Search

Airborne fine particulate matter (PM

Background Aerosol administration is increasingly being used as a therapeutic intervention for mechanically ventilated preterm infants. However, the effects of inhalation therapy on retinopathy of prematurity (ROP) have not yet been explored. Methods A retrospective cohort study was conducted in a tertiary level neonatal intensive care unit (NICU) from 2011 to 2013. All preterm infants with a gestational age (GA) of 24~29 weeks receiving invasive intubation for more than 1 week in the NICU were included. Infants with severe congenital anomalies were excluded. ROP was defined as stage II or greater according to medical records by ophthalmologists. A multivariate logistic regression model was used to estimate the risk of ROP in relation to inhalation therapy after adjusting for confounders. Results In total, 205 infants were enrolled in this study, including 154 with inhalation therapy and 51 without inhalation therapy. Univariate analyses showed an association of inhalation with the following characteristics: sex (p = 0.047), GA (p = 0.029), sepsis (p = 0.047), bronchopulmonary dysplasia (BPD) (p

Oral rotavirus vaccine (RV) administration in conjunction with other injectable vaccines has been used worldwide. However, whether the sequence of RV administration is associated with the reduction of injection-induced pain remains unclear. In this randomized controlled trial, we enrolled 6–12-wk-old healthy infants. The pain response of the infants was scored on the basis of their crying, irritability, facial expression, gagging and distress. A multivariate logistic regression model was used to compare the pain response after adjustment for possible confounders. We enrolled 352 infants, of whom 176 infants received RV before injection (experimental group) and 176 infants received an RV after injection (comparison group). Sex, number of injections, main caregiver, feeding type, and RV type did not differ significantly between the 2 groups. Multivariate regression analyses showed that, at 30 s after the intervention, the episode of gagging was more frequent in the comparison group than in the experimental group (p = 0.004). At 180 s after the intervention, the infants cried more often in the comparison group (p < 0.001). Furthermore, the infants in the experimental group more often relaxed (p < 0.001), rested quietly (p = 0.001), and were smiling (p = 0.001) than did those in the comparison group. Our results indicate that compared with oral RV administration after injection, oral RV administration before injection is more effective in reducing injection-induced pain in 2-mo-old infants. The findings can provide a clinical strategy for relieving pain from vaccination in young infants.

Background. Infant holding position may reduce vaccination pain. However, the optimal position for young infants remains controversial. Objectives. To compare the effectiveness of holding infants in the supine position and the effectiveness of holding infants in upright position for relieving acute pain from vaccine injection. Methods. This prospective cohort study enrolled 6–12-week-old healthy infants. We examined infant pain responses by evaluating the following three categories: (1) crying, (2) irritability, and (3) facial expression. Results. In total, 282 infants were enrolled, with 103 and 179 held in the supine and upright positions, respectively. At 30 s after vaccination, the infants in the supine position showed a larger decrease in crying (p<0.001), irritability (p=0.002), and pained facial expression (p=0.001) than did those in the upright position. However, there was no significant difference in pain response between two groups at 180 s after intervention. Conclusion. In 2-month-old infants, the supine position may reduce acute pain more effectively than does the upright position. Our findings provide a clinical strategy for relieving vaccination pain in young infants.

Background: We developed a training course of fetal monitoring using high-fidelity simulation for obstetric nurses. Method: All participants were assessed by two standardized written tests for knowledge and interpretation of fetal heart rate tracing before and after the training. In addition, a self-estimated questionnaire survey was performed twice—after the training and 6 months later. Results: The knowledge and interpretation of fetal heart rate tracing significantly improved in the simulation group. Compared with the lecture group, the perceived improvements of knowledge and interpretation of fetal heart rate tracing in the simulation group were significantly better following the training and 6 months later. Conclusion: High-fidelity simulation courses are useful in improving the knowledge and interpretation of fetal heart rate tracings for obstetric nurses. They are more effective to improve both short- and long-term management in fetal heart rate monitoring. [ J Contin Educ Nurs . 2019;50(12):557–562.]

