Achievement ; Health Promotion ; Humans ; Mental Disorders ; Mental Health Services ; Risk ; Singapore

PURPOSE: The purpose of this study was to review intervention programs for experienced nurses' job stress and mental health. METHODS: Searches of literature were conducted through four electronic databases (RISS, KISS, PubMed, and CINAHL), focusing on the recent 5-year publications in English or Korean. Thirteen studies were selected for the final analysis and Scottish Intercollegiate Guidelines Network checklist was used to assess methodological rigor and quality. RESULTS: Randomized controlled trials were used in five studies and quasi-experimental designs in eight studies. Cognitive-Behavioral Therapy (CBT) and group approach were the most frequent types of interventions in six and nine studies respectively. On average, the intervention was required for eight weeks and 60~120 minutes per session. After evaluating the effects of CBT, complementary alternative therapy, informative training, simulation training and stimuli control, most of the tested interventions reduced experienced nurses' job stress and improved mental health, but informative training did not. CONCLUSION: Despite the obvious importance of experienced nurses in quality of nursing care, it has not been well studied due to limited numbers of studies with less rigorous design. Study findings provide a basis for developing intervention programs to reduce job stress and improve mental health for experienced nurses.
Checklist ; Mental Health ; Nursing Care ; Simulation Training

PURPOSE: The purpose of this study was to explore the role of clinical nursing instructors' lived experience in clinical practicum.METHODS: Data were collected from 11 clinical nursing instructors by in-depth interviews. The data were analyzed using content analysis of Downe-Wamboldt (1992).RESULTS: Four themes and twelve subthemes were extracted. 1) Recognizing and conducting the roles of clinical nursing instructor: ‘Helping and providing support for successful clinical practicum’, ‘Coordinating clinical activities in daily practice’, ‘Providing mentoring as an elder in life’; 2) Participating in improving integrative nursing competency: ‘Helping to improve cognitive competency’, ‘Helping to improve functional competency’, ‘Contributing to form desirable professionalism’, ‘Helping to deliberate the nature of nursing’; 3) Experiencing difficulties in performing the role of clinical nursing instructor: ‘Facing with difficulty from institutional limits’, ‘Recognizing difficulty from lack of personal knowledge and experience’; 4) Experiencing value of clinical nursing instructor and accomplishing personal growth: ‘Making efforts to widen personal knowledge and experience’, ‘Developing one's own educational competency’, ‘Making a chance to reflect oneself’.CONCLUSION: Despite the distinctive features of clinical nursing instructors, little is known of the characteristics. The results of this study could be used as a reference to improve the quality of clinical nursing education.
Education ; Education, Nursing ; Humans ; Mentors ; Nursing ; Preceptorship ; Qualitative Research

Drug induced liver injury (DILI) may be different in the East compared to the West due to differing disease prevalence, prescribing patterns and pharmacogenetic profiles. To review existing literature on causative agents of DILI in the East compared to the West, a comprehensive literature search was performed on electronic databases: MEDLINE/PubMed, Embase, Cochrane Library and China National Knowledge Infrastructure without language restrictions. Studies which involve patients having DILI and reported the frequency of causative agents were included. A random effects model was applied to synthesize the current evidence using prevalence of class-specific and agent-specific causative drugs with 95% confidence intervals. Of 6,914 articles found, 12 showed the distribution of drugs implicated in DILI in the East with a total of 33,294 patients and 16 in the West with a total of 26,069 DILI cases. In the East, the most common agents by class were anti-tuberculosis drugs (26.6%), herbal and alternative medications (25.3%), and antibiotics (15.7%), while in the West, antibiotics (34.9%), cardiovascular agents (17.3%), and non-steroidal anti-inflammatory drugs (12.5%) were the commonest. For individual agents, the most common agents in the East were isoniazid-rifampicin-pyrazinamide (25.4%), phenytoin (3.5%), and cephalosporin (2.9%) while in the West, amoxicillin-potassium clavulanate combination acid (11.3%), nimesulide (6.3%), and ibuprofen (6.1%) were the commonest. There was significant heterogeneity due to variability in single-centre compared to multi-centre studies. Differences in DILI in the East versus the West both in drug classes and individual agents are important for clinicians to recognize.

