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Hsiao-Ping Huang,1 Kee-Hsin Chen,2– 6 Chen-Liang Tsai,7 Wen-Pei Chang,8,9 Sherry Yueh-Hsia Chiu,10,11 Shin-Rou Lin,10,11 Yu-Huei Lin2 1Nursing Department, Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; 2Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; 3Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan; 4Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; 5Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; 6Evidence-Based Knowledge Translation Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; 7Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; 8Department of Nursing, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; 9School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; 10Department of Health Care Management, College of Management, Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan; 11Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, TaiwanCorrespondence: Yu-Huei Lin, Tel +886 2 27361661 Ext 3620, Fax +886 2 23772842, Email gracelin@tmu.edu.twPurpose: This study aimed to evaluate the efficacy of high-frequency chest wall oscillation for sputum expectoration and hospital length of stay in patients with acute exacerbations of chronic obstructive pulmonary disease. The improvements in pulmonary function and oxygenation were also investigated.Patients and Methods: This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines. Automated literature database searches were conducted from the earliest records to March 31, 2022. The methodological quality of the included studies was assessed using the Cochrane Risk of Bias tool (RoB 2.0), and meta-analysis software (RevMan 5.4) was used to analyze the data.Results: From 5439 identified articles, 13 studies (with 756 patients) were included in this meta-analysis. Compared to other airway clearance techniques, HFCWO significantly increased expectorated sputum volume by 6.18 mL (95% CI: 1.71 to 10.64; I2 = 87%), shortened hospital stay by 4.37 days (95% CI: − 7.70 to − 1.05; I2 = 84%). However, FEV1 (%), PaO2, and PaCO2 did not improve significantly.Conclusion: AECOPD patients may benefit from HFCWO therapy. HFCWO enables AECOPD patients to excrete more sputum and shorten their hospital stays. However, due to heterogeneity among the included research, these results should be interpreted with caution.Keywords: acute exacerbation of chronic obstructive pulmonary disease, AECOPD, high-frequency chest wall oscillation, HFCWO, sputum expectoration, length of hospital stay

Ping-Song Chou,1 Chiou-Lian Lai,1–3 Yii-Her Chou,4,5,* Wei-Pin Chang6,* 1Department of Neurology, Kaohsiung Medical University Hospital, 2Department of Neurology, Faculty of Medicine, College of Medicine, 3Department of Neurology, Kaohsiung Municipal Hsiao-Kang Hospital, 4Department of Urology, Faculty of Medicine, College of Medicine, 5Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 6School of Health Care Administration, Taipei Medical University, Taipei City, Taiwan *These authors contributed equally to this work Purpose: Sleep apnea (SA)-induced chronic intermittent hypoxia increases oxidative stress and inflammation, which may contribute to the pathophysiology of Parkinson’s disease (PD). This study evaluated the risk of PD following SA diagnosis.Patients and methods: This was a 3-year nationwide population-based matched cohort study using claims data from the National Health Insurance Research Database (NHIRD), Taiwan. We analyzed 1,944 patients diagnosed as having SA between 1997 and 2005 and a matched cohort of 9,720 non-SA patients from the NHIRD. Patients with a history of PD were excluded. Each patient was followed up for 3 years to evaluate subsequent PD development.Results: Of the 11,664 patients, 17 (0.9%) and 38 (0.4%) from the SA and matched non-SA cohorts, respectively, were subsequently diagnosed as having PD during follow-up. After adjustments for potential confounders, the SA cohort had a 1.85-fold higher risk of PD than the non-SA cohort (95% confidence interval [CI] =1.02–3.35; P=0.042). After age and sex stratification, PD development was independently associated with SA only in men (adjusted hazard ratio [HR], 2.26; 95% CI =1.11–4.63; P

AIMS: To examine the association between driving time and changes in haematological markers of increased risks for cardiovascular diseases (CVD). METHODS: The authors conducted a cross sectional analysis of baseline data from the Taxi Drivers' Health Study cohort in Taipei, Taiwan. They retrieved information on comorbidity, laboratory tests, age, and anthropometric measures from medical records of 1157 subjects (mean age 44.6 (SD 8.6) years). Whole blood cell (WBC) count was used as the primary haematological marker for increased CVD risk, and platelet count and haematocrit as the secondary markers. Standardised questionnaires were implemented to collect information on demographics, lifestyle, work related physical and psychosocial factors, and driving time profiles. Multiple regression was used to estimate the adjusted effects of driving time on three haematological markers. RESULTS: The mean measured hematological marker was 6656 (SD 1656) cells x10(6)/l for WBC, 47.2 (SD 3.5) % for hematocrit, and 243 (SD 52) cells x10(9)/l for platelets. The driving time was 264 (SD 76) hours/month. Compared with drivers who drove < or =208 hours/month (1st quartile cut off), drivers who drove >208 hours/month had a higher WBC count (by 317 x10(6)/l; 95% CI 99 to 535), haematocrit (by 0.8%; 95% CI 0.3 to 1.2), and platelets (7.9 x10(9)/l; 95% CI 1.0 to 14.8). After adjusting for conventional CVD risk factors (age, sex, smoking, hypertension, diabetes, and hypercholesterolaemia), obesity, alcohol drinking, regular exercise, and sociodemographics (education, marital status, income, and so on), long driving time was still associated with significant increases in WBC and platelets, whereas the effect on haematocrit was diminished and became statistically non-significant. Additional controls for physical workload, self-perceived job stress, and job dissatisfaction did not alter the associations with increased WBC and platelets. CONCLUSIONS: Longitudinal studies are needed to confirm the observed cross sectional association and to further examine the specific occupational exposures accountable for the association between driving time and haematological markers of systemic inflammation and haemostatic alteration. [ABSTRACT FROM AUTHOR]

