The effects of anesthetic agents on pupillary function during general anesthesia using the automated infrared quantitative pupillometer

Pupil reactivity can be used to evaluate central nervous system function and can be measured using a quantitative pupillometer. However, whether anesthetic agents affect the accuracy of the technique remains unclear. We examined the effects of anesthetic agents on pupillary reactivity. Thirty-five patients scheduled for breast or thyroid surgery were enrolled in the study. Patients were divided into four groups based on the technique used to maintain anesthesia: a sevoflurane–remifentanil (SEV/REM) group, a sevoflurane (SEV) group, a desflurane–remifentanil (DES/REM) group, and a propofol–remifentanil (PRO/REM) group. We measured maximum resting pupil size (MAX), reduction pupil size ratio (%CH), latency duration (LAT) and neurological pupil index (NPi). A marked reduction in MAX and %CH compared with baseline was observed in all groups, but LAT was unchanged during surgery. NPi reduced within the first hour of surgery in the SEV/REM, SEV, and DES/REM groups, but was not significantly different in the PRO/REM group. Compared with the PRO/REM group, mean %CH and NPi in patients anesthetized with SEV/REM, SEV or DES/REM were markedly lower at 1 h after surgery had commenced. There was no correlation between NPi and bispectral index. Fentanyl given alone decreased pupil size and %CH in light reflex, but did not change the NPi. NPi was decreased by inhalational anesthesia not but intravenous anesthesia. The difference in pupil reactivity between inhalational anesthetic and propofol may indicate differences in the alteration of midbrain reflexs in patients under inhalational or intravenous anesthesia.     

The effects of pilates and flavanol-rich dark chocolate consumption on the total antioxidant capacity,glycemic control and BMI in diabetic females with neuropathy complications

BackgroundPilates is a type of exercise recommended to diabetic patients due to its health benefits. Dark chocolate is also well known for its antioxidant properties. The purpose of this study has been to compare the effects of regular Pilates and flavanol-rich dark chocolate consumption on the total antioxidant capacity (TAC), fasting blood glucose (FBG) and BMI in diabetic females with peripheral neuropathy complications.Methods36 diabetic patients enrolled in this single-blinded clinical trial. They were randomly allocated to the control (n = 12), Pilates and dark chocolate intake (n = 12), and Pilates and flavanol-free white chocolate (n = 12) groups. Two Pilates groups consumed 25 gr dark or white chocolate 10 min before each Pilates training session, three times per week, for 8 weeks. The control group consumed 25 gr of the same dark chocolate at a pre-determined time 3 times per week, without any regular exercise. Changes in TAC, BMI and FBG were then measured.ResultsPaired t-test analysis showed significant increases in the TAC status, as compared to the baseline in all groups (P ≤ 0.05). However, BMI and FBG reduction were not significant. Covariance (ANCOVA) analysis also showed a significant difference between groups (p < 0.05). Post-hoc Bonferroni test revealed the group that consumed dark chocolate before training had statistically significant increase in the TAC status compared to other groups.ConclusionThe findings indicated that regular flavanol-rich dark chocolate consumption and Pilates significantly increased the TAC status. While FBG was reduced, it was not statistically significant.     

A comparison of manual pupil examination versus an automated pupillometer in a specialised neurosciences intensive care unit

BackgroundThe assessment of pupil size and reaction to light is a fundamental part of the neurological assessment; however, manual examination is prone to inaccuracies. The use of an automated infrared pupillometer is one strategy to limit error in pupil examination.ObjectiveThe main objective was to assess agreement between manual examination and examination using an automated infrared pupillometer in relation to pupil reaction and size in a specialised neurosciences intensive care unit.MethodsWe conducted a single-centre prospective observational study in a specialised tertiary neurosciences intensive care unit. Participants' pupils were examined hourly for 24 h by both manual examination using a pen torch and examination using an automated infrared pupillometer.ResultsTwenty-two participants were enrolled. A total of 935 paired pupil observations were obtained for both pupil reaction and size. There was no statistically significant disagreement in assessing pupil reaction (McNemar's test p = 0.106). Percentage agreement was 96.68% for pupil reaction, with Kappa coefficient, 0.841 (95% confidence interval: 0.7864–0.8956). For all participants, the mean difference in pupil size was 0.154 mm, with limits of agreement of −1.294 mm to +1.603 mm.ConclusionThere was no significant disagreement between manual and automated pupillometer observations for pupil reaction. The mean difference in measurement of pupil size was small.     

