The Development of the “Monitoring Application for Inappropriate Expressions in Nursing Records”for PsyNACS©

Lengthening periods of hospitalization, increasing numbers of patients with age-related complications, and a shortage of nursing staff have been of great concern in medical psychiatry in Japan. Under these circumstances, countries such as Japan that face a super-aging society and a decline in the working-age population, have been recommended for use of advanced information and communications technology (ICT) to improve the efficiency of medical treatment and care. This study aims to develop the “Monitoring Application for Inappropriate Expressions in Nursing Records” for using PsyNACS©, which will enable psychiatric nursing plans to harness the advantages of ICT. The functions considered necessary are as follows: 1) identification of users who enter information;2) a necessary database for lists of inappropriate expressions;3) development of a matching function to recommend proper writing input and a warning function;and 4) a management function for an inappropriate expression list database. A demonstration experiment for developing the application in this study was conducted at a specialized psychiatric hospital. To introduce them to the application, nurses and nurse managers were informed about the system developed in this study, and a survey regarding their opinions on the functions of the application was conducted with ten nurse managers. The results were evaluated in terms of usefulness for nursing care, documentation, and the education of nurses from an ethical perspective. This study suggests that matching their input with an inappropriate expression database will allow nurses to record more appropriate expressions. From an ethical perspective, the ability to use appropriate expressions makes records more likely to withstand disclosure requests from patients and their families.

Efficacy of tolvaptan in an infant with syndrome of inappropriate antidiuretic hormone secretion associated with holoprosencephaly:A case report

BACKGROUND Holoprosencephaly(HPE)is a congenital malformation with various degrees of incomplete separation of the cerebral hemispheres due to differentiation disorders of the forebrain.Although HPE with diabetes insipidus due to associated pituitary dysfunction has been reported,HPE with the syndrome of inappropriate antidiuretic hormone secretion(SIADH)is very rare.Tolvaptan,a vasopressin V2 receptor antagonist,is effective in adults with SIADH.However,there is no report of its efficacy in infants with SIADH.The purpose of this report is to demonstrate that tolvaptan is effective for SIADH in infants and that administration of tolvaptan eliminates the need for restriction of water intake and sodium administration.CASE SUMMARY A 2414-g female infant was born at 38 wk by normal vaginal delivery.Facial anomalies and head magnetic resonance imaging indicated semilobar HPE.After birth,she had hyponatremia due to SIADH and was treated using water and sodium restriction.However,she developed an exaggerated response to the fluid restrictions,resulting in large fluctuations in serum sodium levels.Subsequent administration of tolvaptan improved the fluctuations in serum sodium levels without the need for adjustment of water or sodium administration.Serum sodium was maintained within the normal range after discontinuation of tolvaptan at 80 d of life.There were no side effects,such as hypernatremia or liver dysfunction,during the administration of tolvaptan.CONCLUSION This is the first report on the safety and efficacy of tolvaptan in an infant with SIADH associated with HPE.

Case of inappropriate ADH syndrome:Hyponatremia due to polyethylene glycol bowel preparation

Colonoscopic screening has been reported to reduce deaths from colorectal cancer.Adequate bowel preparation is essential for this and safety is an important issue in choosing the methods.Polyethylene glycol(PEG)is regarded as a safe method for cleansing,especially compared with oral sodium phosphate.Here,we present a case of hyponatremia caused by the syndrome of inappropriate antidiuretic hormone(ADH)syndrome after PEG precolonoscopic cleansing resulting in generalized tonic-clonic seizures.A 62-year-old women had ingested PEG for precolonoscopic bowel cleansing.While waiting for the colonoscopy,she developed a stuporous mentality and generalized tonic-clonic seizures,which did not correlate with brain magnetic resonance imaging.Her serum sodium level was 113 mEq per liter and laboratory analyses were consistent with inappropriate ADH syndrome.Her thyroid and adrenal functions were normal.There were no malignancies,infections,respiratory disorders or central nervous disorders and she had no history of taking either diuretics or other medications,which might have caused inappropriate ADH syndrome.She was treated with 3%hypertonic saline and showed a complete neurological recovery as her sodium levels recovered.Follow-up visits showed the patient to have a normal sodium level without neurologic deficits.This case shows that inappropriate ADH syndrome can be caused by PEG preparation,which implies that physicians have to be aware of the possible side effects of this colonic cleansing approach and mindful of the possible ensuing symptoms.