Purpose: This study investigates the relationship between changes in nutritional status during treatment and overall survival in NPC patients., Method: Using a prospective cohort design, the electronic health records of newly diagnosed NPC patients from a medical center in Taiwan (from January 1, 2018, to March 31, 2024) were analyzed. A total of 73 newly diagnosed NPC patients were tracked; nutritional indicators such as body mass index (BMI), prealbumin levels, and Patient-Generated Subjective Global Assessment (PG-SGA) scores were recorded at four time points: one week before treatment, the first week of treatment, and four and eight weeks after treatment began., Results: The study found that most patients experienced a decrease in BMI (B = -0.62, p < .001) and prealbumin levels (B = -0.79, p = .015) during treatment, although BMI remained in the overweight range and prealbumin stayed within normal levels. PG-SGA scores increased (B = 1.01, p < .001), indicating a shift from low to moderate nutritional risk. Univariate Cox regression analysis showed that the Charlson Comorbidity Index (HR = 1.86, 95% CI: 1.38-2.51), NPC stage (HR = 15.67, 95% CI: 2.07-118.61), treatment method (HR = 2.96, 95% CI: 1.45-6.04), prealbumin (HR = 2.95, 95% CI: 1.46-5.99), and PG-SGA score trajectories (HR = 2.85, 95% CI: 1.27-6.40) were associated with overall survival. However, multivariate analysis revealed that the survival of NPC patients was only associated with CCI and NPC stage., Conclusions: The study underscores the importance of monitoring nutritional status changes during treatment, particularly prealbumin and PG-SGA trajectories., Competing Interests: Declaration of competing interest None declared., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objective: The aim of the study is to understand whether the risk factors of the unplanned extubation (UE) of nasogastric (NG) tubes vary among different inpatient situations., Methods: Inpatients who experienced UE between 2009 and 2022 at a medical center were selected, and electronic medical records were used to collect patient background data and their conditions during UE. A total of 302 patients were included in our analysis., Results: Conscious patients were at greater risk of UE when coughing, scratching their nose, blowing their nose, or sneezing than those who were confused (odds ratio [OR] = 0.07, P < 0.001) and those who were drowsy or comatose (OR = 0.15, P = 0.026). During activity, repositioning, bathing, or changing incontinence pads, the risk of UE was higher in patients whose hands were not restrained at the time of UE than in those whose hands were restrained (OR = 0.05, P = 0.004), higher in those with companions than in those without companions (OR = 7.78, P = 0.002), and higher in those with longer NG tube placement time (OR = 1.05, P = 0.008). Accidental extubation (OR = 2.62, P = 0.007) occurred more frequently during activity, repositioning, bathing, or changing incontinence pads., Conclusions: There is an increased risk of UE in conscious patients during activity, repositioning, bathing, or changing incontinence pads. Patients inserted with an NG tube for a longer period of time were at greater risk of accidental extubation during activity, repositioning, bathing, or changing incontinence pads irrespective of whether a companion could aid them if their hands were or were not restrained., Competing Interests: The authors disclose no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Typically, nurse education curricula are separated into the teaching of theoretical knowledge and practical skills. This separation may hinder nursing students' development of clinical reasoning skills, making it difficult for them to prioritize tasks and make decisions about interventions. Illness scripts have been shown to help medical students improve their clinical reasoning skills; however, they are rarely used in nurse education., Objectives: To evaluate the influence of illness script teaching method on post-baccalaureate nursing students' clinical reasoning skills., Design: The study adopted a single-arm quantitative pre-experimental research design and incorporated qualitative focus group discussions., Settings/participants: This study was conducted at a university in northern Taiwan. Participants included 35 post-baccalaureate nursing students who were enrolled in an elective course focused on clinical skills., Methods: To enhance nursing students' clinical reasoning skills, illness scripts for five clinical scenarios were developed and implemented as part of their curriculum. The Nurses Clinical Reasoning Scale was utilized to assess self-rated clinical reasoning abilities, while dual-teacher scoring was used to evaluate clinical reasoning objectively. The VARK learning preference questionnaire was used to examine how learning preferences affect learning outcomes. After the course, semi-structured focus groups were held to collect student feedback on the effectiveness of the teaching methods and the learning outcomes., Results: This study's quantitative and qualitative results show that illness script-based teaching improves nursing students' clinical reasoning. Quantitative results showed significant objective reasoning score improvements. However, minimal changes in self-rated scores suggest a learning style-influenced gap between perceived and actual abilities. Qualitative findings showed that students valued linking clinical issues to practical applications but struggled with knowledge gaps and engagement., Conclusions: The illness script teaching method improved students' understanding of clinical scenarios and enhanced their clinical reasoning abilities. Incorporating illness scripts into nurse education was beneficial for nursing students., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Yu-Huei Lin reports financial support was provided by Ministry of Education, Taiwan. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Rotating-shift nurses are susceptible to sleep disorders due to numerous factors, such as their biological clock, emotions, and age. At present, a lack of research exists on whether chronotype and shift type jointly influence the sleep quality of nurses., Aim: To verify whether chronotype is a moderator variable of the relationship between shift type and sleep quality in nurses in order to provide empirical evidence for future mental and physical health improvement., Method: Clinical rotating-shift nurses at a medical center in northern Taiwan were recruited as participants between November 1, 2023, and December 13, 2023. All of the nurses were working a monthly rotating shift schedule. Hierarchical multiple regression analysis was employed to investigate whether the influence of shift type on sleep quality in nurses varied with chronotype. The STROBE checklist was used for reporting this study., Results: The participants were 255 rotating-shift nurses in this study. Hierarchical multiple regression results revealed that rotating-shift nurses who were older (B = 0.19, p = 0.029), had greater physical fatigue (B = 0.27, p = 0.016), and had more negative emotions (B = 0.17, p = 0.011) suffered from poorer sleep quality. After controlling the above factors, we further found that chronotype indeed had moderating effects on the influence of shift type on sleep quality (B = -1.83, p = 0.049)., Conclusions: This study demonstrates that early- and intermediate-type nurses are more suitable for working the day and evening shifts, whereas late-type nurses are more suitable for working the night shift., Implication for Nursing and Health Policy: Coordinating chronotype with shift type will ensure that shift schedules better match the biological clocks of nurses; such individual considerations could help to improve their sleep quality., (© 2024 International Council of Nurses.)

Background: Diminished muscle protein synthesis in cirrhosis leads to reduced strength and mass, impacting daily activities and overall quality of life., Aims: This study aimed to examine the effectiveness of exercise intervention in body composition, exercise capacity, fatigue, and quality of life in patients with liver cirrhosis., Methods: A systematic search of medical databases, including PubMed, Embase, Cochrane, and CINAHL, was executed from their inception to November 2022. The inclusion criteria were randomized controlled trials comparing exercise interventions with a control group that did not receive exercise interventions., Results: From the initially identified 2,565 articles, eight studies with a total of 220 patients were eligible for inclusion in this meta-analysis. According to the meta-analysis, exercise significantly improved the six-minute walk distance (6MWD) by 68.93 m (95% CI 14.29-123.57) compared to the control group. Furthermore, the subgroup analysis revealed that combing exercise with amino acid supplementation had a greater positive effect on the 6MWD (MD = 144.72, 95% CI 87.44-202.01). Exercise also significantly increased thigh circumference (MD = 1.26, 95% CI 0.12-2.39) and the thigh ultrasound average compression index (MD = 0.07, 95% CI 0.00-0.14). Moreover, exercise significantly decreased fatigue levels by 0.7 points in patients with liver cirrhosis (95% CI 0.38-1.03). However, no significant effects were observed on body mass index (BMI), fat mass, fat-free mass, and quality of life., Conclusions: Exercise can improve exercise capacity, thigh muscle thickness, and fatigue in patients with cirrhosis, but it does not have a significant impact on fat mass, BMI, or quality of life., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

This study was to verify whether the severity of pressure injuries (PIs) in intensive care unit (ICU) patients plays a mediating role in the relationship between severity of their illnesses and risk of death. I examined adult patients admitted to the ICUs between 1 January 2014 and 31 August 2021. The average follow-up period was 11.34 months. A total of 390 ICU patients suffered from PIs. The influences of the APACHE II score of the ICU patients on the mediating variable 'unstageable & DTPIs vs. Stage 1&2 PIs' and on risk of death were significant. After controlling the influence of APACHE II score on risk of death, the influences of mediating variables 'Stage 3&4 PIs vs. Stage 1&2 PIs' and 'unstageable & DTPIs vs. Stage 1&2 PIs' on risk of death were also significant. The regression coefficient of APACHE II score of the ICU patients declined after the severity of PIs was included. The Sobel test on the indirect effects also reached the level of significance. The severity of illnesses is a factor that is beyond my control, severe PIs should still be prevented to lower the risk of death., (© 2023 The Authors. International Wound Journal published by Medicalhelplines.com Inc and John Wiley & Sons Ltd.)

