Search

BACKGROUND No evidence is currently available to estimate the outcomes of intensity-modulated radiation therapy (IMRT) and surgery for patients with early oral cavity squamous cell carcinoma (E-OCSCC). METHODS We recruited patients from the Taiwan Cancer Registry Database who had received a diagnosis of E-OCSCC. Propensity score matching was performed, and Cox proportional hazards model was used to analyze all-cause mortality. RESULTS In the multivariate Cox regression analyses, the adjusted hazard ratio (aHR) (95% confidence interval [CI]) for surgery compared with definitive IMRT, T2N0M0 compared with T1N0M0, and male patients compared with female patients were 0.303 (0.245, 0.375), 1.340 (1.077, 1.668), and 2.012 (1.432, 2.826), respectively. The aHRs (95% CIs) for age 61 to 70, 71 to 80, and ≧81 years compared with

Background. Occupational stress is a common issue faced by workers in every discipline. Complementary and alternative medicine (CAM) therapies, such as aromatherapy massage or massage, have antistress effects in the literature. The purpose of this randomized clinical trial with triple blinds is to evaluate the immediate effects of lavender aromatherapy massage for improving work stress, burnout, and HRV parameters of female employees in a university. Methods. A total of 53 subjects in experimental group whereas 57 subjects in control group completed interventions and measurement and led to power of 0.98. Inferential statistics, as independent t-test, paired t-test, and Chi-Square test, were performed to verify the expected relationships. Results. The present study found that subjects in experimental group reported a lower role stress and less inclined to type A personality trait after aromatherapy massage with lavender. For control group, only less inclined to type A personality trait was reported after receiving massage. For burnout, a significant lower personal burnout and work-related burnout were reported after aromatherapy massage whereas only increased client-related burnout was reported in control group. For HRV, both the experimental and control groups reported higher SDNN and RMSSD in time domain after intervention. Contradictory HRT and PSI in time domain were significantly lower after intervention. In frequency domain of HRV, both groups reported significantly higher value in VLF and HF. In addition, the experimental group reported significantly higher value in TP and LF after intervention. Conclusions. Both the lavender aromatherapy massage and massage did show immediate effect on different dimensions of work stress, burnout, and HRV. These two interventions can be applied as routine leisure activities by personal preference to reduce stresses occurring in work environment.

This prospective study investigated the preventive effect of transcutaneous electrical nerve stimulation (TENS) for postoperative thirst.This experimental study was conducted with the CONSORT checklist.A total of 105 surgical patients who received general anesthesia were recruited from a medical center. Each patient was randomly assigned to the experimental group (n = 53; 20 min of TENS) or the control group (n = 52; routine care). In each group, oral moisture wetness was measured at 1 min, 20 min, and 50 min post-surgery. Descriptive and inferential statistics (Chi-square test, t test, one-way ANOVA, and generalized estimating equation (GEE) regression analysis) were performed to assess the proposed relationships.The two groups showed similar characteristics at baseline. The oral moisture wetness was significantly higher in the experimental group than the control group at each post-surgery assessment time (all P.001). The GEE results showed that patients in the experimental group reported more oral moisture wetness than patients in the control group.This study demonstrated that TENS can reduce thirst reported by patients after general anesthesia. Thus, this method may have clinical applications for managing postoperative thirst.

