Assessment of Vietnamese nurse’s knowledge and practice regarding patient’s safety after coronary angiography or percutaneous coronary intervention

Original Research

Abstract

Background: Many clinical and paraclinical studies related to coronary artery disease have been done in Vietnam in recent years. However, there have been no studies on nurses’ knowledge and practice regarding patient care after coronary angiography (CAG) or percutaneous coronary intervention (PCI). This study was conducted to assess nurses' knowledge and practice on patient’s safety after CAG or PCI and its associated factors.

Methods: A descriptive cross-sectional study was conducted from December 2019 to June 2020 at the Department of Internal Cardiology, Interventional Cardiology, Intravascular Intervention, and Intensive care unit/Coronary care unit in three general and specialist hospitals in Ho Chi Minh city, Vietnam. 167 nurses who have taken care of patients after CAG or PCI were included in the study through using convenient sampling technique. A translated self-administered questionnaire was utilised. This self-reported survey achieved 100% response rate. Statistical analysis was performed by the Chi-square test (X2). Statistical significance level was at p<0.05 to determine factors related to nurses’ knowledge and practice. Prevalence ratio (PR) with 95% confidence interval (95% CI) were also used to measure the association.

Results: The study findings revealed that only 36% of the study sample had a good knowledge while 78% of them had a good practice on patient’s safety after CAG or PCI. There were association between educational level, working place with the knowledge (PR=1.87-1.92, p<0.01) and practice (PR=1.18-1.35, p<0.05) on patient’s safety after CAG or PCI among Vietnamese nurses. Besides those factors, the number of years working in cardiac specialty were also found to have an association with the practice. A moderately positive correlation between the knowledge and the practice towards patient‘s safety after CAG or PCI has been identified in this study (PR=1.27, 95% CI [1.09 – 1.47], p=0.005).

Conclusions: More than a half of the study sample had poor knowledge but performed good practice in some items of care for patients after CAG or PCI. There was positive association between the knowledge and practice about patient’s safety after CAG or PCI among Vietnamese registered nurses. Educational training programs for staffs working in coronary angiography or percutaneous coronary intervention is recommended to develop.

Graphical abstract

Effectiveness of hydrocolloid nasal dressing pads in preventing nasal ulceration in preterm infants using non-invasive ventilation

Original Research

Abstract

Background: The use of non-invasive ventilation (NIV) in preterm infants is becoming increasingly common. The use of cannula in NIV can cause ulceration of the nasal bridge with the current practices using the thin foam patches. This study aims to evaluate the effectiveness of hydrocolloid nasal dressing pads in preventing nasal ulceration comparing to that of the thin foam patches.

Methods: A prospective cohort study using hydrocolloid dressing pads (1 November to 30 April 2020) was compared to that of a historical control group using thin foam dressing (1 April to 15 October 2019) to evaluate the effectiveness of hydrocolloid dressing pads. All participants were preterm infants (less than 37 weeks of gestational age) and used nasal cannula NIV at the Department of Neonatal Intensive Care (NICU), Children's Hospital 1.

Results: 71 infants used hydrocolloid dressing pads, and 42 used ordinary thin foam nasal dressings. In the hydrocolloid dressings group, two infants (2.8%) had nasal ulcers; among them, one was mild, and the other was moderate. In comparison, ten infants (23.8%) using thin foam dressings developed ulcers, of which seven were mild, two were moderate, and one was severe. Using hydrocolloid nasal dressings significantly reduced nasal ulceration compared to thin foam dressings (OR = 0.09, 95%CI = 0.02 – 0.45).

Conclusion: Using hydrocolloid nasal dressings for preterm infants on nasal cannula NIV significantly reduced nasal ulceration compared to ordinary thin foam dressings.

Graphical abstract

The prevalence of insomnia and characteristics of sleep patterns collected from sleep diary among medical students of University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam

Original Research

Abstract

Introduction: Insomnia is a common disease in all societies and age groups. Among them, medical students are one of the population most susceptible to sleep problems. Studies from many countries have shown high prevalence of insomnia among medical students. Sleep diary is the gold standard for evaluating subjective insomnia and other sleep disorders. This research aims to study the prevalence of insomnia in Vietnamese medical students, associated factors, and their sleep patterns.

Method: In a cross-sectional survey using stratified random sampling, a total of 176 medical students was recruited, each completed a self-administered questionnaire and a 7-consecutive-day sleep diary. Demographic data and lifestyle factors were obtained from the questionnaire, while sleep patterns and quality were collected from the sleep diary. We performed data analysis using SPSS ver 22, p<0.05 was statistically significant.  

Results: Overall, out of 176 participants, 93 (52.8%) were affected by insomnia. On average, students acquired 6.2 hours of sleep each night. 70.94% of the recorded nights had total sleep time (TST) less than 7 hours. Associated factors of insomnia include sleep environment, sleep efficiency (SE), bedtime, falling asleep time, get up time, self-reported sleep quality.

Conclusion: The findings of our study revealed the high prevalence of insomnia among medical students. From recorded sleep data, we observed that sleep deprivation is also a common issue faced by the study participants. The valuable insights provided by sleep diary proved to be crucial in evaluating sleep patterns and quality.