Background: Research on the relationship between obesity and rotator cuff tears (RCTs) has been limited to the impact of obesity on the results of arthroscopic repair of RCTs; thus, a need for rigorous research controlling for other factors affecting RCTs is warranted, especially to better understand the impact of body mass index (BMI) on RCT severity., Methods: A retrospective study of admission records contained in electronic medical records pertaining to patients who were admitted for RCT repair on 1 shoulder between January 2018 and July 2022 was conducted. In total, 386 patients were included. In accordance with guidance regarding obesity from Taiwan's Ministry of Health and Welfare, patients were divided into three groups: underweight or normal weight (BMI <24.0 kg/m 2 ), overweight (BMI 24.0-26.9 kg/m 2 ), or obese (BMI ≥27.0 kg/m 2 ). Magnetic resonance imaging was used to assess RCT severity in terms of four parameters: Patte stage (PS), fatty infiltration (FI), anteroposterior tear size (AP), and retraction size. Multinomial logistic regression analysis was performed on PS and FI grade data, and multiple linear regression analysis was performed on AP tear size and retraction size in order to analyze impact., Results: Our results revealed that the average age of the 386 patients was 63.41 years (SD = 9.29) and the mean BMI was 25.88 (SD = 3.72) kg/m 2 . We found significant differences in PS (P = .003), FI (P < .001), retraction size (P = .001), and AP tear size (P = .001) among patients who were underweight or normal weight, overweight, and obese. After controlling for other risk factors, including age, gender, RCT-prone occupation, duration of shoulder pain prior to surgery, history of shoulder injury, and tobacco use, we found that obese patients had higher severity levels in PS (B = 1.21, OR = 3.36, P = .029), FI (B = 1.38, OR = 3.96, P < .001), retraction size (β = 0.18, P = .001), and AP tear size (β = 0.18, P = .001) compared to underweight or normal weight patients., Conclusions: Our study demonstrates that a correlation exists between BMI-measured obesity and RCT severity. We therefore suggest that adults control their weight given that maintaining a healthy weight is highly associated with better shoulder health., (Copyright © 2023 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Background: Limited research exists regarding the effectiveness of electroencephalogram (EEG) neurofeedback training for children with cerebral palsy (CP) and co-occurring attention deficits (ADs), despite the increasing prevalence of these dual conditions. This study aimed to fill this gap by examining the impact of neurofeedback training on the attention levels of children with CP and AD., Methods: Nineteen children with both CP and co-occurring ADs were randomly assigned to either a neurofeedback or control group. The neurofeedback group received 20 sessions of training, lasting approximately 1 h per day, twice a week. Theta/beta ratios of the quantitative electroencephalography (QEEG) recordings were measured pre-training and post-training in the resting state. The Continuous Performance Test (CPT), the Test of Visual Perceptual Skills-3rd Version (TVPS-3) and the Conners' Parent Rating Scale (CPRS) were measured at pre- and post-training., Results: The neurofeedback group showed both decreased theta/beta ratios compared with control group (p = 0.04) at post-training and a within-group improvement during training (p = 0.02). Additionally, the neurofeedback group had a trend of decreased omission rates of the CPT (p = 0.08) and the visual sequential memory and the visual closure subscores in the TVPS-3, compared with the control group (p = 0.02 and p = 0.01, respectively)., Conclusions: The results suggested that children with CP and co-occurring AD may benefit from neurofeedback training in their attention level. Further research is needed to explore long-term effects and expand its application in this population., (© 2024 John Wiley & Sons Ltd.)

Purpose: The primary purpose of this study was to determine whether hematologic and serum biochemical values used as indicators of nutritional status, anemia, and/or infection were associated with the risk of hospital-acquired pressure injuries (PIs) and stage of PIs in patients., Design: A retrospective review of medical records., Subjects and Setting: Data were collected from medical records including official PI records and PI incident reports of inpatients at a teaching hospital in Taiwan between January 2019 and October 2020., Methods: We collected demographic variables of the inpatients and their hematologic and serum biochemical values within 1 day of PI occurrence (including the day of PI occurrence), 6 to 7 days before PI occurrence, and 13 to 14 days before PI occurrence., Results: Among the 309 inpatients with official PI records, 105 (34.0%) had Stage 1 PIs, 131 (42.4%) had Stage 2 or 3 PIs, and 73 (23.6%) had unstageable or suspected deep tissue injuries. After controlling for the type of department where PIs occurred and length of hospital stay up to the day of PI occurrence, we found significant differences in levels of hemoglobin (odds ratio [OR] = 0.47, P = .009) within 1 day of PI occurrence and in albumin (OR = 0.30, P = .001) 13 to 14 days before PI occurrence., Conclusions: Study findings suggest that lower hemoglobin levels on the day of PI occurrence and lower albumin levels 2 weeks before PI occurrence resulted in a significantly higher risk of developing unstageable or suspected deep tissue injuries than of developing Stage 1 PIs., Competing Interests: The authors have no conflict of interest to disclose, and the study received no grant from any funding agency in the commercial, or not-for-profit sectors., (Copyright © 2024 by the Wound, Ostomy and Continence Nurses Society.)

Background: Neural gating of respiratory sensations (NGRS) characterises the brain's ability to filter out repetitive respiratory sensory stimuli. This mechanism plays a crucial role in the neural processing of respiratory stimuli. However, whether ageing affects NGRS in healthy adults is still unclear. Therefore, we aimed to measure the effect of age on NGRS as well as the corresponding S1 and S2 components of the respiratory-related evoked potentials (RREPs)., Methods: Three age groups of healthy adults participated in this study: a young group (YG; age 20-39 years), a middle-aged group (MG; age 40-59 years) and an old group (OG; age ≥60 years). NGRS was measured by the RREPs in the electroencephalogram in response to short-paired respiratory occlusion stimuli (S1 and S2). The S2/S1 ratio of the RREP N1 amplitude (the negative deflection of the RREP at ∼85-135 ms) was used to characterise NGRS., Results: The results showed a significantly smaller N1 S2/S1 ratio in the YG than in the MG (p=0.01) and OG (p=0.03). Further analysis showed that the S1 N1 amplitude was larger for the YG compared with the MG (p=0.03) and OG (p=0.007). Moreover, age was significantly correlated with the N1 S2/S1 ratio (r=0.43), with higher age relating to higher N1 S2/S1 ratios., Conclusions: The greater N1 S2/S1 ratios observed in older adults suggest that ageing has a negative impact on the NGRS. This might contribute to increased experiences of respiratory sensations such as dyspnoea in ageing adults., Competing Interests: Conflict of interest: None declared., (Copyright ©The authors 2024.)

The effect of egg white protein on the protein structure of highland barely noodles during processing was investigated, and the underlying mechanism was examined. Egg white protein significantly influenced the stress relaxation of highland barley dough. 1% and 2% egg white protein improved the cooking and textural properties of highland barely noodles. During mixing and sheeting, it improved the structure of the protein network by promoting protein aggregation and cross-linking, whereas its effect on non-covalent interactions was quite different. During cooking, egg white protein promoted protein aggregation and cross-linking via heat-induced polymerization, and the distribution regularity of the protein network was improved as its flexibility diminished. The protein structure of highland barely noodles during processing was closely related to the addition amount of egg white protein, and the cooking, textural, and chemical interactions of highland barely noodles during processing changed considerably when more than 3% egg white protein was added., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Objectives: This study aimed to investigate factors that influence the sleep quality and menstrual cycles of female rotating-shift nurses., Methods: A cross-sectional study was conducted in which 213 female rotating-shift nurses between the ages of 20 and 45 were recruited from a medical center in Taiwan from November 1, 2023, to December 31, 2023. Binary logistic regression analysis was performed with regard to sleep quality or menstrual cycle., Results: Female rotating-shift nurses who perceived a higher level of stress (P < .001), were late chronotypes (P = .020), or were working the night shift (P = .006) were more likely to have poor sleep quality. Late-type nurses working the day shift were more likely to have poor sleep quality than were early- and intermediate-type nurses (P < .001). With regard to menstrual cycles, female rotating-shift nurses who perceived a higher level of stress (P = .008), were working the night shift (P < .001), or had poor sleep quality (P = .001) were more likely to have irregular menstrual cycles. Late-type nurses working the day shift were more likely to have irregular menstrual cycles than were early- and intermediate-type nurses (P = .013)., Conclusions: A higher likelihood of poor sleep quality was found in female rotating-shift nurses when they perceived high levels of stress, and the interactions between chronotype and shift type could influence sleep quality. Shift type and the interactions between chronotype and shift type could also influence menstrual regularity., (© The Author(s) [2024]. Published by Oxford University Press on behalf of Journal of Occupational Health.)