Hospice shared care is a model of care widely used in patients with terminal cancer. Appropriate interventions to improve related symptoms should be provided during disease progression through the end of life.The purpose of this study was to explore the related symptoms and to compare symptom severity before and after the implementation of hospice shared care and medical care interventions.Fifty patients with terminal cancer were enrolled in this longitudinal, quasi-experimental research. Inclusion criteria included having an expected life span of6 months and agreeing to enter hospice shared care.The three most-frequently noted physical symptoms were, in rank order: "pain", "weakness", and "dyspnea". In terms of severity, "pain" was the most severe, followed by "weakness" and "disturbance of sleep". The three most-frequently noted psychological symptoms were, in rank order: "depression", "worry about the disease", and "afraid of dragging others down". In terms of severity, "depression" was the most severe, followed by "anxiety" and "worry about the disease". The frequency and severity of the top-3 social and spiritual distress symptoms were, in rank order: "unfinished wish", "economic difficulties", and "painlessness". During the study period, the severity of physical symptoms improved gradually, while the severity of psychological symptoms improved significantly. The top-3 items in the original medical team`s hospice-care interventions were, in rank order: "tube care", "laboratory test", and "wound care" in the non-pharmacological category; "symptom control medication", "antibiotic injection", and "intravenous fluid infusion" in the pharmacological category; and "cognitive clarification of the prognosis condition", "do not conduct resuscitation discussions and signing", and "emotional stress consoling" in the problem-coordination and interview categories. The interventions implemented by the hospice specialist team included "emotional stress interview", "team communication", and "cognitive clarification of prognosis condition" in the problem coordination and interview categories, and "massage", "consultation", and "nursing advice" in the non-pharmacological category.The symptoms identified in this study provide clinical staff with a reference for the rapid assessment of patients with terminal-stage cancer. Manpower from various professional fields are committed to providing diversified services in the care teams, which positively affect the control of related symptoms. The experience presented in this article may be used as a reference to promote the hospice shared care model.癌末接受「安寧緩和共同照護」病人之症狀與照顧措施的探討.「安寧共同照顧（安寧共照）」是癌末廣泛應用的照顧方式，需隨著末期病人疾病進展提供適當的措施，積極改善症狀的照顧，直到病人生命終止。.了解癌末病人接受「安寧共照」期間之症狀，並比較共照前、後症狀嚴重度之變化與醫療團隊提供之照顧內容。.縱貫性類實驗性研究，方便取樣50位接受安寧共照且預估生命存活期不大於6個月之癌末病人。.癌末病人症狀各分類之發生比率與其嚴重度排序前三項，生理症狀為「疼痛」、「虛弱」與「呼吸困難」；嚴重度為「疼痛」、「虛弱」與「睡眠困擾」；心理症狀為「憂鬱」、「擔心病情」與「怕拖累他人」， 嚴重度為「憂鬱」、「焦慮」與「擔心病情」；社會靈性症狀發生比率與嚴重度皆為「心願未了」、「經濟困難」與「痛苦無意義」。研究期間病人症狀的嚴重度有逐漸緩和的趨勢，而心理症狀嚴重度達顯著的改善。安寧共照之原醫療團隊提供的照顧措施排序之前三項，非藥物類為「管路照顧」、「檢驗」與「傷口照顧」；藥物類為「症狀控制用藥」、「抗生素注射」與「大量輸液用藥注射」；問題協調與會談類排序前三項為「病情預後的認知澄清」、「不施行維生醫療討論與簽署」與「情緒壓力的會談」。安寧專科團隊為問題協調與會談類之「情緒壓力的會談」、「團隊溝通」與「病情預後的認知澄清」；非藥物類為「按摩」、「會診」與「護理指導」。.癌末病人症狀的調查，提供臨床人員盡快掌握評估方向，醫療跨專業領域之人力投入安寧療護多樣化的照顧事務，使症狀控制有正面的成效，此可作為推動安寧共照的參考。.

This study aims to compare the early development of professional value between the students in the traditional programme (BSN) and those in the accelerated BSN (ABSN) programmes.A longitudinal design was conducted.Data were collected from three schools of nursing during one academic year. A total of 117 BSN students and 101 ABSN students completed the survey of demographic information and the Nurses' Professional Values Scale-Revised questionnaires. All data were analysed by IBM SPSS-Statistics 22.Results showed that, in the beginning of the first professional nursing course, both students in the BSN and the ABSN programmes reported similar level of professional values. However, after one academic year, the changes in the professional value varied both between these two programmes and among the three different nursing schools. The increased professional value in school A represented the possibility for students to improve during their first-year professional nursing programme. As educators, we should redesign our teaching strategies according to the different conditions of students in each programme.

