Nurse-led early evaluation following corticosteroid prescription in patients with inflammatory bowel disease

Background: The Toronto consensus for management of ulcerative colitis (UC) recommends early evaluation of UC patients 2 weeks after initiation on corticosteroids. A system for early evaluation of inflammatory bowel disease patients was established by specialist nurses in a secondary care centre. Aim: To compare outcomes following early evaluation to the previous service. Methods: All patients undergoing early evaluation over a 1-year period were prospectively audited and compared to a retrospective cohort of patients receiving prednisolone in the preceding year. Findings: Of 140 patients included, 76 (54.3%) underwent early evaluation. All patients in the early evaluation group received drug education and details of the nurse helpline (17.1% of patients did not already have this). Of patients, 81.6% were prescribed Adcal, and 83.9% were on 5-aminosalicylates. Fewer admissions were observed within 6 months following early evaluation (8.6% vs. 23.4%, p=0.013). Conclusion: Multiple benefits of early evaluation were observed, including a potential reduction in hospital admissions.

Validation of a Brochure to Guide Health Professionals in the Dressing and Undressing of Personal Protective Equipment During the SARS-CoV-2 Pandemic

Objective To develop and validate a brochure to guide health professionals in properly dressing and undressing the personal protective equipment (PPE) used in the SARS-CoV-2 pandemic. Methods To develop the brochure, an integrative literature review was conducted after searching the following databases: SciELO, LILACS, and MEDLINE. The brochure was evaluated by 38 health professionals (nurses, physical therapists, and doctors) employing the Delphi technique. The results were analyzed using the Content Validity Index. Results In the first evaluation cycle, the items in the brochure were considered by the panel of experts as ranging from “unsuitable” to “totally adequate”. After the appropriate corrections suggested by the experts, the brochure once again was sent to the second evaluation cycle, in which all items were rated as “adequate” or “totally adequate.” The result is a Content Validity Index of 1.0. Conclusion The present study allowed the development of a brochure and its validation by consensus among the evaluation group. The developed and validated brochure presents the reliability of the technique of dressing and undressing the PPE used by health professionals during the pandemic of COVID-19. This information contributes to the management of assistance with quality and safety for the frontline workers and patients.

Subtypes of nurses’ mental workload and interaction patterns with fatigue and work engagement during coronavirus disease 2019 (COVID-19) outbreak: A latent class analysis

Background Nurses play critical roles when providing health care in high-risk situations, such as during the COVID-19 outbreak. However, no previous study had systematically assessed nurses’ mental workloads and its interaction patterns with fatigue, work engagement and COVID-19 exposure risk. Methods A cross-sectional study was conducted via online questionnaire. The NASA Task Load Index, Fatigue Scale-14, and Utrecht Work Engagement Scale were used to assess nurses’ mental workload, fatigue and work engagement, respectively. A total of 1337 valid questionnaires were received and analyzed. Nurses were categorized into different subgroups of mental workload via latent class analysis (LCA). Cross-sectional comparisons, analysis of covariance (ANCOVA), and multivariate (or logistic) regression were subsequently performed to examine how demographic variables, fatigue and work engagement differ among nurses belonging to different subgroups. Results Three latent classes were identified based on the responses to mental workload assessment: Class 1 – low workload perception & high self-evaluation group (n = 41, 3.1%); Class 2 – medium workload perception & medium self-evaluation group (n = 455, 34.0%); and Class 3 – high workload perception & low self-evaluation group (n = 841, `62.9%). Nurses belonging into class 3 were most likely to be older and have longer professional years, and displayed higher scores of fatigue and work engagement compared with the other latent classes (p < 0.05). Multivariate analysis showed that high cognitive workload increased subjective fatigue, and mental workload may be positively associated with work engagement. Group comparison results indicated that COVID-19 exposure contributed to significantly higher mental workload levels. Conclusions The complex scenario for the care of patients with infectious diseases, especially during an epidemic, raises the need for improved consideration of nurses’ perceived workload, as well as their physical fatigue, work engagement and personal safety when working in public health emergencies.