Objectives: To investigate whether chronotype is a moderator variable that also interacts with shift type and whether they jointly influence the attention performance of nurses working in acute and critical care units., Methods: We adopted a longitudinal research design focusing on nurses working rotating shifts in the emergency room and intensive care units at a medical center. A total of 40 complete samples were obtained. Data analysis was conducted using the generalized estimating equations in SAS 9.4., Results: The mean (SD) age of the participants was 26.35 (2.12) years. After controlling for age, gender, and sleep duration, an interaction effect was discovered between a specific chronotype and shift type; that is, the interaction effect between chronotype and shift type was only significant when comparing late-types working the night shift with early- and intermediate-types working the night shift (B = -18.81, P = .011). The least squares means of the mean reaction time of the interaction effects between the 2 chronotype groups and the 3 shift types found that the mean reaction time of late-types working the night shift was 11.31 ms (P = .044) slower compared with working the day shift., Conclusions: The chronotype is a moderator variable between shift type and mean reaction time, such that matching the chronotype of nurses in acute and critical care units with the appropriate shift type improved their mean reaction time. It is hoped that the results of this study could serve as a reference for acute and critical care nurses when scheduling their shifts., (© The Author(s) [2024]. Published by Oxford University Press on behalf of Journal of Occupational Health.)

Background: Facing patient death is an unavoidable aspect of work for nurses working in healthcare settings. The attitudes of nurses toward death, however, can exert a negative psychological impact on themselves that can even cause them to quit this occupation., Aim: The objective of this study was to explore the attitudes of nurses toward death, the factors influencing said attitudes, and whether nurses basic attributes and attitudes toward death were associated with their future turnover behavior., Method: A prospective study design was adopted. The recruitment period ran from October 2017 to March 2018. A total of 323 nurses completed a basic attributes survey as well as the Death Attitude Profile-Revised questionnaire and were followed until May 30, 2021. The factors influencing turnover were then analyzed using the Cox proportional hazard model. The STROBE checklist was used for reporting in this study., Results: Age was found to be significantly associated with fear of death and death avoidance. Compared with nurses with no religion, nurses who were Buddhists/Taoists were more inclined toward neutral acceptance in their attitude toward death, whereas those who were Christians/Catholics were more inclined toward escape acceptance. Nurses with less than three years of work experience were more likely to resign earlier than those with more than 3 years of work experience. Fear of death and approach acceptance could be used to predict turnover., Conclusions: Younger nurses were more likely to exhibit fear of death and escape behavior, and those with less work experience or a greater fear of death were more likely to resign. Nurses with religious beliefs could accept patient death more positively, whereas those who faced death with positive approach acceptance displayed reductions in turnover., Implication for Nursing and Health Policy: Younger nurses should receive more education regarding death early in their training. Hospitals should also offer more education from a religious aspect in order to reduce turnover., (© 2022 International Council of Nurses.)

Purpose: In late-stage cancer, the cancer itself or the side effects of cancer treatment are known to affect the hemoglobin (Hgb) levels or emotions of patients. We to investigate the relationship between Hgb levels and depression in late-stage cancer patients and verified whether irritability has a mediating effect on this relationship., Method: The research tools included a patient basic information form, the Irritability Scale-Initial Version (TISi), and the Hamilton Depression Rating Scale (HAMD). We first compared the Hgb levels, HAMD scores, and TISi scores of the cancer patients with different attributes, performed multiple hierarchical regression analysis, and then analyzed the mediating effects of TISi scores using the Sobel test., Results: In the 117 late-stage cancer patients, Hgb levels of patients with a BMI<18.5 kg/m2 were lower than those of the patients with a BMI 24.0 kg/m2. Hgb levels had a negative influence on both TISi scores (B = -2.74, p = .001) and HAMD scores (B = -0.75, p = .010). TISi scores mediated the relationship between Hgb levels and HAMD scores (Z = 2.06, p = .040)., Conclusions: Irritability is a mediating variable of the influence of Hgb levels on depression, meaning that lower Hgb levels in late-stage cancer patients may be detrimental to emotional stability, induce irritability, and thereby cause depression. Thus, in the psychological care of late-stage cancer patients, medical teams should be more vigilant in monitoring Hgb levels and anemia treatment., Competing Interests: Declaration of competing interest We declare that we have no financial and personal relationships with other people or organizations that can inappropriately influence our work., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

The complexity and diversity of pain signaling have led to obstacles for prominent treatments due to mechanisms that are not yet fully understood. Among adenosine triphosphate (ATP) receptors, P2×7 differs in many respects from P2×1-6, it plays a significant role in various inflammatory pain, but whether it plays a role in noninflammatory pain has not been widely discussed. In this study, we utilized major neuropharmacological methods to record the effects of manipulating P2×7 during nociceptive signal transmission in the thalamocingulate circuits. Our results show that regardless of the specific cell type distribution of P2×7 in the central nervous system (CNS), it participates directly in the generated nociceptive transmission, which indicates its apparent functional existence in the major pain transmission path, the thalamocingulate circuits. Activation of P2×7 may facilitate transmission velocity along the thalamocingulate projection as well as neuron firings and synaptic vesicle release in anterior cingulate cortical neurons. Targeting thalamic P2×7 affects glutamate and ATP secretion during nociceptive signal transmission. PERSPECTIVE: The observations in this study provide evidence that the ATP receptor P2×7 presents in the central ascending pain path and plays a modulatory role during nociceptive transmission, which could contribute new insights for many antinociceptive applications., (Copyright © 2023. Published by Elsevier Inc.)

Background: To understand the differences between patients with diabetes mellitus and obese patients with respect to the occurrence of peri-prosthetic joint infection (PJI) after lower-extremity joint arthroplasty as well as to identify differences in PJI occurrence at different time periods. Patients and Methods: The Cochrane Library, CINAHL, MEDLINE, and PubMed were searched for literature published between January 2000 and July 2022. Our targets were studies involving patients with PJI who had already been diagnosed as having diabetes mellitus or being obese before receiving lower-extremity joint arthroplasty. Analysis was performed using Comprehensive Meta-Analysis Software (CMA) Version 3 (Biostat, Inc., Englewood, NJ, USA). Results: A total of 53,522 patients with diabetes mellitus and 360,018 obese patients were included. The forest plot for patients with and without diabetes mellitus indicated that patients with diabetes mellitus were more likely to contract PJIs than were patients without diabetes mellitus (odds ratio, 1.84; 95% confidence interval [CI], 1.56-2.16) and that no differences existed among early, delayed, and late PJI occurrence in patients with diabetes mellitus. The forest plot for obese and non-obese patients indicated that obese patients were more likely to contract PJIs than were non-obese patients (odds ratio, 1.86; 95% CI, 1.53-2.14) and that among obese patients, early PJI occurrence was higher than was late PJI occurrence. In addition, the mixed model indicated that obese patients were more likely to develop early PJIs than were patients with diabetes mellitus. Conclusions: Patients with diabetes mellitus and obese patients were more likely to develop PJIs than were patients without diabetes mellitus and non-obese patients, and that obese patients were more likely to develop early PJIs than late PJIs. Also, obese patients were more likely to develop early PJIs than patients with diabetes mellitus.

