 and older admitted for surgical repair of acute hip fracture. Presurgical baseline screening and assessment included the Informant Questionnaire on Cognitive Decline-short form (IQCODE-N), Mini-Mental State Examination, standardized Snellen test for visual impairment, Geriatric Depression Scale, Barthel Index (BI), and Lawton Instrumental Activity of Daily Living (IADL) scale. The number of medical comorbidities and medications at home, American Society of Anesthesiologists score, and Acute Physiology and Chronic Health Evaluation II score were determined according to chart review. Delirium was diagnosed using the Confusion Assessment Method. CSF was collected at the onset of spinal anesthesia. Postoperative delirium occurred in 30 (39.5%) participants. Participants with delirium were older, showed more signs of cognitive decline, were more dependent at home in activity of daily living and IADL functioning, and used more medications before admission. Preoperative CSF Aβ1-42, tau, and Ptau levels were not significantly different in participants who did and did not develop delirium during subsequent hospitalization. In contrast, prefracture cognitive decline (IQCODE-N) was significantly related to delirium (odds ratio=9.43, 95% confidence interval=2.45-36.31). Cognitive impairment predisposes to delirium, but in this study, postoperative delirium was not associated with baseline CSF Aβ1-42, tau, and Ptau levels. These findings suggest that CSF markers for plaque and tangle formation are not strongly associated with delirium risk in older adults with hip fracture.

Dose-dependent hemodynamic effects of propofol induction following brotizolam premedication in hypertensive patients taking angiotensin-converting enzyme inhibitors

Study Objective To determine a propofol dose that minimizes hemodynamic changes on induction of anesthesia in patients chronically taking angiotensin-converting enzyme inhibitors (ACEIs). Design Prospective, randomized trial. Setting Operating room of a university-affiliated general hospital. Patients 88 ASA physical status II and II hypertensive patients chronically taking ACEIs, scheduled for elective abdominal surgery with general anesthesia. Interventions Patients were premedicated with brotizolam and anesthesia was induced with propofol, fentanyl, and rocuronium; anesthesia was then maintained with isoflurane. Patients were randomly assigned to undergo anesthetic induction with propofol in doses of 1.3, 1.6, 2.0, or 2.3 mg/kg. Measurements Oscillometric blood pressure and heart rate were evaluated at one-minute intervals during the first 10 minutes of anesthesia. End-tidal isoflurane concentrations were also recorded. Episodes of hypertension, tachycardia, bradycardia, or hypotension (defined as > 30% of baseline values) were managed per protocol with esmolol, atropine, phenylephrine, or ephedrine. Administration of any of these drugs was considered a pharmacological intervention. Main Results After adjusting for covariables in a model assuming a linear relationship between dose and log-response, each propofol dose increase of 0.3 mg/kg was associated with a 31% increase in mean number of hypotensive/bradycardic episodes requiring interventions (95% confidence intervals of +5% and +65%; P = 0.018). Based on our model, a dose of 1.3 mg/kg resulted in the fewest number of pharmacological interventions. Conclusions In patients chronically taking ACEIs, low doses of propofol reduce hemodynamic instability.

Case-control study of suicide attempts in the elderly

Prior studies have inadequately explored the relationship between late-life suicidal behavior and subclinical/clinical symptoms. This study aimed to assess the risk associated with subclinical symptoms, mild cognitive impairment and clinical factors among late-life suicide attempters. Forty-three elderly patients aged 60 years and older who sought emergency services in a university-affiliated general hospital for attempting suicide and 43 comparison subjects participated in this study between March 2005 and December 2006. The comparison group was recruited by advertising in the community around the hospital. DSM-IV based diagnostic interview and screening instruments including the GDS, MMSE, BSRS-5 and APGAR were applied. Adjusted odds ratios were measured in the final multiple logistic regression model. Suicide attempters were more likely to meet a diagnosis of depressive disorder, after adjustments for BSRS-5 score and drinking habit. The adjusted odds of suicide among people with a BSRS-5 score of more than 5 points was 17.8 times higher than those with the BSRS score less than or equal to 5 points. Our findings support the significant impact on late-life suicidal behavior from the assessment of subclinical symptoms, including anxiety, depression, hostility, sleep condition and interpersonal symptoms. The assessment of subclinical symptoms by the BSRS-5 may help in the future prevention of late-life suicidal behavior in primary care settings.

Changes in Outcome during Implementation of a Fast-Track Colonic Surgery Project in a University-Affiliated General Teaching Hospital

Background and Aims: The aim of this study was to investigate whether changes can be accomplished rapidly after implementing a fast-track colonic surgery project at a university-affiliated general teaching hospital. Methods: In 2004 and 2005 all colonic surgery patients were recorded for a number of pre-, per- and postoperative care elements. In 2006, during the implementation of a fast-track program, changes were recorded. Results: Before the implementation of the fast-track regime at our hospital, 97% of the patients (n = 89/92) received mechanical bowel preparation, in contrast to 3% (n = 1/36) afterwards (p < 0.0001). The application of thoracic epidural analgesia rose from 46% (n = 42/92) in 2004 and 2005 to 94% (n = 34/36) in 2006 (p < 0.0001). The use of nasogastric tubes postoperatively almost disappeared. 77% (n = 28/36) enjoyed a small meal on the 1st day after operation, compared to 0% (n = 0/92) in 2004 and 2005 (p < 0.0001). Median hospital stay was 6 (range 3–27) nights in 2006 compared to 9 (range 3–25) nights in 2005 and 9.5 (range 7–64) nights in 2004 (p < 0.005). Conclusion: These preliminary results show that also at a district general teaching hospital advantages can be reached rapidly and safely by implementing fast-track surgery; especially a faster recovery.

Comparative effects of propofol, landiolol, and nicardipine on hemodynamic and bispectral index responses to endotracheal intubation: a prospective, randomized, double-blinded study

Study Objectives To examine the comparative effects of propofol, landiolol, and nicardipine on hemodynamic responses and bispectral index (BIS) changes to endotracheal intubation. Setting Operating room of a university-affiliated general hospital. Patients 27 ASA physical status I and II patients who were scheduled to undergo elective general surgical, urological, or gynecological procedures with general anesthesia. Study Design Prospective, randomized, double-blinded study. Interventions Patients were divided into three groups as follows: Group 1 received propofol, 1 mg/kg; Group 2 received landiolol, 0.1 mg/kg; and Group 3 received nicardipine, 1 mg. After baseline measurements were recorded, anesthesia was induced with propofol, fentanyl, and vecuronium. Patients' lungs were ventilated with 100% oxygen for 120 seconds, at which time one of one of the study drugs was administered. Laryngoscopy and tracheal intubation were performed 4 minutes after anesthetic induction. Measurements Cardiac index (CI) and stroke volume index (SVI) were monitored continuously. Bispectral index was also monitored continuously from 5 minutes after tracheal intubation. Main Results Heart rate values in Group 3 increased 30 seconds after intubation; this increase lasted for 1 minute after intubation. Systolic blood pressure in all three groups decreased after induction of anesthesia and before tracheal intubation, and values returned closer to baseline values 30 seconds after intubation. In the propofol group, CI and SVI decreased after administration of additional propofol, lasting for 30 seconds after intubation. The BIS values rapidly decreased after induction of anesthesia, with no intergroup differences noted in BIS values (propofol group, 39 ± 7; landiolol group, 44 ± 14; nicardipine group, 41 ± 9). However, BIS was significantly lower in the propofol group than in the other two groups from 30 seconds to 5 minutes after intubation. Conclusions Landiolol, 0.1 mg/kg, before intubation provides effective hemodynamic stability in the postintubation period.