Several studies suggested short-term exposure to air pollution might be associated with suicide mortality, although results have been inconsistent and vary depending upon the type of air contaminants. While seasonal variation associated with suicide was reported to occur and that in the spring and early summer there are peaks in ozone (O3) distribution, the relationship between these two parameters is not known. The aim of this study was to examine the potential association between O3 levels and daily mortality rate related to suicide in Taipei for the period 2004-2008 using a time-stratified case-crossover analysis. In our single pollutant model without adjustment for other pollutants, the risk of suicide increased by 11% on warm days and 15% on cool days for each interquartile range (IQR) rise in O3 concentration, respectively. The relationship was positive but did not reach significance. In our two-pollutant models, O3 remained non-significant on warm days after inclusion of one of any other ambient air contaminants into the model. However, on cool days, a significant association was found between O3 levels and enhanced risk of mortality due to suicide after nitrogen dioxide (NO2) or carbon monoxide (CO) were included. The overall positive but not significant findings of elevated risk of mortality frequently attributed to suicide on days with higher O3 levels suggest that outdoor exposures to this gaseous contaminant may contribute to increases in daily mortality rate related to suicide.

Background Infants in a neonatal intensive care unit (NICU) have a higher incidence of bloodstream infections (BSIs) than any other pediatric or adult population. The predisposing factors have not been comprehensively evaluated in this population in Taiwan. Methods A retrospective matched case-control study was conducted in the NICUs of a teaching hospital in Taiwan. The case patients were identified from a staff-maintained electronic database containing the records of BSIs from July 2003 to June 2006. The case patients and the control patients (who did not develop BSI during their NICU stay) were 1:1 matched by birth weight, gestational age, gender, Apgar score, and date of birth. Results A total of 164 infants with culture-proven BSI were identified. Of these, 74 (45.1%) infants were female. The mean gestational age and birth weight were 30.7 ± 0.7 weeks and 1512 ± 804 g, respectively. The common etiologic pathogens included coagulase-negative staphylococci (28.7%), Staphylococcus aureus (16.5%), and Klebsiella pneumoniae (14.6%). Candida spp. accounted for 11 (6.7%) episodes. Two independent factors associated with BSIs in the neonates, as identified by multivariate analysis using conditional logistic regression, were the use of parenteral nutrition (matched odds ratio [mOR], 6.07; 95% confidence interval [CI], 1.14–32.32; p = 0.034) and intraventricular hemorrhage (mOR, 2.68; 95% CI, 1.20–5.99; p = 0.017). Conclusion Parenteral nutrition was a significant and independent risk of late-onset neonatal sepsis. This risk should be considered when implementing early parenteral nutrition in NICUs.

Prolonged jaundice is a commonly evaluated condition. The aim of this study was to assess the risk factors of jaundice in healthy infants at one month of age. This prospective cohort study enrolled 509 healthy infants from 2013 to 2018. Those with gestational age (GA) less than 35 weeks, birth weight less than 2000 grams, and illness were not enrolled. Jaundice was defined as a transcutaneous bilirubin value ≥5 mg/dL at 25–45 days of age. Umbilical cord blood samples were obtained to examine seven common gene variants. The incidence of prolonged jaundice was 32.2%. Prolonged jaundice was more common in infants with exclusive breastfeeding (p 4 times/d (p

Many studies examined the short-term effects of air pollution on frequency of daily mortality over the past two decades. However, information on the relationship between exposure to levels of coarse particles (PM(2.5-10)) and daily mortality rate is relatively sparse due to limited availability of monitoring data and findings are inconsistent. This study was undertaken to determine whether an association exists between PM(2.5-10) levels and rate of daily mortality in Kaohsiung, Taiwan, a large industrial city with a tropical climate. Daily mortality rate, air pollution parameters, and weather data for Kaohsiung were obtained for the period 2006-2008. The relative risk (RR) of daily mortality occurrence was estimated using a time-stratified case-crossover approach, controlling for (1) weather variables, (2) day of the week, (3) seasonality, and (4) long-term time trends. For the single-pollutant model without adjustment for other pollutants, PM(2.5-10) exposure levels showed significant correlation with total mortality rate both on warm and cool days, with an interquartile range increase associated with a 14% (95% CI = 5-23%) and 12% (95% CI = 5-20%) rise in number of total deaths, respectively. In two-pollutant models, PM(2.5-10) exerted significant influence on total mortality frequency after inclusion of sulfur dioxide (SO(2)) on warm days. On cool days, PM(2.5-10) induced significant elevation in total mortality rate when SO(2) or ozone (O(3)) was added in the regression model. There was no apparent indication of an association between PM(2.5-10) exposure and deaths attributed to respiratory and circulatory diseases. This study provided evidence of correlation between short-term exposure to PM(2.5-10) and increased risk of death for all causes.