Objective: To explore the characteristics and risk factors of facial pressure injuries in patients using noninvasive positive pressure ventilation., Setting and Sample: Patients who developed facial pressure injuries due to non-invasive positive pressure ventilation at a teaching hospital in Taiwan from January 2016 to December 2021 were selected, resulting in a total of 108 patients in our case group. A control group was formed by matching each case by age and gender to three acute inpatients who had used non-invasive ventilation but had not developed facial pressure injuries, resulting in 324 patients in the control group., Research Methodology: This study was a retrospective case-control study. The characteristics of the patients who developed pressure injuries at different stages in the case group were compared, and the risk factors of non-invasive ventilation-related facial pressure injuries were then determined., Results: Higher duration of non-invasive ventilation usage, higher length of hospital stay, lower Braden scale score, and lower albumin levels in the former group. The results of multivariate analysis from binary logistic regression involving the duration of non-invasive ventilation usage demonstrated that the patients who used this device for 4-9 days and 16 days were at greater risk of facial pressure injuries than those who used it for 3 days; in terms of the Braden scale score, higher Braden scale scores were correlated with a higher risk of facial pressure injuries. In addition, albumin levels lower than the normal range were correlated with a higher risk of facial pressure injuries., Conclusion: Patients with pressure injuries at higher stages had a higher duration of non-invasive ventilation usage, higher length of hospital stay, lower Braden scale scores, and lower albumin levels. Thus, a longer duration of non-invasive ventilation use, lower Braden scale scores, and lower albumin levels were also risk factors for non-invasive ventilation-related facial pressure injuries., Implications for Clinical Practice: Our results serve as a useful reference for hospitals, both in creating training programs for their medical teams to prevent and treat facial pressure injuries and in drafting guidelines for assessing risk in order to prevent facial pressure injuries caused by non-invasive ventilation. The duration of device usage, Braden scale scores, and albumin levels in particular should be seriously monitored to reduce the occurrence of facial pressure injuries in acute inpatients treated with non-invasive ventilation., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background: Oral mucositis (OM) considerably affects the experience of patients with cancer during treatment. This study investigated the effects of cryotherapy on cancer therapy-induced OM., Objective: This study aimed to systematically appraise evidence on whether cryotherapy can reduce the incidence and severity of OM., Methods: We conducted an umbrella review to examine the effect of cryotherapy on cancer-related OM. The primary outcome was the incidence and severity of OM. We performed a subgroup analysis including solid cancers and hematological malignancies., Results: Five meta-analyses were included. Cryotherapy could more effectively reduce the incidence of severe OM (risk ratio [RR], 0.37; 95% prediction interval [PI], 0.22-0.64). In the subgroup analyses of solid cancers or hematological malignancies, cryotherapy significantly reduced the incidence of grades 2 to 4 OM in patients with solid cancers (RR, 0.51; 95% PI, 0.34-0.78 and RR, 0.52; 95% PI, 0.36-0.74). However, no significant difference was observed in the incidence of OM in patients with hematological malignancies regarding any grade or grade 3 or 4 OM. Moreover, cryotherapy did not significantly reduce the OM duration (mean difference, -0.13; 95% PI, -20.89 to 20.63; mean difference, -2.99, 95% PI, -8.10 to 2.12)., Conclusion: Cryotherapy can reduce the incidence of severe OM induced by chemotherapy or radiotherapy., Implication for Practice: We recommend the inclusion of this safe, simple, and convenient intervention in chemotherapy or radiotherapy plans. Additional clinical trials are warranted to extend the limited evidence on the effectiveness of cryotherapy in reducing the severity and duration of OM., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

This study was to clarify the connection between extrinsic factors and the risk of perioperative pressure injuries (PIs) through the case-control approach, which involved making the intrinsic factors of the patients in the control group with no PIs consistent with those of the case group with PIs. We collected samples from a teaching hospital in Taiwan. We found a total of 132 patients deemed to have developed perioperative PIs. Using 1:2 frequency matching, we matched these cases with patients who had not developed PIs by gender, age, and BMI. Binary logistic regression analysis of the odds ratios of the extrinsic factors and PI risk revealed that the independent variables with statistical significance included duration of anaesthesia 3 h, amount of blood loss, use of electric blankets, diastolic blood pressure below 60 mmHg during surgery, and oxyhemoglobin saturation by pulse oximetry (SPO 2 ) below 93% during surgery. Emphasis should be placed on cooperation among the medical team during surgery, less use of electric blankets, control over the duration of anaesthesia and blood loss, continuous monitoring of the patient during surgery for any emergencies, and the maintenance of patient diastolic blood pressure and blood oxygen levels to reduce the risk of PIs., (© 2022 The Authors. International Wound Journal published by Medicalhelplines.com Inc (3M) and John Wiley & Sons Ltd.)

Aim: To understand whether the sleep quality of the caregivers of elderly inpatients is associated with their own characteristics and with the characteristics or sleep quality of the elderly inpatients., Design: A cross-sectional study design that recruited participants from September to December 2020 was adopted, in which 106 pairs of elderly inpatients and caregivers were recruited., Methods: Data collected from the elderly inpatients included demographic characteristics as well as the numerical rating scale (NRS) score, Charlson Comorbidity Index (CCI), Geriatric Depression Scale Short Form (GDS-SF) score, and Pittsburgh Sleep Quality Index (PSQI). Caregiver data included demographic characteristics and PSQI., Results: In the regression analysis of caregiver characteristics and caregiver sleep quality, only caregiver age and the relationship between caregiver and inpatient (other vs. spouse) were correlated with caregiver sleep quality. In the regression analysis of elderly inpatient characteristics, caregiver characteristics, and caregiver sleep quality, only the PSQI of elderly inpatients and the relationship between caregiver and inpatient (other vs. spouse) were correlated with caregiver sleep quality., Patient or Public Contribution: Poor caregiver sleep quality was more likely to manifest when the elderly inpatients had poor sleep quality, when the caregivers themselves were older, and when the caregiver was the inpatient's spouse., (© 2023 The Authors. Nursing Open published by John Wiley & Sons Ltd.)

Background: For psychiatric patients, the issue of falling is complex., Aim: The objective of this study was to compare the risk factors for falling in psychiatric inpatients and general ward inpatients who had fallen., Methods: The researchers first derived official fall records for 122 psychiatric inpatients and then selected 122 psychiatric inpatients who had not fallen as well as 122 general ward patients who had fallen, matched for gender, age, and length of hospital stay at the time of the fall incident., Results: After controlling other variables, multinomial logistic regression analysis revealed that psychiatric inpatients who had fallen and had dizziness (odds ratio [OR] = 7.11, p < .001), had an unsteady gait (OR = 1.97, p = .030), or were not using aids (OR = 0.42, p = .042) were at greater risk of falling than those who had not fallen. The researchers also found that general ward inpatients who had fallen and had higher Charlson Comorbidity Index scores (OR = 1.77, p < .001), were clear-headed (OR = 27.15, p = .001), had dizziness (OR = 11.55, p < .001), were unable to walk (OR = 64.28, p < .001), or were using aids (OR = 3.86, p = .001) were at greater risk of falling than those who had not fallen before., Conclusions: The causes of falling among psychiatric inpatients and general ward inpatients are different. Medical personnel should understand the medications and attributes of patients for an accurate assessment of their risk factors for falling and thus implement fall prevention measures and health education to reduce falls.

