How long should local warming for venodilation be used for peripheral intravenous cannulation? A prospective observational study

BackgroundLocal warming is one of the most common venodilation techniques for achieving peripheral intravenous cannulation, but the time of application is unclear.ObjectiveTo compare the effectiveness of local warming applied for 5, 10, and 15 min.DesignA prospective, observational study.SettingA university in Japan.ParticipantsIn total, 40 healthy female volunteers aged 20–45 years were recruited via e-mail.MethodsParticipants received 15 min of local warming with a warmed heat pack (40 ± 2 °C). The primary outcome was the cross-sectional area of the target vein at 5, 10, and 15 min of warming, which was measured after the intervention by blinded review using ultrasound. Secondary outcomes included forearm target site temperature at 5, 10, and 15 min of local warming, which was measured with a temperature sensor and handheld thermometer.ResultsCompared to outcomes before local warming, vein cross-sectional area at 5, 10, and 15 min of warming significantly (p < 0.001) increased by 2.8, 2.9, and 2.3 mm². The target site temperature increased by 6.9 °C, 6.4 °C, and 6.0 °C, respectively. However, no significant differences were found in cross-sectional area among the time points of 5, 10, and 15 min of local warming. The target site temperature at 15 min of local warming was significantly (p < 0.001) different than that at 5 and 10 min. No adverse events occurred with local warming.ConclusionCompared with outcomes before local warming, vein size after warming for 5, 10, and 15 min was significantly larger. No significant differences were found in vein size among the time points of 5, 10, and 15 min of local warming. Our result demonstrated the effectiveness of shorter-duration (5 min) local warming for inducing venodilation for peripheral intravenous cannulation.     

Effects of Local Warming on the Peripheral Vein Cross-Sectional Area in Children Under Sedation

PurposePeripheral venous catheterization is challenging in small children. The local warming technique has been used to increase the peripheral vein cross-sectional area (CSA) and improve the success rate. However, there is limited evidence on the effect of local warming on venous CSA in children under sedation.DesignA pilot randomized controlled trial.MethodsEligible children aged 1 to 4 years undergoing ambulatory surgery were enrolled. At the bedside in the ambulatory surgery center, they were routinely sedated with 1 mcg/kg of intranasal dexmedetomidine. Through a computer allocation program, children were randomized into either a control group or a local warming group. Cephalic vein and basilic vein at 1 cm proximal to cubital fossa were scanned with ultrasound to measure venous CSA. Children in the control group received no intervention; those in the local warming group had a prepared hot pack of ~40°C applied to the target area on the arm for 5 minutes. A second ultrasound measurement was undertaken in both groups.FindingsA total of 35 from 40 children were analyzed. Cephalic vein CSA and basilic vein CSA increased significantly vs the first measurement within the local warming group (P < .05 for both) but not in the control group (P > .05 for both). Cephalic vein CSA was significantly different between groups at the second measurement (P < .05) but not at the first measurement (P > .05). Basilic vein CSA was significantly different between groups neither at the first measurement nor at the second measurement (P > .05 for both). The application of local warming resulted in an average of 34% increase (from 4.1 to 5.5 mm²) in cephalic vein CSA and an average of 21% increase (from 4.8 to 5.8 mm²) in basilic vein CSA.ConclusionsThe application of local warming induced mild venodilation in cephalic vein with an increase in CSA by 34% and had little venodilation effect on the basilic vein with an increase in CSA by only 21%.     