Graphical abstract

Psychometric properties of Body Mass Index in screening malnutrition of COPD inpatients admitted at Nguyen Tri Phuong Hospital, Vietnam: a cross-sectional study

Original Research

Abstract

Introduction: This study assessed the validation of Body Mass Index (BMI) against Subjective Global Assessment (SGA), and identify the prevalence of malnutrition and its associated factors in Chronic Obstructive Pulmonary Disease (COPD) inpatients at Nguyen Tri Phuong Hospital, Ho Chi Minh City, Vietnam.

Methods: A cross-sectional study was conducted to consecutively select COPD inpatients based on medical records and consultancy with doctors. A structured questionnaire was designed to collect socio-demographic characteristics, health status and comorbidities, nutritional status, and handgrip strength. Nutritional status was assessed using SGA and BMI. Handgrip strength was measured using a hand dynamometer. Health status was collected from medical records.

Results: The mean age of 83 COPD inpatients recruited in this study was 67 (SD=10.4) years. Most of the sample population was ≥60 years old (75%), male (86%), Kinh ethnic (89%), married (72%), not currently working (70%), and less than junior high school (81%). Nearly 68% had at least one comorbidity and 27% were active smokers. The mean handgrip strength was 21.6 kg (SD=8.7), and mean weight was 53.9 kg (SD=10.0). The mean BMI was 20.4 kg/m2 (SD=3.4) with 58% having BMI <21 kg/m2. SGA provided the prevalence of malnutrition of 65%. Age-group, BMI and handgrip strength were associated with malnutrition. A BMI cut-off point of <21 kg/m2 provided the highest ROC area of 84% (95%CI: 76%-92%).

Conclusion: Malnutrition is common in COPD inpatients. This study confirms findings of previous studies that a BMI cut-off point of <21 kg/m2 was sensitive and specific for screening malnutritional risk at bedside.

Graphical abstract

Development of the optimal procedure for increasing HbA1c concentration in control materials for external quality assessment

Original Research

Abstract

Background: The research aimed to increase certain HbA1c concentrations at medical decision levels for external quality control samples from healthy donor blood.

Methods: The in vitro study was performed from October 2019 to January 2021 at Quality Control Center for Medical Laboratory at University of Medicine and Pharmacy at Ho Chi Minh City. The study observed on the conditions including the optimal buffer solutions (BAGPM, BPS, Ringer, Saline), temperature (2ºC - 8ºC, 22ºC - 24ºC, 37ºC), and glucose concentration (100 mM, 305 mM, 500 mM) affecting the HbA1c concentration in vitro to make the external quality control samples fell in normal, prediabetes, and diabetes range. At every condition, the HbA1c concentration was measured by Tina Quant method to look for the optimal procedure to increase HbA1c concentration required of the external quality control protocol.

Results: The highest HbA1c concentration (11.57±0.2%) was found in BAGPM solution with 100 mM glucose after 15 days with the baseline HbA1c 5.43±0.13%; the HbA1c level increase dramatically at 37ºC in BAGPM 500 mM glucose solution in fifteen days (40.03±1.05%).

Conclusions: The appropriate conditions were identified to prepare HbA1c standards for prediabetic and diabetic levels. The standards for HbA1c concentrations were recommended to prepare by incubating RBCs from non-diabetic donor blood in BAGPM solution containing glucose at 37ºC for 24 hours. Glucose concentrations should be 100 mM and 500 mM, respectively, for prediabetic level (HbA1c ~ 6.0 ± 0.12%) and diabetic level (HbA1c ~ 9.6 ± 0.17%).

Graphical abstract

Budget impact analysis of the HIV/AIDS treatment on a national scale: a study from the Vietnam Social Security perspective

Original Research

Abstract

Objectives: To analyze the budget impact of the HIV/AIDS treatment on a national scale, from the Vietnam Social Security (VSS) perspective.

Methods: A model with a 5-year time horizon was developed. The total first year direct medical cost (DMC) and its cost components were estimated for HIV-infected populations each year. Budget impact was described through the proportion of the DMC over the social health insurance (SHI) budget. A scenario analysis was conducted with four settings of different proportions of members and coverage levels of the SHI. All costs were converted to 2020 US dollars. 1-way sensitivity analyses were conducted with variations of mean values in a range of ±25%.

Results: The total DMC was estimated at $1.8M (10,000 cases) to treat all new infections and $27.7M (150,000 cases) to reach the treatment goal of the Ministry of Health (MOH) in 2020. The total DMC accounted for 0.6% of the SHI budget for the year 2020 to meet the treatment goal. The costs of CD4-count test and fully suppressive regimen containing Tenofovir Disoproxil Fumarate (TDF) were identified as key cost drivers. The proportion of the total DMC over the SHI budget among different scenarios did not vary significantly.

Conclusion: This is the first-ever study analyzing the budget impact of the HIV/AIDS treatment on a national scale, from the VSS perspective. The results showed that the cost of HIV/AIDS care was economical and the impact on the SHI budget was reasonable. Findings could be used to notify the MOH to allocate domestic resources and to optimize the current programs.