Objective: This study aimed to demonstrate the temporal trend in incidence of head and neck cancer (HNC) in Taiwan., Materials and Methods: Patients with a HNC were retrieved from the Taiwan's Health Insurance Database. We identified 16,894 patients aged ≥20 years who had received a first-time diagnosis of cancer of the oral cavity, oropharynx, larynx, hypopharynx, nasopharynx, sinonasal, salivary gland or thyroid gland between 2010 and 2018. We calculated the annual incidence rate per 100,000 population, overall, and classified by gender and cancer type. We also used the annual percent change (APC) to characterize trends in head and neck cancer rates over time., Results: The incidence rate showed a gradual decline during this period from 2010 to 2018 with an APC of -2.81% (p < 0.001). Within gender groups, the decline was not statistically significant among females (APC = -1.69, 95% CI = -3.58 ∼ 0.23, p = 0.080). Within cancer types, strikingly high magnitude and statistically significant declines were observed in respect of cancer of the nasopharynx (APC = -7.89%, 95% CI = -9.43%∼-6.31%, p < 0.001), sinonasal cancer (APC = -10.08%, 95% CI = -16.66%∼-2.99%, p = 0.012) and oropharyneal cancer (APC = -9.47%, 95% CI = -15.15%∼-3.42%, p = 0.013) over the study period. In contrast, there was a statistically significant increase in incidence on thyroid cancer over the study period with an APC of 4.75% (95% CI = -2.81%∼6.75%, p < 0.001)., Conclusions: HNCs in Taiwan are showing a decreasing trend, led by the upper respiratory and oropharyngeal cancers. However, there was a concurrent increasing trend of the incidence on thyroid cancer. These trends may be attributable to changing lifestyles and behavioral choices in Taiwan., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background: A good dynamic balance control and stable gait played an important role in the daily ambulation, especially for older adults with sensorimotor degeneration. This study aimed to systematically review the effects and potential mechanisms of mechanical vibration-based stimulation (MVBS) on dynamic balance control and gait characteristics in healthy young and older adults., Method: Five bioscience and engineering databases, including MEDLINE via PubMed, CINAHL via EBSCO, Cochrane Library, Scopus, and Embase, were searched until September 4th, 2022. Studies published between 2000 and 2022 in English and Chinese involving mechanical vibration related to gait and dynamic balance were included. The procedure was followed via the preferred reporting items for systematic reviews and meta-analysis method. The methodological quality of included studies was assessed using the NIH study quality assessment tool for observational cohort and cross-sectional studies., Results: A total of 41 cross-sectional studies met the inclusion criteria and were included in this study. Eight studies were good-quality while 26 were moderate-quality and 7 were poor-quality. There were six categories of MVBS at various frequencies and amplitudes utilized in included studies, including plantar vibration, focal muscle vibration, Achilles tendon vibration, vestibular vibration, cervical vibration, and vibration on nail of hallux., Significance: Different types of MVBS targeting different sensory systems affected the dynamic balance control and gait characteristics differently. MVBS could be used to provide improvement or perturbation to specific sensory systems, to induce different sensory reweight strategies during gait., Competing Interests: Conflict of interest statement The authors reported no conflicts of interest., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Background: Stroke may cause debilitating neurological deficiencies that result in motor, sensory, and cognitive deficits and poorer psychosocial functioning. Prior studies have provided some initial evidence for the significant roles of health literacy and poor oral health for old people. However, few studies have focused on the health literacy of individuals who had a stroke; therefore, the relationships between the health literacy and oral health-related quality of life (OHRQoL) among middle-aged and older adults who had a stroke are unknown. We aimed to assess the relationships between stroke prevalence, health literacy status, and OHRQoL in middle-aged and older adults., Methods: We retrieved the data from The Taiwan Longitudinal Study on Aging, a population-based survey. For each eligible subject, we gathered data in 2015 on age, sex, level of education, marital status, health literacy, the activity daily living (ADL), stroke history and OHRQoL. We evaluated the respondents' health literacy by using a nine-item health literacy scale and categorized their health literacy level as low, medium, or high. OHRQoL was identified based on the Taiwan version of the Oral Health Impact Profile (OHIP-7T)., Results: The final study contained 7702 community-based dwelling elderly people (3630 male and 4072 female) were analysis in our study. Stroke history was reported in 4.3% of participants, 25.3% reported low health literacy, and 41.9% had at least one ADL disability. Furthermore, 11.3% of participants had depression, 8.3% had cognitive impairment, and 3.4% had poor OHRQoL. Age, health literacy, ADL disability, stroke history, and depression status were significantly associated with poor OHRQoL after sex and marital status was adjusted. Medium (odds ratio [OR] = 1.784, 95% confidence interval [CI] = 1.177, 2.702) to low health literacy (OR = 2.496, 95% CI = 1.628, 3.828) was significantly associated with poor OHRQoL., Conclusions: Base our study results, people with stroke history had poor OHRQoL. Lower health literacy and ADL disability were associated with worse QHRQoL. Further studies are necessary to define practical strategies for reducing the risk of stroke and oral health with constantly lower health literacy, thereby improving the quality of life and providing health care of older people., (© 2023. The Author(s).)

Competing Interests: Declaration of competing interest None.

Aims and Objectives: The purpose of this study was to investigate the adverse effects of non-intubated suctioning., Background: Airway hygiene aims to maintain a patent airway to ensure adequate ventilation. Nasopharyngeal, oropharyngeal or nasotracheal suctioning may be used in patients who require airway suctioning but do not have an artificial airway. However, no studies till date provide insight into the adverse effects of non-intubated airway suctioning., Design: A clinical data-based retrospective design., Method: Using institutional and clinical databases of three university hospitals in 2008-2016, we conducted a study with a propensity score matching method of 3,326 hospitalised patients who had undergone suction therapy with or without a tracheotomy. Conditional logistic regression analyses were performed to investigate the link between suctioning and the probabilities of adverse effects. STROBE checklist was used to report the current study., Results: Patients who required nasopharyngeal, oropharyngeal or nasotracheal suctioning had a higher risk of gastrointestinal ulcers than tracheotomised patients (adjusted OR 1.99; 95% CI, 1.24-3.20). Patients who received non-intubated suction had a higher risk of developing pneumonia (adjusted OR 1.59; 95% CI, 1.26-2.00), and the risk of aspiration pneumonia was three times higher than tracheotomised patients (adjusted OR 3.04; 95% CI, 1.40-6.60)., Conclusions: Non-intubated patients who require suctioning for airway clearing are more susceptible to gastrointestinal ulcers, pneumonia and aspiration pneumonia. The findings would facilitate in alerting healthcare professionals to this group of patients. However, more clinical research is needed to elucidate the mechanisms of adverse effects in non-intubated patients who require suctioning., Relevance to Clinical Practice: The adverse effects of suctioning can easily be overlooked in debilitated patients with no intubation. Professionals must be aware of the discomfort and risks that patients may experience., (© 2022 John Wiley & Sons Ltd.)

The satisfaction of nurses with the leadership of their supervisors exerts a positive association with their job satisfaction. This study identified factors associated with nurse satisfaction with supervisor leadership and developed a model of causal relationships based on social exchange theory. A satisfaction scale was developed to measure how nurses felt about the leadership of their supervisor, which also assessed the validity and reliability using a cross-sectional descriptive survey questionnaire administered to nurses working in a teaching hospital in northern Taiwan. A total of 607 valid questionnaires were returned. Structural equation modeling was used to test the theoretical model of this study. Only questions that were scored above 3 were included in the scale. A total of 30 questions were placed under seven constructs of this scale upon the assessment of content validity. The results indicate that satisfaction with shift schedules, educational training, and internal communication exerted direct, significant, and positive associations with satisfaction with the supervisor leadership. Furthermore, satisfaction with policies and guidelines exerted direct, significant, and positive associations with satisfaction with internal communication and exerted indirect associations with satisfaction with supervisor leadership through internal communication. In particular, satisfaction with shift schedules and internal communication were most significantly associated with satisfaction with supervisor leadership. The results of this study offer a reference for hospital management and emphasize focusing on the arrangement of nurse shifts in all departments. The establishment of diverse communication channels can enhance the degree of nurse satisfaction with supervisor leadership., Competing Interests: The authors declare no conflicts of interest.