Aim The aim of this study is to explore the effects of exercise interventions by type, duration and intensity of exercise for fatigue in breast cancer survivors who had completed their treatment. Background Most studies found that exercise has valuable outcomes for cancer survivors. This meta-analysis comprehensively summarizes the benefits of exercise intervention for fatigue in breast cancer patients who had completed their adjuvant treatments. Methods We conducted a meta-analysis on randomized control trials published during 1 January 2000 through 31 December 2019, from PubMed, Cochrane Library databases, EMBASE, Medline (ProQuest), CINAHL, PsycINFO, Chinese Electronic Periodical Service and Wan Fan Data with prespecified searching criteria. Breast cancer patients earlier than stage IIIc and completing adjuvant treatments were included, and the effects of exercise on fatigue were investigated. Results Nine randomized controlled trials (RCTs) were included (N = 581). Patients receiving exercise interventions showed reduced fatigue comparing with those without exercise. Exercise with low-moderate intensity, 20 min/day, three times per week and lasting up to 12 weeks had a significant effect on reducing fatigue for breast cancer survivors. Conclusion Our study suggested that exercise interventions can reduce fatigue for this group of cancer survivors. The duration and intensity of exercise intervention could be prescribed for this specific group of cancer patients as a basic requirement to handle their reported fatigue.

The existing concept suggests early palliative and hospice therapy for a better quality of care (QOC) and less medical expense in terminal cancer patients, but the time points of “early” initiation were defined by pre-set study protocol rather than the real-world data. The study aimed to determine the optimal timing of initiating palliative care for patients with terminal cancer. This retrospective population-based study was conducted using a nationwide database. We extracted patients with cancer who were in their last year of lives in the period from 1 January 2010 to 31 December 2013 and categorized them into two groups (“hospice-shared care” (HSC) group and “usual care” (UC) group) after a matching process. Subsequently, we used a generalized linear mixed-effects model to compare the QOC and medical expenses between groups. After the selection and matching process, we enrolled 1714 patients (67.7 ± 13.2 years, 62.7% male) categorized into the HSC and UC groups (n = 857 in each group). The HSC groups showed generally better QOC in the four indices (with emergency room visit, hospitalization, intensive care unit admission, and receiving chemotherapy) than the UC group in those who initiated HSC 8–60 days before death. The HSC group also had significantly lower medical expenses than the UC group in those who initiated HSC 15–90 days before death. Among patients with terminal cancer, HSC initiation before the last 8 days and 15 days of lives can effectively improve QOC and save medical expenses, respectively.

The optimal timing for initiating palliative care in cancer patients varied widely. This retrospective population-based study aimed to determine the optimal initiation timing of hospice-shared care (HSC), which maximizes the beneficial effects of quality of care (QOC) and medical expenses among terminal cancer patients. We extracted cancer patients who were in their last year of lives during 1 January 2010 to 31 December 2013 from a nationwide database. After the selection and matching process, 1,714 patients (67.7±13.2 years, 62.7% male) were enrolled and categorized into the HSC group and usual care (UC) group (n=857 in each group). By suing the generalized linear mixed-effects model for comparisons between groups, we found that the HSC groups showed generally better QOC in the four indices (with emergency room visit, hospitalization, intensive care unit admission, and receiving chemotherapy) than the UC group in those who initiated HSC 8-60 days before death. The HSC group also had significantly lower medical expenses than the UC group in those who initiated HSC 15-90 days before death. In conclusion, HSC initiation before the last eight days and 15 days of lives were found to effectively improve QOC and save medical expenses, respectively, among patients with terminal cancer.