Previous studies suggested an elevated risk of non-Hodgkin's lymphoma (NHL) among farmers. To date, no apparent study examined the association between farming and NHL in Asian countries. The aim of this study was to investigate whether farmers in Taiwan exhibited an increased risk of mortality attributed to NHL. To this end, a mortality odds ratio (MOR) study was conducted to estimate the relative risk of mortality attributed to NHL for farmers in Taiwan. Data on the decedents enrolled in this investigation were derived from the death certificate database for the period 1997-2009. The study group comprised individuals who died from NHL and who were 50 years or older. The control group consisted of subjects who died from all other causes, excluding cancers, in the corresponding age group. Multiple logistic regression analysis was performed to compute the MOR, with adjustments for gender, age at death, year of death, marital status, and urbanizational levels. Among 32,456 deceased farmers, 205 died due to NHL. Farmers were found to have a nonsignificantly higher MOR than nonfarmers. This risk estimate is similar to estimates in previous meta-analyses. The MOR for NHL was higher among farmers who died 65 years or older than among those who died at younger ages. The findings indicate that farming in Taiwan may increase the risk of death attributed to NHL. Exposure to pesticides might be an influential factor contributing to high risk of mortality attributed to NHL among farmers and therefore needs to be further investigated.

G6PD-deficient adults are reported to be susceptible to severe infection, and decreased cytokine responses have been postulated as the underlying mechanism. However, investigating the association of G6PD deficiency and cytokine responses during infancy is lacking. The current study aims to determine whether cytokine responses of tumor necrosis factor ()-α, interleukins (IL)-6, and IL-10 are impaired in the G6PD-deficient infants. Upon agreements with informed consents, peripheral blood mononuclear cells (PBMCs) of enrolled infants were collected twice at 1 month and 1 year of age. PBMCs were then stimulated with toll-like receptor (TLR) agonists-including PAM3csk4 for TLR1-2, poly (I:C) for TLR3, and lipopolysaccharide for TLR4-to analyze the expression of TNF-α, IL-6, and IL-10. Males (P = .004) and phototherapy during neonatal period (P = .008) were more common among G6PD-deficient infants than G6PD-normal subjects. After the stimulation of TLR agonists, there was no significant difference in the expression of TNF-α, IL-6, and IL-10 between PBMCs of G6PD-deficient and -normal infants at both 1 month and 1 year of age. In conclusion, the clinical characteristics of G6PD-deficient infants are different from those of G6PD-normal subjects. The data suggest that the innate immune responses to TLR agonists in G6PD-deficient infants are not different from those of G6PD-normal infants.

BACKGROUND: Evidence-based practice (EBP) has been proposed as a core competence to improve healthcare quality. The profile of EBP among respiratory therapists (RTs) has not been explored. We investigated how RTs in Taiwan perceive the implementation of EBP. METHODS: We surveyed RTs in Taiwan9s regional hospitals during a 4-month period in 2011. RESULTS: A majority of RTs were aware of EBP (88.0%). Although most RTs held a favorable impression of EBP, their knowledge of and skill in EBP implementation were deficient. Only half of the RTs had implemented EBP. Insufficient convenient kits (59.1%), deficient designated personnel (50.0%), and lack of time (45.5%) were major barriers to implementing EBP. RTs rated MEDLINE as the most commonly used evidence-based retrieval database, followed by UpToDate, the Cochrane Library, MD Consult, ProQuest, CINAHL, DynaMed, and Micromedex. Multivariate regression analyses demonstrated sufficient skill in EBP and use of online databases as favorable factors for implementing EBP. In contrast, barriers of time constraint and insufficient knowledge were unfavorable factors for the implementation of EBP. CONCLUSIONS: EBP is not widespread among RTs in Taiwan. We have identified important factors in the implementation of EBP. The data provide valuable evidence for plotting strategies for disseminating EBP implementation.