抗利尿激素不适当分泌综合征(Treatment of the syndrome of inappropriate secretion of antidiuretic hormone)的治疗

抗利尿激素不适当分泌综合征(SIADH)是因多种病理因素引起的抗利尿激素(ADH)分泌异常增多,导致体内水潴留,持续性低钠血症、低渗透压血症、尿呈反常的高渗透压、尿钠排泄增多等现象。由于低钠血症和低血浆渗透压,其临床特征则以脑细胞肿胀(脑水肿)所致中枢神经系统的功能紊乱为主要表现。

Remote monitoring of implantable defibrillators is associated with fewer inappropriate shocks and reduced time to medical assessment in a remote and rural area

BACKGROUND Implantable cardioverter defibrillators(ICDs)and cardiac resynchronisation therapy with defibrillators(CRT-D)reduce mortality in certain cardiac patient populations.However,inappropriate shocks pose a problem,having both adverse physical and psychological effects on the patient.The advances in device technology now allow remote monitoring(RM)of devices to replace clinic follow up appointments.This allows real time data to be analysed and actioned and this may improve patient care.AIM To determine if RM in patients with an ICD is associated with fewer inappropriate shocks and reduced time to medical assessment.METHODS This was a single centre,retrospective observational study,involving 156 patients implanted with an ICD or CRT-D,followed up for 2 years post implant.Both appropriate and inappropriate shocks were recorded along with cause for inappropriate shocks and time to medical assessment.RESULTS RM was associated with fewer inappropriate shocks(13.6%clinic vs 3.9%RM;P=0.030)and a reduced time to medical assessment(15.1±6.8 vs 1.0±0.0 d;P<0.001).CONCLUSION RM in patients with an ICD is associated with improved patient outcomes.

Nedaplatin-induced syndrome of inappropriate secretion of antidiuretic hormone:A case report and review of the literature

BACKGROUND Syndrome of inappropriate secretion of antidiuretic hormone(SIADH)is relatively common in several cancers,such as small cell lung cancer.However,nedaplatin-induced SIADH is rare.We describe a case of SIADH mediated by nedaplatin.CASE SUMMARY A 54-year-old female with nasopharyngeal carcinoma was treated with nedaplatin and developed severe hyponatremia due to SIADH.The side effects were successfully treated by fluid restriction and sodium supplementation.CONCLUSION This case report highlights the importance of cautiously treating life-threatening hyponatremia in patients treated with nedaplatin.

Natural killer/T-cell lymphoma with concomitant syndrome of inappropriate antidiuretic hormone secretion: A case report and review of literature

We report a case of natural killer(NK)/T-cell lymphoma with concomitant syndrome of inappropriate antidiuretic hormone secretion(SIADH).The patient was a 64-yearold woman with a history of nasopharyngeal carcinoma of over 30 years.She was admitted with a chief complaint of intermittent fever for 2 mo.Palpation after admission indicated a swollen lymph node below the left jaw.Multiple imaging examinations on admission indicated multiple enlarged lymph nodes throughout the body.We performed a left submandibular lymph node biopsy,and the results revealed NK/T-cell lymphoma.A biochemical examination indicated Epstein-Barr virus positivity.At the same time,the patient developed hyponatremia.Based on her laboratory examination and clinical manifestation,decreased plasma osmolality,urine osmolality greater than plasma osmolality,lack of skin swelling,normal blood pressure,normal renal function,no adrenal function detected on serology,and no abnormalities in imaging examination of the adrenal glands,the likelihood of SIADH in the patient was high.After fluid restriction and administration of sodium chloride,the patient’s blood sodium level gradually increased.Subsequently,the immune function of the patient declined,there were severe symptoms of infection,and she died of respiratory failure.NK/T-cell lymphoma associated with SIADH has not,to our knowledge,been previously reported in PubMed.This case emphasizes the importance of monitoring serum ion levels,especially serum sodium,in patients with NK/T-cell lymphoma.

