Abstract To investigate factors predicting hospital mortality and hospital length of stay (LOS) in traumatized adults and older adults, we conducted a three-year retrospective study at an academic hospital, Bangkok, Thailand. We reviewed medical records of 627 trauma patients admitted to the ED. Subjects were classified into 2 groups: adults (□55y), and older adults (□55y). Data were collected for demographic and clinical characteristics, physiologic deterioration using the Modified Early Warning Score (MEWS), severity of injury using the Circulation Respiration Abdomen Motor and Speech Score (CRAMS), and outcomes of hospital mortality and LOS. Multivariable logistic and linear regression models were performed. For hospital mortality, an elevated MEWS (Older adults [n= 267]: MEWS≥3, OR=4.80, 95%CI, 1.02-22.56 vs Adults [n = 360]: MEWS≥4, OR=11.63, 95%CI, 1.94-69.82) and CRAMS (Older adults: CRAMS≤9, OR=19.21, 95%CI, 2.78-132.98 vs Adults: CRAMS≤6, OR=18.58, 95%CI, 3.40-101.65) were strongly predictive, adjusted for demographic and clinical data. For LOS, road traffic accident (RTA) (Older adults: β=0.80, 95%CI, 0.31-1.29, p < .01 vs Adults: β=0.44, 95%CI, 0.21-0.67, p < .001) and falls (Older adults: β=0.88, 95%CI, 0.44-1.32, p < .001 vs Adults: β=0.33, 95%CI, 0.02-0.65, p < .05) were associated with LOS, adjusted for demographic and clinical data. MEWS and CRAMS predicted hospital mortality, and RTA and falls predicted LOS in both age groups. Results support the need for interventions for close monitoring and medical management for older traumatized patients based on CRAMS and MEWS assessment to decrease the risk of death, and targeting those sustaining falls and RTA to reduce prolonged LOS.
Abstract Postcholecystectomy syndrome (PCS) is persistent distressing symptoms which develops following a laparoscopic cholecystectomy (LC); in cases when the condition is severe, readmission may be necessary. However, research on the prevalence of PCS and potential factors associated with PCS in Nepalese patients is still limited. An observational point-prevalence, correlational predictive cross-sectional study was conducted to determine the prevalence of PCS and examine what predicting factors including preoperative anxiety, preoperative dyspepsia, smoking, alcohol consumption, and duration of preoperative symptoms are associated with PCS. A total of 127 eligible Nepalese patients who came for follow-up after 1 week of LC at outpatient department of surgery in one single university hospital, Kathmandu, Nepal, were recruited. A set of questionnaires consisting participants' information record form, Hospital Anxiety and Depression Scale (HADS), Leeds Dyspepsia Questionnaires (LDQ), Fagerstrom Test for Nicotine Dependence (FTND), and Alcohol Use Disorder Identification Test (AUDIT) was administered for data collection. The associations between influential factors and PCS were analyzed using Binary logistic regression. 43.3% of participants reported PCS after 1 week of surgery. The findings from logistic regression analysis affirmed that the patients with preoperative anxiety (OR = 6.38, 95%CI = 2.07–19.67, p < 0.01) and moderate to severe dyspepsia (OR = 4.01, 95%CI = 1.34–12.02, p < 0.05) held the likelihood to report PCS 6.38 and 4.01 times, respectively, greater than others. The implications from study results are that screening of anxiety and patients’ tailored interventions to reduce anxiety should be implemented preoperatively. An appropriate health education about persistence of PCS and self-management should be provided to those postoperative patients.
Objective: This research aimed to study the effects of a physical exercise program on physical mobility in cranial surgery patients.Materials and Methods: The researcher used a quasi-experimental method of surveying 58 patients who had cranial surgery at Siriraj Hospital. The research group was divided into two groups: an experimental group (28 patients) participating in a physical exercise program of patients after cranial surgery, and a control group (30 patients) receiving routine nursing care only. The evaluation of the patients’ physical mobility was performed three days after the surgery.Results: Most patients in the research group had an intracranial tumor (86.2%). One day after the surgery, the experimental group had minor pain at the wound site while the control group had moderate pain. Both groups felt discomfort (64.2%) or had muscle stiffness in the neck and shoulder areas (63.3%). Three days after the surgery, at the end of the program, the body movement function of both groups was reduced compared with the preoperative data. However, the experimental group showed better body movement function scores than the control one as the scores of the former were reduced less than those of the latter at p < 0.05.Conclusion: Nurses who provide health care services to patients after cranial surgery should apply the physical exercise program to promote the recovery of the patients’ physical mobility.
Background: Mild traumatic brain injury (MTBI) is a stressful life event. Most patients recover, but a subset of patients experience somatic, cognitive and behavioural symptoms that affect health-related quality of life (HRQOL). Aims: To identify the level impact on HRQOL and to examine the associated factors of HRQOL among patients with MTBI. Methods: This was a correlational predictive study. Findings: The mean age of the participants was 33.89 years, with a range from 18 to 62 years. HRQOL was at amoderate level. In multiple regression analysis, social support (β = .419, p = .000), PCS severity (β = -.245, p = .003) and economic status (β = .167, p = .035) accounted for 36.3% of explained variance on HRQOL. Conclusions: Post-concussion symptoms after discharge should be evaluated, and patients' need for support must be thoroughly assessed.
