BACKGROUND: Unlike other diseases, the management of sepsis has not been fully integrated in our daily practice. The aim of this study was to determine whether repeated training could improve compliance with a 6-h resuscitation bundle in patients with severe sepsis and septic shock. METHODS: Repeated education regarding a sepsis bundle was provided to the intensive care unit and emergency department residents, nurses, and faculties in a single university hospital. The educational program was led by a multidisciplinary team. A total of 175 adult patients with severe sepsis or septic shock were identified (88 before and 87 after the educational program). Hemodynamic resuscitation bundle and timely antibiotics administration were measured for all cases and mortality at 28 days after sepsis diagnosis was evaluated. RESULTS: The compliance rate for the sepsis resuscitation bundle before the educational program was poor (0%), and repeated training improved it to 80% (p < 0.001). The 28-day mortality was significantly lower in the intervention group (16% vs. 32%, p = 0.040). Within the intervention group, patients for whom the resuscitation bundle was successfully completed had a significantly lower 28-day mortality than other patients (11% vs. 41%, p = 0.004). CONCLUSIONS: Repeated education led by a multidisciplinary team and interdisciplinary communication improved the compliance rate of the 6-h resuscitation bundle in severe sepsis and septic shock patients. Compliance with the sepsis resuscitation bundle was associated with improved 28-day mortality in the study population.
Adult ; Anti-Bacterial Agents ; Compliance ; Critical Pathways ; Diagnosis ; Education ; Emergency Service, Hospital ; Hemodynamics ; Humans ; Intensive Care Units ; Interdisciplinary Communication ; Mortality ; Resuscitation* ; Sepsis* ; Shock, Septic

No abstract available.
Mesenteric Artery, Superior*

Purpose: This study investigated the influence of nursing practice readiness and, resilience on the nursing performance of new nurses. Methods: Participants were 234 new nurses with 6-24 months of working experience at the wards in university and general hospitals in the B area and C areas. The collected data were analyzed using SPSS/Win 24.0, and frequency percentage, mean, and standard deviation were calculated, Mann-Whitney U test, Kruskal-Wallis test, analysis of variance, Pearson's correlation coefficients, and multiple regression analyses were performed, and the variable selection method was set as stepwise. Results: Nursing performance significantly differed by weekly job-related education (Z=10.01, p=.007) and salary satisfaction (Z=13.04, p=.001). The nursing performance of new nurses was positively correlated with nursing practice (r=.70, p<.001) and resilience (r=.51, p<.001). The significant predictors of nursing performance were nursing practice readiness (β=.61, p<.001), resilience (β=.16, p=.003), and job training hours (β=.11, p=.02). The explanatory power of these factors was 52.0% of the variance. Conclusion To enhance the nursing performance of new nurses, it is necessary to improve nursing practice readiness, provide job training, and strengthen resilience. In addition, it is necessary to support programs at the institutional level for nursing performance.

Genetic causes of developmental and epileptic encephalopathy (DEE) have been rapidly uncovered from mid-2010s. The mutations of gene enconding calcium channel, voltage-dependent, P/Q type, alpha 1A subunit (CACNA1A) are recently detected in DEE, which gene is already known well in familial hemiplegic migrine type 1 or episodic ataxia type 2. Ketogenic diet therapy (KDT) is effective in some DEE, which data is short in CACNA1A encephalopathy. A 3-month-old male with global developmental delay and multidrug-resistant focal seizures was diagnosed as epilepsy of infancy with migrating focal seizures (EIMFS). Brain magnetic resonance imaging and metabolic screening were all normal. Whole exome sequencing revealed two variants of CACNA1A : c.899A>C, and c.2808del that is from his mother. His seizures disappeared within 3 days whenever on KDT, which recurred without it. To our knowledge, this rare case of EIMFS with novel mutations of CACNA1A, is the first report in CACNA1A encephalopathy becoming seizure-free on KDT.

Purpose: This study aimed to examine the impacts of alternative clinical practice on nursing professionalism in nursing students during the coronavirus disease 2019 (COVID-19) pandemic. Methods: A cross-sectional study was used for this study. Data were collected from 178 junior and senior nursing students from December 28, 2022 to January 6, 2023. The nursing students’ characteristics, nursing professionalism, clinical competence, extent of alternative clinical practice, and satisfaction with alternative clinical practice were self-reported through an on-line survey. Multiple linear regressions were conducted to examine the impacts of alternative clinical practice on nursing professionalism along with the confounding variables. Results: The nursing students reported that they performed alternative clinical practice for more than half of their clinical practice throughout 2022. The extent of alternative clinical practice (β=-.11, p=.028), satisfaction with content (β=.14, p=.045), and evaluation of the alternative clinical practice (β=.17, p=.007) were found to have impacted nursing professionalism. These variables explained 55.6% of the variance in nursing professionalism. Conclusion The study results suggest that the alternative nursing practice could impact nursing students’ professionalism. However, it would be possible to develop nursing professionalism if the students’ satisfaction with the alternative clinical practice were increased. Nurse educators need to improve the content and evaluation methods of alternative clinical practice to promote nursing professionalism during the implementation of such alternative clinical practice.