Shotgun Wounds: Nationwide Trends in Epidemiology,Injury Patterns,and Outcomes from US Trauma Centers

BackgroundShotguns represent a distinct form of ballistic injury because of projectile scatter and variable penetration. Due in part to their rarity, existing literature on shotgun injuries is scarce.ObjectiveThis study defined the epidemiology, injury patterns, and outcomes after shotgun wounds at a national level.MethodsPatients with shotgun injury were identified from the National Trauma Data Bank (2007–2014). Transferred patients and those with missing procedure data were excluded. Demographics, injury data, and outcomes were collected and analyzed. Categorical variables are presented as number (percentage) and continuous variables as median (interquartile range).ResultsShotgun wounds comprised 9% of all firearm injuries. After exclusions, 11,292 patients with shotgun injury were included. The median age was 29 years (21–43) and most were male (n = 9887, 88%). Most injuries occurred in the South (n = 4092, 36%) and among white patients (n = 4945, 44%). The median Injury Severity Score was 9 (3–16). Overall in-hospital mortality was 14% (n = 1341), with 669 patients (7%) dying in the emergency department. Assault was the most common injury intent (n = 6762, 60%), followed by accidental (n = 2081, 19%) and self-inflicted (n = 1954, 17%). The lower and upper extremities were the most commonly affected body regions (n = 4071, 36% and n = 3422, 30%, respectively), while the head was the most severely injured (median Abbreviated Injury Scale score 4 [2–5]).ConclusionsIn the United States, shotgun wounds are an infrequent mechanism of injury. Shotgun wounds as a result of interpersonal violence far outweigh self-inflicted and accidental injuries. White men in their 20s in the southern parts of the country are most commonly affected and thereby delineate the high-risk patient population for injury by this mechanism at a national level.     

Efficacy,Safety, and Tolerability of a Novel Cyclosporine,a Formulation for Dry Eye Disease: A Multicenter Phase II Clinical Study

PurposeThe purpose of this study was to explore the efficacy, safety, and tolerability of a novel cyclosporine formulation for dry eye disease (DED).MethodsThis is an exploratory, multicenter, single-blind, randomized, positive-controlled Phase II clinical trial between cyclosporine ophthalmic gel (CyclAGel) and an open-label comparator (Restasis, positive control). A total of 240 eligible patients with moderate to severe DED were randomized to 4 study groups: CyclAGel 0.05%/once daily (QD) (n = 59), CyclAGel 0.05%/BID (n = 60), CyclAGel 0.1%/QD (n = 60), and Restasis 0.05%/BID (n = 61). After receiving BID dosing of hypromellose eye drops during a 2-week run-in period, patients were randomized to the respective treatment group and dosed QD or BID for 12 weeks. Efficacy was assessed based on a number of sign and symptom end points, including eye dryness score (visual analog scale), 6 other parameters of symptoms for dryness (burning/stinging, itching, foreign body sensation, discomfort, sensitivity to light, and pain), and corneal fluorescein staining. The Schirmer test was used to assess dry eye symptoms (visual analog scale severity) at visit 3 (week 2), visit 4 (week 6), and visit 5 (week 12).FindingsCyclAGel showed a consistent improvement in eye dryness score and the 6 other parameters of symptoms for dryness, corneal fluorescein staining, breakup time, and Schirmer test scores compared with Restasis over the 12-week treatment period. However, there were no statistically significant differences between CyclAGel and Restasis after baseline corrections were made, and the results of the full analysis set remained consistent with those of the per-protocol set (P > 0.05). Moreover, each CyclAGel-treated group (0.05%/QD, 0.05%/BID, and 0.1%/QD) exerted better effects than the Restasis group, and CyclAGel 0.05%/QD showed the most significant improvement. The number of ocular-related treatment-emergent adverse events was low in all treatment groups, with no serious drug-related treatment-emergent adverse events.ImplicationsCyclAGel showed excellent safety, tolerability, and comfort profiles at 2 concentrations and frequency in moderate to severe DED.     

