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Moderated Poster-1 and an Aortic Bypass with Dacron Graft

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Moderated Poster-1 and an Aortic Bypass with Dacron Graft [Downloaded free from http://www.tcmjmed.com on Tuesday, August 21, 2018, IP: 10.2.4.97] Tzu Chi Medical Journal 2018; 30(Suppl 1): S1-S18 September 2018 Volume 30 Supplement 1 2018 Annual Meeting of Buddhist Tzu Chi Medical Foundation 15-16 September 2018, New Taipei, Taiwan Indexed in: DOAJ, EMBASE/Excerpta Medica, Emerging Sources Citation Index, PubMed Central, SCOPUS www.tcmjmed.com Moderated Poster-1 and an aortic bypass with Dacron graft. Tissue biopsy was performed during operation. MP1-1: Results: Microscopic findings found diffused fibroblast and ESSENTIAL THROMBOCYTHEMIA CONCOMITANT epitheloid cells gathering and granulomatous inflammation WITH TAKAYASU ARTERITIS: A CASE REPORT in the junction between tunica media and adventitia. Mason trichrome stain confirmed much fibro-collagen infiltration in Hui-Sheng Wang1, Song-Chao Chu1,2, Yung-Hsiang Hsu3, 1,4 5 1,6 tunica media. Orcein stain confirmed elastic fibers infiltrates Yu-Chih Chen , Jui-Chih Chang , Kuei-Ying Su tunica intima, indicting thickening of internal elastica layer. 1Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Thrombus was identified in the aortic lumen. However, there Tzu Chi Medical Foundation, Hualien, Taiwan; 2Division of was no atherosclerotic change. Thus, the diagnosis of granu- Hematology and Oncology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan; 3Division of lomatous pan-vasculitis, Takayasu vasculitis was made. A Pathology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical neck MRA was arranged and showed no stenosis of sub- Foundation, Hualien, Taiwan; 4Division of Cardiology, Hualien clavian nor carotid arteries. After the surgery, the patient Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, was treated with methylprednisolone 80 mg (2 mg/kg/day) Hualien, Taiwan; 5Division of Cardiovascular Surgery, Hualien in dividing doses intravenously for Takayasu vasculitis. Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Serum creatinine returned gradually to 1.3 mg/dL; bilateral Hualien, Taiwan; 6Division of Rheumatology and Immunology, leg claudication had completely relieved. The patient was Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, discharged with oral prednisolone 20 mg BID. The serum Hualien, Taiwan levels of ESR and CRP were 23 mm/hr and 0.07 mg/dL, respectively, at the latest blood tests. Currently the patient Objectives: Essential thrombocythemia (ET) is a myeloprolif- was followed-up regularly at our OPD and received pred- erative disorder majorly caused by gain-of function mutations nisolone 12.5 mg daily, methotrexate 12.5 mg weekly, and at Janus kinase 2 (JAK2). Clinical symptoms of ET come from Anagrelide 1mg TID. the occlusion of small or large vessels due to atherosclerosis Conclusion: Large vessel vasculitis, i.e., Takayasu vasculitis and thrombosis in nature. However, when vessel occlu- and giant cell arteritis, should always be considered in patients sion occurs in patients with ET, it is important to distinguish presented with bilateral renal artery stenosis and abdominal ET-induced thromboembolic events from other causes, such as aortic occlusion, regardless of underlying hematologic disor- vasculitis. In this case report, we present a patient with history ders (such as ET) prone to thromboembolic or atherosclerotic of ET developed bilateral renal artery stenosis and abdominal events. aorta occlusion induced by Takayasu arteritis. Materials and Methods: This 38-year-old woman has a history of ET (confirmed by genetic test showing JAK2 V617F MP1-2: THE EFFECT OF BUNDLE CARE INTERVENTION ON mutation), and was treated with Hydroxyurea and Anagrelide CATHETER-ASSOCIATED URINARY TRACT INFEC- since 2010 until her pregnancy in late 2016. During her preg- TIONS RATE IN MEDICAL INTENSIVE CARE UNIT nancy, gestational hypertension was diagnosed since second trimester and was treated with Amlodipine. Meanwhile, pro- Meng-Yi Liu1, Qian-Yi Su1, Yi-Hsuan Chen1, Yue-Wun Gao1, gressive bilateral limb claudication developed. For worsened Wen-Lin Su2, Chun-Chuan Sun3, Shu-Yi Tang3 1 leg numbness and claudication after delivery, she was then Department of Nursing, Taipei Tzu Chi Hospital, Buddhist 2 treated with Valsartan additional to Amlodipine for hyper- Tzu Chi Medical Foundation, New Taipei, Taiwan; Department of Pulmonary Medicine, Taipei Tzu Chi Hospital, Buddhist tension control. However, 2 weeks after Valsartan treatment, 3 her urine output reduced progressively. Serum creatinine Tzu Chi Medical Foundation, New Taipei, Taiwan; Department of Infection Control Center, Taipei Tzu Chi Hospital, Buddhist rapidly increased from normal to 8.0 mg/dL. The patient Tzu Chi Medical Foundation, New