Adverse effects of non-intubated airway suctioning: a clinical data-based study

AIMS AND OBJECTIVES

The purpose of this study was to investigate the adverse effects of non-intubated suctioning.

BACKGROUND

Airway hygiene aims to maintain a patent airway to ensure adequate ventilation. Nasopharyngeal, oropharyngeal or nasotracheal suctioning may be used in patients who require airway suctioning but do not have an artificial airway. However, no studies till date provide insight into the adverse effects of non-intubated airway suctioning.

DESIGN

A clinical data-based retrospective design.

METHOD

Using institutional and clinical databases of three university hospitals in 2008-2016, we conducted a study with a propensity score matching method of 3,326 hospitalised patients who had undergone suction therapy with or without a tracheotomy. Conditional logistic regression analyses were performed to investigate the link between suctioning and the probabilities of adverse effects. STROBE checklist was used to report the current study.

RESULTS

Patients who required nasopharyngeal, oropharyngeal or nasotracheal suctioning had a higher risk of gastrointestinal ulcers than tracheotomised patients (adjusted OR 1.99; 95% CI, 1.24-3.20). Patients who received non-intubated suction had a higher risk of developing pneumonia (adjusted OR 1.59; 95% CI, 1.26-2.00), and the risk of aspiration pneumonia was three times higher than tracheotomised patients (adjusted OR 3.04; 95% CI, 1.40-6.60).

CONCLUSIONS

Non-intubated patients who require suctioning for airway clearing are more susceptible to gastrointestinal ulcers, pneumonia and aspiration pneumonia. The findings would facilitate in alerting healthcare professionals to this group of patients. However, more clinical research is needed to elucidate the mechanisms of adverse effects in non-intubated patients who require suctioning.

RELEVANCE TO CLINICAL PRACTICE

The adverse effects of suctioning can easily be overlooked in debilitated patients with no intubation. Professionals must be aware of the discomfort and risks that patients may experience.

[Evaluating the Health and Social Care Competences of Nursing Students Using Skills Competition]

BACKGROUND

After graduation, new nurses provide care directly to clients in the health and social care sectors. Nurses with higher levels of health and social care competences have been shown to provide better quality of care. The skills competitions organized and held by the Ministry of Labor follow international standards and address the general roles and functions of care providers worldwide. Using the results of these skills competitions to confirm the health and social care competences of nursing students important for nursing education.

PURPOSE

This study was designed to assess the performance of nursing students in the skills competition and to identify the strengths and weaknesses of these students with regard to related competences in the context of current global standards.

METHODS

This was a retrospective research study. Data were collected from the results of skills competitions using the Scenario-based Objective Structured Clinical Examination method. Descriptive statistics were used to analysis the data.

RESULTS

The mean score for health and social care competence was 67.9 ± 12.9. The score for the home care dimension (65.1 ± 14.1) was the lowest dimension score. The most two improved of the six competence dimensions were problem solving/innovation and creativity (53.7 ± 3.9) and evaluating response to care (55.9 ± 4.0). The lowest health and social care item scores were practicing the five moments of hand hygiene (42.7%) and encouraging patient to discuss health problems (43.1%).

CONCLUSIONS / IMPLICATIONS FOR PRACTICE

The results showed that the competence level of the students was moderate. Nursing educators should develop appropriate education approaches for teaching and evaluation and improve the health and social care competences of nursing students.

[Application of the 6-Minute Walking Test and Shuttle Walking Test in the Exercise Tests of Patients With COPD]

Exercise training improves the management of stable chronic obstructive pulmonary disease (COPD). COPD patients benefit from exercise training programs in terms of improved VO2 peak values and decreased dyspnea, fatigue, hospital admissions, and rates of mortality, increasing exercise capacity and health-related quality of life (HRQOL). COPD is often associated with impairment in exercise tolerance. About 51% of patients have a limited capacity for normal activity, which often further degrades exercise capacity, creating a vicious circle. Exercise testing is highly recommended to assess a patient's individualized functions and limitations in order to determine the optimal level of training intensity prior to initiating an exercise-training regimen. The outcomes of exercise testing provide a powerful indicator of prognosis in COPD patients. The six-minute walking test (6MWT) and the incremental shuttle-walking test (ISWT) are widely used in exercise testing to measure a patient's exercise ability by walking distances. While nursing-related articles published in Taiwan frequently cite and use the 6MWT to assess exercise capacity in COPD patients, the ISWT is rarely used. This paper introduces the testing method, strengths and weaknesses, and application of the two tests in order to provide clinical guidelines for assessing the current exercise capacity of COPD patients.

The epidemiology and clinical manifestations of human immunodeficiency virus-associated tuberculosis in Hong Kong

OBJECTIVE

To evaluate the epidemiology and clinical manifestations of human immunodeficiency virus-associated tuberculosis in Hong Kong.

DESIGN

Retrospective study.

SETTING

Tuberculosis and Chest Service and Special Preventive Programme, Public Health Services Branch, Centre for Health Protection, Department of Health, Hong Kong Special Administrative Region.

PATIENTS

Cases reported to the TB/HIV Registry jointly kept by the Tuberculosis and Chest Service and Special Preventive Programme from 1996 to 2006 were reviewed. The Registry includes cases of human immunodeficiency virus-associated tuberculosis diagnosed in the two services, and cases referred from regional hospitals under the Hong Kong Hospital Authority and the private sector.

RESULTS

Tuberculosis has become an increasingly important acquired immunodeficiency syndrome-defining illness in Hong Kong, and overtook Pneumocystis jiroveci pneumonia for the first time as the most common primary acquired immunodeficiency syndrome-defining illness in 2005 (accounting for 39% and 31% of all such illnesses, respectively in that year). The presentation of human immunodeficiency virus-associated tuberculosis is often atypical. In these patients moreover, there was a slightly higher rate of multidrug-resistant tuberculosis (2%) than in the general population (range, 0.7-1.5%).

