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Background The updated prevalence of Helicobacter pylori (H. pylori) is lacking in Taiwan. We aimed to assess the accuracy of Vstrip® H. pylori Stool Antigen Rapid Test (Vstrip®HpSA) in the detection and surveillance of the updated prevalence of H. pylori in Taiwan. Methods A total of 347 adult subjects including 152 volunteers and 195 symptomatic patients were recruited. Stool samples were collected for detection of H. pylori using Vstrip® HpSA, ImmunoCard STAT!® HpSA and Premier Platinum HpSA® PLUS. All subjects who have completed the stool sample collections were included in the ITT analysis. The sensitivity, specificity, and accuracy of Vstrip® HpSA were calculated compared to gold standard test with 13C-Urea breath test. Results The un-adjusted prevalence of H. pylori infection was 22.5% (95% CI: 18.3–27%) in 2018. The age-standardized prevalence of H. pylori was 21.8% in asymptomatic adults in Taiwan. The sensitivity, specificity, and accuracy of the Vstrip® HpSA, and ImmunoCard STAT!® HpSA tests were 91% (95% CI: 82–96%) versus 76.9% (95% CI: 66–86%), 97% (95% CI: 94.1–98.6%) versus 97% (95% CI: 94.1–98.6%), and 95.7% (95% CI: 92–97%) versus 92.5% (95% CI: 89–95%), respectively. Conclusion The age-standardized prevalence of H. pylori infection in Taiwan was 21.8% in asymptomatic adults in 2018. The Vstrip® HpSA had equivalent performance as the ImmunoCard STAT!® HpSA, and can be used in future mass screening of H. pylori infection for gastric cancer prevention.

BACKGROUND AND AIM The reported prevalence of Helicobacter pylori infection in Taiwan was 54.4% in 1992. An updated prevalence of H. pylori infection in asymptomatic adults is lacking in Taiwan. We aimed to assess the updated age-standardized prevalence of H. pylori infection in asymptomatic subjects and in patients with dyspepsia and to assess the accuracy of H. pylori stool antigen (HpSA) test for screening of H. pylori in Chinese population. METHODS Asymptomatic adult subjects (N = 189) were screened for H. pylori infection using HpSA, serology, and 13 C-urea breath test (13 C-UBT) in 2016-2017. Adult patients with dyspepsia (N = 145) were screened for H. pylori using 13 C-UBT, HpSA, serology, rapid urease test, and histology during 2016-2018. Two types of HpSA, including the Diagnostec HpSA ELISA Kit (HpSA ELISA) and Rapid Test Kit (HpSA Rapid), were used in this study. Sensitivity, specificity, and accuracy of the HpSA tests were calculated using the 13 C-UBT as golden standard test. RESULTS The unadjusted prevalence of H. pylori was 21.2% in asymptomatic adults and 37.9% in patients with dyspepsia (P

