Failure To Rescue, What Can Be Done To Prevent It?

Introduction: Failure to Rescue (FTR) is the failure to prevent a patient’s death after a complication. It measures the ability of a hospital to prevent the death of patients who develop one or more complication that was not present at the time of admission. Therefore, the aim of this study is to review the factors that contribute to FTR, and the measures and strategies that can be applied to prevent the FTR events, in order to discuss the best way to improve patient outcomes in the hospital setting. Methods: A search was conducted on PUBMED retrieving a total of 464 articles. A review of the selected articles’ bibliography was conducted to find other relevant articles. Sixty studies were reviewed in this paper. Results: Patient factors as increasing age, comorbidities and frailty increase the risk of FTR, as well as an increasing number of complications. Several hospital factors, nursing care, and microsystem also influence FTR. Some track and Trigger Systems (TTS) and Early Warning Scores (EWS) have been shown to predict clinical deterioration. On the other hand, machine learning systems have outperformed EWS. Rapid response teams have become the standard approach to delivery and escalation of care, and cognitive aids and crisis checklists also have potential to help reduce FTR. Conclusion: Patient and hospital factors are often non-modifiable; thus, microsystem factors could be a target for improvement. Creating clinical pathways can improve surveillance, and communication tools like SBAR can help relay information. EWS, machine learning models and continuous monitoring are strategies that can help detect clinical deterioration. In the efferent limb rapid response teams have shown to reduce FTR.

Mitochondrial DNA Diversity of the Nangan Islanders Living in the Mazu Archipelago of the Taiwan Strait

This study investigates the genetic relationship of the Mazu peoples on the east coast of China in the Taiwan Strait. Using partial and complete mitochondrial DNA (mtDNA) sequences, we compare Mazu with surrounding East Asia populations. Mazu shows no exclusive affinities with either Southeast or Northeast Asia. High genetic diversity and a very high number of exclusive haplogroups of various Asian origins suggest that Mazu resulted from a process of continuous resettlement that started when it first became an archipelago at the end of the last glacial maximum and that continued till the last century. As a result, genetic drift did not contribute to an exclusive Mazu profile. The structure of haplogroups that show signatures of the Neolithic era (N9a10a), or influx from Island Southeast Asia (F1a4a) suggest recent gene flows and Mazu relationship with it's pre-Neolithic era (presence of pre-E1a or R9/pre-F from Liangdao man) was not seen.

The Importance of Time in Range (TIR) for Continuous Glucose Monitoring (CGM) in the Clinical Practice for Diabetes

As to the development of treatment for diabetes, Continuous Glucose Monitoring (CGM) has been recently prevalent rapidly. By the analysis of real-time CGM, Ambulatory Glucose Profile (AGP) has been used. It includes time in range (TIR, 70-180 mg/dL), time above range (TAR, >181mg/dL), time below range (TBR, <69 mg/dL), Glycemic Variability (GV), Glucose Management Indicator (GMI), Glycemic variability, Coefficient Of Variation (CV%) and so on. TIR value indicating approximately 70% seems to correlate closely with the HbA1c level of 6.77.0%. Marked discordance of HbA1c values has been found between laboratory HbA1c and estimated HbA1c (eA1c) using GMI from CGM.

COVID-19 Pneumonia with Atrial Fibrillation, Coronary Spasm, and Wavy Triple Sign (Yasser’s Sign); Dramatic Reversal at Home Management