Glioblastoma multiforme (GBM) is the most common primary brain cancer. Even with aggressive combination therapy, the median life expectancy for patients with GBM remains approximately 14 months. In order to improve the outcomes of patients with GBM, the development of newer treatments is critical. The concept of using the immune system as a therapeutic option has been suggested for several decades; by harnessing the body's adaptive immune mechanisms, immunotherapy could provide a durable and targeted treatment against cancer. However, many cancers, including GBM, have developed mechanisms that protect tumor cells from being recognized and eliminated by the immune system. For new immunotherapeutic regimens to be successful, overcoming immunosuppression via immune checkpoint signaling should be taken into consideration.
Brain Neoplasms ; Glioblastoma* ; Humans ; Immune System ; Immunosuppression ; Immunotherapy ; Life Expectancy ; Radiosurgery

Amyloidosis/diagnostic imaging* ; Cardiomyopathies/diagnostic imaging* ; Diagnostic Imaging ; Humans ; Prealbumin/genetics*

Background: Periocular dark circles (PDCs) are a common cosmetic complaint. Grading systems based on objective measures have been used but no standard system is in place. Objective: To determine factors associated with subjective and objective PDC severity. Methods: Enrolled patients (n=100) completed a questionnaire comprised of demographic variables, medical history, and self-perception of PDC. Those perceiving PDC graded dissatisfaction on a 10-point scale. Clinical severity (grades 0∼4) and subtype (constitutional, post-inflammatory, vascular, shadow effects, or others) were determined. A Konica Minolta CR-400 chromameter was used to obtain colorimetry measurements (L*a*b* values). The objective average difference in darkness (ΔL*) between the periocular region and the cheek was determined. Comparisons were made using Spearman correlation coefficients (r). Results: Patient dissatisfaction correlated with both clinical severity (r=0.46,p＜0.001) and the ΔL* by colorimetry (r=0.35, p=0.004). Factors associated with subjective dissatisfaction were female sex (r=0.38, p=0.002), higher Fitzpatrick skin type (r=0.42, p=0.001), fewer hours of sleep (r=–0.28, p=0.03), and use of concealer (r=0.35, p=0.004). Factors associated with objective measures were higher Fitzpatrick skin type (r=0.36, p= 0.0007 and r=0.28, p=0.009, respectively), family history of PDC (r=0.34, p＜0.001 and r=0.20, p=0.05), and history of eczema (r=0.45, p＜0.001 and r=0.20, p=0.0504). Clinical severity grading correlated with colorimetric severity (r=0.36, p=0.0003). Conclusion Overall, subjective dissatisfaction was associated with clinical severity. However, factors associated with subjective severity did not necessarily overlap with factors associated with objective severity. These findings highlight the importance of patient-reported grading. There may be added value in incorporating a component of subjective grading into the traditionally objective PDC grading scales.

Background: Periocular dark circles (PDCs) are a common cosmetic complaint. Grading systems based on objective measures have been used but no standard system is in place. Objective: To determine factors associated with subjective and objective PDC severity. Methods: Enrolled patients (n=100) completed a questionnaire comprised of demographic variables, medical history, and self-perception of PDC. Those perceiving PDC graded dissatisfaction on a 10-point scale. Clinical severity (grades 0∼4) and subtype (constitutional, post-inflammatory, vascular, shadow effects, or others) were determined. A Konica Minolta CR-400 chromameter was used to obtain colorimetry measurements (L*a*b* values). The objective average difference in darkness (ΔL*) between the periocular region and the cheek was determined. Comparisons were made using Spearman correlation coefficients (r). Results: Patient dissatisfaction correlated with both clinical severity (r=0.46,p＜0.001) and the ΔL* by colorimetry (r=0.35, p=0.004). Factors associated with subjective dissatisfaction were female sex (r=0.38, p=0.002), higher Fitzpatrick skin type (r=0.42, p=0.001), fewer hours of sleep (r=–0.28, p=0.03), and use of concealer (r=0.35, p=0.004). Factors associated with objective measures were higher Fitzpatrick skin type (r=0.36, p= 0.0007 and r=0.28, p=0.009, respectively), family history of PDC (r=0.34, p＜0.001 and r=0.20, p=0.05), and history of eczema (r=0.45, p＜0.001 and r=0.20, p=0.0504). Clinical severity grading correlated with colorimetric severity (r=0.36, p=0.0003). Conclusion Overall, subjective dissatisfaction was associated with clinical severity. However, factors associated with subjective severity did not necessarily overlap with factors associated with objective severity. These findings highlight the importance of patient-reported grading. There may be added value in incorporating a component of subjective grading into the traditionally objective PDC grading scales.