Taipei, Taiwan came to Hualien Tzu Chi General Hospital for further treat- ment. On examination, abdominal auscultation revealed aortic Objective: Catheter-associated urinary tract infections bruits. One week after discontinuation of Valsartan and care- (CAUTI) are the most common health care-associated infec- fully hydration, the serum creatinine decreased to 2.0 mg/dL. tions (HAI) in medical intensive care units (MICU), accounting Angiography via magnetic resonance and computed tomogra- for 30% - 40% of all HAI. CAUTIs prolong hospital stay and phy were arranged and confirmed the diagnosed of bilateral exacerbate mortality rate. According to the 2016 nosocomial renal artery stenosis. Additionally, and unexpectedly, imaging infection records provided by the Infection Control Center of studies also showed a segmental, total occlusion of infra-renal Taipei Tzu Chi Hospital, the infection density of CAUTIs in aortic artery, with collateral circulating vessels. Subsequent MICU was elevated to 4.17‰ and medical costs increased. operations were performed: bilateral renal artery stenting Therefore, the collaboration practice team assembled from © 2018 Tzu Chi Medical Journal | Published by Wolters Kluwer - Medknow S1 [Downloaded free from http://www.tcmjmed.com on Tuesday, August 21, 2018, IP: 10.2.4.97] Tzu Chi Medical Journal 2018; 30(Suppl 1): S1-S18 Infection Control Center and Center of Quality Management Materials and Methods: As part of the AVERT (Acute promote the bundle care intervention. Video-oculography for Vertigo in Emergency Rooms for Materials and Methods: The collaborating team surveyed Rapid Triage) trial (ClinicalTrials.gov #NCT02483429), we the bundle care intervention through brainstorming and cause- prospectively recruited consecutive patients with acute vertigo and-effect analysis. After reviewing literatures, the team from three hospital EDs (2016-2017). Patients underwent mul- investigated the current states of indwelling catheter imple- tiple ocular motor tests (~28 per battery) using a portable, mentation of three aspects: the “care knowledge,” “placement,” lightweight VOG device (ICS Impulse, Otometrics, Taastrup, and “care checklist”. Different understandings of the bundle Denmark). We compared automated nystagmus detection care process were survey for medical team. The completion based on peak slow-phase velocity ≥ 10 deg/sec (Otosuite rate of accurate catheter care calculated from nursing team software v4.0) to human expert assessment of pathologic scoring. Daily evaluation instruments for catheter placement nystagmus by video review. We calculated test accuracy and and care investigated. Finally, the team invited external infec- classified artifacts. tion control experts to MICU for intervention measures of Results: We reviewed 2,656 individual VOG tests in 101 bundle care implementation, standards of the placement and patients (31 with nystagmus). Pathologic nystagmus was daily care, professional training sessions, instructional films present per expert review in 4.1% of tests with automated for placement, daily care for patients, and a digitized platform detection sensitivity 95.2%, specificity 95.3%, positive predic- for daily care evaluation. The team expected that these mea- tive value 52.1%, negative predictive value 99.7%. Among 91 sures would alleviate the CAUTI rate. false-positive tests, 34% had physiologic “artifacts” (normal Results: The research team enhanced health care profession- slow eye movements or end-gaze nystagmus); 49% had pupil- als’ knowledge of bundle care intervention for CAUTI through tracking artifacts (blinking, ptosis, pupil out-of-frame, eyelash/ revised standard operating procedures of indwelling catheter long-hair in frame); and 16% had non-classifiable artifacts. placement and care, lecture instructions, and self-learning via At the patient level, there were 1 false negatives and 24 false instructional films. Furthermore, this study ensured accurate positives. implementation through an objective structured clinical exami- Conclusion: Automated nystagmus detection by VOG is both nation (OSCE), group discussions, and subsequent audits. The sensitive and specific. However, when used in ED patients CAUTI infection rate was decreased from 4.17‰ to 1.68‰, with a low likelihood of nystagmus undergoing multi-test indicating the effectiveness of the intervention. batteries, patients without any nystagmus are frequently mis- classified as having nystagmus (36.4%). Human review of Conclusions: The OSCE results demonstrated that after positive results may be necessary pending improved computer educational training, both nurses in the nurse postgraduate algorithms. nursing year training program (NPGY program) and the clini- cal nursing teachers had higher levels of knowledge on bundle care intervention of CAUTI than clinical
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