Wen-Chun Chen,1– 3 Chiu-Chu Lin,2,4,5 Chia-Chi Kuo,6,7 Chia-Chen Wu,8 Tz-Jie Liu,9 Mei-Tsu Chen9 1Department of Community Medicine, St. Martin De Porres Hospital, Chiayi, Taiwan; 2School of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan; 3Department of Nursing, Chang Jung University of Science and Technology, Chiayi Campus, Tainan, Taiwan; 4Department of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; 5Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; 6Emergency Department, Chi-Mei Medical Center, Tainan, Taiwan; 7Department of Nursing, Chang Jung Christian University, Tainan, Taiwan; 8School of Nursing, Fooyin University, Kaohsiung, Taiwan; 9Health Management Center, St. Martin De Porres Hospital, Chiayi, TaiwanCorrespondence: Chiu-Chu Lin Email chiuchu@kmu.edu.twObjective: To improve the quality of peer leader training, this study developed a theory-based self-management training program for older adult peer leaders with diabetes and assessed its feasibility.Background: Current self-management programs are designed mainly to be implemented by healthcare professionals, but healthcare staff may not fully perceive the needs and obstacles of older adults in disease management due to a lack of similar illness experience. To target this problem, peer leaders with successful self-management experiences, similar cultural backgrounds and languages, and related illness experiences are trained to guide and mentor peer patients in self-management programs.Study Design and Methods: This study was conducted in two stages. In stage 1, a peer leader training program was developed based on experiential learning theory as the framework and self-regulation theory as the activity design strategy. In stage 2, program feasibility was assessed via participants’ feedback toward the training program by three indicators: attendance, future willingness to lead the peer-led self-management program, and leadership skills evaluated by a peer leader training assessment tool.Results: In this study, peer leaders demonstrated good leadership skills by expressing active willingness to lead self-management programs in the community. Peer leaders’ feedback indicated that the program’s training content was helpful in preparing peer leaders to guide older adults in learning self-management skills and in improving the abilities and confidence of peer leaders in mentoring self-management.Conclusion: Findings in this study showed that peer leader training can impact the effectiveness and success of self-management in older adults with diabetes. Even in a small-scale study, the impact was evident, which demonstrated the feasibility of the program. More large-scale studies on the effectiveness of various peer leader training programs in diverse disciplines are recommended.Clinical Trials Registry: ClinicalTrials.gov Identifier: NCT04298424 (the Peer-Led Self-Management Program).Keywords: older adult, peer leader, diabetes, theory-based, peer-led, self-management

Background Incarcerated persons are a special population with higher hepatitis C virus (HCV) prevalence and should be prioritized for microelimination. In this study, we investigate the seroprevalence and evaluate the effectiveness and safety of direct-acting antiviral (DAA) therapy in custodial settings. Methods Incarcerated persons in Yunlin Prison were recruited to receive anti-HCV antibody screening. Patients with positive HCV ribonucleic acid (RNA) were treated with glecaprevir/pibrentasvir (GLE/PIB) in our special chronic hepatitis C (CHC) clinic in prison. The primary endpoint was sustained virologic response at week 12 off therapy (SVR12). Results A total of 1402 incarcerated persons were invited to anti-HCV screening and 824 (58.7%) accepted. The prevalence of anti-HCV positivity was 33.5% (276 of 824), and the viremic rate (detectable HCV RNA) was 69.2% (191 of 276). According to fibrosis index based on 4 factors, patients with F3 stage were 6 (3.1%), but none met the criteria of F4 stage. However, 6 (3.1%) had liver cirrhosis with splenomegaly, confirmed by findings of ultrasonography. The median log10 HCV RNA level at baseline was 6.235 (2.394–7.403). Genotype (GT) 6 was predominant (39.3%), followed by GT 1a (22.0%) and 1b (14.1%). Mixed GT HCV infection accounted for 3.6% of total infections. In total, 165 patients received GLE/PIB therapy. The overall SVR12 rates were 100%. Conclusions Direct-acting antiviral therapy is highly effective and safe for incarcerated patients in Taiwan. Our special prison-based CHC clinic, linking universal screening to medical care, can serve as a model for microelimination of HCV in custodial settings., We established a special hepatitis C clinic in prison and offered universal hepatitis C screening for incarcerated persons. The prevalence of anti-HCV positivity was 33.5%, and the viremic rate (detectable HCV RNA) was 69.2%. All treated patients achieved SVR.