Objective: To study the predictive power of systemic inflammatory response syndrome (SIRS) scores, platelet count, and blood glucose level for multiple organ dysfunction syndrome (MODS) in patients with major trauma. Methods: The sample was 87 patients with major trauma, hospitalized within 24 hours after injury. SIRS score, platelet count and maximum blood glucose level were measured within the first 24 hours after injury, while MODS was measured by the Denver post-injury multiple organ failure (MOF) score at the 3rd day after injury. Multiple regression analysis, using the enter method, was employed to analyze the data with a significance level of .05. Results: The majority of the samples were male (85.1%) with an average age of 40.39 years. Most of them sustained multiple organ injuries and received surgical treatment within the first 24 hours. It was found that 25.3% of these patients developed organ dysfunction on the 3rd day after injury while 9.2% experienced MODS. SIRS score, platelet count and blood glucose level could predict MODS in patients with major trauma, with 41.7% of the variance explained (R2 = .417, p < .001). Conclusion: Patients with major trauma should receive close monitoring on their SIRS score, platelet count and blood glucose level within 24 hours after injury. Moreover, Denver post-injury MOF score should be routinely used for detection of organ dysfunction so that preventative measures can be appropriately implemented.
Objectives: To evaluate coping and the health problems of caregivers at the time of survivor discharge and at one month after discharge and to determine correlations among personal data, coping and health problems of caregivers and disability of survivors. Method: Eighty-five dyads of survivors with traumatic brain injury and their caregivers were included. The instruments employed for data collection were the 27-item Thai version of the Coping and Adaptation Processing Scale-Short Form, the Health Problem Questionnaire for caregivers and the Disability Rating Scale for survivors. The Roy Adaptation Model was used as a conceptual framework for this study. Pearson’s product moment correlation coefficient was employed for analysis. Results: No statistical differences were found between coping and health problems among caregivers. The health problems most frequently reported by caregivers were headache on the day of discharge and no health problems after one month of caregiving engagement. The disability level and marital status of the caregivers were correlated negatively with coping (r = -.245, p = .024, r = -.220, p = .043, respectively). Conclusions: The findings delineated that the caregivers remained able to handle the difficulties involved in caring for survivors at home with fewer health problems. Married caregivers were likely to manage this burden better than other caregivers.
The purpose of this study was the development of a clinicalnursing practice guideline (CNPG) for preparation of caregivers ofpatients with TBI (traumatic brain injury) using the IOWA model. Theestablishment of CNPG was done from the analysis of problemknowledge and patient observation. By searching databases andchecking reference lists, 29 related research literature were selected.These studies were analyzed and synthesized to develop a preparationof caregivers of patients with TBI, which included two phases. Theclinical nursing practice guideline was validated by five experts and wasrevised according to the experts’ comments and suggestions. CNPGwas tested on five sample of patients with TBI in the intensive care unitof Rayong hospital. Study results revealed that the established CNPGwas able to aid in preparing caregivers of patients with TBI. It is recommended that the CNPG should be carried out todetermine its effectiveness and to continue further development thisguideline should be integrated into routine practice for nurses andhealthcare team members.
A cross-sectional predictive design was used to study the relationships among recovery symptoms, mood state, and physical functioning and to identify predictors of physical functioning in patients who underwent surgery for brain tumor at the first follow-up visit (2 weeks) after hospital discharge. The sample included 88 patients who were 18 years or older, had full level of consciousness, and underwent first-time surgery for brain tumor without other adjuvant treatments from a tertiary hospital in Bangkok, Thailand. Descriptive statistics, Pearson product–moment correlation coefficient, and multiple regression were used for data analysis. The results revealed that most participants were women (75%) with an average age of 45.18 ± 11.49 years, having benign brain tumors (91%) and pathological results as meningioma (48.9%). The most common recovery symptoms were pain (mean = 3.2, SD = 2.6) and sleep disturbance (mean = 3.1, SD = 3.0). As for mood state, the problem of confusion was found the most (mean = 4.6, SD = 2.7). The physical functioning problem found the most was work aspect (mean = 66.3, SD = 13.3). Recovery symptoms had positive relationships with physical functioning and mood state (r = .406, .716; p < .01), respectively. At the same time, mood state had positive relationships with physical functioning (r = .288, p < .01). Recovery symptoms, total mood disturbance, fatigue, and vigor were statistically significant predictors of physical functioning and could explain variance of postoperative physical functioning in these patients at 2 weeks after discharge by 35%. Total mood disturbance was the strongest predictor of physical functioning followed by vigor, fatigue, and recovery symptom, respectively. Interventions to improve physical functioning in postoperative brain tumor patients during home recovery should account for not only recovery symptom management but also mood state.
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