Graphical abstract

Validity of puberty self-report in children and adolescents in Ho Chi Minh City

Original Research

Abstract

Background: Puberty is a milestone in child and adolescent development, yet a feasible tool to accurately assess pubertal stage in community context has not been validated in Vietnam.

Aim: This study was conducted to validate pubertal self-report among Ho Chi Minh City children and adolescents in comparison with paediatrician’s assessment.

Methods: 80 girls and 76 boys aged from 6 to 17 years old from 5 schools in Ho Chi Minh City were recruited. Self-administered questionnaires about sexual maturation were distributed to participants and results were compared with physician’s pubertal examination. Kappa statistic and Kendall’s τ b were used to evaluate validity of the questionnaire.

Results: Boys tended to overestimate their development stages while girls tended to underestimate. Fair to almost perfect agreement between students’ reports and paediatricians’ evaluation, along with high concordance was recorded, however younger boys (aged 6-11) showed limited evaluation of their own sexual maturation.

Conclusion: This method was inaccurate to evaluate younger boys’ sexual maturation; however, acceptable accuracy in sexual maturation estimation among younger girls and adolescents could allow it to serve as an effective screening tool in community context.

Graphical abstract

Factors Relating to Preventive Practices of Health Science Students during the Early Stage of the COVID-19 Pandemic

Original Research

Abstract

Objectives: We assessed the factors relating to the prevention of the Novel Coronavirus Disease (COVID-19) for students at the University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam. 

Methods: A cross-sectional study was performed in February and March 2020. A 21 item self-administered questionnaire on the knowledge, attitude, and practices regarding COVID-19 was collected from students of the first to the sixth year using the strategy of simple random sampling. The aim was to establish factors that relate to practices using Odds ratio (OR) and 95% confidence interval (95% CI) which were estimated by the logistic regression model, p-value <0.05 shows a significant difference.

Results: Of the 551 students, 41.0% recorded responses indicating good practices toward prevention measures, while around half the students reported that they did not wash their hands for 20 full seconds (50.5%). The overall rate of good knowledge and positive attitude was 49.0% and 26.1%, respectively. When adjusted for all variables in the logistic regression model, a positive overall attitude was associated with good overall preventive practice; AOR = 1.72 (95% CI: 1.16 – 2.55). Furthermore, students mainly accessed information via social media and television (95.8% and 85.8%, respectively).

Conclusions: There were only 41.0% recorded responses indicating good practices toward prevention measures. Besides, knowledge and attitudes about COVID-19 among students were inadequate. Further health education interventions should be focused to change bad hand-washing habits via mass media messages.

Graphical abstract

The effectiveness of music on the result of non-stress test

Original Research

Abstract

Objectives: Determined the effects of music on the result of non-stress test at 33 weeks of gestational ages for prenatal assessment.

Methods: The cohort design was conducted between 89 women who had regular NST (without music), and 88 women who do NST with music. These are women with a single pregnancy of 33 weeks or older who are not in the risk pregnancy group, with no signs of preterm labor.

Results: There were 178 pregnant women participating in the study. The median age of pregnant women in the study group who did not listen to music or listen to music was 30.0 ± 4.60 and 30.4 ± 4.00, respectively. The average gestational age in our study was 36.73 ± 1.64 and 36.07 ± 1.91, respectively, for with and without music group. Music increased the average number of fetal movements in the group of pregnant women listening to the music compared to the group that did not listen to music (11.13 ± 0.91 and 17.52 ± 1.63) during the NST. Music also increased the number of accelerations (5.54 ± 0.43 compared to 7.28 ± 0.47) and the resulting reactive NST in pregnant women.

Conclusion: Music increased the average number of fetal movements and the number of accelerations the group of pregnant women listening to the music compared to the group that did not listen to during the NST. Music also increased the resulting reactive NSTs in pregnant women. We can consider using music during NSTs.

Graphical abstract

Implementation status of antimicrobial stewardship programs in hospitals: A quantitative analysis study in Ho Chi Minh city, Vietnam

Original Research

Abstract

Vietnam has one of the highest multi drug resistance in Asia. Although, despite many efforts to implement the Antimicrobial Stewardship Programs (the ASP) since 2016, studies that on the implementation policy are very lacking of this program are limited. For that reason, we conducted this cross-sectional study to analyze the viewpoint of health workers (HWs) on the implementation of the ASP at some hospitals in Ho Chi Minh City (HCMC). An assessment of 234 HWs showed that the implementation of the ASP in HCMC hospitals was above average (62.7/100.0). A barrier to the implementation consisted of the deficiency in finances, guidelines for diagnosis, and specific interventions for some common infections, such as distributing current antibiogram and monitoring rate of Clostridioides difficile infections. These were the widely recognized problems in initially implementing the ASP. Although most HWs are aware of the importance of implementing the ASP (79.1%), the specific assessment has not been recorded clearly due to the numerous neutral responses. Despite the support of the leadership, the implementation still faces many difficulties and limitations, especially in 3rd and 4th class hospitals. Besides, there was a lack of wide dissemination of information on the ASP at each unit. To generalize the status of the ASP implementation, researchers should conduct qualitative and quantitative studies with a larger scale.