This study investigated the perceptions of short-term assignments of medical services among participating health care professionals dispatched from Taiwan to underdeveloped areas. Structured questionnaires were mailed to four groups of professionals (physicians, pharmacists, nurses, and public health personnel) who had participated in any of 88 medical missions dispatched to 24 allied nations. A total of 278 returns were valid for analysis. Among them, 222 respondents reported that they had participated in just one overseas medical mission (79.9%). The majority of physicians, pharmacists, and nurses listed humanitarianism as their foremost incentive for participation. In contrast, public health personnel most frequently reported that they had been assigned to the mission abroad. Pharmacists, nurses, and public health personnel most commonly stated that their top goal was health care; but physicians said that aiding Taiwan’s diplomatic relations was their main motive. While all groups generally recognized language proficiency and cultural awareness as important for conducting successful short-term medical aid missions (STMMs), many members of groups did not rate their own capabilities in those area as sufficient, especially pharmacists ( p < .001). Orientation for participants and training for local health workers were seen as relatively insufficient. In conclusion, there are considerable differences in the thoughts about STMMs across four key groups of heath personnel. The findings can help inform efforts to integrate evidence into the deployment of STMMs.

Online databases have been increasingly used as a key resource in the search for health information. The current study aims to compare the use patterns of online databases between physicians and nurses. A structured questionnaire was mailed to physicians and nurses of randomly selected regional hospitals in Taiwan. Valid questionnaires with complete answers were collected from 544 physicians and 1,573 nurses from November 2008 to February 2009. In general, physicians made more use of online databases than nurses (p 0.001). They more often accessed English-language online databases (p 0.001), including MEDLINE, MD Consult, UpToDate, Cochrane Library and ProQuest. On the other hand, nurses accessed Chinese-language online databases more frequently than physicians (p 0.001). Using a multivariate logistic regression model to adjust the personal characteristics, we found that nurses more often accessed Chinese-language online databases than physicians. Physicians used online databases to locate health information the most for clinical practice (76.6%), followed by instruction preparation (63.3%), and research (57.0%). Nevertheless, nurses used such databases more often for class assignments (66.4%) and clinical practice (55.8%). In conclusion, the behavior and motivation of access to online databases varied between physicians and nurses. Our findings provide evidence in the strategies to enhance the accessing of online databases.

The aim of this study is to identify clinical, etiologic, and laboratory factors that potentiate adverse outcome of hyperbilirubinemia among term and late preterm neonates in logistic regression analysis. A retrospective cohort of infants with total serum bilirubin (TSB) ≥ 20 mg/dL from 1995 to 2007 was surveyed. Eighteen infants had adverse outcome. Controls were 270 infants without sequelae. Risks were significantly higher in infants with six etiologies causing hyperbilirubinemia: sepsis (odds ratio [OR] = 161.7, 95% confidence interval [CI] = 11.7 to 2242.8), gastrointestinal obstruction (OR = 39.2, 95% CI = 2.7 to 567.3), Rh incompatibility (OR = 31.0, 95% CI = 5.1 to 188.9), hereditary spherocytosis (OR = 19.6, 95% CI = 1.6 to 235.5), ABO incompatibility (OR = 5.1, 95% CI = 1.3 to 19.7), and glucose-6-phosphate dehydrogenase deficiency (OR = 4.7, 95% CI = 1.3 to 16.7). Infants with acute bilirubin encephalopathy were more likely to have adverse outcome than subjects without acute bilirubin encephalopathy (OR = 281.7, 95% CI = 25.8 to 3076.7). Adverse outcome was more common in infants with a positive direct Coombs test (OR = 4.5, 95% CI = 1.3 to 15.4). Infants with hemoglobin < 10 g/dL tended to have adverse outcome more often than those with hemoglobin ≥ 13 g/dL (OR = 11.8, 95% CI = 3.3 to 42.9). Infants with TSB of 35 mg/dL or more (OR = 472.5, 95% CI = 47.8 to 4668.8) and of 30 to 34.9 mg/dL (OR = 9.5, 95% CI = 1.6 to 57.9) carry greater risks as compared with those with TSB of 20 to 24.9 mg/dL. In conclusion, this study quantitatively verified the potential risks for adverse outcome of neonatal hyperbilirubinemia.