Urine discoloration occurs in the intensive care unit (ICU) due to many causes such as medications, metabolic disorders, and infections. Propofol is advocated as one of the first line sedatives in the ICU, but it is not well known to the intensivists that propofol can induce urine color change. We experienced two cases of green urine after propofol infusion. Propofol should be warranted as the cause of urine discoloration during ICU stay.
Hypnotics and Sedatives ; Intensive Care Units* ; Propofol*

BACKGROUND: We assessed the accuracy of staging in evaluation of bronchial invasion thus found the role of CT in patients who underwent resective surgery in primary lung cancer. Materials and METHODS: Authors retrospectively analized the preoperative CT scans of 156 patients receiving pneumonectomy(n=95) and lobectomy(n=61). Among lobectomy patients 7 patients subsequently performed pneumonectomy because of positive resection margin of bronchus in frozen biopsy. We also retrospect lively analized CT scans of non-operated 60 patients who Performed sufficient bronchoscopic biopsy. Bronchial wall thickness more than 3mm, irregular wall thickening find reduction of diameter by CT were defined as bronchial invasion. The pathologic examination of resection margin were positive in 20, stump recurrence occurred in 6 of the operated group, and the pathologic examination of biopsy of bronchial wall were positive in 34 of the non operated group, and these were all regarded as bronchial invasion. RESULTS: The CT assessment of bronchial invasion revealed low sensitivity (11.5%), low positive predictability(38%), but high specificity(96%) and relatively high accuracy (84%) in the operated group and higher sensitivity (62%), higher positive predictability(95%) in non-operated group. CONCLUSION: In lung cancer patients who underwent operation CT showed very low sensitivity and positive predictability In evaluation of bronchial invasion Because the usefulness of CT in evaluation of bronchial invasion is limited, therefore aggressive fiberoptic bronchoscopic biopsy is thought to be necessary before surgical attempt.
Biopsy ; Bronchi ; Humans ; Lung Neoplasms* ; Lung* ; Pneumonectomy ; Recurrence ; Retrospective Studies ; Tomography, X-Ray Computed

No abstract available.
Membranes* ; Pregnancy* ; Rupture*

BACKGROUND: Disordered lactate metabolism which is due to tissue hypoxia and hypoperfusion is frequently encountered in critically ill patients. These patients suffer from a high hospital mortality rate and are at great risk of developing multiple organ failure. The present study was designed to evaluate the prognostic value of blood lactate as a determinant of mortality in comparison with the APACHE II score. METHODS: 29 adult ICU patients participated in this study. Blood lactate concentrations, arterial blood gas analysis, hemodynamic data and APACHE II scores were collected on the first and last days of ICU stay. These data were compared between survivor and non-survivor groups. RESULTS: On the day of admission, blood lactate concentrations and APACHE II scores of non-survivors were 48.5 +/- 27.0 mg/dl and 18.5 +/- 5.9, while those of survivors were 23.7 +/- 12.9 mg/dl and 6.7 3.1. On the day of discharge, arterial blood lactate concentrations and APACHE II scores of non-survivors were 143.2 +/- 54.0 mg/dl and 28.2 +/- 6.0, while those of survivors were 14.9 +/- 7.1 mg/dl and 4.7 +/- 2.2. There was a significant positive correlation between high arterial blood lactate concentration and fatal outcome in critically-ill patients. There was also a significant positive correlation between arterial blood lactate concentration and APACHE II score. Furthermore, decreases in arterial blood lactate levels during the course of ICU stay may indicate a favorable outcome. The mortality increased abruptly in critically-ill patients with an initial arterial blood lactate concentration higher than 40 mg/dl. CONCLUSIONS: The result shows that arterial blood lactate concentration can serve as a reliable prognostic predictor and clinical guide to therapy in critically ill patients.
Adult ; Anoxia ; APACHE* ; Blood Gas Analysis ; Critical Illness* ; Fatal Outcome ; Hemodynamics ; Hospital Mortality ; Humans ; Lactic Acid* ; Metabolism ; Mortality ; Multiple Organ Failure ; Survivors

No abstract available.
Hyperprolactinemia*