Graphical abstract

Isolation of Lactic acid bacteria showing antagonistic activity against Streptococcus mutans

Original Research

Abstract

Background and Objectives: Streptococcus mutans is a major pathogen that initiates dental plaque and dental caries due to its strong acid production and biofilm-forming ability. Recent studies showed that lactic acid bacteria (LAB), exert useful properties which make them become potential tools to fight against S. mutans and its relating diseases. The current study aimed to isolate and screen for LAB strains that could inhibit S. mutans growth as well as its biofilm production.

Methods and Results: Using the spread plate technique, fifty-one LAB strains were isolated from fermented vegetables and healthy human saliva. From that, fourteen isolates showed the inhibitory effect on S. mutans growth in well-diffusion assay. These strains were then screened on the ability in reducing S. mutans biofilm formation by colorimetric assay. Next, potential LAB was evaluated on some probiotic characteristics including saliva amylase tolerance, acid tolerance, bile tolerance as well as antibiotic susceptibility properties. As a result, four strains showed the most promising features were further tested for the ability to reduce Streptococcus mutans biofilm by scanning electron microscopy (SEM) observation and by expression analysis of biofilm-forming genes (gtfB and luxS) using RT-qPCR method. Finally, these four strains were identified to species level using API® 50 CHL kit and 16S rDNA sequencing method. The result showed that two strains belong to L. plantarums, one belongs to L. brevis and the other is Weisella confusa

Conclusion: This study was successful in isolating LAB that showed promising probiotic effects against S. mutans.

Graphical abstract

The prevalence and related factors of phantom vibration among medical students: A first look in Vietnam

Original Research

Abstract

Background: Phantom vibration (PV) is an illusionary perception in which people perceive their mobile phone vibrates while it actually does not. Recently, PV has attracted attention in psychology and medical field. There are several studies investigating the prevalence and risk factors associated with this phenomenon. However, the findings are inconsistent. The prevalence of PV fluctuates from 21% to 89% among different groups and its mechanism remains unclear. Further understanding is necessary to identify the settings in which PV may harm the population and warrant further exploration.

Objectives: This study aims to explore the prevalence of PV among medical students in Ho Chi Minh City and settings that PV can risk people’s health. Relationships between PV and phone usage habits as well as psychiatric disturbance also are investigated.

Methods: By using online questionnaire on 377 undergraduate medical students in Ho Chi Minh City, Vietnam, the cross-sectional study explored factors associated with PV, including demographic, behavioral phone usage, and mental/emotional factors using the Self Reporting Questionaire - 20 (SRQ-20). The descriptive and association analyses were employed using R software.

Results: The study found a significant association between mental/emotional factors (i.e. mental disturbance and phone attachment) and PV (OR=2.15, 95% CI=1.21-3.81, p value=0.009; OR=1.75, 95% CI=1.02-3.01, p value=0.043 respectively), which suggests an important role of mental/emotional factors in explaining the potential mechanism of PV. A high proportion of participants also experienced PV while driving (55.5%) within the last month. This implies the impact of PV possibly becomes significant, causing an increase in the risk of traffic accident due to distracted driving.

Graphical abstract

Direct cost of treatment in patients with acute ST-elevation myocardial infarction in Vietnam

Original Research

Abstract

Background: Acute myocardial infarction has become a serious financial burden for patients, healthcare system, and society. It is therefore necessary to assess treatment cost of myocardial infarction that had been conducted in many countries in the world and still not fully analysed in Vietnam. Thus, we sought to describe acute ST-elevation myocardial infarction treatment cost and analyse related factors to acute ST-elevation myocardial infarction treatment cost.

Methods and Materials: A retrospective cross-sectional study. Patients who was diagnosed by ST-elevation myocardial infarction at Cho Ray Hospital from June 2018 to February 2019, satisfied inclusion and exclusion criteria.

Results: We collected 130 patients with acute ST-elevation myocardial infarction with male: female ratio of 3:1, at average age of mean ± Standard deviation (SD) = 62.9 ± 12.6. The length of stay in hospital was mean ± SD = 7.1 ± 3.3 days and the median direct cost of MI was 68,902,500 VND (interquartile range (IQR): 5,737,200 – 104,266,000 VND). The average total cost of acute ST-elevation myocardial infarction in the percutaneous coronary intervention group was more than 16 times as the conservative group. The treatment strategies and hospital complications were major factors that affected treatment cost.

Conclusion: The median direct cost of acute ST-elevation myocardial infarction was accounted for 68,902,500 VND. Complications directly affected costs.

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Evaluation of R-CHOP and R-CVP in the treatment of elderly patient with non-Hodgkin lymphoma

Original Research

Abstract

Introduction: Little information is available on the outcomes of R-CHOP (rituximab with cyclophosphamide, doxorubicin, vincristine and prednisone) and R-CVP (rituximab with cyclophosphamide, vincristine and prednisone) in treatment of the elderly patients with non-Hodgkin lymphoma (NHL), especially in Vietnam.