A quality improvement initiative to optimize use of a mechanical chest compression device within a high-performance CPR approach to out-of-hospital cardiac arrest resuscitation

BackgroundMinimizing the chest compression pause associated with application of a mechanical CPR device is a key component of optimal integration into the overall resuscitation process. As part of a multi-agency implementation project, Anchorage Fire Department deployed LUCAS CPR devices on BLS and ALS fire apparatus for initiation early in resuscitation efforts. A 2012 report identified the pause interval for device application as a key opportunity for quality improvement (QI). In early 2013 we began a QI initiative to reduce device application time interval and optimize the overall CPR process. To assess QI initiative effectiveness, we compared key CPR process metrics from before to during and after its implementation.MethodsWe included all cases of EMS-treated out-of-hospital cardiac arrest during 2012 and 2013 in which a mechanical CPR device was used and the defibrillator electronic record was available. Continuous ECG and impedance data were analyzed to measure chest compression fraction, duration of the pause from last manual to first mechanical compression, and duration of the longest overall pause in the resuscitation effort.ResultsCompared to cases from 2012 (n = 61), median duration of the pause prior to first mechanical compression for cases from 2013 (n = 71) decreased from 21 (15, 31) to 7 (4, 12) s (p < 0.001), while median chest compression fraction increased from 0.90 (0.88, 0.93) to 0.95 (0.93, 0.96) (p < 0.001). Median duration of the longest pause decreased from 25 (20, 35) to 13 (10, 20) s (p < 0.001), while the proportion of cases where the longest pause was for mechanical CPR application decreased from 74% to 31% (p < 0.001).ConclusionsOur QI initiative substantially reduced the duration of the pause prior to first mechanical compression. Combined with the simultaneous significant increase in compression fraction and significant decrease in duration of the longest pause, this finding strongly suggests a large improvement in mechanical CPR device application efficiency within an overall high-performance CPR process.     

Comparison study of upper arm and forearm non-invasive blood pressures in adult Emergency Department patients

BackgroundForearm blood pressures have been suggested as an alternative site to measure blood pressures when the upper arm is unavailable. However there is little evidence utilising clinical populations to support this substitution.ObjectivesTo determine agreement between blood pressures measured in the left upper arm and forearm using a singular oscillometric non-invasive device in adult Emergency Department patients. The secondary objective was to explore the relationship of blood pressure differences with age, sex, ethnicity, smoking history and obesity.DesignSingle centre comparison study.SettingAdult Emergency Department, Tertiary Trauma Centre.ParticipantsForty-four participants who met inclusion/exclusion criteria selected sequentially from the Emergency Department arrival board.MethodsA random assignment of order of measurement for left upper arm and forearm blood pressures was utilised. Participants were eligible if they were aged 18 years or older, had been assigned an Australasian Triage Scale code of 2, 3, 4, or 5, were able to consent, and able to have blood pressures measured on their left arm whilst lying at a 45° angle. The Bland–Altman method of statistical analysis was used, with the level of agreement for clinical acceptability for the systolic, diastolic and mean arterial pressure defined as ±10 mmHg.ResultsThe forearm measure overestimated systolic (mean difference 2.2 mmHg, 95% limits of agreement ±19 mmHg), diastolic (mean difference 3.4 mmHg, 95% limits of agreement ±14.4 mmHg), and mean arterial pressures (mean difference 4.1 mmHg, 95% limits of agreement ±13.7 mmHg). The systolic measure was not significantly different from zero. Evidence of better agreement was found with upper arm/forearm systolic measures below 140 mmHg compared to systolic measures above 140 mmHg using the Levene's test (p = 0.002, F-statistic = 11.09). Blood pressure disparity was not associated with participant characteristics.ConclusionsForearm measures cannot routinely replace upper arm measures for blood pressure measurement. If the clinical picture requires use of forearm blood pressure, the potential variance from an upper arm measure is ±19 mmHg for systolic pressure, although the variability may be close to ±10 mmHg if the systolic blood pressure is below 140 mmHg.     