Background: Glecaprevir/pibrentasvir (GLE/PIB) is a pangenotypic direct-acting antiviral agent for the treatment of chronic hepatitis C virus (HCV) infection. Real-world data of GLE/PIB in Asian patients other than Japanese are limited. We thus investigated the effectiveness and safety profile of GLE/PIB in Taiwanese patients with chronic hepatitis C (CHC). Methods: CHC patients who received 8, 12, or 16 weeks of GLE/PIB between August and October of 2018 were consecutively enrolled. The treatment duration was determined according to drug label. The hepatic fibrosis was staged according to liver histology, transient elastography, fibrosis index based on 4 factors (FIB-4), or findings of ultrasonography/endoscopy. The primary endpoint was sustained virological response at week 12 off therapy (SVR12). The safety profiles were also assessed. Results: A total of 110 CHC patients with 51% of males were enrolled. The median age was 70 years. A majority (82%) of patients were infected with HCV genotype 2. Forty-six (42%) and 64 (58%) patients had advanced hepatic fibrosis and compensated cirrhosis, respectively. Forty-five (41%) non-cirrhotic patients were treated for 8 weeks. The overall SVR12 rates were 100%, regardless of baseline clinical characteristics. The common adverse events (AEs) were pruritus (12%), anorexia (6%), and fatigue (5%). Nine (8%) serious AEs unrelated to GLE/PIB occurred. Three (2%) patients had Grade 3 elevation of total bilirubin level. None had premature treatment termination, hepatic decompensation, or death. Conclusion: Interferon-free GLE/PIB regimen is highly effective and safe for Asian chronic hepatitis C patients with advanced hepatic fibrosis or compensated cirrhosis. Keywords: Chronic hepatitis C, Direct-acting antiviral, Glecaprevir, Pibrentasvir, Taiwan

Objective Nurse burnout is a global issue; however, it remains unclear how coping strategies over a maintained period of time may influence nursing burnout. This meta-analysis aimed to evaluate the literature on the effects of coping strategies in reducing nurse burnout. Methods Systematic reviews of English and Chinese articles were conducted for relevant articles published between 1979 and 2014 in six electronic databases (PubMed, CINAHL, The Cochrane, PsycARTICLES, Airiti Library, and the Index of the Taiwan Periodical Literature System). The search terms included ‘nurse,' ‘burnout' and ‘coping.' Studies were included in the review if they were randomized controlled trials or controlled clinical trials, and they used the measurement tool, Maslach Burnout Inventory-Human Service Survey. Three hundred fifty-one studies were identified, and seven studies were ultimately included in the meta-analysis. Results A total of 1,521 participants were included in the meta-analysis for each burnout subgroup. Participants were measured immediately after the intervention and 6months, 1year, 2years, 2.5years, and 4years thereafter. Coping strategies were hypothesized to decrease burnout. The maintained period for coping strategies was 1year for emotional exhaustion and depersonalization and 6months for personal accomplishment. Conclusions Coping strategies can reduce nurse burnout and maintain effectiveness between 6months and 1year.

Aim To synthesize the effects of Internet empowerment-based self-management interventions on adults with metabolic diseases. Background Metabolic diseases are prevalent and burden healthcare systems; they have become a major health problem worldwide. The effects of IESMIs on lifestyle changes have been shown to improve adults' physiological and psychological conditions. However, we found no systematic review evaluating these effects. Design Systematic review and meta-analysis of randomized and non-randomized controlled trials, conducted according to the Cochrane handbook. Data resources A literature search was conducted using the Airiti Library, Association for Computing Machinery, CINAHL, Cochrane Library, Embase, ProQuest, PubMed/MEDLINE and Index of the Taiwan Periodical Literature System databases (earliest-June 2016). Review methods Two reviewers used the Cochrane Collaboration bias assessment tool to assess the methodological quality of included studies. Extracted data were entered and analysed using RevMan 5.3.5 software. Inverse variance was used to estimate effect sizes. Weighted and standardized mean differences with 95% confidence intervals were calculated using a random effects model. Subgroup and sensitivity analyses were performed. Results Twenty-one randomized controlled trials were reviewed. Meta-analysis showed that the intervention significantly improved adults' exercise habits, glycated haemoglobin (HbA1c) levels, body weight, empowerment levels and quality of life. Conclusion The intervention significantly improve the health status of adults with metabolic diseases, in particular their exercise habits, HbA1c levels, body weight, empowerment and quality of life. The intervention provides more convenient and faster access to healthcare for busy individuals with time constraints. These results suggest that healthcare professionals could develop accessible and friendly interactive online interfaces for patients to expand the use of these interventions in the clinical setting.