Nurse-led early evaluation following corticosteroid prescription in patients with inflammatory bowel disease

Background The Toronto consensus for management of ulcerative colitis (UC) recommends early evaluation of UC patients 2 weeks after initiation on corticosteroids. A system for early evaluation of inflammatory bowel disease patients was established by specialist nurses in a secondary care centre. Aim To compare outcomes following early evaluation to the previous service. Methods All patients undergoing early evaluation over a 1-year period were prospectively audited and compared to a retrospective cohort of patients receiving prednisolone in the preceding year. Findings Of 140 patients included, 76 (54.3%) underwent early evaluation. All patients in the early evaluation group received drug education and details of the nurse helpline (17.1% of patients did not already have this). Of patients, 81.6% were prescribed Adcal, and 83.9% were on 5-aminosalicylates. Fewer admissions were observed within 6 months following early evaluation (8.6% vs. 23.4%, p=0.013). Conclusion Multiple benefits of early evaluation were observed, including a potential reduction in hospital admissions.

Role of Voice Therapy in Adherence to Voice Rest After Office-Based Vocal Fold Procedures

Purpose Patients undergoing vocal fold procedures significantly reduce but often do not cease voice use during absolute postprocedure voice rest. We hypothesized that patients who completed preprocedure voice therapy would increase adherence to postprocedure voice rest. Method Eighty-six participants completed this prospective cohort study. Patients scheduled for office-based vocal fold procedures, 1–3 days of absolute postprocedure voice rest, and preprocedure speech-language pathology (SLP) care were recruited. SLP care consisted of either (a) multiple voice therapy sessions, (b) one counseling/therapy session, or (c) voice evaluation only. Participants reported talking and other specific voice behaviors on 100-mm visual analog scales for up to 3 days pre- and postprocedure as well as changes in overall voice use at follow-up at least 1 week postprocedure. Results Talking decreased postprocedure by 63% in the therapy group and 65% in the counseling group, both significantly more than the 35% decrease measured in the evaluation group. There were group differences in talking at baseline but not during voice rest. Coughing and throat clearing were highest in the voice evaluation group and decreased less than talking during voice rest. At follow-up, 84% of participants reported that they completed voice rest for at least as long as recommended and 39.5% reported that they never used their voices during voice rest. Participants estimated a 98% overall reduction in voice use during voice rest at follow-up. Conclusions Voice use before and after vocal fold procedures varies by participation in preprocedure voice therapy. Patients significantly decrease talking during postprocedure voice rest but are not perfectly adherent. Communicative voice use decreases more than noncommunicative voice use during voice rest. Patients may overestimate adherence to voice rest at follow-up. Supplemental Material https://doi.org/10.23641/asha.16589864

Effectiveness of Animation Videos as an Auxiliary Tool to Conventional Lectures for Teaching Paediatric Surgery – An Interventional Study, Kozhikode, Kerala

BACKGROUND At present, concepts of basic paediatric surgical disorders by undergraduate medical students is limited, which is likely due to deficiencies of traditional teaching methods. This therefore results in delay in identifying situations that mandate initial management and timely referrals. The primary objective of this study is to determine the efficacy of animation videos in conjunction with conventional lectures while teaching paediatric surgical disorders. METHODS This is an interventional study involving 60 final year MBBS students at a tertiary care institution. They were divided into two comparable groups of 30 each. One group (Group A) was educated using animation videos and conventional lectures that included three crucial topics in paediatric surgery - malrotation, intussusception and cleft lip/palate. The other group (Group B) was taught the same topic by means of conventional techniques alone (power point, pictures and usage of black board). The same teacher took these sessions (six exposures, 3 each in two groups) for both the groups, on consecutive days. After conclusion of the session, two sets of assessments (multiple choice questions) were provided to students, one soon after class and another two weeks later. Appropriate statistical methods were employed to compare scores obtained by them and their feedback through a questionnaire. RESULTS On immediate evaluation, Group A (N = 30) achieved a mean score of 21.8 ± 1.1 in comparison to 17.8 ± 1.3 achieved by Group B. On statistical analysis with independent t test, the positive difference was statistically significant (P < 0.0001). At 2 weeks’ evaluation, Group A achieved a mean score of 20.5 ± 1.3, and Group B 17.9 ± 1.5. This difference was also found to be significant (P = 0.006). On assessing feedback questionnaire responses, majority of students found the video assisted teaching method with animation video practical and valuable. CONCLUSIONS The teaching method using animation videos in conjunction with conventional lecture is more effective in paediatric surgery than teaching with conventional lectures alone. The students have also shown a favourable perception towards this method of teaching. KEYWORDS Animation Videos, Conventional Lecture, Teaching, Paediatric Surgical Disorders