OBJECTIVE To compare the efficacy and safety of exchange transfusion (ET) via three different catheterization methods: femoral vein (FV); umbilical vein (UV); and umbilical artery/vein (UA/V). DESIGN A retrospective cohort of neonates who underwent ET for hyperbilirubinemia between 1996 and 2007 was surveyed. Subjects with gestational age < 33 wks were excluded. SETTING Neonatal intensive care units in a tertiary referral hospital. PATIENTS A total of 109 neonates with 128 ET procedures (33 via FV, 35 via UV, and 60 via UA/V routes) were analyzed. MEASUREMENTS AND MAIN RESULTS There was no significant difference in the decline of total serum bilirubin between each group. When compared with the UA/V group, the transfusion rate was slower in the FV and UV groups (p < .001). Adverse events with clinical significance were more common in ET via the UA/V route than ET via the FV and UV routes (p < .05; odds ratio, 2.4; 95% confidence interval, 1.2-5.0). Neonates with ET via the UA/V route tended to have more asymptomatic laboratory aberrances (p < .01; odds ratio, 2.5; 95% confidence interval, 1.3-4.6). There were no significant differences in the transfusion rate (p = .498) and adverse events (p = .822) between the FV and UV groups. CONCLUSIONS ET through the FV route is an effective and secure method for the treatment of neonatal hyperbilirubinemia when the UV route is unavailable. Physicians should be cautious when using UA/V catheterization for ET.

Rationale To disseminate evidence-based practice (EBP) among hospital-based health professionals, since 2007 the National Health Research Institutes (NHRI) of Taiwan has run a complex outreach program that includes information resource support and promotional campaigns. Objectives The aim is to evaluate the impact of this outreach program on the diffusion of EBP. Setting Sixty-one regional hospitals in Taiwan. Design A cross-sectional, pre- and post-survey of a nationally representative sample of physicians and nurses was carried out in 2007 and 2009 to examine views related to EBP including changes in beliefs, attitudes, knowledge, skills, perceived barriers and behaviors. Results Physicians and nurses in the 2009 survey tended to have more knowledge and skill of EBP than their counterparts in the 2007 survey. They were less likely, however, to believe that EBP can improve patient care quality and to support the implementation of EBP. The prevalence of perceived barriers to EBP declined during the 2-year study period. In addition, physicians and nurses were more likely to access the online evidence retrieval databases according to the 2009 survey when compared with responses to the 2007 survey. Conclusions The knowledge of, skill in, and behavior regarding EBP have improved among physicians and nurses of regional hospitals in Taiwan after a promotion period of 2 years and they perceive fewer barriers to EBP. These data suggest that the multifaceted nationwide promotion program of the type conducted by NHRI succeeded in diffusion and implementation of EBP among professionals.

Although evidence-based practice (EBP) has been widely investigated, few studies compare physicians and nurses on performance.A structured questionnaire survey was used to investigate EBP among physicians and nurses in 61 regional hospitals of Taiwan. Valid postal questionnaires were collected from 605 physicians and 551 nurses during February to May 2007.Physicians were more aware of EBP than nurses. Although both groups had high recognition of belief in and favorable attitudes toward EBP, their knowledge of and skill in EBP were relatively low. When compared with nurses, physicians were more willing to support the promotion of EBP implementations in clinical services. Physicians' knowledge and skills regarding the application of EBP principles were greater than nurses. Furthermore, physicians more often accessed the on-line evidence-retrieval databases, including the Cochrane Library. The most commonly ranked barriers to EBP applications for both groups included lack of designated personnel, lack of convenient kits, limited basic knowledge of EBP, and time. In general, nurses generated more barriers than physicians.There were significant discrepancies between physicians and nurses in their awareness of, attitude toward, knowledge of, skill in, behavior toward, and barriers regarding EBP. In implementing EBP, strategies to overcome barriers and provide on-line evidence-retrieval systems should differ for physicians and nurses.

Physicians have to deal with a broad range of medical problems in clinical practice, thus making the timely acquisition of relevant information is a critical skill for physicians to improve care quality. The current national study investigates how physicians search for medical information and analyses how they use online medical databases. A structured questionnaire survey was conducted, with 457 valid returns collected. Internet-based resources (Web portals, online databases, and electronic journals) were more often accessed by physicians to look for medical information than personal or paper ones. Almost universally, physicians have accessed online databases. MEDLINE was the most frequently accessed database. Furthermore, physicians under 50 years old tended to access online databases more often than their elder colleagues (OR = 5.27, 95% CI = 1.96-14.14 for age35; OR = 4.68, 95% CI = 2.07-10.60 for ages 35-50). In addition, physicians with faculty position were more often accessing online databases (OR = 3.32; 95% CI = 1.75-6.30). Other factors - including clinical experience, administrative position, gender, academic degree, and professional specialty - carried no significant differences. These data may assist in determining how to promote the use of online evidence-based medical information for clinical services.