Aims The aim of this study was to determine the effects of nursing preceptorship on the competence, job satisfaction, professional socialization and retention of new nurses. Background Although studies have focused on the effects of nursing preceptorship on new nurses’ competence and retention, a systematic review of the overall effects is lacking. Design A quantitative systematic review. Data sources Five English/Chinese databases were searched for original articles published before June 2015 and only six articles published between 2001–2014 were included in the final analysis. Review methods Joanna Briggs Methodology was used to process one randomization control trial, one quasi-experimental study and four observational studies. Two appraisers independently reviewed each study using the standardized critical appraisal tools from the Joanna Briggs Institute. Results The most adopted preceptorship was a fixed preceptor/preceptee model and one-on-one for 1–3-month duration. It showed that new nurses’ overall competence increased significantly due to preceptorship. Only a few studies explored the effects of preceptorship on the job satisfaction and professional socialization of new nurses. Clear conclusions regarding the effect of preceptorship on nurses’ retention rate could not be made because of inconsistent time points for calculation and a lack of control groups in the study design. Conclusions Preceptorship can improve new nurses’ nursing competence; however, more studies are needed to ascertain its effects on new nurses’ retention rates, job satisfaction and professional socialization to promote nursing care quality and resolve nursing shortages.

Background: Whether adjunctive N-acetylcysteine (NAC) may improve the efficacy of triple therapy in the first-line treatment of Helicobacter pylori infection remains unknown. Our aim was to compare the efficacy of 14-day triple therapy with or without NAC for the first-line treatment of H. pylori. Material and methods: Between 1 January 2014 and 30 June 2018, 680 patients with H. pylori infection naïve to treatment were enrolled in this multicenter, open-label, randomized trial. Patients were randomly assigned to receive triple therapy with NAC [NAC-T14, dexlansoprazole 60 mg four times daily (q.d.); amoxicillin 1 g twice daily (b.i.d.), clarithromycin 500 mg b.i.d., NAC 600 mg b.i.d.] for 14 days, or triple therapy alone (T14, dexlansoprazole 60 mg q.d.; amoxicillin 1 g b.i.d., clarithromycin 500 mg b.i.d.) for 14 days. Our primary outcome was the eradication rates by intention to treat (ITT). Antibiotic resistance and CYP2C19 gene polymorphism were determined. Results: The ITT analysis demonstrated H. pylori eradication rates in NAC-T14 and T14 were 81.7% [276/338, 95% confidence interval (CI): 77.5–85.8%] and 84.3% (285/338, 95% CI 80.4–88.2%), respectively. In 646 participants who adhered to their assigned therapy, the eradication rates were 85.7% and 88.0% with NAC-T14 and T14 therapies, respectively. There were no differences in compliance or adverse effects. The eradication rates in subjects with clarithromycin-resistant, amoxicillin-resistant, or either clarithromycin/amoxicillin resistant strains were 45.2%, 57.9%, and 52.2%, respectively, for NAC-T14, and were 66.7%, 76.9%, and 70.0%, respectively, for T14. The efficacy of NAC-T14 and T14 was not affected by CYP2C19 polymorphism. Conclusion: Add-on NAC to triple therapy was not superior to triple therapy alone for first-line H. pylori eradication [ClinicalTrials.gov identifier: NCT02249546].