Rapid on-site evaluation of touch imprints of biopsies improves the diagnostic yield of transbronchial biopsy for endoscopically nonvisible malignancy: a retrospective study

Objective Rapid on-site evaluation has long been used for transbronchial needle aspiration or fine-needle aspiration to evaluate the adequacy of biopsy materials for the diagnosis of peripheral lung lesions. However, research on rapid on-site evaluation combined with transbronchial forceps biopsy in the diagnosis of lung carcinoma is rarely reported. Therefore, we aimed to investigate the value of rapid on-site evaluation during transbronchial forceps biopsy for endoscopically visible (tumor, infiltrative and necrotic) or nonvisible (compressive, nonspecific and normal) malignancy. Methods A retrospective analysis was performed between January 2015 and January 2019 in Taihe Hospital with 1216 lung cancer patients who underwent bronchoscopy procedures, and these patients were allocated into the rapid on-site evaluation group and non-rapid on-site evaluation group, depending on the timing of the procedure. According to endoscopic features, bronchoscopic appearance was described as endoscopically visible malignancy (tumor, infiltrative and necrotic) and endoscopically nonvisible malignancy (compressive, nonspecific and normal). The diagnostic yield was compared, and the concordance between the rapid on-site evaluation results and the final histology was analyzed. Results There was a statistically significant difference in the diagnostic yield between the rapid on-site evaluation and non-rapid on-site evaluation groups for endoscopically nonvisible malignancy (74.3% vs. 51.7%, P &lt; 0.05). However, we found no significant improvement in terms of diagnostic yield for endoscopically visible malignancy (95.2% vs. 91.2%, P &gt; 0.05). The rapid on-site evaluation results showed high-level concordance with histology in the diagnosis of squamous cell carcinoma, adenocarcinoma and small cell carcinoma, with kappa values of 0.749 (P &lt; 0.05), 0.728 (P &lt; 0.05) and 0.940 (P &lt; 0.05), respectively. Conclusions The findings demonstrated that the diagnostic yield of transbronchial biopsy for endoscopically nonvisible malignancy (compressive, nonspecific and normal) was significantly improved when rapid on-site evaluation was implemented. In addition, the rapid on-site evaluation results had high-level concordance with the final histological diagnosis.

Elkövetőből áldozat – a csoportközi konfliktusok narratív konstrukciójának percepciója*