Inappropriate secretion of antidiuretic hormone:a rare complication after common bile duct exploration

BACKGROUND: The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) as a dilutional hyponatremia is due to a pathological increase of antidiuretic hormone (ADH). It is characterized by hyponatremia and decreased serum osmolarity as well as an increase in urinary osmolarity. The most common etiological factors of this syndrome include diseases or trauma of the central nervous system and malignant tumor or inflammation of the lung. SIADH following abdominal surgery is rare. METHODS: We report the case of a 68-year-old woman who developed, 24 hours after common bile duct exploration and stone removal, continuous hyponatremia for 20 days and clinical manifestations of nausea, vomiting, and lethargy without focal neurological signs. RESULT: Laboratory examinations supported the diagnosis of SIADH. After therapy with fluid restriction, the patient recovered. CONCLUSION: There are diverse causes for SIADH. It is important to have kept this clinical possibility in mind in the differential diagnosis of refractory hyponatremia under any circumstances.

Unusual Presentation of COVID-19: Encephalitis and Syndrome of Inappropriate Anti-Diuretic Hormone Secretion

COVID-19 is a new challenge in clinical medicine. Although typical presentations include fever and pneumonia, we describe a case of COVID-19 presenting with neurological symptoms of encephalitis and infectious-related syndrome of inappropriate anti-diuretic hormone secretion. Because of the epidemic health problems, it is crucial to identify these patients as early as possible to follow the isolation procedures. We suggest that unclear neurological clinical presentations of patients should be considered for COVID-19.

Exploration of Inappropriateness of E-C Trademark Translations

Based upon an exploration of the versions of trademarks mainly from English into Chinese, this thesis illustrates some typical examples of inappropriateness for trademark translations and analyzes some factors that would influence the way a trademark is rendered. In addition, certain tactics for improvement are recommended.

Radiofrequency Catheter Ablation Of Inappropriate Sinus Tachycardia

Objective:To investigate the mechanism of inappropriate sinustachycardia and the safety,effectiveness on radiofrequency catheterablation of it.Methods:Radiofrequency catheter ablation wasperformed on a 52-year-old female patient and changes in Holter,heart rate variability,intrinsic heart rate and syndromes were comparedbetween before and after radiofrequeney catheter ablation.Results:The inappropriate sinus tachycardia could not be induced and terminatedby atrial program electric stimulation and burst stimulation,whichsuggests that the mechanism of inappropriate sinus tachycardia isreentry.After radiofrequency catheter ablation,the total heart beatsdecreased from 173490 to 129172 times,the lowest heart rate did from79 to 71 bpm,the highest heart rate from 200 to 122 bpm,the averageheart rate from 117 to 90 bpm,and intrinsic heart rate from 166 to 93Variables of heart rate variability varied too.PNN50 increased from O to11,RMSSD did from 8 to 35.However,LF/HF ratio decreased from12.23 to 0.86.Transesophageal eleetrophysiologic studies demonstratethat sinoatrial node function is normal after radioflequency catheterablation.The patient has been followed up for six months,she has beenbeing free of palpitation,chest distress and dizziness,etc.Conclusion:The inappropriate sinus tachycardia could be due to abnormal sinoatrialnodal automaticity resulting from excessive sympathetic nerve influencesor deficient vagal nerve influences and modification of sinus node withradiofrequency catheter ablation is a safe,effective method for thetreatment of inappropriate sinus tacbycardia.

Beyond authorship: Analyzing contributions in PLOS ONE and the challenges of appropriate attribution

Purpose:This study aims to evaluate the accuracy of authorship attributions in scientific publications,focusing on the fairness and precision of individual contributions within academic works.Design/methodology/approach:The study analyzes 81,823 publications from the journal PLOS ONE,covering the period from January 2018 to June 2023.It examines the authorship attributions within these publications to try and determine the prevalence of inappropriate authorship.It also investigates the demographic and professional profiles of affected authors,exploring trends and potential factors contributing to inaccuracies in authorship.Findings:Surprisingly,9.14%of articles feature at least one author with inappropriate authorship,affecting over 14,000 individuals(2.56%of the sample).Inappropriate authorship is more concentrated in Asia,Africa,and specific European countries like Italy.Established researchers with significant publication records and those affiliated with companies or nonprofits show higher instances of potential monetary authorship.Research limitations:Our findings are based on contributions as declared by the authors,which implies a degree of trust in their transparency.However,this reliance on self-reporting may introduce biases or inaccuracies into the dataset.Further research could employ additional verification methods to enhance the reliability of the findings.Practical implications:These findings have significant implications for journal publishers,Beyond authorship:Analyzing contributions in PLOS ONE and Maddi,A.,&the challenges of appropriate attribution highlighting the necessity for robust control mechanisms to ensure the integrity of authorship attributions.Moreover,researchers must exercise discernment in determining when to acknowledge a contributor and when to include them in the author list.Addressing these issues is crucial for maintaining the credibility and fairness of academic publications.Originality/value:This study contributes to an understanding of critical issues within academic authorship,shedding light on the prevalence and impact of inappropriate authorship attributions.By calling for a nuanced approach to ensure accurate credit is given where it is due,the study underscores the importance of upholding ethical standards in scholarly publishing.