Statistical methods used in the estimation of age-specific paediatric reference intervals for laboratory blood tests: A systematic review

IntroductionThere is an emerging realisation that paediatric reference intervals (RIs) estimated using discrete age-groups may be misleading, especially close to age cut-off values. This limitation has been addressed by estimating RIs that vary continuously with age. This systematic review examines the range of statistical methods used over the past 25 years for estimation of age-specific RIs, and identifies trends in usage and reporting.MethodsLiterature searches were conducted using predefined search criteria for original publications between 1993 and 2018 on the MEDLINE and Embase databases. Data related to sample size, treatment of age (as categorical or continuous), and statistical methods were extracted from the selected publications.ResultsA total of 238 publications were reviewed. Not all publications reported the statistical methods used in different steps. Among the publications, 167 (70%) reported discrete age-group RIs, 54 (23%) reported continuous RIs and 17 (7%) reported both types of RIs. The nonparametric statistical method was commonly used for discrete age-group RIs (64%, n = 117), whereas a wide variety of curve-fitting approaches, including Cole's lambda-mu-sigma method (28%, n = 20), parametric curve-based methods (28%, n = 20), generalised additive model for location, scale and shape method (13%, n = 9) and quantile regression (11%, n = 8) were used for continuous RIs.ConclusionsImprovement in the reporting of statistical methods used for estimating age-specific paediatric RIs is required. There has been insufficient uptake of methods for producing continuous RIs, especially for biomarkers that display strong age-dependence.     

Nutrition-related outcomes and dietary intake in non–mechanically ventilated critically ill adult patients: A pilot observational descriptive study

BackgroundCritically ill patients who do not receive invasive mechanical ventilation (IMV) are a growing population, experiencing complex interventions that may impair dietary intake and nutrition-related outcomes.ObjectivesThe objectives of this study were to quantify intake and nutrition-related outcomes of non-IMV critically ill patients and to establish feasibility of methods to measure nutrition-related outcomes in this population.MethodsNon-IMV adult patients expected to remain in the intensive care unit (ICU) for ≥24 h were eligible. Nutrition-related outcomes were assessed at baseline by subjective global assessment (SGA); on alternate study days by mid-upper arm circumference (MUAC), calf circumference (CC), and ultrasound of quadriceps muscle layer thickness (QMLT); and daily by body weight and bioelectrical impedance analysis (BIA). Data were censored at day 5 or ICU discharge. Dietary intake from all sources, including oral intake via investigator-led weighed food records, was quantified on days 1–3. Feasibility was defined as data completion rate ≥70%. Data are expressed as mean (standard deviation) or median [interquartile range (IQR)].ResultsTwenty-three patients consented (50% male; 53 [42–64] y; ICU stay: 2.8 [1.9–4.0] d). Nutrition-related outcomes at baseline and ICU discharge were as follows: MUAC: 33.2 (8.6) cm (n = 18) and 29.3 (5.4) cm (n = 6); CC: 39.5 (7.4) cm (n = 16) and 37.5 (6.2) cm (n = 6); body weight: 95.3 (34.8) kg (n = 19) and 95.6 (41.0) kg (n = 10); and QMLT: 2.6 (0.8) cm (n = 15) and 2.5 (0.3) cm (n = 5), respectively. Oral intake provided 3155 [1942–5580] kJ and 32 [20–53] g protein, with poor appetite identified as a major barrier. MUAC, CC, QMLT, and SGA were feasible, while BIA and body weight were not.ConclusionsOral intake in critically ill patients not requiring IMV is below estimated requirements, largely because of poor appetite. The small sample and short study duration were not sufficient to quantify changes in nutrition-related outcomes. MUAC, CC, QMLT, and SGA are feasible methods to assess nutrition-related outcomes at a single time point in this population.     

