Meyrick Chow

The Effect of Diabetes Self-Management Education on Body Weight, Glycemic Control, and Other Metabolic Markers in Patients with Type 2 Diabetes Mellitus

Aims. To comprehensively evaluate the effect of a short-term diabetes self-management education (DSME) on metabolic markers and atherosclerotic parameters in patients with type 2 diabetes. Methods. 76 patients with type 2 diabetes were recruited in this study. They were divided into the intervention group (n = 36) and control group (n = 40). The patients in the intervention group received a 3-month intervention, including an 8-week education on self-management of diabetes mellitus and subsequent 4 weeks of practice of the self-management guidelines. The patients in the control group received standard advice on medical nutrition therapy. Metabolic markers, carotid intima-media thickness (CIMT), and carotid arterial stiffness (CAS) of the patients in both groups were assessed before and after the 3-month intervention. Results. There was a significant reduction in hemoglobin A1c (HbA1c, −0.2 ± 0.56% versus 0.08 ± 0.741%; P < 0.05) and body weight (−1.19 ± 1.39 kg versus −0.61 ± 2.04 kg; P < 0.05) in the intervention group as compared to the control group. However, no significant improvements were found in other metabolic markers, CIMT and CAS (P > 0.05). Conclusions. DSME can improve HbA1c and body weight in patients with type 2 diabetes.

Exploring the intention to use a clinical imaging portal for enhancing healthcare education

Clinical imaging plays an integral role in disease diagnosis and patient care. It is good for healthcare professionals such as nurses to acquire skills and knowledge in radiological examination requests and image interpretation, since this kind of role extension provides more personalized patient care and streamlines the service. This study described the development of a clinical imaging portal to facilitate independent learning in image interpretation and explored factors affecting intentions to use the portal based on the technology acceptance model (TAM), with the computer self-efficacy construct as an external variable. One hundred and twenty-eight nursing students participated in this survey study and the results indicated that the portal was perceived as easy to use, useful and satisfying. Structural equation modeling (SEM) showed that attitude toward using the portal exhibited the strongest total effect on behavioral intention to use, followed by perceived ease of use and computer self-efficacy. Although some TAM researchers have suggested that the inclusion of attitude is not meaningful, we argue that attitude should continue to be used in subsequent research.

Factors Associated with Resilience of Adult Survivors Five Years after the 2008 Sichuan Earthquake in China

Given the paucity of quantitative empirical research on survivors’ resilience and its predictors in the context of long-term recovery after disasters, we examined how resilience predictors differed by gender among adult survivors five years after the Sichuan earthquake. This was a cross-sectional survey study of adult survivors (N = 495; aged 18–60) living in reconstructed communities five years into the recovery process after the Wenchuan earthquake. The instruments we used included assessments of sociodemographic characteristics and earthquake exposure level, the Connor-Davidson Resilience Scale, and the Social Support Rating Scale. Support-seeking behaviors emerged as a significant predictor of male survivors’ resilience, while subjective support and marital status were found to be predictors of female survivors’ resilience. Annual household income and chronic disease were predictors for both male and female groups. The findings of this study can be used in devising methods to boost survivors’ resilience by promoting their satisfaction with social support and their ability to obtain effective support. Additionally, the results suggest how to assist survivors who may have relatively poor resilience.

Cumulative effects of hypertension, dyslipidemia, and chronic kidney disease on carotid atherosclerosis in Chinese patients with type 2 diabetes mellitus.

Aims. The aim of this study is to determine the extent of carotid atherosclerosis in Chinese patients with type 2 diabetes in relation to the cumulative atherosclerosis risk factors using ultrasonography. Methods. The presence of hypertension, dyslipidemia, and chronic kidney disease (CKD) was documented in 106 Chinese subjects with type 2 diabetes. Subjects with 0, 1, and ≥2 additional atherosclerosis risk factors were assigned into groups 1, 2, and 3, respectively (n = 17, 49, and 40, resp.). Using ultrasound, the carotid arteries were assessed for the presence of carotid plaque, plaque score, intima-media thickness (IMT), and carotid arterial stiffness. Results. With the adjustment for age and gender, the presence of plaque and plaque score were significantly higher in groups with more atherosclerosis risk factors (P < 0.05). In addition, age > 60 years old (odds ratio = 2.75; 95% CI: 1.26–6.0) and the presence of hypertension (odds ratio = 2.48; 95% CI: 1.11–5.58), dyslipidemia (odds ratio = 2.41; 95% CI: 1.05–5.51), and CKD (odds ratio = 7.80; 95% CI: 1.46–41.72) could independently predict higher plaque score (P < 0.05). Conclusions. Hypertension, dyslipidemia, and CKD in Chinese patients with type 2 diabetes have cumulative effects on the burden of carotid plaque.