Inappropriate use of empirical antibiotics in adults with acute infectious diarrhea in a large teaching hospital

Overuse of antibiotics for the treatment of acute diarrhea is very common. The aim of the current study was to investigate the inappropriate use of antibiotics in adults with acute infectious diarrhea and to evaluate the association between the use of antibiotics and clinical features. To achieve this aim, we reviewed 4891 patients＇ medical records from Apr. 2008 to Oct. 2009. Of the total 4891 cases, 30.5% had clinical features of invasive bacterial diarrhea, 48.1% were prescribed with antibiotics, and 20.3% received inappropriate antibiotic treatment. Of note, 19% involved unnecessary antibiotic prescriptions in non-indicated cases, which accounted for 39.4% of all antibiotics prescribed in the total 4891 patients. There was no significant differences between physicians and medical trainees in the inappropriate use of antibiotics （P = 1.0）. Logistic regression analysis demonstrated that except for body temperature, other clinical symptoms including abdominal pain, tenesmus, and faecal WBC count （〉10 cells/HPF） were associated with the use of antibiotics. In addition, other clinical indicators including vomiting, stool frequency of 5-10 times/d, mucous stool, and fecal WBC count of 1-10 cells/HPF, which are not normally indicators for prescribing antibiotics, were also associated with the use of antibiotics. This might suggest that these symptoms were mistaken as features of invasive bacterial diarrhea, thus leading to the overuse of antibiotics.

Patients Aged 80 Years or Older are Encountered More Potentially Inappropriate Medication Use

Background： Polyphamlacy and potentially inappropriate medications （PIMs） are prominent prescribing issties in elderly patients. This study was to investigate the different prevalence of PIM use in elderly inpatients between 65-70 years of age and 80 years or older, who were discharged from Geriatric Depamnent in West China Hospital. Methods： A large-scale cohort of 1796 inpatients aged 65 years or over was recruited. Respectively. 618 patients were 65 79 years and 1178 patients were 80 years or older. Updated 2012 Beers Criteria by the Anaerican Geriatric Society was applied to assess the use of PIM among the investigated samples. Results： A review of the prescribed medications identified 686 patients aged 80 years or older constimed at least one PIM giving a rate of 58.2%. Conversely, 268 （43.4%） patients aged 65-79 years consumed at least one PIM （x^2=40.18, P 〈 0.001）. Patients aged 80 years or older had higher hospitalization expenses, length of stay, co-morbidities, medical prescription, and mortality than patients aged 65-79 years （all with P 〈 0.001 ）. Patients aged 80 years or older were prescribed with more benzodiazepines, drugs with strong anticholmergic properties, megestrol, antipsychotics, theophylline, and aspirin. In multiple regression analysis, PIM use was significantly associated with female gender, age, number of diagnostic disease, and number of prescribed medication. Conclusions： The finding from this study revealed that inpatients aged 80 years or older encountered more PIM use than those aged 65-79 years. Anticholinergic properties, megestrol. antipsychotics, theophylline, and aspirin are medications that often prescribed to inpatients aged 80 years or older. Doctors should carefully choose drugs for the elderly, especially the elderly aged 80 years or older.

Clinical analysis of the syndrome of inappropriate antidiuretic hormone secretion after brain injury

Objective: To study the diagnosis and treatment of the syndrome of inappropriate antidiuretic hormone secretion (SIADH) after brain injury. Methods: A retrospective analysis was conducted on 12 patients suffered from SIADH after brain injury. The clinical features of these patients were similar to those of common hyponatremia. Most of the hyponatremia were detected by routine examinations. Supplement of salt as the initial treatment was used in these patients. If natremia did not rise or descended 2 3 days after treatment, SIADH was considered or diagnosed. Treatment scheme should be adjusted to limit water and natrium instead of supplying salt. Frusemide and albumin were the first choice for dehydration therapy. Results: 24 48 hours after limiting water and natrium, 12 patients natremia level was back to normal. Eight out of 12 patients were corrected completely in 1 week, 1 in 14 days, and 1 in 3 months after injury. Conclusions: Diagnosis of SIADH is difficult before treatment though effective treatment can be obtained if we adopt correct strategy. In these patients, the diagnosis of SIADH is confirmed in the course of treatment.