Rationale: A novel COVID-19 with a severe acute respiratory syndrome or pneumonia had arisen in Wuhan, China in December 2019. Emerging atrial fibrillation in COVID-19 patients is highly significant in cardiovascular medicine. A newly coronary artery spasm in the presentation of COVID-19 infection has certainly a risk impact on both morbidity and mortality of COVID-19 patients. Wavy triple an electrocardiographic sign (Yasser Sign) is an innovated sign of hypocalcaemia linked to tachypnea and acute respiratory distress. Patient concerns: An elderly male COVID-19 patient presented to physician outpatient clinic with bilateral pneumonia, atrial fibrillation, evidence of coronary artery spasm, and Wavy triple an electrocardiographic sign (Yasser Sign). Diagnosis: COVID-19 pneumonia with coronary artery spasm and the Wavy triple an electrocardiographic sign (Yasser Sign). Interventions: Chest CT scan, electrocardiography, oxygenation, and echocardiography. Outcomes: Gradual dramatic clinical, electrocardiographic, and radiological improvement had happened. Lessons: The reversal of electrocardiographic ST-segment depressions in a COVID-19 patient after adding oral nitroglycerine is an indicator for the presence of coronary artery spasm. It signifies the role of the anti-infective drugs, anticoagulants, antiplatelet, and steroids in COVID-19 patients with bilateral pneumonia, AF, coronary artery spasm are effective therapies. The disappearance of AF after initial therapy may a guide for a good prognosis in this case study. The evanescence of Wavy triple ECG sign as a hallmark for the existence of the Movable-weaning phenomenon of hypocalcaemia is recommended for further wide-study.

Proximate Analysis and Mineral Content Determination of Traditionally Processed Locust Bean (Parkia biglobosa) Fruit Pulp for Possible Industrial Application

This study examined the nutritional properties and industrial application of African locust bean properly known as Iru in southwest Nigeria. Locust bean was processed into food condiment which is used as a spice that gives an African meal a pleasant flavor. The production process of locust bean includes boiling for 12 hours, soaking the seeds in water, de-hulling, boiling for another 6 hours and ferment for 4 days. Proximate analysis and mineral content of the African locust bean (Parkia biglobosa) fruit pulp was determined using standard methods Association of Analytical Communities (AOAC) (1995). The results showed that African locust bean contain 42.8% Moisture, 37.34% Protein, 24.21% Fiber, 0.9% Fat, 3.55% Ash, and 17.0% Carbohydrate using proximate Analysis. The Mineral elements present are Calcium 9.01 mg/100 g, Potassium 20.5 mg/100 g, Magnesium 35.00 mg/100 g, Iron 3.31 mg/100 g, Phosphorus 73.00 mg/100 g with the use of Atomic Absorption Spectrophotometer Analysis technique. With the values gotten for the nutritional and mineral analysis of African locust bean, it should therefore be substituted for Monosodium Glutamate (MSG) used industrially for the production of various magi and flavorings which are not nutritive but are carcinogenic chemicals while locust bean has no health side effect. The food industry should package the locust bean in a way which would make the condiment much more attractive to its consumer and non-consumers because is faced with packaging problem.

Masking Tape Art-Work May Provide Beneficial Positive Effects

Background: The authors and colleagues have been involved in treatment and care for the elderly with rehabilitation, Integrative Medicine (IM), art in hospitals for artworks using masking tape. Combined together, we conducted a pilot study for medical application of masking tape art-work for elderly subjects. Subjects and Methods: Subjects enrolled were 12 elderly patients with dementia regularly coming to day care center for rehabilitation (M/F 3/9, 78-100 years, 88.3±6.0 years). As methods, masking tape has been known as Washi Tape (wa=Japanese and shi=paper), which is adhesive tape easily to stick and peel off for decorative work. Protocol included i) working 2-3 times a week, ii) sticking masking tape on a rough sketch paper, iii) evaluation of several biomarkers before and after the intervention. Results: i) Artworks were performed satisfactory for each case, ii) grasping power (right) showed increasing tendency from 13.5±7.7kg to 14.8±6.8kg (p=0.11), iii) vitality test showed significantly increase (p=0.02). Discussion and Conclusion: Artworks of masking tape seem to be beneficial for improving grasping power and psychological condition. This study included other biomarkers such as Mini-Mental State Examination (MMSE), pinch power, language word test and Barthel index. We plan to develop further detail analyses in the future research.