Comparison of the effects of lidocaine pre-administration and local warming of the intravenous access site on propofol injection pain: Randomized,double-blind controlled trial

BackgroundLidocaine reduces pain that occurs upon the intravenous injection of propofol. But, there are few non-pharmacological nursing interventions to reduce propofol injection pain.ObjectiveTo compare the effects of lidocaine pre-administration and local warming of the intravenous access site on propofol injection pain.DesignProspective, double-blind, randomized controlled trial.SettingThe 555 bed, non-teaching National Cancer Center in Kyunggido, South Korea.ParticipantsA total of 96 patients who underwent thyroidectomy under total intravenous general anesthesia with propofol were randomly allocated to the control, lidocaine pre-administration (LA) or local warming (LW) group.MethodsAll three groups received 2% propofol with an effect-site target at 3 μg/mL for induction dose. The control group received 2% propofol with no intervention. The lidocaine pre-administration group received 2% propofol 30 s after 1% lidocaine 30 mg. The local warming group received 2% propofol after warming of the intravenous access site for 1 min using 43 °C forced air. Propofol injection pain was assessed by four-point verbal categorial scoring (VCS), numerical rating scale (NRS) and surgical pleth index (SPI).ResultsPain VCS of the LA group (mean ± SD, 1.11 ± 0.45) was significantly reduced (U = −3.92, p < .001) compared to the control group (mean ± SD, 1.71 ± 0.74). Pain VCS of the LW group (mean ± SD, 0.76 ± 0.44) was significantly reduced (U = −5.17, p < .001) compared to the control group (mean ± SD, 1.71 ± 0.74). Pain VCS of the LW group was significantly reduced compared to the LA group (U = −3.33, p = .001]. Pain NRS of the LA group (mean ± SD, 4.31 ± 2.32) was significantly reduced (mean difference, 1.82; 95% CI, 0.63–3.00; p = .003) compared to the control group (mean ± SD, 6.13 ± 2.39). Pain NRS of the LW group (mean ± SD, 3.06 ± 2.37) was significantly reduced (mean difference, 3.07; 95% CI, 1.63–4.51; p < .009) compared to the control group. There were significant differences in pain NRS between the LA group and the LW group (mean difference, 1.25; 95% CI, 0.09–2.42; p = .035). SPI of the LA group (mean ± SD, 64.1 ± 16.3) was significantly reduced (mean difference control versus LA, 8.36; 95% CI, 1.64–15.1; p = .016) compared to the control group (mean ± SD, 72.5 ± 9.56). SPI of the LW group (mean ± SD, 55.0 ± 16.2) was significantly reduced (mean difference control versus LW, 17.4; 95% CI, 10.8–24.0; p < .001) compared to the control group. There was a significant difference in SPI between the LA group and LW group (mean difference, 9.06; 95% CI, 1.02–17.1; p = .028).ConclusionLocal warming of the intravenous access site by 43 °C forced air for 1 min is slightly more effective in reducing propofol injection pain compared to lidocaine pre-administration.     

Methods to determine the internal length of nasogastric feeding tubes: An integrative review

ObjectivesImproper placement of nasogastric tube used for feeding may lead to serious complications, including death of the patient. There are several different methods used to determine the appropriate length of nasogastric tube for optimal placement in adults. This integrative review of the literature was designed to identify the most accurate method to determine the internal length of nasogastric feeding tube in adults.DesignAn integrative review of the research literature (1979–2015) using the population–intervention–comparison-outcomes strategy.Data sourcesThe literature search included the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, Joanna Briggs, PubMed (MEDLINE), SCOPUS, and Web of Science electronic databases.Review methodsTwo researchers evaluated the literature to determine if an article met inclusion and exclusion criteria. The quality of the evidence was assessed using the Johns Hopkins Strength of the Evidence critical appraisal tool.ResultsTwenty studies, published between 1979 and 2014, met inclusion criteria. Of these, nine articles were expert opinion, seven were original research, three were review articles, and one was a guideline. Despite seven original research papers being found, only five reports were about the methods to determine the internal length of nasogastric feeding tube in adults. The literature suggests that four different methods for measuring the tube length are likely to result in proper placement of the tip of the tube in the stomach and all side ports inside it: [nose-to-ear-to-xiphisternum – 50] cm/2 + 50 cm]; [gender-weight and nose-umbilicus-flat]; [xiphisternum-to-ear-to-nose + 10 cm]; [earlobe to xiphisternum to umbilicus – tip of the nose to earlobe]. Four studies found nose-to-ear-to-xiphisternum was most likely to result in a tube that is positioned incorrectly, either ending in the esophagus, in the stomach but too close to the esophagus, or too far into the stomach or duodenum.ConclusionsThe nose-to-ear-to-xiphisternum and Hanson method should no longer be taught in nursing programs or used in practice by the nurse. The [gender-weight and nose-umbilicus-flat] method has been shown to be safer.     