Interrater reliability in pupillary assessment among intensive care nurses

BackgroundPupillary abnormalities are a common and reliable finding of brain herniation, ischaemia, and acute brain injury in critically ill patients. Reliable pupil assessment is a vital evaluation in diagnostic and therapeutic procedures for neurocritical patients.AimTo evaluate inter-rater reliability of pupillary assessment among intensive care.MethodsIn this prospective, blind observational study, intensive care nurses and two researchers evaluated the pupil size, reactivity and symmetry of 200 patients with neurosurgery or neurological diseases. A total of 200 pupillary measurement sets were completed independently and blindly.ResultsThree observers –two researchers and the nurse– found fair-to-good and excellent agreements in initial pupil size evaluations of right and left pupils, respectively (ICC = 0.70, 95%; ICC = 0.75, 95%). In patients with pupil size ≥4 mm, the observers found fair-to-good agreements in both right and left pupil initial size measurements (ICC = 0.52; ICC = 0.65). Agreement in pupil symmetry was moderated (K = 0.58), and reactivity was near perfect (K = 0.89) between the three observers.ConclusionAlthough the two researchers found near perfect agreement in pupil size, symmetry and reactivity assessment, two researchers and the nurse found moderate agreement in pupil symmetry and fair-to-good agreement in pre- and post-light stimulation pupil size.     

Prevalence of hemorrhagic ovarian cysts in patients with rare inherited bleeding disorders

BackgroundIn comparison with the general population, women with bleeding disorders are more prone to develop obstetrical and gynecological problems. However, no comprehensive evaluation has investigated the prevalence of hemorrhagic ovarian cysts (HOCs) in rare bleeding disorders (RBDs). In this study, we sought to determine the prevalence of HOCs in a large cohort of Iranian patients with RBDs.MethodsA total of 210 symptomatic patients suspected of HOCs with RBD were included. The median age of the study population was 24 years. Patients were diagnosed with fibrinogen disorders (n = 7, 3%), factor (F) II (n = 4, 2%), FV (n = 28, 13%), FVII (n = 4, 2%), FX (n = 6, 3%), FXIII (n = 122, 58%), combined FV and FVIII (n = 8, 4%), Glanzmann’s thrombasthenia (n = 10, 5%), and von Willebrand disease (VWD) type 3 (n = 21, 10%).ResultsFollowing further clinical and ultrasound examinations of these 210 patients, 68 (32.4%) were confirmed with a diagnosis of HOCs. Of which, FXIII deficiency with 46 cases (67.6%), followed by VWD type 3 (6 cases, 8.8%) showed the highest number. Other coagulation defects associated with HOCs were including fibrinogen deficiency (n = 2, 3%), FII (n = 2, 3%), FV (n = 4, 6%), FVII (n = 2, 3%), FX (n = 1, 1.5%), combined FV and FVIII (n = 2, 3%), and Glanzmann’s thrombasthenia (n = 3, 4.5%).ConclusionThis study found a high prevalence of HOCs in patients with RBDs, indicating the importance of early diagnosis and optimal management of obstetric and gynecological complications in these patients.     

The effects of Pilates training on static and dynamic balance of female deaf students: A randomized controlled trial

IntroductionTo evaluate the effect of Pilates training on static and dynamic balance of deaf female.MethodsThis study is a randomized, controlled trial with concealed randomization and blinded assessments. 19 female deaf students participated in this study and were randomly assigned into experimental (EXP, n = 9) and control (CON, n = 10) groups. Static balance was examined by Balance Error Scoring System (BESS), and dynamic balance was examined by Y balance test (YBT). The experimental group performed a Pilates training program for 8 weeks (three sessions of 60 min).ResultsThe findings showed that experimental group showed a significant change in static balance (with open eye and close eye) and dynamic balance (dominant limb and non-dominant limb) after 8 weeks Pilates training (p < 0.05). The control also showed no significant changes after training duration (p > 0.05).ConclusionsThis study showed that Pilates training significantly improve balance in female deaf students.     