Material and methods: All patients were newly diagnosed with CD20-positive non-Hodgkin lymphoma (NHL) at Blood Transfusion and Hematology Hospital, Ho Chi Minh city (BTH) between 01/2013 and 01/2018 who were age 60 years or older at diagnosis. A retrospective analysis of these patients was perfomed.

Results: Twenty-one Vietnamese patients (6 males and 15 females) were identified and the median age was 68.9 (range 60-80). Most of patients have comorbidities and intermediate-risk. The most common sign was lymphadenopathy (over 95%). The proportion of diffuse large B cell lymphoma (DLBCL) was highest (71%). The percentage of patients reaching complete response (CR) after six cycle of chemotherapy was 76.2%. The median follow-up was 26 months, event-free survival (EFS) was 60% and overall survival (OS) was 75%. Adverse effects of rituximab were unremarkable, treatment-related mortality accounted for less than 10%. There was no difference in drug toxicity between two regimens.

Conclusions: R-CHOP, R-CVP yielded a good result and acceptable toxicity in treatment of elderly patients with non-Hodgkin lymphoma. In patients with known cardiac history, omission of anthracyclines is reasonable and R-CVP provides a competitive complete response rate.

Graphical abstract

Effect of auricular acupuncture on exam anxiety in first-year medical students

Original Research

Abstract

Background and Objectives: Exam anxiety is a commonly seen problem among medical students. Auricular acupuncture has been shown to have an anxiety-reducing effect, however, data on exam anxiety is limited. Research in dental and preoperative anxiety has indicated that anxiety level could be reduced by using ear acupoints on the non-dominant side. Therefore, this study aims to determine whether needling at acupoints on the non-dominant side can reduce exam anxiety in medical students.

Method: This is a prospective observational study on 32 students at The Faculty of Traditional Medicine, Ho Chi Minh City University of Medicine and Pharmacy. Eligible students received auricular acupuncture on the non-dominant side at the Master cerebral, Tranquilizer and Relaxation points. Levels of anxiety were measured using a visual analogue scale before and after the intervention as well as before the exam. The State-Trait Anxiety Inventory, heart rate, exam performance and adverse events occurring during the study were also collected.

Results: Exam anxiety level and heart rate decreased 30 minutes after auricular acupuncture (p<0.05). Before the exam, exam anxiety level and heart rate increased significantly compared to after the intervention but still lower than baseline (p<0.05). The exam anxiety level with heart rate at each time point did not differ significantly in gender and trait anxiety levels (p>0.05). No adverse events from auricular acupuncture were observed.

Conclusion: Auricular acupuncture at the Master cerebral, Tranquillizer and Relaxation points on the non-dominant side is effective in reducing exam anxiety in medical students.

Graphical abstract

The effect of diet on the fluctuations of human gut microbiota

Review

Abstract

It was previously thought that the establishment of the gut microbiota was completed within the first two years of life, and this community maintains fairly stable throughout the adult lifetime thereafter. However, recent evidence shows that the gut microbiota composition is constantly changing in the gut environment and is heavily influenced by diet. The individual differences responding to diets would root on the fluctuations of gut microbiota if dietary fluctuations affect the composition of gut microbiota so significantly.

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Factors predicting physical and mental health-related quality of life among post-myocardial infarction patients: Bayesian model averaging analysis

Original Research

Abstract

Coronary artery disease was the cause of half of morbidity and mortality due to cardiovascular diseases in 2013. Myocardial infarction (MI) has been a common medical emergency with high mortality rate and complications unless it is early and appropriately treated. Health-related quality of life (HRQoL) has been popularly used in assessment of health state among coronary artery disease patients undergone both medical and surgical therapies. Bayesian model averaging approach statistically facilitated for identifying potential predictors of HRQoL among post-MI patients following up at University Medical Center, Ho Chi Minh City. The cross-sectional descriptive study was conducted on 146 participants diagnosed and treated with acute myocardial infarction from April 1st 2017 to June 30th 2017. The better HRQoL in physical component summary was associated with higher educational levels (coeff­icient=1.2) and weekly moderate – intensity physical activity (coeff­icient=0.002) but the contrast status for the female (coeff­icient =-3.7) in the fit model with R2= 0.24, BIC=-25.7 and posterior probability=11.7%. The good economic household (coeff­icient=9.8), more daily sitting time (coeff­icient =1.4) and weekly moderate – intensity physical activity (coeff­icient =0.004) predicted the increase of mental component summary score in the given model with R2= 0.08, BIC=-20.3 and posterior probability=25%. The post – MI patients experienced low physical health much more than mental health. The female and suitable physical activity should be concerned in the rehabilitation program as well as follow-up care during the discharge process.

Graphical abstract

Commitment: A concept analysis in nursing field

Review

Abstract

Aim: To clarify the meaning of commitment and to provide the empirical referents to measure the concept of commitment.

Method: By using the Walker and Avant (2011) methodology, data were analyzed with the focusing on critical attributes of concept, constructed cases, antecedents and consequences of the concept. Additionally, the empirical referents and implications for nursing knowledge are presented to further elucidate the concept of commitment.