Application of cabbage leaves compared to gel packs for mothers with breast engorgement: Randomised controlled trial

BackgroundThe effects of cold cabbage leaves and cold gel packs on breast engorgement management have been inconclusive. No studies have compared the effects of these methods on breast engorgement using a rigorous design.ObjectivesTo examine the effectiveness of cold cabbage leaves and cold gel packs application on pain, hardness, and temperature due to breast engorgement, the duration of breastfeeding and satisfaction.DesignA randomised controlled three-group pre-test and repeated post-test study.SettingA private maternal and children’s hospital in Singapore.ParticipantsMothers (n = 227) with breast engorgement within 14 days after delivery.MethodsThe mothers were randomly assigned into either cold cabbage leaves, cold gel packs, or the control group. Pain, hardness of breasts, and body temperature were measured before treatment. Two sets of post-test assessments were conducted at 30 min, 1 h, and 2 h after the first and second application. The duration of breastfeeding was measured up to 6 months. IBM SPSS 23.0 was used to analyse the data.ResultsMothers in the cabbage leaves and gel packs groups had significant reductions in pain at all post-intervention time points compared to the control group, starting from 30 min after the first application of cabbage leaves (mean difference = −0.38, p = 0.016) or gel packs (mean difference = −0.39, p = 0.013). When compared to the control group, mothers in the cabbage leaves group had significant reductions in the hardness of breasts at all post-intervention time points, and mothers in the gel packs group had significant reductions in the hardness of breasts at two time points (1 h and 2 h after the first and second application, respectively). Mothers in the cabbage leaves group had significant reductions in pain (mean difference = −0.53, p = 0.005) and hardness of breasts (mean difference = −0.35, p = 0.003) at 2 h after the second application compared to those in the gel packs group. Both interventions had no impact on body temperature. There was no significant difference in the durations of breastfeeding for mothers among the three groups at 3-month and 6-month follow-up. More mothers were very satisfied/satisfied with the breast engorgement care provided in the cabbage leaves group compared to the other groups.ConclusionWhile cold cabbage leaves and cold gel packs can relieve pain and hardness in breast engorgement, the former had better effect, which can be recommended to postnatal mothers to manage breast engorgement.     

Quality and relevance of master degree education for the professional development of nurses and midwives

BackgroundAdvanced education in nursing is essential to provide safe, high quality and efficient health services in line with population needs. However, there is an almost complete lack of studies on how nurses view the usefulness of post-graduate education for their current employment and for professional advancement.ObjectivesTo evaluate how nurse graduates view the quality, relevance and applicability of the knowledge and skills acquired during the Master of Science in Nursing (MSN) degree.DesignMulticentre cross-sectional study.MethodsA multicenter cross-sectional study was carried out through an online questionnaire mailed (July 2014–June 2015) to 560 nurses who obtained the MSN degree from 23 Italian universities in the academic year 2010–2011.DiscussionA total of 426 nurses completed the survey (response rate 76.1%), 80% of whom believed they had acquired knowledge and skills useful in their professional life after graduation. A multiple logistic regression model highlighted the characteristics of nurse graduates who judged the master's course relevant for their present role. In brief, they are expert nurses (OR = 3.41, 95% CI = 1.54–7.54) who achieved professional growth after the course (OR = 5.25, 95% CI = 2.67–10.33) and who judged the course very good or excellent (OR = 2.16, 95% CI = 1.04–4.52). Only 8% of the respondents achieved a full professional growth after the course.ConclusionIn Italy, MSN courses are able to provide a high level of skills and competencies. However, given the low rate of professional growth after the course, specific policies should increase the employment rates of new master's graduate nurses.     