Implementing a systematic care pathway for management of dysphagia after cardiothoracic surgery

ObjectivesThis longitudinal quality improvement study explored the impact of a new multidisciplinary dysphagia care pathway on swallow screening referrals, patient journeys and swallow outcomes in patients after cardiac surgery.Research methodologyThe new dysphagia care pathway consisted of i) nurse chart review triaging using established risk factors, ii) nurse swallow screening (including a cough reflex test and water swallow test) and iii) rapid referral routes to speech pathology. All patients referred for swallow screening in 2020 after the commencement of the new dysphagia care pathway were included (n = 114). Data was compared to two historical, published data sets at the research site (n-41 in 2012–2013 and n = 121 in 2013–2016).SettingCardiovascular intensive care unit.Results52% failed chart review and 29% failed cough reflex test. All patients who passed chart review and cough reflex test returned to a normal diet without need for speech pathology referral. Silent aspiration rates were high in those who failed chart review and the cough reflex test (42%, 43% respectively). For those who received a swallow screen, enteral feeding rates were 70% on first assessment and 27% by discharge from the unit in historical data (2013–2016). In comparison, in 2020, enteral feeding rates were 44% and 8% respectively.ConclusionsReferrals for nurse swallow screening and speech pathology increased following the introduction of the care pathway. There has been a reduction in enteral feeding rates and length of enteral feeding at discharge. High rates of silent aspiration in those who fail screening suggests stepwise nurse dysphagia screening successfully picks up at-risk patients.     

Alternative and complementary medicine in neurological disorders and neurological disability patients: Prevalence,factors, opinions and reasons

ObjectivesThis cross-sectional study is aimed to investigate the prevalence of the use of complementary and alternative medicine (CAM), types of CAMs used, as well as reasons and factors found in patients with neurological diseases or neurological disability.MethodsAn anonymous, self-administered survey was designed to collect information about demographics, personal medical history, CAM usage habits, and different opinions about CAM vs. conventional medicine (CM). The survey was applied by non-medical personnel in a rehabilitation hospital to patients older than 18 years, with a confirmed diagnosis of neurological disorder or neurological disability.Results453 patients were included, 59.7 % were female. Mean age: 49 years (SD: 18.2). 200 patients (44.2 %) had a history of chronic diseases. Depression was found in 139 patients (30.7 %). Neurological disorders were: peripheral neuropathy: 97 (21.4 %), headache or migraine: 78 (17.2 %), neurodegenerative diseases: 69 (15.2 %) and stroke: 58 (12.8 %). 60.2 % (n = 273) had some degree of disability. Prevalence of CAM use was 36 % (n = 163). Most common CAMs were: Biological therapies: 133 (71.1 %), energy-based therapies: 63 (33.7 %) and body manipulation therapies: 51 (27.3 %). Reasons to use CAM were: “to complement the pharmacological treatment” (45 = 27.6 %), and “treatment failure with CM” (43 = 26.4 %). Finally, older age (p = 0.0280) and having a chronic disease (p = 0.0229) or depression (p < 0.001) were the factors associated with the current use of CAM.ConclusionOne third of patients with neurological pathologies use CAM, the most popular type of CAM is biologic therapies. As in other pathologies, CAM use was associated with older age, history of depression, and chronic diseases. Therefore, it is suggested that physicians routinely ask patients about the use of CAM, if they need more information about CAM, and even verify the possibility of drug interactions or adverse effects.     