Findings: The critical attributes of commitment derived from this analysis are 1) Promising to involve in an action; 2) Acceptance of responsibility for the action; and 3) Persistent involvement in an action. The process of analysis concept of commitment leads to a better understanding of the concept itself. Nurses can use the ideas of this analysis as conceptual tools to assess the level of commitment among patients/clients in their action toward the health promoting behavior.

Conclusion: This analysis proposes a definition with the critical attributes of the concept which can be considered to use in nursing practice. Nursing is a universal profession; hence, the definition was proposed from this concept analysis can be considered as a beginning point for the further study in nursing field of each country.

Graphical abstract

Online training needs of Methadone Maintenance Treatment clinics in southern Vietnam

Original Research

Abstract

Introduction: Continuing Medical Education (CME) significantly improves the competency of healthcare workers in Methadone Maintenance Treatment (MMT) clinics. However, CME courses are very costly, and a few participants fully attended a course. Online training is an alternative approach to efficiently improve training outcomes. The study assessed needs and possibility of online training courses of MMT clinics in southern Vietnam.

Methods: A google form was designed to collect characteristics, man-powers, facilities, online activities and training needs of MMT clinics. E-mails were sent to all MMT clinics in southern Vietnam to ask for their participants. A representative of MMT clinics who satisfied the inclusion invited to complete the form.

Result: 93 MMT clinics completed the survey. The response rate was 62% (93/150). One MMT clinic had 3 doctors/assistant doctors, 3 pharmacists/drug dispensers, 2 consultants and 3 other professionals on average. The number of clients visiting the clinic in the last month was 150. About 94% (93/95) of MMT clinics provide other additional services. On average, 385 clients came to MMT for other services. All clinics had adequate devices for online and blended training.

Conclusion: MMT clinics had high training needs and were willing to attend online and blended training courses. Online and blended training were possible in MMT clinics.

Graphical abstract

Budd-Chiari syndrome due to segmental obstruction of the inferior vena cava successfully managed with endovascular stenting

Case Study

Abstract

Budd–Chiari syndrome (BCS), a rare and life-threatening disorder due to hepatic venous outflow obstruction, is occasionally associated with hypoproteinemia. We herein report the first case of BCS with segmental obstruction of the intrahepatic portion of inferior vena cava (IVC) and hepatic veins (HVs) successfully treated by endovascular stenting in Vietnam. A 32-year-old female patient presented with a 2-month history of massive ascites and leg swelling. She refused history of oral contraceptives use. Hepatosplenomegaly without tenderness was noted. Laboratory data showed polycythemia, mild hypoalbuminemia and hypoproteinemia, slightly high total bilirubin and normal transaminase level. The serum ascites albumin gradient was 1.9 g/dL and ascitic protein level was 1.1 g/dL. The other data were normal. BCS was suspected because of the discrepancy between mild liver failure and massive ascites; and the presence of hepatosplenomegaly and polycythemia. On abdominal magnetic resonance imaging, the segmental obstruction of three HVs and IVC was 2-3 cm long without thrombus. Cavogram revealed the severe segmental stenosis of intrahepatic portion of IVC with no visualized HV and extensive collateral veins. A Protégé stent was deployed to IVC. Leg swelling and ascites were completely resolved within 3 days after stenting. During 1-year follow-up, edema was not recurred and repeated laboratory results were all normal.

Graphical abstract

Pursuing a targeted dream specialty and a research career: Opinions and observations from a fifth-year medical student’s perspective

Letter to Editor

Abstract

With our fast-pacing life, numerous learning and scientific sources and information are available and required for medical students to boost their skills since their early life to accommodate with the great knowledge they take. Medical students should re-elaborate what they studied and exploit knowledge clinically. A good doctor is a good observer, so eyes should be kept on while mentor managing patients in order to add more to our medical notions. A seed to become a great future doctor starts by searching for a specialty that fits your personality, to practice it as a volunteer, to gain its skills earlier. So when you graduate, you have more time to gain other learning experience. As long as you practice it, the more chance to become one of its experts. Managing your patient as a relative, not as a bag of money, is very important to be applied. Inability to diagnose a patient is not a shame, so never let a patient go home without referring him to another doctor who has more experience than you. Having a background in other medical specialties will help you recognize common signs of other related medical conditions that could lead you to refer him to right specialty doctor. Joining a research lab will keep you updated with new inventions, drugs, algorithms, and guidelines, which will help you become more acknowledged with medical problems that you were unaware of. Time management is the key to success as a researcher without affecting your daily life activities and study requirements.

Graphical abstract

Translation and cross-cultural adaptation of the Vietnamese version of the Diabetes Distress Scale

Original Research

Abstract

Background: The Diabetes Distress Scale (DDS) is a valid instrument to measure diabetes distress included in American Diabetes Association and Canadian Diabetes Association guidelines but not available in Vietnamese. This study translated and culturally adapted the DDS to assess diabetes distress of Vietnamese type 2 diabetics and evaluated its internal consistency, face and content validity.