Proprioceptive use and sit-to-stand-to-sit after lumbar microdiscectomy: The effect of surgical approach and early physiotherapy

BackgroundIndividuals with non-specific low back pain show decreased reliance on lumbosacral proprioceptive signals and slower sit-to-stand-to-sit performance. However, little is known in patients after lumbar microdiscectomy.MethodsPatients were randomly assigned into transmuscular (n = 12) or paramedian lumbar surgery (n = 13). After surgery, the same patients were randomly assigned into individualized active physiotherapy starting 2 weeks after surgery (n = 12) or usual care (n = 13). Primary outcomes were center of pressure displacement during ankle and back muscles vibration (to evaluate proprioceptive use), and the duration of five sit-to-stand-to-sit movements, evaluated at 2 (baseline), 8 and 24 weeks after surgery.FindingsTwo weeks after surgery, all patients showed smaller responses to back compared to ankle muscles vibration (P < 0.05). Patients that underwent a transmuscular surgical procedure and patients that received physiotherapy switched to larger responses to back muscles vibration at 24 weeks, compared to 2 weeks after surgery (P < 0.005), although not seen in the paramedian group and usual care group (P > 0.05). Already 8 weeks after surgery, the physiotherapy group needed significantly less time to perform five sit-to-stand-to-sit movements compared to the usual care group (P < 0.05).InterpretationShortly after lumbar microdiscectomy, patients favor reliance on ankle proprioceptive signals over lumbosacral proprioceptive reliance to maintain posture, which resembles the behavior of patients with non-specific low back pain. However, early active physiotherapy after lumbar microdiscectomy facilitated higher reliance on lumbosacral proprioceptive signals and early improvement of sit-to-stand-to-sit performance. Transmuscular lumbar surgery favoured recovery of lumbosacral proprioception 6 months after surgery.Clinical Trial Number: NCT01505595     

Non-invasive central venous pressure measurement by compression ultrasound—A step into real life

Aim of the studyInformation on central venous pressure (CVP) is helpful in clinical situations like cardiac failure and sepsis. Compression ultrasound (CU) of a forearm vein has been shown to be a reliable method for CVP measurement when assessed by experienced personal under study conditions.To test the hypothesis, that CU can be reliably used for CVP measurement after a training program and using a portable ultrasound system, we investigated feasibility and accuracy of CU, comparing the results of vascular experts vs. trainees as well as high-end vs. a portable ultrasound system.MethodsCU with non-invasive CVP measurement (CVP_ni) was performed by four investigators in 50 patients of an intensive care unit and compared with invasive CVP measurement (CVP_i).ResultsFeasibility was between 88 and 92% in the different investigator groups. CVP_ni measurement showed a significant linear correlation (r = 0.58–0.68; p < 0.001) with CVP_i in all groups. Mean difference between CVP_i and CVP_ni was 2.4 ± 3.1 mmHg and similar between the investigators. No differences were observed between measurements done by vascular experts and trainees, as well as between high-end and portable ultrasound systems. Further we demonstrated, that CU is able to detect changes in CVP during the respiratory cycle.ConclusionsAfter a training program CU can be used by non-vascular clinician for reliable CVP measurement with good quality portable systems. Furthermore, respiratory changes in CVP are detectable by CU. These data suggest CU to be an efficient method for measuring CVP under real life conditions.     

