Nursing experiences and knowledge of paediatric delirium: Analysing knowledge-practice gaps

BACKGROUND

Delirium commonly occurs in paediatric patients with acute critical illness and negatively affects clinical outcomes. Variations in delirium knowledge levels and its management have been noted among nurses.

AIMS

This study investigated nurses' experiences and knowledge levels regarding paediatric delirium. Additionally, we aimed to assess the gap between knowledge levels and practical experiences with paediatric delirium.

STUDY DESIGN

This cross-sectional descriptive study conveniently sampled paediatric nurses from a university hospital in South Korea between September 2022 and March 2023. Nursing experiences with paediatric delirium and delirium knowledge levels were measured using structured survey questionnaires. Delirium knowledge was scored 0 to 47, and higher scores indicated higher levels of delirium-related knowledge. Data were analysed using descriptive statistics and presented as mean, standard deviation, frequency and percentage.

RESULTS

A total of 127 paediatric nurses participated in this study; 40.2% had experience with 1-5 delirium cases in the previous year, and 86.6% (n = 110) had never used assessment tools for paediatric delirium assessment. The mean total delirium knowledge score was 34.45 ± 5.4; the mean scores of knowledge regarding aetiology, signs and symptoms and nursing management of delirium were 8.93 ± 1.31, 13.24 ± 2.81 and 12.3 ± 2.7, respectively. Interventions associated with a lower level of delirium-related knowledge and a lower performance rate included avoiding restraint use and maintaining hydration and electrolyte levels. Interventions associated with a higher level of delirium-related knowledge but a lower rate of performance comprised providing orientation, offering emotional support, allowing participants to stay with family members and administering medications to manage delirium.

CONCLUSIONS

Although nurses working in paediatric units exhibited high rate of delirium nursing care, there was the gap between their delirium-related knowledge and practice. Nurses need to be aware of the insufficient part of delirium care, and paediatric delirium education should be reinforced.

RELEVANCE TO CLINICAL PRACTICE

Preventing, assessing and systematically managing paediatric delirium is crucial, and considering the study results, delirium education among nurses is needed.

Current status of nutritional provision and effects of nutritional support on the clinical outcomes of acute kidney injury requiring continuous renal replacement therapy in the surgical intensive care unit

BACKGROUND AND OBJECTIVES

Patients with acute kidney injury requiring continuous renal replacement therapy are at high risk of malnutrition. Nutritional support is an important part of treatment for patients with critical illness admitted to the intensive care unit. We aimed to investigate the status of nutritional provision and the effects of nutritional support on clinical outcomes.

METHODS AND STUDY DESIGN

Our institution's medical records (from January 1, 2020, to December 31, 2021) were analyzed in this retrospective cohort study. We included 43 patients aged >18 years who received continuous renal replacement therapy for acute kidney injury in the surgical intensive care unit.

RESULTS

The demographic characteristics were similar between the survivor and non-survivor groups. The protein supply per body weight (0.88 ± 0.37 g/kg vs. 0.47 ± 0.53 g/kg, p = 0.029) and the proportion of patients who met the target protein level (58.9 ± 24.9% vs. 30.8 ± 34.9%, p = 0.022) were significantly higher in the survivor group. Approximately 79.1% of the patients had a high malnutrition risk with a modified Nutrition Risk in the Critically Ill score of ≥5. The lengths of hospital and intensive care unit stays were longer in the high nutritional risk group compared with that in the low nutritional risk group, but the result was not significant.

CONCLUSIONS

The nutritional amount provided in patients with critical illness is significantly lesser than the recommended amount. Ensuring proper nutritional support can improve the clinical outcomes.

The Effect of Epoxidized Soybean Oil on the Physical and Mechanical Properties of PLA/PBAT/PPC Blends by the Reactive Compatibilization

Poly (lactic acid) (PLA)/poly (butylene adipate-co-terephthalate) (PBAT)/poly (propylene carbonate) (PPC) multi-phase blends were prepared by melt processing technique under the presence of compatibilizer with various composition. The effect on the physical and the mechanical property with/without ESO was characterized with spectrophotometric analysis, mechanical properties, thermal properties, rheological properties and barrier properties, and the structure-properties relationship was assessed. ​​The functional groups of PPC were found to effective to improve an interaction with carboxyl/hydroxyl group of PLA/PBAT binary blends to enhance the mechanical and physical properties on multi-phase blend system. The presence of PPC in PLA/PBAT blend affected the reduction of voids on the interface phase resulting in enhancing the oxygen barrier properties. With addition of ESO, the compatibility of ternary blend was found to be enhanced since the epoxy group of ESO reacted with the carboxyl/hydroxyl group of PLA, PBAT, and PPC, and under the condition with critical content of 4 phr of ESO, the elongation behavior dramatically increased as compared to that of blends without ESO while affecting reduction of oxygen barrier properties. The effect of ESO as a compatibilizer was clearly observed from the overall performances of ternary blends, and the potential feasibility of the PLA/PBAT/PPC ternary blends as packaging materials was confirmed at this study.

Bio-Inspired and Smart Nanoparticles for Triple Negative Breast Cancer Microenvironment

Triple negative breast cancer (TNBC) with poor prognosis and aggressive nature accounts for 10-20% of all invasive breast cancer (BC) cases and is detected in as much as 15% of individuals diagnosed with BC. Currently, due to the absence of the estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor 2 (HER2) receptor, there is no hormone-based therapy for TNBC. In addition, there are still no FDA-approved targeted therapies for patients with TNBC. TNBC treatment is challenging owing to poor prognosis, tumor heterogeneity, chemotherapeutic side effects, the chance of metastasis, and multiple drug-resistance. Therefore, various bio-inspired tumor-homing nano systems responding to intra- and extra- cellular stimuli are an urgent need to treat TNBC patients who do not respond to current chemotherapy. In this review, intensive efforts have been made for exploring cell-membrane coated nanoparticles and immune cell-targeted nanoparticles (immunotherapy) to modulate the tumor microenvironment and deliver accurate amounts of therapeutic agents to TNBC without stimulating the immune system.