Methods: The translation process followed standard guidelines for adaptation of an instrument: forward translation, back translation, synthesis, evaluation by an expert panel and pretest. The expert panel included three English specialists as linguistic experts and six content experts in multidisciplinary areas relevant to the study. The pretest was conducted on a sample of 31 type 2 diabetics in the Endocrinology outpatient clinic at Trung Vuong hospital. Content validity was determined based on experts’ concurrence using content validity index for items (I-CVI). Face validity is assessed by participants in pretest. Internal consistency was measured using Cronbach’s alpha.

Results: Final version was equivalent with the original English version and easy to understand. I-CVI of 17 items were 1.00 in linguistic experts and greater than 0.83 in content experts. All 31 participants involved in the pretest commented that the items were very clear and acceptable regarding their socioeconomic background. Cronbach’s alpha coefficient was 0.76 – 0.93 for each subscale and 0.94 for the overall.

Conclusion: Vietnamese version of the DDS was reliable, face and content-valid to assess diabetes distress in type 2 diabetics among Vietnamese.

Graphical abstract

Switching to Effective and Optimal Study Methods - A necessary tool for Educational Success

Case Study

Abstract

The secret of educational success and splendid future with prosperous career lies in the constant hard work performed in a smart way. By that way, the change or modification in study methods, exam strategies, and learning techniques is necessity. Deriving from our own experience as medical students from some developing countries from all over the world, authors support some tips and methods to approach the medical field more productive.

Graphical abstract

How to overcome challenges related to English and academic writing skills when studying abroad

Case Study

Abstract

Nowadays, pursuing postgraduate study abroad after completing a Medical Doctor (MD) degree in their home country is common among Vietnamese doctors. There are several challenges in studying overseas that international students need to overcome to ensure a favorable outcome of their learning journey. The presenting paper mainly discussed about the challenges related to English and academic writing skills and aimed to provide some tips for studying effectively in developed countries. Based on his own experiences as a postgraduate international student in Australia, the author found that a successful learning journey could be facilitated by (1) feeling free to ask, (2) making friends with the locals and other international students, (3) exploring the local life, (4) learning and using a reference management software, and (5) attending all free academic skills workshops and consultations provided by the university.

Graphical abstract

Content validity of a professionalism OSCE developed in family medicine training University of Medicine and Pharmacy at Ho Chi Minh city Vietnam

Original Research

Abstract

Background: Assessments of professional behaviors such as professionalism Mini clinical examination (PMEX) and OSCE (POSCE) are playing an important role in driving the practice professionalism in medical training. Simulation-based assessment or POSCE has been used to evaluate several professional attributes. However, few evidence of content validity proving that whether POSCE is really measuring specific professional attributes have been reported in medical education literature.

Methods:  The four-step process of developing FM POSCE was analyzed to highlight the validity evidence according framework of Downing (2003). Group of 5 independent FM experts from Vietnam, Boston University, US and Liege, Belgium evaluated the blueprints, scenarios and item lists on a scale (1-totally disagree to 5-totally agree) regarding to what extent test blueprint, cases and item lists were relevant to the content domains and cultural context. The results of their evaluation were considered as an evidence of content validity. The mean and standard deviation of the scores given by them were calculated using SPSS, 20.0.

Results: Important evidence of content validity were found in the process of developing POSCE. Content experts’ evaluation showed that all professional attributes represented medical professionalism. However, the adequacy of professional attributes to evaluate the broad construct of professionalism was controversial (M=3.75, SD=0.95). Cases are relevant to assess these professional attributes and culture. Only the cases of “Respecting the patient” and “Making altruistic decision” contained some inappropriate marking items (M=3.75, SD=0.95; M=3.00, SD=0.92).  

Discussion and conclusion: FM POSCE developed in Vietnamese context can assess six specific professional attributes. This study suggested a process of developing POSCE that has several features such as using both sources of expertise and medical literature to build up the content of POSCE to improve the content validity.

Graphical abstract

Evaluation of ESP Effectiveness in Faculty of Pharmacy, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam

Original Research

Abstract

Since 2011, English for Specific Purposes (ESP) curriculum in Faculty of Pharmacy, University of Medicine and Pharmacy at Ho Chi Minh City (Vietnam) has been changed in accordance with pharmaceutical specialization orientation and did apply the active learning-learner centered teaching methods. Our study used three self-administered questionnaires to collect the feedbacks from sophomores, final-year and pharmacist graduating in 2016 in evaluating ESP course effectiveness. Data analyzed with STATA 13 indicated that English lecturers made efforts to organize the active learning activities in ESP class but their target has neither been effective nor met the required students’ needs in academic purposes as well as their occupational purposes. In addition, students’ passivity and lack of apparent motivation made it more difficult to apply the active learning method. Generally, final-year pharmacy students and newly graduated pharmacists, besides their moderate English competence, had a low frequency in using English. It is also found that there exists the relationship between final-year pharmacy students’ frequency of using English, their English competence and pharmaceutical specialization as well as that between English use frequency and occupation.