A cross-sectional study of assessing knowledge,attitude, and practice of COVID-19 resuscitation among health care workers in a hybrid hospital for COVID-19 in Malaysia

BackgroundThe COVID-19 pandemic is an international public health emergency. As hospitals receive more severe forms of COVID-19 that necessitate resuscitation, emergency health care workers (HCW) must follow interim COVID-19 resuscitation guidelines.ObjectiveThe aim is to evaluate the levels of knowledge, attitude, and practice among emergency HCW of the COVID-19 resuscitation protocol by the European Resuscitation Council (ERC).MethodsA cross-sectional study using a validated questionnaire was conducted among HCW in the emergency department of University of Malaya Medical Centre (UMMC), Malaysia from April to June 2021.ResultsA total of 159 respondents were included in the analysis (89% response rate). Sixty-eight percent of respondents had adequate knowledge regarding COVID-19 resuscitation. Majority of the respondents had knowledge on airborne-precaution personal protective equipment (PPE) (99%) and infection control measures (98%). Nearly 73% were pessimistic about the COVID-19 prognosis. Seventy-three percent of respondents thought an arrested COVID-19 patient may benefit from cardiopulmonary resuscitation (CPR) and 94% were willing to administer CPR provided airborne-precaution PPE was available. Ninety percent of respondents reported adherence to resuscitation guidelines. There were significant differences in the mean knowledge scores between designation, education levels, and COVID-19 training. Overall, the respondents’ level of practice was insufficient (27%), with a mean score of 53.7% (SD = 14.7). There was a lack of practice in the resuscitation of the intubated and patients who were being prone. There was insufficient practice about ventilation technique, use of supraglottic devices, and intubation barriers. There was a positive correlation between adequate knowledge and good practice.ConclusionEmergency HCW have adequate knowledge, but poor compliance to the ERC COVID-19 guidelines. Emergency HCW were willing and confident to resuscitate COVID-19 patients, despite fears of nosocomial infection and expectation of poor patients’ prognosis. Ongoing education and training programs are recommended to improve their knowledge, cultivate a positive attitude, and achieve good compliance with COVID-19 resuscitation guidelines.     

Motor-cognitive dual-task training improves local dynamic stability of normal walking in older individuals

BackgroundExtreme levels of gait variability and local dynamic stability of walking are associated with risk of falling and reduced executive functions. However, it is not sufficiently investigated how gait variability and local dynamic stability of human walking develop in the course of a motor-cognitive intervention. As dancing implies high demands on (and therewith trains) executive functioning and motor control, it might increase local dynamic stability or reduce gait variability.Methods32 older healthy participants were randomly assigned to either a health-related exercise group (age: mean = 68.33 years, standard deviation = 3.17 years; BMI: mean = 27.46, standard deviation = 2.94; female/male: 10/6) or a dancing group (age: mean = 66.73 years, standard deviation = 3.33 years; BMI: mean = 26.02, standard deviation = 3.55; female/male: 11/5). Based on angular velocity data of trunk kinematics, local dynamic stability and stride-to-stride variability in level overground walking were assessed prior to and after the specific intervention. The data were analysed by a blinded observer using two-way repeated measures ANOVAs. Based on one-way ANOVAs, time and group effects were determined.FindingsRegarding the variability of trunk movements, no interaction effect was observed (F _1,30 = 0.506, P = .482; η2 = 0.017). For local dynamic stability of trunk movements, an interaction effect in favour of the dancing group was observed (F _1,30 = 5,436; P = .026; η2 = 0.146).InterpretationOur data indicate that a dancing programme (which combines cognitive and motor efforts) might increase local dynamic stability in older people.     