Background Management of chronic metabolic diseases has recently become an important global health issue. Extensive research on empowerment-based self-management interventions (EBSMIs) for patients with chronic metabolic diseases has been conducted, but no systematic review has evaluated their effects. Aim To evaluate the effects of EBSMIs on patients with chronic metabolic diseases. Methods A systematic review and meta-analysis was conducted. Five electronic databases (Airiti Library, CINAHL, Cochrane Library, PubMed/ MEDLINE, and Index of Taiwan Periodical Literature System) were searched from the earliest year available to October 2012. Controlled trials about the effectiveness of interventions on patients with chronic metabolic diseases were included. Each study was appraised by three reviewers and assigned a level of evidence based on the modified Jadad scale. Extracted data were entered and analyzed using Review Manager 5.2. Findings Nineteen studies were reviewed. Most studies showed that EBSMIs improved patients’ hemoglobin A1c test (HbA1c) (p < .00001), waist circumference (p = .02), and empowerment level (p = .004). Four studies compared the effect on body weight and body mass index, but the overall effect was not significant (p = .33 and .73, respectively). Five studies compared the effect on self-efficacy, four of which indicated significant increase. However, the overall effect on self-efficacy was not compared because studies used different scales. Linking Evidence to Action EBSMIs improved HbA1c test results, waist circumference, self-efficacy, and empowerment level in patients with chronic metabolic diseases. When implementing the EBSMIs, healthcare institutions need to provide training programs related to empowerment from which health professionals can acquire competence in patient empowerment. Moreover, healthcare leaders should assess and overcome barriers (e.g., time, manpower, cost, etc.) to implementing EBSMIs in clinical settings.

Background: Ice pack therapy has been widely used in treatment for soft tissue injuries. However, no studies have yet explored the most appropriate and effective duration for ice therapy with ice packs.Purpose: This study explored the antiswelling and analgesic effects of different ice pack therapy durations on soft tissue injuries as well as patient discomfort.Methods: An experimental design including pretest and three posttests with three groups was used in this study. Using convenience sampling and randomized block assignment, 99 participants with soft tissue injuries from the emergency department of a medical center in southern Taiwan were included in this study. With 33 participants in each group, three groups with ice pack therapy for 10, 20, and 30 minutes were indicated to compare skin temperature, swelling, and pain differences in ice treated areas as well as participant discomfort.Results: This study found no significant differences in the effect of different ice pack therapy durations among the three groups. However, this study identified significant differences between pretest and each posttest in terms of changes in skin temperature, pain, and numbness and rash-related discomfort in each group.Conclusion/Implications for Practice: Research results found that the three different ice pack therapy durations could lower skin temperature and reduce partial pain. The different ice pack therapy durations would cause similar discomfort incidence rates in the three groups. Ice pack therapy for 10 minutes could reduce partial swelling and pain effectively. Accordingly, we suggest that 10 minutes is the optimal ice pack therapy duration for persons with soft tissue injuries. However, the ice pack therapy duration should be adjusted according to individual needs and situation.

OBJECTIVE The common adverse effects associated with targeted therapy for cancer, such as epidermal growth factor receptor inhibitors (EGFRIs), are dermatologic toxicities that cause the patient physical discomfort and affect treatment. Colloidal oatmeal lotion (COL) has been proven to help prevent dermatitis and xerosis. Evidence of its effect on EGFRI-induced dermatologic toxicities, however, is limited. The purpose of this study was to explore the effect of COL on EGFRI-induced dermatologic toxicities. DESIGN AND SETTING This study used a 1-group pretest-posttest design with a convenience sample of 30 patients with cancer who developed EGFRI-induced dermatologic toxicities from a medical center in southern Taiwan. All participants applied topical COL 3 to 5 times a day for 4 consecutive weeks and received a pretest and 4 posttests. OUTCOME MEASURES A generalized estimating equation was used to assess the impact of demographics, disease characteristics, and weeks of COL use on dermatologic toxicity severity, body surface area affected, and level of pruritus. MAIN RESULTS Significant differences were found between the pretest and all posttests after using COL with regard to the severity, body surface area affected, and level of pruritus in participants who developed EGFRI-induced dermatologic toxicities (P < .05). There were no significant differences in demographics or disease characteristics on EGFRI-induced dermatologic toxicities. CONCLUSIONS Based on the study results, COL could improve the symptoms of dermatologic toxicities in those receiving EGFRIs with no adverse effects. Therefore, the authors suggest the use of COL in clinical settings.