Background An increasing number of short-term medical missions (STMMs) are being dispatched to provide humanitarian healthcare; however, extensive investigations on how recipient patients perceive STMMs are lacking. The current study evaluated the perceptions of patients toward medical services provided by a Taiwanese STMM in a resource-poor area of Swaziland. Methods A structured questionnaire survey was completed by patients who had received medical services from the medical mission of Taipei Medical University in Swaziland in July 2014. Results In total, 349 questionnaires were valid for the analysis. More respondents were female than male (69.6 % vs 30.4 %). The most common chief complaint was musculoskeletal problems (45.8 %), followed by respiratory symptoms (35.0 %). Most of the patients stated that their overall experience with the medical services was excellent (91.4 %). Universal patients would like to see the service provided in the future (99.7 %). Nearly 90 % of the patients were aware of how to take care of the medical problem they were diagnosed with. A majority of the patients comprehended what their medical providers said. Only a few patients did not understand what physicians said (5.2 %). Conclusion Medical services provided by the STMM were helpful in resolving patients’ problems. The data have crucial implications for evaluating overseas mobile medical aid from the viewpoint of patients. Electronic supplementary material The online version of this article (doi:10.1186/s12913-015-1186-4) contains supplementary material, which is available to authorized users.

Background: Directors of nursing (DONs) have an important influence in the dissemination of evidence-based practice (EBP) in hospital settings. The current study examined how the knowledge, skills, and behaviors of DONs changed when EBP was implemented during a 5-year, nationwide promotional campaign providing EBP-related information resources and promotional activities in regional hospitals in Taiwan. Method: Cross-sectional questionnaire surveys for a nationwide representative sample of DONs were conducted in 2007, 2009, and 2011 to examine views related to EBP, including changes in beliefs, attitudes, knowledge, skills, behaviors, and barriers. Results: This study enrolled 267 DONs in 2007, 257 in 2009, and 287 in 2011. During the study period, DONs' EBP knowledge and skills increased, but their beliefs and attitudes did not significantly change. Furthermore, the use of Internet-based resources, including web portals, electronic textbooks, electronic journals, and evidence-based online databases, increased. Most barriers significantly declined after the intervention. Conclusion: DONs' knowledge, skills, and behaviors regarding EBP increased after the multifaceted intervention. The data suggest this outreach program is useful in disseminating EBP implementation to DONs. J Contin Educ Nurs. 2016;47(4):181–188.

Background Although evidence-based practice (EBP) has been widely investigated, few studies have investigated its correlation with a clinical nursing ladder system. The current national study evaluates whether EBP implementation has been incorporated into the clinical ladder system. Methods A cross-sectional questionnaire survey was conducted nationwide of registered nurses among regional hospitals of Taiwan in January to April 2011. Subjects were categorized into beginning nurses (N1 and N2) and advanced nurses (N3 and N4) by the clinical ladder system. Multivariate logistic regression model was used to adjust for possible confounding demographic factors. Results Valid postal questionnaires were collected from 4,206 nurses, including 2,028 N1, 1,595 N2, 412 N3, and 171 N4 nurses. Advanced nurses were more aware of EBP than beginning nurses (p < 0.001; 90.7% vs. 78.0%). In addition, advanced nurses were more likely to hold positive beliefs about and attitudes toward EBP (p < 0.001) and possessed more sufficient knowledge of and skills in EBP (p < 0.001). Furthermore, they more often implemented EBP principles (p < 0.001) and accessed online evidence-based retrieval databases (p < 0.001). The most common motivation for using online databases was self-learning for advanced nurses and positional promotion for beginning nurses. Multivariate logistic regression analyses showed advanced nurses were more aware of EBP, had higher knowledge and skills of EBP, and more often implemented EBP than beginning nurses. Linking Evidence to Action The awareness of, beliefs in, attitudes toward, knowledge of, skills in, and behaviors of EBP among advanced nurses were better than those among beginning nurses. The data indicate that a clinical ladder system can serve as a useful means to enhance EBP implementation.