A tourniquet assisted cardiopulmonary resuscitation augments myocardial perfusion in a porcine model of cardiac arrest

ObjectiveDuring cardiopulmonary resuscitation (CPR), myocardial blood flow generated by chest compression rarely exceeds 35% of its normal level. Cardiac output generated by chest compression decreases gradually with the prolongation of cardiac arrest and resuscitation. Early studies have demonstrated that myocardial blood flow during CPR is largely dependent on peripheral vascular resistance. In this study, we investigated the effects of chest compression in combination with physical control of peripheral vascular resistance assisted by tourniquets on myocardial blood flow during CPR.MethodsVentricular fibrillation was induced and untreated for 7 min in ten male domestic pigs weighing between 33 and 37 kg. The animals were then randomized to receive CPR alone or a tourniquet assisted CPR (T-CPR). In the CPR alone group, chest compression was performed by a miniaturized mechanical chest compressor. In the T-CPR group, coincident with the start of resuscitation, the thin elastic tourniquets were wrapped around the four limbs from the distal end to the proximal part. After 2 min of CPR, epinephrine (20 μg/kg) was administered via the femoral vein. After 5 min of CPR, defibrillation was attempted by a single 150 J shock. If resuscitation was not successful, CPR was resumed for 2 min before the next defibrillation. The protocol was continued until successful resuscitation or for a total of 15 min. Five minutes after resuscitation, the elastic tourniquets were removed. The resuscitated animals were observed for 2 h.ResultsT-CPR generated significantly greater coronary perfusion pressure, end-tidal carbon dioxide and carotid blood flow. There was no difference in both intrathoracic positive and negative pressures between the two groups. All animals were successfully resuscitated with a single shock in both groups. There were no significant changes in hemodynamics observed in the animals treated in the T-CPR group before-and-after the release of tourniquets at post-resuscitation 5 min.ConclusionsT-CPR improves myocardial and cerebral perfusion during CPR. It may provide a new and convenient method for augmenting myocardial and cerebral blood flow during CPR.     

Los factores que influyen en el proceso de adaptación 6 meses después de un ictus:un análisis de trayectoria

ObjectiveThe purpose of this study was to identify the determinant factors that influence the adaptation process and quality of life after a stroke.MethodsThis study is an observational study using a cross-sectional design. Respondents were patients who were 6 months post-discharge after non-hemorrhagic stroke and their family caregivers. Information about respondents was taken from medical record data at two regional general hospitals in West Kalimantan Province, Indonesia. A total of 80 patients were selected using a consecutive sampling method. Theoretical models of patient and caregiver factors that influence adaptation responses and post-stroke quality of life were tested using path analysis.ResultsCaregiver coping, self-efficacy, and illness acceptance had a direct effect on the post-stroke psychosocial adaptation response by 58.1%, with self-efficacy contributing the most (β = 0.668, p < 0.0001). Self-efficacy, illness acceptance, and healthy behavior had a direct effect on the physiological adaptation response by 24.3%, where self-efficacy also contributed the most (β = 0.272, p < 0.014). Psychosocial adaptation and physiological adaptation had a direct effect on the quality of life by 54.6%, where psychosocial adaptation showed the largest contribution (β = 0.63, p < 0.0001).ConclusionSelf-efficacy contributes the most to both psychosocial and physiological adaptations 6 months after stroke. Psychosocial adaptation and self-efficacy have been proven to be the determinant factors that contribute the most to the quality of life of patients 6 months after stroke.     

Circulating sTWEAK improves the prediction of coronary artery disease

ObjectivesDecreased concentrations of circulating soluble tumor necrosis factor-like weak inducer of apoptosis (sTWEAK) were recently reported to be associated with atherosclerosis, but there are still no data concerning its predictive performance.Design and methodsThe current cross-sectional study investigates the potential of the novel atherosclerotic biomarker for the prediction of coronary artery disease (CAD). Serum sTWEAK was measured by ELISA in 76 CAD patients and 82 CAD-free subjects.ResultsSerum sTWEAK concentrations were significantly lower in the patients (534.5 ± 110.9 μg/L) than in the controls (688.1 ± 150.0 μg/L, p < 0.001), even after adjusting for different confounders (p < 0.001). The areas under ROC curves (AUC)s calculated for logistic regression models that included different known risk factors were significantly increased when sTWEAK was added to the corresponding model (p = 0.011–0.035).ConclusionsThe measurement of serum sTWEAK concentrations improves the prediction of CAD based on existing biomarkers.     