Graphical abstract

The Incidence and Characteristics of Gastrointestinal Intolerance on Mechanically Ventilated Patients with Continuous versus Intermittent Feeding Method in The Intensive Care Unit: A Randomized Controlled Trial

Original Research

Abstract

Background: Enteral nutrition therapy via nasogastric tube can be administered through continuous or intermittent feeding methods for critically ill patients. However, there has not been existing consensus on the superiority of either method for mechanically ventilated patients due to insufficient evidence comparing the effectiveness of the two methods. The present study aimed to compare the impact of continuous versus intermittent feeding methods on gastrointestinal intolerance in mechanically ventilated patients.

Methods: 41 mechanically ventilated patients in the intensive care unit, University Medical Center, Ho Chi Minh City, Vietnam from 3/2017 to 5/2017 were enrolled in a randomized controlled trial. They were randomly and equally assigned to the two study groups and monitored for 4 consecutive days on incidence of gastrointestinal intolerance including high gastric residual volume, abdominal distention, diarrhea, and tube occlusion.

Results: There was statistically significant difference when comparing the gastric residual volumes between two groups with a median at 0.93ml (0.09-1.93) versus 11.61ml (7.61-17.28) (p < 0.001). The mean number of abdominal distention episodes in the continuous group was significantly lower than in the intermittent group (2.8 ± 2.66 versus 8.29 ± 5.1 episodes, respectively, p < 0.001). The diarrhea scores were not significantly different (p < 0.05) and there were no cases of occlusion recorded in the two groups.

Conclusions: Continuous feeding method offered less gastrointestinal intolerance than intermittent feeding method by reducing gastric residual volumes and limiting abdominal distention. The feeding method did not increase the risk of tube obstruction if it was flushed regularly.

Graphical abstract

The Vietnamese Version of the Health-related Quality of Life Measure for Children with Epilepsy (CHEQOL-25): Reliability

Original Research

Abstract

Purpose: This study aimed to translate and culturally adapt the self-report and parent-proxy Health-Related Quality of Life Measure for Children with Epilepsy (CHEQOL-25) into Vietnamese and to evaluate their reliability.

Methods: Both English versions of the self-report and parent-proxy CHEQOL-25 were translated and culturally adapted into Vietnamese by using the Principles of Good Practice for the Translation and Cultural Adaptation Process. The Vietnamese versions were scored by 77 epileptic patients, who aged 8–15 years, and their parents/caregivers at neurology outpatient clinic of Children Hospital No. 2 – Ho Chi Minh City. Reliability of the questionnaires was determined by using Cronbach’s coefficient α and intra-class correlation coefficient (ICC).

Results: Both Vietnamese versions of the self-report and parent-proxy CHEQOL-25 were shown to be consistent with the English ones, easy to understand for Vietnamese children and parents. Thus, no further modification was required. Cronbach’s α coefficient for each subscale of the Vietnamese version of the self-report and parent-proxy CHEQOL-25 was 0.65 to 0.86 and 0.83 to 0.86, respectively. The ICC for each subscale of the self-report and parent-proxy CHEQOL-25 was in the range of 0.61 to 0.86 and 0.77 to 0.98, respectively.

Conclusion: The Vietnamese version of the self-report and parent-proxy CHEQOL-25 were the first questionnaires about quality of life of epileptic children in Vietnam. This Vietnamese version was shown to be reliable to assess the quality of life of children with epilepsy aged 8–15 years.

Graphical abstract

Phytochemical Screening and Total Phenolics and Flavonoids Contents of Hibiscus Rosa Sinensis. L Cultivated in Viet Nam

Original Research

Abstract

Background: Phenolics and flavonoids are regarded as the highest potential of chemotherapeutic activities. This investigation was carried out to evaluate phytochemical and total phenolics content (TPC) and total flavonoids content (TFC) and Fourier-transform infrared spectroscopy (FTIR) spectral analysis of Hibiscus Rosa Sinensis L. extracts (crude extract, n-hexane extract, ethyl acetate extract, and methanol extract) for further applications in pharmaceutical development.

Method: Total phenolics were estimated by Folin-Ciocalteu method; while, Aluminum chloride was employed to quantify total flavonoids in the sample extracts. And, functional groups of Hibiscus Rosa Sinensis compound was determined using a FTIR-spectrophotometer.  

Result: Results showed the leaves extracts to encompass the high amount of total phenolic and total flavonoid content. TPC values for crude extract, methanol extract, ethyl acetate extract and n-hexane extract were 57.09 ± 0.35 mg/g, 70.98 ± 0.03 mg/g, 21.31 ± 0.01 mg/g, and 18.45 ± 0.003 mg/g as gallic acid equivalent, respectively. Crude extract, methanol extract, ethyl acetate extract and n-hexane extract showed total flavonoids 26.87 ± 0.01 mg/g, 21.08 ± 0.03 mg/g, 21.70 ± 0.001 mg/g, 14.95 ± 0.02 mg/g as rutin equivalent. FTIR spectra of four extracts were comparable and showed the presence of nitro compounds and ring aromatic compounds.  

Conclusion: Our results indicate the potential of exploiting Hibiscus Rosa Sinensis leaves as a source of chemotherapeutic compounds, and it is worthy doing further researches on isolated bioactive compounds for developing novel functional foods or new drugs.

 

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