Incidence and causes of inappropriate detection and therapy by implantable defibrillators of cardioversion in patients with ventricular tachyarrhythmia

Background Implantable cardioverter defibrillator （ICD） is the only effective therapy in patients with life threatening ventricular arrhythmias. Inappropriate detection and therapy by ICDs are the most common causes of side effects that affect the quality of life in ICD recipients. This study evaluated the incidence and causes of inappropriate detection and therapy by ICDs in patients in our hospital. Methods From January 2000 to December 2005, fifty patients who received ICD implantation for ventricular arrhythmias for prevention of sudden cardiac death were evaluated in this study. Each ICD was programmed using clinical arrhythmic and cardiac data of the patient before discharge. Patients were followed up by standard schedule after implantation and all data retrieved from each device were collected and saved for further analysis. Results No arrhythmic event was detected in 12/50 （24%） patients during the period of follow-up. Among the remaining patients, 11 （22%） experienced inappropriate detections and therapies during follow-up in this study. ICD detected 383 ventricular tachyarrhythmia （VT） and 108 ventricular fibrillation （VF） episodes and delivered 678 therapies. In VT group, ICD delivered 413 antitachycardiac pacings （ATPs） and 118 shocks, among which 78 ATPs and 9 shocks were initiated by 55/383 （14.3%） inappropriate detections. In VF group ICD delivered 147 shocks, among which 56 shocks were initiated by 28/108 （26.9%） inappropriate detections. Overall, more than 50% of these episodes were caused by atrial fibrillation （AF） with rapid ventricular response, followed by electromagnetic or myopotential interference. In addition, most inappropriate therapies occurred within one year after ICD implantation. Conclusions About one fifth of patients experienced ICD inappropriate detection and therapy after implantation. The main cause was AF with rapid ventricular response, followed by electromagnetic or myopotential interference.

Syndrome of inappropriate antidiuresis in prostate adenocarcinoma with neuroendocrine differentiation: a case report and literature review

Syndrome of inappropriate antidiuresis (SIAD) is a common paraneoplastic syndrome commonly associated with thoracic malignancies, gastrointestinal cancers and kidney tumors. It is defined as hyponatremia in euvolemic patients, often due to abnormal secretion of antidiuretic hormone by tumor cells. Tolvaptan, a vasopressin-2-receptor antagonist, is currently recommended for patients affected by SIAD with mild or moderate symptoms. Among patients with prostatic cancer, SIAD represents a rare condition but it is frequently associated with poorly differentiated adenocarcinoma or pure small-cell carcinoma histotype. We report a case of SIAD appeared at disease progression in a 60-year-old male patient with acinar adenocarcinoma with neuroendocrine differentiation together with a literature review.

T-wave oversensing and inappropriate shocks in implantable cardioverter defibrillators

The implantable cardioverter defibrillator （ICD） represents today the treatment and prophylaxis of choice for patients at risk for sustained ventricular tachyarrhythmias.1-6 Accurate sensing of ventricular tachyarrhythmias is a critical aspect of the function of ICD. All currently available models include algorithms with variable sensitivity, allowing adjustments which optimize the detection of low amplitude signals during ventricular tachyarrhythmia. However,

Inappropriate antidiuretic hormone secretion in a patient with pulmonary lymphoepithelioma like carcinoma

Antidiuretic hormone （ADH） is produced by an area of he brain called the hypothalamus. The hormone is stored in and released by the pituitary gland. When ADH （also called vasopressin） is produced somewhere other than the hypothalamus, the condition is called syndrome of inappropriate antidiuretic hormone （SIADH）. A variety of conditions can trigger abnormal ADH production, but the main cause is cancer. It is frequently one of the first signs of lung cancer, especially small cell carcinoma, which produces ADH ectopically.l

The Classification of Inappropriate Diction in the English Descriptions

Nappropriate diction in the English Descriptions is complex and difficult to solve.In my study,I introduces four types of inappropriateness classified on the basis of related linguistic theories that deal with the choice of words.The four types of inappropriate diction are entitled respectively semantic inappropriateness,pragmatic inappropriateness,stylistic inappropriateness and social inappropriateness.