The nitric oxide synthase 3 gene polymorphisms and their association with deep vein thrombosis in Asian Indian patients

BackgroundEndothelium derived nitric oxide is formed from l-arginine by endothelial nitric oxide synthase encoded by the nitric oxide synthase 3 (NOS3) gene. Nitric oxide possesses a variety of protective effects on endothelial cells and therefore NOS3 is a logical candidate gene to be investigated for the susceptibility of deep vein thrombosis (DVT).MethodsOne hundred consecutive patients (M: F = 56:44) with idiopathic deep vein thrombosis and an equal number of age and sex matched healthy controls were the study subjects. All study subjects were typed for five NOS3 polymorphisms (? 786C/T, ? 922A/G, 894G/T, Intron 4 VNTR, and Intron 23 G10T).ResultsTwo polymorphisms (? 922A/G and 894G/T) are showing their association with DVT. ? 922A/G shows both genotypic (P = 0.0218; χ² = 5.25; O.R = 1.94) as well as allelic association (P = 0.0014; χ² = 10.19; O.R = 2.0) while 894G/T shows only allelic (P = 0.04; χ² = 3.93; O.R = 3.93) association with DVT.ConclusionSusceptibility to DVT in North Indian Asian patients may be associated with some variants of NOS3 gene.     

Effects of prenatal yoga on women’s stress and immune function across pregnancy: A randomized controlled trial

ObjectiveThe effects of prenatal yoga on biological indicators have not been widely studied. Thus, we compared changes in stress and immunity salivary biomarkers from 16 to 36 weeks’ gestation between women receiving prenatal yoga and those receiving routine prenatal care.DesignFor this longitudinal, prospective, randomized controlled trial, we recruited 94 healthy pregnant women at 16 weeks’ gestation through convenience sampling from a prenatal clinic in Taipei. Participants were randomly assigned to intervention (n = 48) or control (n = 46) groups using Clinstat block randomization.InterventionThe 20-week intervention comprised two weekly 70-min yoga sessions led by a midwife certified as a yoga instructor; the control group received only routine prenatal care.Main outcome measuresIn both groups, participants’ salivary cortisol and immunoglobulin A levels were collected before and after yoga every 4 weeks from 16 to 36 weeks’ gestation.ResultsThe intervention group had lower salivary cortisol (p < 0.001) and higher immunoglobulin A (p < 0.001) levels immediately after yoga than the control group. Specifically, the intervention group had significantly higher long-term salivary immunoglobulin A levels than the control group (p = 0.018), and infants born to women in the intervention group weighed more than those born to the control group (p < 0.001).ConclusionPrenatal yoga significantly reduced pregnant women’s stress and enhanced their immune function. Clinicians should learn the mechanisms of yoga and its effects on pregnant women. Our findings can guide clinicians to help pregnant women alleviate their stress and enhance their immune function.     

Effect of different calcineurin inhibitors on AOPP and TAS after kidney transplantation

ObjectivesLittle is known about the influence of calcineurin inhibitors on advanced oxidation protein products (AOPP) and total antioxidant status (TAS) after renal transplantation.Design and methodsAOPP and TAS were evaluated in transplanted patients on different calcineurin inhibitors. Thirty-five patients were treated with cyclosporine A (group A) and 33 with tacrolimus (group B).ResultsOver 6 months, the mean levels of AOPP in group A decreased from 205.9 ± 125.7 to 140.9 ± 78.9 µmol/L and TAS from 1.89 ± 0.30 to 1.75 ± 0.27 mmol/L. In group B, the mean levels of AOPP decreased from 196.5 ± 123.9 to 129.6 ± 63.8 µmol/L and TAS from 1.80 ± 0.39 to 1.78 ± 0.23 mmol/L.ConclusionNo significant differences in AOPP and TAS were found with respect to treatment. The only exception was the higher mean concentration of AOPP at month 1 in group A (p = 0.026).