Negative emotions have been found associated with high prevalence of respiratory disease and increased subjective feelings of dyspnea, while positive emotional stimulus has been suggested to alleviate dyspneic feelings. However, the extent to which different emotional contexts affect individuals' respiratory interoceptive attention was not clear. Therefore, the purpose of this study was to investigate the influences of emotional contexts on respiratory interoceptive accuracy, and the relationships between respiratory interoceptive accuracy and negative emotions as well as respiratory symptoms. Fifty-six healthy participants completed the self-reported questionnaires of depression, anxiety, and respiratory symptoms. During the experiment, the participants were instructed to watch one neutral and one positive affective picture series and mentally count the number of perceived occlusions (reported at the end of the trials). The Wilcoxon Signed-Rank test and Spearman's correlations were used to examine the effect of the emotional pictures and to explore the relationships between the level of emotional status or respiratory symptoms and respiratory interoceptive task performance. The significance level was set at p < 0.05. Our results did not show a significant difference in participants' occlusion counting task performance between the neutral and positive emotional context. However, Spearman's Rho correlation analysis revealed that depression level was negatively correlated with accuracy of the task performance in the neutral emotional context, and this relationship diminished in the positive emotional context. In summary, our study demonstrated that negative emotional status, especially depression, may lead to decreased respiratory interoceptive accuracy. Future studies are recommended to test the effect of positive emotional context on respiratory interoceptive task performance in individuals with clinical depression and anxiety., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Background: Single-row (SR) and double-row repair techniques have been described to treat rotator cuff tears. We present a novel surgical strategy of arthroscopic-assisted mini-open repair in which a locking-loop suture bridge (LLSB) is used., Purpose: To compare the functional outcomes and repair integrity of LLSB technique to the SR technique for arthroscopic-assisted mini-open repair of small to medium rotator cuff tears., Study Design: Cohort study; Level of evidence, 3., Methods: Included were 39 patients who underwent LLSB repair (LLSB group) and 44 patients who underwent SR suture anchor repair (SR group) from 2015 to 2018. We evaluated all patients preoperatively and at 3, 6, 12, and 24 months postoperatively using the visual analog scale (VAS) for pain, Oxford Shoulder Score (OSS), and American Shoulder and Elbow Surgeons (ASES) score. Also, shoulder sonography was performed at 12 months postoperatively to evaluate repair integrity using the Sugaya classification system. The independent-sample t test was used to analyze functional outcomes (VAS, OSS, and ASES scores), and the Fisher exact test was used to analyze postoperative sonography results., Results: Patients in both the LLSB and SR groups saw a significant improvement on all 3 outcome measures from preoperatively to 24 months postoperatively ( P < .001 for all). However, when comparing scores between groups, only the scores at 3 months postoperatively differed significantly (VAS: P = .002; OSS: P < .001; ASES: P = .005). Shoulder sonography at 12 months postoperatively revealed no significant difference in repair integrity between the LLSB and SR groups (retear rate: 10.26% and 6.82%, respectively; P = .892)., Conclusion: Better outcome scores were seen at 3-month follow-up in the LLSB group, with no difference in retear rates compared with the SR group at 12 months postoperatively. The LLSB technique was found to be a reliable technique for rotator cuff repair of small- to medium-sized tears., Competing Interests: The authors declared that there are no conflicts of interest in the authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2023.)

Background: Irritability is a common experience of depressed Chinese patients but is understudied and poorly measured., Objective: We aimed to assess psychometric properties of a new measure of irritability in Chinese cancer patients across the social and political spectrum., Methods: The Irritability Scale-Initial Version (TISi) was translated into Chinese and tested in two samples of Chinese cancer patients undergoing treatments: 52 patients in Beijing, China, between 2018 and 2019 and 65 patients in Taipei, Taiwan, in 2020., Results: The Chinese version of TISi demonstrated high internal consistency, high reliability based on the split-half method in the two samples, and satisfactory discriminant validity using the Chinese version of the 17-item Hamilton Rating Scale for Depression and the seven-item depression subscale of the Hospital Anxiety and Depression Scale in the Beijing sample. A confirmatory factor analysis produced factor loadings in both samples, which resembled a sample of American cancer patients. Three TISi items were loaded more highly on the physical instead of the original behavioral subscale in the Beijing sample. A possible influence of cultures was explained., Conclusion: The Chinese version of TISi has satisfactory psychometric properties for assessing the level of irritability in Chinese cancer patients. Future large-sample studies are needed to further determine TISi's factorial structure, test-retest reliability, sensitivity to change, and predictive validity for depression in Chinese cancer patients., Competing Interests: The authors have no conflicts of interest to report., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Aims and Objectives: This study investigated the factors of pressure injuries in patients in intensive care units (ICU)., Background: Pressure injuries among patients in ICUs can be prevented by the early assessment of risk factors and taking appropriate preventative measures., Design: A retrospective study., Methods: ICU patients who suffered from pressure injuries between January 2016 and August 2018 at a hospital in Taiwan were selected. Patient medical histories and data associated with pressure injuries and medical treatment were collected from electronic medical records. A total of 256 patients were included in our analysis. The study adhered to the STROBE checklist., Results: A multivariate model of multinomial logistic regression analysis indicated that when compared to Stage 1 pressure injuries, Stage 2-4 pressure injuries were associated with albumin levels. Patients with lower albumin levels were at greater odds of Stage 2-4 pressure injuries than Stage 1 pressure injuries. In addition, when compared to unstageable pressure injuries or deep tissue injuries, Stage 1 pressure injuries were associated with the use of fentanyl and haemoglobin levels. Patients using fentanyl were more likely to suffer from unstageable pressure injuries, and those with lower haemoglobin levels were more likely to suffer from unstageable pressure injuries or deep tissue injuries., Conclusion: When patients were simultaneously on ventilators and taking midazolam or fentanyl, the incidence of pressure injuries with greater severity became higher. Furthermore, ICU patients with lower albumin and haemoglobin levels were more likely to suffer from pressure injuries of greater severity., Relevance to Clinical Practice: For critically ill patients on ventilators, it is recommended to devise a means of assessing each patient daily as well as systematically reduce their dosage of midazolam or fentanyl. Furthermore, regularly monitoring albumin and haemoglobin levels to understand their nutritional status is necessary., (© 2022 John Wiley & Sons Ltd.)

Background: Previous studies have compared different kinds of fixations for anterior cruciate ligament reconstruction. Nevertheless, there is no optimal method to date. To the best of authors' knowledge, there is no article discussing the combination of adjustable suspensory device and interference screw for hybrid tibial fixation., Methods: In total, 66 patients (n = 34, adjustable suspensory device and interference screw; n = 32, cortical screw and interference screw) were analyzed. Their International Knee Documentation Committee score and Tegner activity level scale were evaluated before and after a 2-year follow-up. The Single Assessment Numeric Evaluation score was evaluated after a 2-year follow-up. Physical exams such as range of motion, anterior knee pain (VAS > = 3) and Lachman test were assessed before and at least 12 months after surgery. To evaluate tunnel widening, anteroposterior and lateral view radiography was conducted 1 day and at least 12 months after surgery. A more than 10% change was considered tibial tunnel widening. Mann-Whitney U test, independent t test, paired t test, Fisher's exact test and chi-squared test were used to compare the variables. Linear and logistic regression models were applied to adjust for potential confounders., Results: No variable except gender (P = 0.006) showed significant difference with regard to demographic data. After adjustment, there was no statistically significant difference between the groups regarding post-operative physical exams. Patients who used adjustable suspensory device and interference screw had lower post-operative Single Assessment Numeric Evaluation score (adjusted β - 8.194; P = 0.017), Tegner activity level scale (adjusted β - 1.295; P = 0.001) and pre-operative degrees of knee flexion (adjusted β - 2.825; P = 0.026). Less percentage of tunnel widening in the lateral view of radiographs was seen in patients in group of adjustable suspensory device and interference screw (adjusted β - 1.733; P = 0.038). No significant difference was observed in the anteroposterior view of radiographs (adjusted β - 0.667; P = 0.26)., Conclusion: In these 66 patients, we observed less tibial tunnel widening and lower post-operative functional scores in the group of adjustable suspensory device and interference screw. Both groups displayed similar outcomes of physical exams as well as improvement after operation. The proposed method may become an alternative option. Nonetheless, the quality of our study is still limited, and thus further studies are warranted to determine the efficacy and further application., Trial Registration: Joint Institutional Review Board of Taipei Medical University, Taipei, Taiwan (No: N201805094 )., Study Design: Prospective comparative cohort study; Level of evidence, II., (© 2022. The Author(s).)

