Upper gastrointestinal endoscopy:Are preparatory interventions or conscious sedation effective? A randomized trial

AIM: The fears and concerns are associated with gastroscopy (EGD) decrease patient compliance. Conscious sedation (CS) and non-pharmacological interventions have been proposed to reduce anxiety and allow better execution of EGD. The aim of this study was to assess whether CS, supplementary information with a videotape, or presence of a relative during the examination could improve the tolerance to EGD. METHODS: Two hundred and twenty-six outpatients (pts), scheduled for a first-time non-emergency EGD were randomly assigned to 4 groups: Co-group (62 pts): throat anaesthesia only; Mi-group (52 pts): CS with i.v. midazolam; Re-group (58 pts): presence of a relative throughout the procedure; Vi-group (54 pts): additional information with a videotape. Anxiety was measured using the “Spielberger State and Trait Anxiety Scales” The patients assessed the overall discomfort during the procedure on an 100-mm visual analogue scale, and their tolerance to EGD answering a questionnaire. The endoscopist evaluated the technical difficulty of the examination and the tolerance of the patients on an 100-mm visual analogue scale and answering a questionnaire. RESULTS: Pre-endoscopy anxiety levels were higher in the Mi-group than in the other groups (P<0.001). On the basis of the patients' evaluation, EGD was well tolerated by 80.7% of patients in Mi-group, 43.5% in Co-group, 58.6% in Regroup, and 50% in Vi-group (P<0.01). The discomfort caused by EGD, evaluated by either the endoscopist or the patients, was lower in Mi-group than in the other groups. The discomfort was correlated with “age” (P<0.001) and “groups of patients” (P<0.05) in the patients' evaluation, and with “gender” (females tolerated better than males, P<0.001) and “groups of patients” (P<0.05) in the endoscopist's evaluation. CONCLUSION: Conscious sedation can improve the tolerance to EGD. Male gender and young age are predictive factors of bad tolerance to the procedure.

Nurses’ movements within and between various paths when improving their communication skills—An evaluation of validation method training

Aims and objectives: To explore any changes in nurses’ skills at communicating with residents with dementia disease when using the validation method, as observed in one-to-one videotaped conversations. Background: Communication difficulties due to cognitive impairment among residents with dementia disease may complicate care situations. Training can improve nurses’ communication skills and increase care quality. The validation method aims to facilitate communication with residents with dementia disease through empathic and confirmatory approaches. Evaluations of the validation method have primarily focused on the residents’ perspective, and reports on nurses’ experiences are sparse. Improved communication and relationships with residents after validation method training have been described previously. Videotaped data could provide additional information about these earlier results. Design: A descriptive qualitative design. Methods: Eight nurses participated in a year of validation method training, including videotaped conversations with eleven residents. Videotapes with at least five months between the first and last recording were analysed and compared qualitatively. Results: The analysis revealed an overall pattern: nurses’ movements within and between various paths when improving their communication skills. This was based on three sub-patterns: from controlling communication towards developing attentiveness in communication, from ambiguous communication towards developing coherence in communication, and from being open and attentive towards having a refined attuned communication. Conclusions: All nurses developed their communication skills during the programme, albeit to different degrees. The findings are in congruence with the experiences described by nurses, and so it is reasonable to believe that the programme helped to improve the nurses’ skills in communicating with residents with dementia disease. Relevance to clinical practice: A validation method training programme could give nurses the possibility to develop their skills in communicating with residents with dementia disease.

The nestling diet of fairy pitta <i>pitta nympha</i>on Jeju Island, Korea

The nestling diet of the Fairy Pitta (pitta nympha) was studied by videotaping during breeding period in Jeju Island, 2009. Earthworms of several species were the most common food resources for nestlings, averaging 82% of all items, followed by 4% of Homoptera larvae. The remaining was only rarely recorded, including Lepidopteran larvae and adults, slugs, spiders, beetle adults and larvae (Coleoptera) and grasshoppers. Adults provided the number of preys ranging from 1 to 7 items to chicks per one visit. The average value of prey number per visit was 3.0 (SD = 1.38). The estimated average length of prey was 5.7 cm (SD = 2.85), and 96% of the food items were smaller than 10 cm. The staying time for feeding in an early stage was longer than other stages. Provision rate at a forenoon (mean ± SD, 14.7 ± 4.92) and an afternoon time (15.8 ± 5.30) was not significantly higher than that of noon time (11.7 ± 4.49). These results provide basic information for conservation action of international endangered species of this species.