Effect of continuous oral suctioning on the development of ventilator-associated pneumonia: A pilot randomized controlled trial

BACKGROUND Both continuous and intermittent aspiration of subglottic secretions by means of specially designed endotracheal tubes containing a separate dorsal lumen that opens into the subglottic region have been shown to be useful in reducing ventilator-associated pneumonia (VAP). However, the high cost of these tubes restricts their use. OBJECTIVE The aim of this pilot randomized controlled trial was to test the effect of a low-cost device (saliva ejector) for continuous oral suctioning (COS) on the incidence of VAP in patients receiving mechanical ventilation. METHODS The study was conducted in the six-bed medical-surgical ICU of a hospital with over 400 beds that provides comprehensive medical services to the public. The design of this study was a parallel-group randomized controlled trial. While both the experimental and control groups used the conventional endotracheal tube, the saliva ejector was only applied to patients assigned to the experimental group. The device was put between the patients cheek and teeth, and then connected to 100mmHg of suction for the continuous drainage of saliva. RESULTS Fourteen patients were randomized to receive COS and 13 patients were randomized to the control group. The two groups were similar in demographics, reasons for intubation, co-morbidity, and risk factors for acquiring VAP. VAP was found in 3 patients (23.1%; 71 episodes of VAP per 1000 ventilation days) receiving COS and in 10 patients (83.3%; 141 episodes of VAP per 1000 ventilation days) in the control group (relative risk, 0.28; 95% confidence interval, 0.10-0.77; p=0.003). The duration of mechanical ventilation in the experimental group was 3.2 days (SD 1.3), while that in the control group was 5.9 days (SD 2.8) (p=0.009); and the length of ICU stay was 4.8 days (SD 1.6) versus 9.8 days (SD 6.3) for the experimental and control groups, respectively (p=0.019). CONCLUSION Continuous clearance of oral secretion by the saliva ejector may have an important role to play in reducing the rate of VAP, decreasing the duration of mechanical ventilation, and shortening the length of stay of patients in the ICU.

Validity and reliability of the proposed core competency for infection control nurses of hospitals in Hong Kong

Literature review and the Delphi approach were used to draft the core competency items of hospital infection control nurses in Hong Kong. Content validity, internal consistency, and test-retest reliability of the proposed core competency were ensured. The result serves as the foundation of developing training and assessment tools for infection control nurses in Hong Kong.

College students’ knowledge and attitudes toward bystander cardiopulmonary resuscitation: A cross-sectional survey

Abstract Background: Sudden cardiac arrest attracts global attention because it is a fatal public health concern. Early implementation of high-quality cardiopulmonary resuscitation (CPR) can significantly improve chances of survival. The significance of CPR training is well recognized by the American Heart Association. College students are potential bystanders who could perform CPR in the community. Aim: This study purpose is to explore college students’ knowledge and attitudes toward CPR. Methods: A cross-sectional survey with convenience sampling was conducted in a tertiary college. From September to October 2015, 506 hard-copies of a well-validated questionnaire were distributed. Results: Of 351 respondents, 73 (21.8%) were male and 278 (79.2%) were female. The mean knowledge score was 4.97 out of 10 with a standard deviation of 1.61. Over half of the respondents (n = 194, 55.3%) had attended a CPR course before. The mean attitude score was 26.53 out of 30, and the standard deviation was 2.68. Most of the respondents (87.0%) showed a willingness to perform CPR. The reasons for attending CPR training were mainly “interest” (n = 106, 46.5%), followed by “extra-curricular activity” (n = 37, 16.2%), “to help family and friends in need” (n = 37, 16.2%) and “others” (n = 29, 12.7%) such as to fulfill job or academic requirement. The most frequently reported inhibitors of performing bystander CPR were a lack of confidence due to forgetting CPR procedures (28.8%) and lack of confidence due to not having received any CPR training (19.1%). Conclusions: Although students had a positive attitude toward CPR, inadequate knowledge and training were found. Incorporation of CPR training into the college curricula could be a long-term strategy to enhance CPR benefits to the wider community. Maintaining better knowledge and skills retention, regular and refresher training for students are recommended.

Identifying Core Competencies of Infection Control Nurse Specialists in Hong Kong.

Purpose: To confirm a core competency scale for Hong Kong infection control nurses at the advanced nursing practice level from the core competency items proposed in a previous phase of this study. This would serve as the foundation of competency assurance in Hong Kong hospitals. Design: A cross-sectional survey design was used. Setting: All public and private hospitals in Hong Kong. Subjects: All infection control nurses in hospitals of Hong Kong. Methods: The 83-item proposed core competency list established in an earlier study was transformed into a questionnaire and sent to 112 infection control nurses in 48 hospitals in Hong Kong. They were asked to rate the importance of each infection prevention and control item using Likert-style response categories. Data were analyzed using the Rasch model. Results: The response rate of 81.25% was achieved. Seven items were removed from the proposed core competency list, leaving a scale of 76 items that fit the measurement requirements of the unidimensional Rasch model. Conclusions: Essential core competency items of advanced practice for infection control nurses in Hong Kong were identified based on the measurement criteria of the Rasch model. Several items of the scale that reflect local Hong Kong contextual characteristics are distinguished from the overseas standards. Implications: This local-specific competency list could serve as the foundation for education and for certification of infection control nurse specialists in Hong Kong. Rasch measurement is an appropriate analytical tool for identifying core competencies of advanced practice nurses in other specialties and in other locations in a manner that incorporates practitioner judgment and expertise.