Most advanced lung cancer patients have already received many types of treatment before starting immunotherapy. Compared with advanced lung cancer patients under first-line treatment, those receiving immunotherapy are vulnerable to many health problems and increased frailty.This study was designed to investigate frailty in advanced lung cancer patients before starting immunotherapy.A total of 52 pre-immunotherapy patients completed the survey. Frailty status was determined using the Fried standard and survey questionnaires included the Barthel Index, Center for Epidemiologic Studies Depression Scale, the Chinese version of scales of international physical activities questionnaire (short version). In addition, the handgrip and 4.6-meter walk speed of the participants were measured.The ratio of frailty was 17.3%, with comorbidities (p = .023), body mass index (p = .004), Eastern Cooperative Oncology Group Status (p.001), activities of daily living status (p.001), albumin (p = .042), and C-reactive protein (p = .048) all associated with frailty.In this study, weight loss and low physical activity were the main symptoms of frailty in patients with advanced lung cancer. Therefore, healthcare workers should assess the nutrition and physical activity status of patients before initiating immunotherapy. We suggest that clinical care workers provide frailty care to patients before administering immunotherapy.晚期肺癌病人接受首次免疫療法前衰弱狀況之初探.大多數晚期肺癌病人在接受免疫療法前，往往都先歷經過其他的治療。相較於接受第一線治療之晚期肺癌病人，這些病人更易出現易受傷害的傾向及衰弱的狀況。.本研究在探討晚期肺癌病人接受首次免疫療法前之衰弱狀況。.收集將接受免疫療法52位晚期肺癌病人以Fried標準判定其衰弱狀況。使用工具包括：病人基本資料、巴氏量表、美國流行病學研究中心憂鬱量表、國際身體活動量表及手握力與4.6公尺行走速度。.發現衰弱者占17.3%，衰弱分組會受到共病症（p = .023）、身體質量指數（p = .004）、日常體能狀態（p.001）、日常生活活動功能（p.001）及生理檢驗數值白蛋白（p = .042）、C反應蛋白（p = .048）的影響。.本研究晚期肺癌病人以體重減輕與低身體活動量為衰弱的主要症狀。因此，醫療人員在病人接受免疫療法前，應評估病人的營養與身體活動功能狀況。盼藉由此研究可提供臨床照護人員思考如何在接受免疫療法之前，提供病人衰弱相關照護。.

Although patients aged70 years are subject to early oral cavity squamous cell carcinoma (E-OCSCC), evidence is currently lacking regarding the probable outcomes of definitive radiotherapy (RT) compared to surgery in this population.We recruited patients aged ≥70 years with a diagnosis of E-OCSCC from the Taiwan Cancer Registry Database. Propensity score matching was performed, and Cox proportional-hazards model curves were used to analyze all-cause mortality of patients at different age intervals undergoing different treatments.The matching process yielded a final cohort of 604 patients in the definitive RT and surgery cohorts who were eligible for further analysis. These patients were classified as old (70-80 years) and very old (80 years). In the multivariate Cox regression analysis, the adjusted hazard ratio (aHR) (95% confidence interval [CI]) for surgery compared with definitive RT was 0.465 (0.354-0.610, P 0.001). The aHR (95% CI) for age80 years compared with age 70-80 years was 2.370 (1.720, 3.265, P 0.001). The aHR (95% CI) for T2N0M0 compared with T1N0M0 was 1.752 (1.321-2.32, P 0.001). The aHR (95% CI) for Charlson Comorbidity Index (CCI) ≥ 2 compared with CCI = 0 was 1.264 (1.137-1.738, P = 0.011). After stratified analysis, the aHRs for surgery compared with definitive RT were 0.484 (0.352-0.665, P 0.001) and 0.411 (0.232-0.728, P = 0.002) among old and very old patients with E-OCSCC, respectively.Surgery may be more beneficial than definitive RT in selected elderly patients with E-OCSCC.

Background For first-time mothers, not knowing how to interact with newborn infants increases anxiety and decreases the quality of the parent–infant interactions. A substantial lack of interactional knowledge can ultimately limit the adjustments necessary for a stable transition into motherhood. This study investigated how postpartum parenting education influenced first-time mothers’ mother–infant interaction quality and parenting sense of competence. Methods Eighty-one healthy first-time-mother and infant dyads were recruited. The control group (n = 40) received postpartum care based on the medical and cultural norms practiced in Taiwan, while the experimental group (n = 41) received, on top of typical care, education by way of a 40-min videotape on infant states, behaviors, and communication cues, as well as a handout on play practices. Data were collected at five points: within the first week, and during follow-ups in the first, second, third, and sixth months after birth. We administered the Chinese versions of the Parenting Sense of Competence Scale and Edinburgh Perinatal Depression Scale, and used the Nursing Child Assessment Teaching Scale to score videotaped mother–infant interactions. Results We observed an increase in the quality of mother–infant interaction within the experimental group only. Furthermore, at the five assessment points, we observed no significant changes in perceived parenting competence. Among all subjects, there were correlations between postpartum depression scores, parenting competency, and quality of mother–infant interaction. Conclusions Our results indicate that first-time mothers in Taiwan who are provided with extra education on infants’ abilities and how to effectively play with infants are likely to exhibit improvements in quality of interaction. Electronic supplementary material The online version of this article (10.1186/s12884-018-1979-7) contains supplementary material, which is available to authorized users.