Objective: Undifferentiated and dedifferentiated endometrial carcinoma is a rare type of uterine malignancy. This study assesses disease characteristics, treatment and survival outcomes in patients with undifferentiated and dedifferentiated endometrial carcinoma treated at BC Cancer. Methods: All patients diagnosed with undifferentiated and dedifferentiated endometrial carcinoma between 2000 and 2019 at BC Cancer were reviewed centrally. Clinical, pathologic, treatment and outcomes were reviewed retrospectively. The Kaplan-Meier method was used to evaluate overall survival (OS) and disease-free survival (DFS). Multivariable analysis was performed using Cox regression analysis. Results: Fifty-two patients were included, 33% had undifferentiated carcinoma and 67% dedifferentiated carcinoma. Sixty-nine percent of those who had mismatch repair (MMR) testing of their tumor had an abnormal profile. The 5-year DFS was 80% (95% confidence interval [CI]=71%–89%) for stage I/II, 29% (95% CI=28%–40%) for stage III and 10% (95% CI 1%–19%) for stage IV. The 5-year OS was 84% (95% CI=75%–92%) for stage I/II, 38% (95% CI=26%–50%) for stage III and 12% (95% CI=1%–24%) for stage IV. Multivariate analysis showed that receiving adjuvant chemotherapy, adjuvant radiotherapy, lower stage and better Eastern Cooperative Group performance status were associated with improved DFS (p<0.05). Conclusion Patients with stage I/II undifferentiated and dedifferentiated endometrial carcinoma had excellent survival outcomes, those with stage III/IV had worse outcomes, similar to previously reported. Adjuvant chemotherapy and radiotherapy were associated with improved DFS. MMR testing should be performed for these patients due to the high incidence of abnormal profiles.

OBJECTIVES: This study aims to evaluate the effectiveness of the Lean Six Sigma approach in improving procedure for (TAT) of reverse transcriptase polymerase chain reaction (RT-PCR) for SARS-CoV-2 testing at The Medical City. Specific objectives of the study are to determine the following: 1) baseline sigma and average TAT (in hours); 2) post-implementation sigma and average TAT (in hours) 3) compare if there is a significant improvement between baseline and post-implementation sigma and average TAT (in hours) 4) effect on workflow efficiency. METHODOLOGY: Lean Six Sigma method for quality improvement was applied using DMAIC: Define, Measure, Improve, and Control. The root causes identified were lack of manpower, equipment, space, and manual and complex processes. Then, process wastes were identified, and corresponding proposed solutions were sustained in the control phase, such as standardization and the use of automation. Measurement of turn-around time and six sigma of the process were performed for evaluation. RESULTS: Results showed a significant improvement in the TAT in RT-PCR results, with most results released within 24 hours. The pre-Lean Six Sigma data on TAT were as ollows: 24.88% released within 24 hours; 65.14% released within 24-48 hours; 3.56% released within 48-72 hours, and 6.42% released in more than 72 hours. The post Lean Six Sigma TAT were as ollows: 95.32% released within 24 hours; 4.29% released within 24 to 48 hours; 0.13% released within 48-72 hours, and 0.12% released more than 72 hours. The computed sigma post-implementation was increased from 3.56 to 4.82. The p-value was calculated using the chi-square test, and the computed chi-square statistic is 1894.1021. The p-value is <0.00001 and the result is significant at p<.05. Although there is a significant decrease in the volume of samples post implementation due to the changing COVID-19 situation, real time TAT was improved. It also resulted to increased workflow efficiency with the use of lesser manpower with more appropriate utilization. CONCLUSION Applying the Lean Six Sigma method to improve quality processes in the laboratory is shown to be practical, cost-effective, and straightforward.
Lean Six Sigma ; SARS-CoV-2