This study aimed to understand the correlation between non-alcoholic fatty liver disease (NAFLD) and metabolic syndrome in nurses. Questionnaires were used to eliminate individuals with a daily drinking habit, hepatitis B or C, or incomplete data. A total of 706 valid samples were obtained. The prevalence of NAFLD among nurses was 36.8%. Nurses with a greater age (OR = 1.08, 95% CI: 1.01-1.16), obese BMI (OR = 23.30, 95% CI: 8.88-61.10), overweight BMI (OR = 3.89, 95% CI: 2.15-7.04), waist circumference exceeding the standard (OR = 2.10, 95% CI: 1.14-3.87), fasting blood glucose 100-125 mg/dL (OR = 4.09, 95% CI: 1.19-14.03), and overly low HDL-C (OR = 2.01, 95% CI: 1.05-3.85) were at greater risk of NAFLD. Furthermore, male nurses (OR = 6.42, 95% CI: 1.07-38.70), nurses with triglycerides over 150 mg/dL (OR = 4.80; 95% CI: 1.05-21.95), and nurses with HDL-C lower than the standard (OR = 5.63, 95% CI: 1.35-23.49) were at greater risk of moderate/severe NAFLD. Among younger nurses, those of greater age, male nurses, obese and overweight nurses, and those with a waist circumference exceeding the standard, 100-125 mg/dL, overly low HDL-C, and triglycerides over 150 mg/dL should consider the possibility that they have NAFLD.

This study examined the relationship between the personal predisposing factors of patients and the severity of pressure injuries (PIs) developed during surgery. This retrospective cohort study collected 439 cases of peri-operative PIs. Using binary logistic regression to identify the variables associated with PI severity, the effects of interactions between associated variables were then tested. The results of this study revealed that among the personal predisposing factors, only higher patient age (P = .001) and higher body mass index (P < .001) posed a greater risk of stage 2 PIs or higher. Among the surgery-related facilitating factors, only patients who were placed in the prone position during surgery and patients who lost ≥1000 mL of blood during surgery were at greater risk of stage 2 PIs or higher, compared, respectively, to those placed in the supine position and those who lost ≤100 mL of blood. Furthermore, the amount of blood lost during surgery moderated the influence of age on PI severity. For elderly patients who are expected to lose a large blood volume during surgery or lose an immeasurable amount of blood due to the use of cardiopulmonary bypass, taking more precautionary measures to prevent PIs is recommended., (© 2022 The Authors. International Wound Journal published by Medicalhelplines.com Inc (3M) and John Wiley & Sons Ltd.)

Aims and Objectives: To investigate whether the sleep quality and fatigue of female nurses working rotating shifts could be used to predict future turnover status., Background: Female nurses working rotating shifts often suffer from sleep problems and fatigue, and the turnover rates of nurses are generally higher than those of other hospital personnel., Design: A prospective study., Methods: We recruited a total of 198 female nurses working rotating shifts from December 2017 to March 2019. The nurses completed the Checklist Individual Strength (CIS) scale and wore an actigraph for seven consecutive days in order to collect their sleep parameters. Their turnover status was tracked until 31 May 2021 at which time 55 participants (27.8%) had resigned. The Cox proportional hazard model was used to analyse the factors influencing turnover. In addition, the study adhered to the STROBE checklist., Results: The results revealed significant differences between the nurses in the still-working group and the resigned group in terms of the sleep quality parameters sleep efficiency (SE) and wake after sleep onset (WASO) as well as CIS scores. WASO was significantly correlated with intensity of fatigue, and fatigue was common among all of the nurses working rotating shifts. As time progressed, the sleep quality parameter WASO and CIS scores could be used to predict turnover status after 2.4 years., Conclusion: The results of this study indicated more sleep fragmentation and poor sleep efficiency in the resigned group. Sleep fragmentation was highly correlated with fatigue, and sleep fragmentation and fatigue could be used to predict turnover status., Relevance to Clinical Practice: We suggest that relevant hospital management pay more attention to the sleep conditions and fatigue of female nurses working rotating shifts when arranging personnel and schedules and offer them more understanding., (© 2021 John Wiley & Sons Ltd.)

Psychological challenges have been found to impact respiratory symptom perception in healthy individuals as well as in patients with various neurological disorders. Human respiratory sensory gating is an objective measure to examine respiratory sensory information processing of repetitive respiratory mechanical stimuli in the central nervous system. With this electrophysiological method, patients with higher anxiety levels showed reduced respiratory sensory gating function in the cortex, and increased symptom perception. In addition, positive emotional contexts were found to increase the respiratory sensory gating function using RREPs. However, neural substrates related to emotional impacts on respiratory sensory gating remain still unclear. In the present study, we examined the emotion processing of respiratory sensory gating using functional magnetic resonance imaging. We hypothesized that positive compared with neutral stimuli would result in reduced brain activations in cortical areas with the paired occlusion paradigm. Thirty-five healthy adults participated in this event-designed fMRI experiment. Paired inspiratory occlusions (two transient occlusions with a 500 ms inter-stimulus-interval are delivered during one inspiration) were provided using an external trigger outside of the scanner. At least 40 paired inspiratory occlusions were collected for each trial. The experiment contained three runs during which participants underwent 12 min for the paired inspiratory occlusion paradigm while watching a fixation cross (the control condition), neutral and positive emotional picture series. The order of emotional picture series was randomized across the participants. Our results revealed an overall trend of reduction of brain activity from the neutral (minus fixation) condition, to the pleasant (minus fixation) condition. For bilateral thalamus and primary visual cortices, there was no significant difference in neural activation between the two contrasts of pleasant (Contrast P-F ) and neutral condition (Contrast N-F ). The activation of the mid-cingulate and the orbitofrontal cortex was lower in Contrast P-F compared to Contrast N-F . In conclusion, our results suggest that emotional context, especially positive valence, modulates neural correlates in middle cingulate cortex and orbitofrontal cortex in terms of respiratory sensory gating. Future studies are recommended to test emotional impacts on respiratory sensations in patients with neurological disorders., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Chan, Chang, Cheng, Liu, von Leupoldt, Hsu and Wu.)

The majority of shift nurses are female, there is still an expectation that they fulfil the traditional role of women in the family in Asia, often conflicting with shift work, increases stress, and affects cortisol secretion patterns. This study was to understand the changes in the cortisol awakening response (CAR) and work stress in nursing personnel working in different shifts. We recruited 41 female shift nurses. We administered the Taiwan Nurse Stress Checklist (NSC), and the nurses themselves collected saliva samples upon waking and 30 minutes after waking for three consecutive days at home. The saliva samples enabled us to analyze the increase in cortisol levels following waking (CARi) of nurses working different shifts (day, evening, and night). We then analyzed the data obtained using a hierarchical linear model (HLM). The results indicated that in terms of stress from the inability to complete personal tasks, the regression coefficients of night-shift nurses vs. day-shift nurses ( B = 4.39, p < .001) and night-shift nurses vs. evening-shift nurses ( B = 3.95, p < .001) were positive, which means that night-shift nurses were under significantly greater stress than day-shift and evening-shift nurses. With regard to CARi, the regression coefficients of night-shift nurses vs. day-shift nurses ( B = -3.41, p < .001) and night-shift nurses vs. evening-shift nurses ( B = -2.92, p < .01) were negative, which means that night-shift nurses ha ve significantly lower CARi values than day-shift and evening-shift nurses. With regard to cortisol levels 30 minutes after waking, the regression coefficients of night-shift nurses vs. day-shift nurses ( B = -3.88, p < .01) and night-shift nurses vs. evening-shift nurses ( B = -3.31, p < .01) were negative, which means that night-shift nurses ha ve significantly lower cortisol levels 30 minutes after waking than day-shift and evening-shift nurses. These results indicate that female night-shift nurses display the lowest CARi and cortisol levels 30 minutes after waking and are more negatively affected by being unable to complete personal tasks., Competing Interests: The authors declare that they have no conflicts of interest in this study., (Copyright © 2022 Yu-Huei Lin et al.)