Teaching and learning about dementia care among undergraduate nursing students: A scoping review

AimReview available evidence on teaching methods and learning outcomes among undergraduate nursing students regarding care for people with dementia. Background: The debilitating nature and the rapidly growing number of dementia cases will cause significant increase in the demand of healthcare services. Nurses play an essential role in improving the quality of care for people with dementia, although some evidence suggests that training in dementia care among nurses is poor.DesignA scoping review of the literature. following the Joanna Briggs Institute methodology for scoping reviews. The source of evidence selection adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping review.MethodsData sources were Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, Web of Science, Education Resources Information Centre and Scopus. Inclusion criteria were studies found through database search up to 15th December 2020, published in English or Spanish with data regarding any method used for dementia education among undergraduate nursing students.Results19 studies were included in this review. The identified methods were simulation (n = 5), awareness-raising activities (n = 4), placement (n = 3), home visits (n = 3), combined activities (n = 3) and service learning (n = 1). Learning outcomes were measured in terms of knowledge, attitudes, preparedness, empathy, self-confidence, self-efficacy, awareness and students´ perceptions.ConclusionsThis scoping review has found high heterogeneity among dementia education programs and learning outcomes. Nursing education can be enhanced by designing and measuring effective and evidence-based educational interventions so that nursing students develop competencies which make it easier to deliver quality care for people with dementia.     

Quantitative versus standard pupillary light reflex for early prognostication in comatose cardiac arrest patients: an international prospective multicenter double-blinded study

Purpose

To assess the ability of quantitative pupillometry [using the Neurological Pupil index (NPi)] to predict an unfavorable neurological outcome after cardiac arrest (CA).

Methods

We performed a prospective international multicenter study (10 centers) in adult comatose CA patients. Quantitative NPi and standard manual pupillary light reflex (sPLR)—blinded to clinicians and outcome assessors—were recorded in parallel from day 1 to 3 after CA. Primary study endpoint was to compare the value of NPi versus sPLR to predict 3-month Cerebral Performance Category (CPC), dichotomized as favorable (CPC 1–2: full recovery or moderate disability) versus unfavorable outcome (CPC 3–5: severe disability, vegetative state, or death).

Results

At any time between day 1 and 3, an NPi?≤?2 (n?=?456 patients) had a 51% (95% CI 49–53) negative predictive value and a 100% positive predictive value [PPV; 0% (0–2) false-positive rate], with a 100% (98–100) specificity and 32% (27–38) sensitivity for the prediction of unfavorable outcome. Compared with NPi, sPLR had significantly lower PPV and significantly lower specificity (p? <?0.001 at day 1 and 2; p ?=?0.06 at day 3). The combination of NPi?≤?2 with bilaterally absent somatosensory evoked potentials (SSEP; n?=?188 patients) provided higher sensitivity [58% (49–67) vs. 48% (39–57) for SSEP alone], with comparable specificity [100% (94–100)].

Conclusions

Quantitative NPi had excellent ability to predict an unfavorable outcome from day 1 after CA, with no false positives, and significantly higher specificity than standard manual pupillary examination. The addition of NPi to SSEP increased sensitivity of outcome prediction, while maintaining 100% specificity.

     

Measurement of pupil reactivity using fast pupillometry

Analysis of human eye pupil reactivity is a very valuable diagnostic method used mainly for evaluation of the condition of the autonomic nervous system and the visual system. The paper presents an experimental pupillometer built in the Institute of Physics of the Wroclaw University of Technology. The apparatus makes it possible to record and analyze pupillary light reflex and spontaneous changes in the pupil diameter during a session in the dark. The detector system used in the pupillometer allows us to record the pupil diameter at a rate of 90 Hz with a linear accuracy of 0.008 mm. In this paper, the proposed detection method, the principle of operation and calibration of the apparatus and the possibilities of the measurement system are presented.     