Improved Hypertension by Investigating Circadian Rhythm of Blood Pressure

Case: The case is 86-year-old male hypertensive patient with anti-hypertensive drug for 5 years. He has been provided Amlodipine besilate 5mg at 0800h and doxazosin mesylate 2mg at 2300h for long. In June 2020, he noticed unstable fluctuation of Blood Pressure (BP) during morning, afternoon and night. Results: Then, he checked the circadian rhythm of BP, which showed higher BP in early morning, decreasing BP 0800-1000h, minimum BP during 1000-1400h, increasing BP during 1400-1800h and stable BP during 1800-2400h. Due to the result, he changed to take amlodipine at 2300h. Consequently, his BP gradually became stable during 24 hours after 2 weeks. Discussion: Some factors may exist for contributing improved BP fluctuation. They include a) pathophysiological characteristics of BP circadian rhythm, b) effective time for anti-hypertensive drug, c) accuracy of the obtained BP data and d) the social and psychological reliability of the patient. Regarding d) he was engaged in research and development work as a senior researcher at a chemical company. He has been also a member of New Elderly Association (NEA), which was established by Shigeaki Hinohara. He lives on the philosophy of Hinohara-ism for long, associated with stable mind and body.

Osteolysis of the Carpus as a Presentation of Pancoast's Tumor

Lung cancer is most often located in the right upper lobe and is called a Pancoast tumor. On many occasions, the Pancoast tumor begins with osteomyoarticular manifestations. A 72-year-old white male patient of peasant origin is presented who attends the Guard Corps because for a few weeks an increase in volume has been noted on the back of the right hand accompanied by pain in the absence of trauma. An X-ray of the hand was performed, observing osteolysis of the carpal bones, in the preoperative preparation a chest X-ray was performed where an image of condensation of the upper lobe of the right lung was observed. An excisional biopsy of the carpal lesion was performed, the result of which was metastasis of highly undifferentiated lung adenocarcinoma.

Fibula Ostectomy as Palliative Treatment of Knee Osteoatrosis

Osteoarthrosis is a degenerative joint condition characterized by progressive loss of joint cartilage. The knee joint is one of the most affected by this disease. Although there are different procedures for the surgical treatment of this pathology, fibular ostectomy in recent years is giving very good results. Although this surgical technique does not eliminate osteoarthritis of the knee, it does improve the symptoms and functional disability of the joint. Fibula Ostectomy is a palliative treatment of choice in knee osteoarthritis.

Elderly Diabetic Patients with Effective Add-on Therapy of Dulaglutide as a GLP-1 Receptor Analogue (GLP-1 RA)

Background: For diabetic treatment, Dulaglutide has been used and effective as a glucagon-like peptide-1 receptor analogue (GLP-1 RA). This report is to describe the various responses and to analyze dulaglutide administration in the elderly with DM. Case presentation: Two patients were Type 2 Diabetes Mellitus (T2DM) treated with add-on therapy of Dulaglutide. Case 1 is 81-year-old female is diabetic for 2 years, and on Metformin and Glimepiride as Oral Hypoglycemic Agents (OHAs). Her HbA1c was higher with 10.6% and she was started to given Dulaglutide 0.75mg. Remarkable efficacy was found in 3 months with HbA1c 6.7%. Value of LDL-C increased from 135 mg/dL to 158 mg/dL. Case 2 is 83-year-old male with 27 years of diabetes. He was on medication of Metformin and Glimepiride. His HbA1c persisted around 9.0%-9.4%, then he was provided Dulaglutide as add-on therapy. In 3 months, HbA1c decreased to 8.2% and LDL-C increased from 57 mg/dL to 116 mg/dL. Discussion and conclusion: Dulaglutide is a useful GLP-1 RA with once a week administration. There were some reports concerning LDL changes after dulaglutide therapy, showing that the changes may depend on the basal LDL value before the administration of dulaglutide. Dulaglutide may influence lipid metabolism. This report is expected to become reference in diabetic practice and research in the future.