An integrated optical sensing chip for multiple bio-signal detections (MBSD) including peripheral capillary oxygen saturation (SpO 2 ), pulse rate (PR), and fingerprint (TP) is proposed and prototyped in standard 0.18um CMOS technology. A MBSD CMOS optical sensing chip with a 128×64 dual-mode CMOS image sensor (CIS) array is implemented to achieve the multi-domain (temporal and spatial) signal detection using a single sensing array and shared LED source. In oximeter (OXI) mode (temporal-domain), the proposed sensing chip reports the continuous photoplethysmogram (PPG) signal for SpO 2 calculation with a measured photo-sensitivity of 7.271nA/Lux, an achieved error of ±0.81% for R∗ ratio, a resulting error of ±1.01% for SpO 2 , and a total power of 99μW (without LEDs). In optical fingerprint (OFP) mode (spatial-domain), the fingerprint pattern is successful demonstrated by captured images with a measured sensitivity of 1.983V/Lux•s and a low FPN of 0.098% at 30fps. ∗R = (AC of Red / DC of Red) / (AC of IR / DC of IR).

A 1.5V(A)/0.8V(D) high dynamic range (HDR) readout integrated circuit (ROIC) with tunable sensitive range and fixed pattern noise (FPN) reduction for infrared focal plane arrays (IR FPAs) is presented. A pulse width modulation (PWM) readout with capacitive trans-impedance amplifier (CTIA) front end, dual-exposure extended-counting (DEEC) [1], and aligned time-control ramp (ATCR) generator are developed for dynamic range boost. Auto-zeroing and offset cancellation (AZOC) mechanisms are implemented to reduce readout noise and FPN. The digital supply voltage of logic part is decreased to 0.8V for power reduction. The ROIC prototype with an embedded test CMOS image sensor array of 64×64 and 15μm×15μm pixel pitch has been designed and fabricated in 0.18μm CMOS technology. The experimental results show an achieved high dynamic range of 132dB, a FPN in dark of 0.02%, a frame rate of 230fps, and an iFOM of 1.27 nW/frame.pix at 1.5V(A)/0.8V(D) operation.

Aims and objectives This study presents a discussion of the physiological and psychological efficacy of a self-regulation protocol in lowering acute exacerbation symptoms in patients with chronic obstructive pulmonary disease. Background Patients with chronic obstructive pulmonary disease are often troubled by acute exacerbation and must learn how to prevent this. Design A two-group, pretest–post-test experimental design was used in this study. Methods Data were collected between January–July 2008. Sixty-four participants were randomly assigned either to an intervention (n = 33) or to a comparison (n = 31) group. Both groups were assessed on four separate occasions, namely pretest, post-test 1 (5th week), post-test 2 (9th week) and post-test 3 (13th week). The intervention group received a four-week self-regulation protocol. The comparison group received the self-regulation guidebook only. The Borg Dyspnea Scale, the Symptom Distress Scale, the Pulmonary Functional Status Scale, the chronic obstructive pulmonary disease Self-Efficacy Scale and the peak expiratory flow were used to measure differences between pretest and post-test values. Results On the 5th, 9th and 13th weeks after the self-regulation protocol intervention, we found significantly better scores in the four scales in the intervention group compared to those in the comparison group. On the 9th and 13th weeks, there was a significantly greater peak expiratory flow in the intervention group. The intervention group also showed a lower rate of unscheduled physician visits because of acute exacerbation than the comparison group. Conclusion The findings indicate that the self-regulation protocol developed in this study could significantly assist participants to control their individual symptoms and avoid acute exacerbation. Relevance to clinical practice Healthcare professionals could apply the protocol developed in this study to assist patients to learn the strategies of self-regulation to prevent their acute exacerbation symptoms.