CONCLUSIONS

Programmes for the provider-initiated human immunodeficiency virus testing policy to reduce diagnostic delays should continue and be enhanced. Continual surveillance of both conditions is imperative, especially in view of a possible link between human immunodeficiency virus and multidrug-resistant tuberculosis.

Pregnant women's decisions on antenatal HIV screening in Hong Kong

Identification of HIV-infected pregnant women by antenatal screening is crucial to prevent mother-to-child transmission. In Hong Kong, little is known about women's opinions about the screening test. This cross-sectional study examines the decisions of Hong Kong Chinese pregnant women to undergo antenatal HIV screening and the reasons for their choices. Among 191 pregnant women studied, 147 (77.0%) indicated that they would opt for antenatal HIV screening if offered. Of those, 113 (76.9%) would do so for 'the health of their newborns' and 93 (63.3%) for 'their own health'. Fourteen (7.3%) would decline the test, because they have 'one stable sexual partner' (n=9, 64.3%) and believe that 'HIV infection was not their concern' (n=8, 57.1%). Women with a lower educational attainment (adjusted OR=3.77; 95% C.I., 1.12-12.67, p=0.03) were likely to choose antenatal HIV screening. Results of this study are predictive of pregnant women's responses to Hong Kong's newly enacted antenatal HIV screening programme.

Small-group hypertension health education programme: a process and outcome evaluation

AIM

This paper reports a study to explore the expectations, attainments and opinions of the participants, the objectives and experiences of nurse facilitators, and the changes in nurse-client relationship after a small-group hypertension health education programme.

BACKGROUND

Effective control of blood pressure among hypertensive patients is essential in the reduction of cerebrovascular-related morbidity and mortality. A 'small-group hypertension education programme' has been implemented in all general outpatient clinics in Hong Kong since 2000. In order to identify what aspects of the programme were beneficial and how it benefited clients, a process evaluation study was conducted.

METHODS

Following implementation of a small-group hypertension health education programme, two focus groups were run to collect data from eight nurse facilitators, and individual semi-structured interviews were conducted with 16 programme participants. The data were collected in 2001.

FINDINGS

The findings indicate that both clients and nurses gained a great deal from and enjoyed the process of this health education programme, and their relationships were improved after the programme. About half of the clients reported having adopted health-enhancing behaviour. The study also revealed discrepancies between the nurses and clients in their perceptions of the objectives of the programme. This indicates that there is a need to clarify the objectives with clients to minimize disappointments from unrealistic expectations.

CONCLUSION

There is a need for the nurse facilitators to clarify the goal of the programme as an education group rather than as a support group. Also, needs assessment is suggested before group member recruitment in order to make the group more homogeneous.

Determinants of adherence to highly active antiretroviral therapy (HAART) in Chinese HIV/AIDS patients

OBJECTIVE

Drug adherence is crucial to the success of highly active antiretroviral therapy (HAART) in the treatment of HIV disease. Adherence to HAART and its determinants may, however, differ across HIV/AIDS populations.

METHODS

We retrospectively studied drug adherence by self-report in HIV-1 infected Chinese patients who have been on HAART for at least 1 year as at the end of year 2000. HAART is defined as three or more antiretrovirals with at least one protease inhibitor or non-nucleoside analogue reverse transcriptase inhibitor.

RESULTS

The last drug adherence level assessed by self-report in 161 Chinese patients were: grade A (100%) - 130, 80.7%; grade B (95-99%) - 25, 15.5%; grade C (90-94%) - three, 1.9% and grade D (< 90%) - three, 1.9%. Patients with full adherence were more likely to have undetectable (< 500 copies/mL) plasma virus level (adjusted OR, 4.22; 95% CI, 1.75-12.33). Patients' demographics, HIV disease status and antiretroviral regimen did not affect adherence. Partial drug adherence was, however, independently associated with the psychosocial factors of missing clinic appointments (adjusted OR, 3.13; 95% CI, 1.23-8.33), forgetfulness (adjusted OR, 4.55; 95% CI, 1.64-12.5) and a busy work life (adjusted OR, 6.67; 95% CI, 1.75-25).

CONCLUSION

There were similarities and differences in determinants affecting HAART adherence in Chinese compared with other patients. Psychosocial factors rather than HIV disease or treatment were more important factors in our Chinese patients. The relevance of patient populations and care setting for adherence to HAART shall be further studied.

Reinforcement of complete denture bases with continuous high performance polyethylene fibers

Clinical literature details the causes for deformation and failure of acrylic resin complete denture bases. These findings are used to select patterns of high performance polyethylene fiber reinforcement that would best use the properties of the material and improve the mechanical behavior of the prostheses. A technique is described for making reinforced maxillary and mandibular bases with the fibers placed as suggested by the analysis. Microscopic observations of cross sections of reinforced bases revealed good fiber/resin integration and polish.

The rabbit muscle phosphofructokinase gene: cDNA cloning and sequencing

A partial cDNA for rabbit muscle phosphofructokinase (Rm-PFK) has been cloned and sequenced. The nucleotide sequence of the cDNA agrees with the previously determined Rm-PFK genomic sequence. In addition, the amino acid sequence deduced from the cDNA is nearly identical to the Rm-PFK sequence previously determined by peptide analysis. A significant degree of homology exists when the amino acid sequence of Rm-PFK is compared with the sequences of Bacillus stearothermophilus PFK or Escherichia coli PFK-1. The cloning and sequencing of the PFK cDNA fragment represents significant progress toward the long term goal of using site-specific mutagenesis to investigate the structure-function relationships in this allosteric enzyme.