Background Implementation of evidence-based practice (EBP) is regarded as core competence to improve healthcare quality. In the current study, we investigated the EBP of six groups of professionals: physicians, nurses, pharmacists, physical therapists, technicians, and other allied healthcare personnel. Methods A structured questionnaire survey of regional hospitals throughout Taiwan was conducted by post in 2011. Questionnaires were mailed to all healthcare workers of 11 randomly selected hospitals. Linear and logistic regression models were used to examine predictors for implementing EBP. Results In total, 6,160 returned questionnaires, including 645 from physicians, 4,206 from nurses, 430 from pharmacists, 179 from physical therapists, 537 from technicians, and 163 from other allied healthcare professionals, were valid for the analysis. Physicians and pharmacists were more aware of EBP than were the other professional groups (p Conclusions This study depicts various levels of EBP implementation among medical, nursing, pharmacological, and allied healthcare personnel. There were significant differences in their implementation of EBP. We observed that certain factors were associated with EBP implementation, including personal backgrounds and perceptions toward EBP. The data suggest that strategies for enhancing EBP implementation should differ for various groups of professionals.

Background Competition and education are intimately related and can be combined in many ways. The role of competition in medical education of evidence-based medicine (EBM) has not been investigated. In order to enhance the dissemination and implementation of EBM in Taiwan, EBM competitions have been established among healthcare professionals. This study was to evaluate the impact of competition in EBM learning. Methods The EBM competition used PICO (patient, intervention, comparison, and outcome) queries to examine participants’ skills in framing an answerable question, literature search, critical appraisal and clinical application among interdisciplinary teams. A structured questionnaire survey was conducted to investigate EBM among participants in the years of 2009 and 2011. Participants completed a baseline questionnaire survey at three months prior to the competition and finished the same questionnaire right after the competition. Results Valid questionnaires were collected from 358 participants, included 162 physicians, 71 nurses, 101 pharmacists, and 24 other allied healthcare professionals. There were significant increases in participants’ knowledge of and skills in EBM (p p p p p p = 0.001), CINAHL (p = 0.001), and MicroMedex (p = 0.024). Conclusions The current study demonstrates a method that successfully enhanced the knowledge of, skills in, and behavior of EBM. The data suggest competition using PICO queries may serve as an effective way to facilitate the learning of EBM.

Dietitians can obtain nutrition-related information from a variety of sources. The current study was to investigate how registered dietitians look for nutritional information and perceive evidence-based nutrition (EBN). A postal questionnaire survey was conducted, with 67 valid returns collected. The most common informational sources were Web portals, followed by continuing education, colleague consultation, textbooks, online databases, electronic journals, printed journals, and electronic textbooks. Among the 11 commonly used online databases, dietitians preferred to access MEDLINE and three databases in Chinese. Sixty-two dietitians (92.5%) were aware of EBN. Although they had a favorable impression of EBN, their knowledge of and skills in EBN were relatively lacking. The most common barrier to the implementation of EBN was a lack of library resources in Chinese (58.1%), followed by deficient skill in critical appraisal (54.8%), insufficient convenient kits (53.2%), and time constraints (50.0%). In conclusion, most registered dietitians search for information through non-EBN resources. Language is an important element relevant to the implementation of EBN. These findings may help the refining of strategies to promote the accessing of evidence-based information.

There are a variety of resources to obtain health information, but few studies have examined if main and allied health professionals prefer different methods. The current study was to investigate their information-searching behaviours.A constructed questionnaire survey was conducted from January through April 2011 in nationwide regional hospitals of Taiwan. Questionnaires were mailed to main professionals (physicians and nurses) and allied professionals (pharmacists, physical therapists, technicians and others), with 6160 valid returns collected.Among all professional groups, the most commonly used resource for seeking health information was a Web portal, followed by colleague consultations and continuing education. Physicians more often accessed Internet-based professional resources (online databases, electronic journals and electronic books) than the other groups (P0.05). In contrast, physical therapists more often accessed printed resources (printed journals and textbooks) than the other specialists (P0.05). And nurses, physical therapists and technicians more often asked colleagues and used continuing education than the other groups (P0.01). The most commonly used online database was Micromedex for pharmacists and MEDLINE for physicians, technicians and physical therapists. Nurses more often accessed Chinese-language databases rather than English-language databases (P0.001).This national survey depicts the information-searching pattern of various health professionals. There were significant differences between and within main and allied health professionals in their information searching. The data provide clinical implications for strategies to promote the accessing of evidence-based information.