Fatal cerebral edema in patients with decompensated cirrhosis: A case series

PurposeUnlike patients with acute liver failure, patients with cirrhosis are not traditionally thought to be at risk for developing cerebral edema. In the largest case series to date, we document clinical characteristics of cirrhotic patients who develop cerebral edema.Materials and methodsIn this retrospective case series, seventeen adult patients with acute-on-chronic liver failure (ACLF) were identified using Morbidity & Mortality data. Neurological decompensation was defined by focal neurological deficits or abnormal movements. Elevated ICP was diagnosed clinically by pupillary reflex change improving with hyperosmolar therapy, or by herniation on CT. Pulsatility indices >1.2 on transcranial Dopplers (TCDs) and/or optic nerve sheath diameter (ONSD) >0.5 cm were acceptable alternatives.ResultsMedian MELD-Na was 36 (IQR 31.5,43) compared with 20 (IQR 19,23) prior to admission. Neurological decompensation was associated with abnormal pupil reactivity in 76% and abnormal movements in 65%. Cerebral edema was diagnosed by CT (n = 14). For those too ill to transport, elevated ICP was confirmed with TCDs for three patients and ONSD for two. Mortality was 100% a median of 3 days (IQR 1.5,5) from neurologic decompensation.ConclusionsACLF patients with neurological decompensation exhibit distinct clinical changes. Noninvasive bedside techniques may serve as surrogate measures for ICP.     

Effects of a multifaceted neurological assessment educational program in nursing students: A randomized crossover study

AimThis study aimed to verify the effects of a multifaceted neurological assessment educational program on neurological assessment-related knowledge, skills, communication ability and self-efficacy in nursing students.BackgroundNurses should be equipped with optimal neurological assessment competency to ensure quality care for patients with neurological symptoms.DesignThis study involved a waitlist control group with a randomized crossover design.MethodsFourth-year nursing students were randomly assigned to an intervention group (n = 28) or a waitlist control group (n = 27). Pre- and post-intervention differences in neurological assessment knowledge, skills, communication ability and self-efficacy between the intervention and the waitlist control group were analyzed using generalized estimated equations.ResultsThe nursing students in the intervention group showed significantly improved knowledge, skills, communication ability and self-efficacy scores compared with those in the waitlist control group. Scores related to knowledge, skills and communication ability were maintained and self-efficacy scores had further increased at 2 weeks after the educational program in the intervention group.ConclusionsOur multifaceted neurological assessment educational program is useful for improving nursing students' knowledge, skills, communication ability and self-efficacy.     

Clinical efficacy of casirivimab-imdevimab antibody combination treatment in patients with COVID-19 Delta variant

IntroductionCasirivimab-imdevimab, an antibody cocktail containing two severe acute respiratory syndrome coronavirus 2 neutralizing antibodies, reduces the viral load and the risk of coronavirus disease 2019 (COVID-19)-related hospitalization or death. The objective of this study was to evaluate the clinical efficacy of casirivimab-imdevimab in patients with COVID-19 Delta variant in Japan.MethodsThis study was conducted at five institutions and assessed a total of 461 patients with COVID-19 who met the inclusion criteria. The treatment group received a dose of casirivimab-imdevimab consisting of a cocktail of two monoclonal antibodies, (casirivimab 600 mg and imdevimab 600 mg intravenously). The control consisted of age- and sex-matched COVID-19 patients (n = 461) who sufficed the inclusion criteria but did not receive casirivimab-imdevimab. The outcome was the requirement of oxygen therapy.ResultsIn the treatment group, patients received oxygen therapy (n = 30), nasal canula (n = 23), high flow nasal cannula (n = 5), and mechanical ventilation (n = 2). In the control group, patients received oxygen therapy (n = 56), nasal canula (n = 45), high flow nasal cannula (n = 8), and mechanical ventilation (n = 3). The administration of oxygen therapy was significantly lower in the treatment group than the control group (6.5% vs. 12.1%, P = 0.0044). All these patients admitted to our hospitals and received additional therapy and recovered.ConclusionsOur results demonstrate that the casirivimab-imdevimab combination antibody treatment is associated with reduced rates of requiring oxygen therapy among high-risk patients with COVID-19 Delta variant.