American Health Network

This study analyzed the contents of critical reflective journals written by new nurses during their orientations using a text network. This study aimed to find ways to reduce turnover and improve clinical field adaptability among new nurses. The authors analyzed the content of reflective journals written by 143 new nurses from March 2020 to January 2021. Text network analysis was performed using the NetMiner 4.4.3 program. After data preprocessing, frequency of occurrence, degree centrality, closeness centrality, betweenness centrality, and eigenvector community were analyzed. In total, 453 words were extracted and refined, and words with high simple frequency and centrality were “incompetence,” “preparation,” “explanation,” “injection,” “time,” “examination,” and “first try.” “Medication” had the highest frequency of occurrence, and “incompetence” was the most important keyword in the centrality analysis. In addition, component analysis and eigenvector community analysis revealed three sub-theme groups: (1) basic nursing skills required for new nurses, (2) insufficient competency, and (3) explanation of nursing work. Significantly, this study is the first to use the text network method to analyze the subjective experiences of the critical reflective journals of new nurses. In conclusion, changes are needed to improve the education system for new nurses and promote efficient sharing of nursing tasks.

Oxalate nephropathy is a rare condition and may be overlooked due to lack of recognition and understanding of triggers. An 81-year-old man was sent to nephrologist because of significantly increased creatinine (1.5–1.9 mg/dL) noted for 3 months. He had well-controlled diabetes but no history of kidney disease. He had no chronic diarrhoea or intestinal surgery. He was a health-minded individual who had read extensively about benefit of antioxidants. Initial work-up was unrevealing. Within a few weeks after first visit, he developed acute symptomatic worsening kidney injury with nausea, vomiting and creatinine up to 6.8 mg/dL. Repeat examination of the urine sediment revealed casts containing calcium oxalate crystals. A deeper dietary history revealed widespread oxalate precursor consumption. A kidney biopsy confirmed oxalate nephropathy. Restriction of oxalate consumption combined with adequate hydration, oral calcium acetate resulted in partial renal recovery without need for haemodialysis.

Background The goal of this study is to better understand the epidemiologic features and the patient-community-emergency medical service (EMS)-hospital factors affecting outcomes of out-of-hospital cardiac arrest (OHCA). Methods and Results This study was performed in an EMS system with a single-tiered basic-to-intermediate service level and approximately 900 destination hospitals for eligible OHCA cases. A nationwide OHCA database including demographic, Utstein, EMS, and hospital factors and outcomes was constructed using EMS run sheets of eligible cases transported by 119 EMS ambulances and followed by medical record review for 2006 to 2010. Cases with unknown outcome were excluded. The primary end points were survival to discharge. The epidemiologic characteristics of OHCA were described and adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated for main outcome, adjusting for potential predictors. There were 97,291 EMS-assessed OHCAs excluding 14,798 cases because the medical records were not available (N=10,626) and the survival outcomes were unknown (N=4,172). Of these, 73,826 (75.9%) OHCAs were resuscitation attempted by EMS. The survival to discharge was 3.0% for EMS-assessed (3.3% for cardiac origin vs. 2.3% for non-cardiac origin), 3.6% for EMS-treated (4.0% for cardiac vs. 2.7% for non-cardiac), and 20.9% for cardiac origin with shockable rhythm. The drowning, intoxication, and asphyxia induced OHCAs had statistically better survival rates than cardiac origin. The odds for survival to discharge are significantly lower for elderly, asystole as primary ECG, OHCA with cardiac origin occurred in winter or 6PM to midnight, un-witnessed, no bystander cardiopulmonary resuscitation, OHCA with longer EMS response, and being transported to lower level of ED. Conclusions In this nationwide cohort study from 2006 to 2010, the standardized incidence rate increased 46.3 in 2006 to 52.0 per 100,000 person-years for EMS-assessed OHCA and overall survival rate was 3.0%. Potential factors for poor outcome were systemically identified in individual, community, EMS, and hospital chain.