SUMMARY This study analyzes the clinical features of glucose-6-phosphate dehydrogenase (G6PD) deficiency in infants with marked hyperbilirubinemia. We retrospectively assessed a cohort of 413 infants with peak total serum bilirubin (TSB) level >or=20 mg/dL from 1995 to 2007. The prevalence of G6PD deficiency was proportional to the level of peak TSB: 21.1% (81/383) in 20 mg/dL to 29.9 mg/dL, 45.5% (10/22) in 30 mg/dL to 39.9 mg/dL, and 100% (8/8) in >or=40 mg/dL. Male sex was more common in G6PD deficiency (75.8%). When compared with G6PD-normal infants, those with G6PD deficiency tended to have extreme hyperbilirubinemia (peak TSB level >or=25 mg/dL) and hemoglobin value

Blood group mismatch between a mother and newborn carries a substantial risk for neonatal hyperbilirubinemia and kernicterus. In the current study, we investigate the spectrum and outcome of marked neonatal hyperbilirubinemia with blood group incompatibility.We retrospectively assessed a cohort of 413 neonates with peak total serum bilirubin (TSB) valuesor = 20 mg/dL between 1995 and 2007. Those with a gestational age34 weeks, birth weight2000 grams or G6PD deficiency were excluded. A total of 83 subjects with blood group incompatibility were enrolled. Neonates with unknown etiology of hyperbilirubinemia (except breast milk feeding) were selected as the controls (n = 168). Kernicterus referred to classic neurological signs after follow up for more than 1 year.The clinical symptoms of acute bilirubin encephalopathy included apnea (2.4%), tachypnea (6.0%), fever (1.2%), irritability (2.4%), lethargy (4.8%), seizures (1.2%) and poor feeding (19.3%). Hyperbilirubinemia was more severe among babies with Rh incompatibility than those with ABO incompatibility. After double-volume exchange transfusion, the TSB levels significantly decreased from 25.8 3.5 to 17.6 4.0 mg/dL. Using logistic regression analysis, we found neonates with blood group incompatibility more often had a reticulocyte count7 %, a hemoglobin value13 g /dL and a peak TSB at age3 days old than the controls (p0.01). Furthermore, kernicterus was more common in neonates with blood group incompatibility (9.8 %) than in the controls (0.0%) (p0.01).This survey depicts the clinical profiles of babies with marked neonatal hyperbilirubinemia with blood group incompatibility. Neonates with blood group incompatibility often develop early-onset, hemolysis-mediated hyperbilirubinemia. Our findings show they are at great risk of kernicterus.

A cohort study was carried out to assess the association between glucose-6-phosphate dehydrogenase (G6PD) deficiency, diagnosed by quantitative enzyme assay, and neonatal hyperbilirubinemia, defined as serum total bilirubin >/=15 mg/dl, in the well-baby nursery of Chang Gung Children's Hospital. Among 42,110 inborn infants, 757 male (3.54%) and 326 female (1.57%) newborns were G6PD-deficient. Compared to the occurrence of hyperbilirubinemia in G6PD-normal newborns (1.41% in male, 1.44% in female) in the well-baby nursery, a significantly higher incidence was observed in both G6PD-deficient male (11.36%) and female (7.06%) newborns. Further analyses demonstrated that the enzyme activity of G6PD in G6PD-deficient male newborns with hyperbilirubinemia (1.56+/-1.37 U/g Hb) were significantly lower than the subjects without hyperbilirubinemia (2.01+/-1.7 U/g Hb). No significant difference was observed in G6PD-deficient female newborns with hyperbilirubinemia (6.91+/-2.76 U/g Hb) compared to those without hyperbilirubinemia (7.81+/-2.84 U/g Hb). These data suggest that the G6PD-deficient neonates are at increased risk for hyperbilirubinemia even in the nursery free from agents that can potentially cause hemolysis to G6PD-deficient red cells. The lower G6PD enzyme activity was associated with the neonatal hyperbilirubinemia in G6PD-deficient male neonates.

Background Hyperbilirubinemia is a common disorder during neonatal period in Taiwan. Gene variants may play an important role in the development of neonatal hyperbilirubinemia. The current study investigated the association between neonatal hyperbilirubinemia and common gene variants involving the production and metabolism of bilirubin. Methods This prospective study enrolled 444 healthy infants born in the Chang Gung Memorial Hospital at Taipei from 2013–2015. Hyperbilirubinemia was defined as a total bilirubin ≥ 15 mg/dL. A log-binomial model was used to assess the risk of gene variants. Results The most common genetic variant was short heme oxygenase (HO)-1 promoter GT-allele (