Háttér és célkitűzések:Tanulmányunkban azokat a narratív eseménykonstrukciós eszközöket vizsgáljuk, amelyek összefüggésbe hozhatók a kollektív áldozati tudat (Bar-Tal, Chernyak-Hai, Schori és Gundar, 2009) közvetítésével és fenntartásával. Igazolni kívánjuk, hogy a László (2012) által felvázolt áldozati narratív kompozíciós eszközök (nyelvi ágencia, értékelés, és pszichológiai perspektíva csoportelfogult használata) révén közvetíthető egy csoport áldozati pozíciója. Továbbá megvizsgáljuk, hogy egy csoport konfl iktustörténetének percepcióját képes-e megváltoztatni a narratív kompozíció kísérleti úton történő manipulálása: lehetséges-e elkövetőből áldozatot kreálni pusztán a nyelvi megszerkesztettség útján?Módszer:A társas észlelési paradigmára épülő vizsgálatban nemzeti csoportok áldozati történeteinek szisztematikus nyelvi manipulációján keresztül kialakított elfogult és elfogulatlan változatát megítélve, kérdőíves módszerrel (Egyéni és Csoportvélekedés Skála, Eidelson, 2009) mértük fel a narratív kompozíciós eszközök észlelésre gyakorolt hatását.Eredmények:Az áldozati narratívum kompozíciós eszközei statisztikai értelemben is hatással voltak a bemutatott csoportok áldozati pozíciójának észlelésére. A csoportok megítélése attól függően változott, hogy a résztvevők melyik szövegváltozatot olvasták: az elfogulatlan eseményleírás esetén az „áldozati” csoport, az elfogult változat esetén az „agresszor” észlelt áldozati pozíciója válik hangsúlyosabbá. Egyúttal azt is sikerült bizonyítani, hogy pusztán a nyelvi megszerkesztettség útján megváltoztatható egy agresszor csoport észlelése, és áldozati színezettel is bemutathatók tetteik.Következtetések:A László és munkatársai által leírt narratív kompozíció közvetíti az áldozati tudattal összefüggő hiedelmeket, és a csoport szemantikus szerepe képes felülírni az objektíven meghatározott cselekményszerepeket.Background and goals:In this paper we explore the narrative event-constructional devices that can be linked to the transmission and sustainment of collective victim consciousness (Bar-Tal, Chernyak-Hai, Schori, and Gundar, 2009). Our goal is to verify that with the narrative compositional devices (linguistic agency, evaluation, group-biased use of psychological perspective) described by László (2012), a group’s victim position can be transmitted. It is further explored, if the perception of a group’s confl ict-story can be altered by the experimental manipulation of the narrative composition: is it possible to create a victim from a perpetrator by just the linguistic composition?Method:The study is based on the social perception paradigm, in which biased and unbiased variants of national groups’ victimhood stories were created through systematic linguistic manipulation. The effect of the narrative compositional devices on the perception of the stories was evaluated with a questionnaire (Individual- and Group Beliefs Scale, Eidelson, 2009).Results:The narrative compositional devices of the victimhood narrative had a statistically signifi cant effect on the perception of the introduced groups’ victimhood position. The evaluation of the groups changed according to which variant of the story was introduced: in the case of the unbiased event-description, the „victim” group’s victim position is salient; and in the case of the biased event-description, the „perpetrator” group’s victim position becomes more salient. In addition, it is demonstrated that the perception of a perpetrator group can be changed by only the narrative construction and their actions can acquire a „victim tone”.Conclusion:The narrative compositional devices described by László et al. transmit the beliefs linked to victimhood consciousness, and the group’s semantic role can overwrite the objectively defi ned roles.

NCOG-20. AWAKE SURGERY FOR RIGHT FRONTAL LOBE GLIOMA CAN IMPROVE THE RESECTION RATE AND PRESERVE HIGHER COGNITIVE FUNCTIONS

OBJECTIVE Awake surgery is the standard treatment to preserve motor and language functions. The aim of this study is to evaluate the awake surgery for the patients with right frontal lobe (RFL) glioma on resection rate and preservation of higher cognitive functions. METHODS Out of the 139 cases that underwent awake surgery at our hospital between 2013 and 2019, 34 cases (mean age: 47.8 years) of RFL glioma were included in this study. The WHO classification was grade II, III, and IV for 15, 13, and 6 cases, respectively. We evaluated visual spatial cognition (VSC), spatial working memory (SWM), and social cognition (SC) before and after the surgery. These relevant areas were mapped intraoperatively. We did not map these areas in the cases in which the task could not be accomplished. Therefore, each function was divided into an intraoperative evaluation group (EG) and a non-evaluation group (NEG), and the resection rate and functional outcomes were compared. RESULTS The removal rate was significantly higher in the EG group for VSC and SC than that in the NEG (p= 0.0078 and 0.0024, respectively). The chronic disability rate of VSC was significantly lower in the EG than that in the NEG (5.6% vs. 31.3%, p= 0.043). None of the patients had postoperative disability of SWM in the EG which is significantly lower than that in the NEG (16.7%, p= 0.049). SC tended to have a lower disability rate (20.0%) in the EG compared to that in the NEG (45.8%). The probability that the posterior deep part of the middle frontal gyrus, which is the relevant area of VSC, was resected higher in the NEG (p= 0.0052). CONCLUSIONS We scientifically verified that the awake surgery for RFL glioma contributes to the improvement of resection rate and the preservation of higher cognitive functions.