Background The prevalence of cognitive impairment is increasing due to the aging population, and early detection is essential clinically. The Ascertain Dementia 8 (AD8) questionnaire is a brief informant-based measure recently developed to assess early cognitive impairment, however, its overall diagnostic performance is controversial. The objective of this meta-analysis was to assess the diagnostic accuracy of the AD8 for cognitive impairment. Methods All relevant studies were collected from databases including MEDLINE, EMBASE and the Cochrane Library up to April 2017. We used QUADAS-2 to assess the methodological quality after the systematic search. The accuracy data and potential confounding variables were extracted from the eligible studies which included those in English and non-English. All analyses were performed using the Midas module in Stata 14.0 and Meta-DiSc 1.4 software. Results Seven relevant studies including 3728 subjects were collected, and classified into two subgroups according to the severity of cognitive impairment. The overall sensitivity (0.72, 0.91) was superior to specificity (0.67, 0.78). The pooled negative likelihood ratio (0.17, 0.13) was better than the positive likelihood ratio (2.52, 3.94). The areas under the summary receiver operating characteristic curve were 0.83 and 0.92, respectively. Meta-regression analysis showed that location (community versus non-community) may be the source of heterogeneity. The average administration time was less than 3 minutes. Conclusion Our findings suggest that the AD8 is a competitive tool for clinically screening cognitive impairment and has an optimal administration time in the busy primary care setting. Subjects with an AD8 score ≧2 should be highly suspected to have cognitive impairment and a further definite diagnosis is needed.

Aims and objectives To determine the individual and mutual predictors of the marital satisfaction of couples in which the husband experienced prostate cancer. Background Marital satisfaction of prostate cancer patients has been insufficiently studied in Asian countries as compared with Western countries. Design This study used a prospective and repeated-measures design. Methods Seventy Taiwanese couples in which the husband had prostate cancer completed measures at 6 and 12 months post-treatment. Assessments of physical symptoms, marital satisfaction, coping behaviour, and psychological distress were conducted. Multiple linear regression was used to analyse the data. Results The marital satisfaction of prostate cancer patients and that of their spouses were significantly correlated. At 6 months, spouses’ marital satisfaction, patients’ appraisal of prostate cancer as a threat, and patients’ serum prostate-specific antigen (PSA) levels were found to be the predictors of patients’ marital satisfaction. Furthermore, patients’ marital satisfaction and their spouses’ psychological distress were predictors of spouses’ marital satisfaction. At 12 months, spouses’ marital satisfaction and patients’ appraisal of prostate cancer as harm were predictors of patients’ marital satisfaction. Finally, spouses’ marital satisfaction (at 6 months) and appraisal of prostate cancer as a threat were predictors of spouses’ marital satisfaction. Conclusions At 6 months post-treatment, patients’ and spouses’ marital satisfaction will influence each other. However, at 12 months, patients’ marital satisfaction exerts an insignificant effect on spouses’ marital satisfaction. Moreover, patients’ serum PSA level or the negative appraisal of prostate cancer affects their marital satisfaction. Spouses’ marital satisfaction is affected by psychological distress and their negative appraisal of prostate cancer. Relevance to clinical practice The results can be used to develop interventions for prostate cancer couples. Such an intervention can be used to modify couples’ appraisal of prostate cancer by changing incorrect thinking or to ease the psychological distress to improve marital satisfaction. This article is protected by copyright. All rights reserved.

OBJECTIVES This study aimed to identify the cognitive factors associated with the professional healthcare advice (PHCA) seeking behavior in breast cancer-related lymphedema (BCRL). METHODS From January 2018 to December 2018, patients with BCRL were prospectively enrolled for a cross-sectional survey of lymphedema-related perceived risks, lymphedema quality of life (LYMQoL), knowledge scale of lymphedema, and PHCA behavior at first clinical visit, 3 and 6 months postbaseline. RESULTS A total of 180 patients including 100 (55.6%) patients underwent a vascularized lymph node transfer (VLNT) and 80 (44.4%) patients received compressive decongestive therapy (CDT) were enrolled. At 6 months of follow-up, mean episodes of cellulitis (from 2.2 to 0.2 times/year), mean circumferential difference (7.8 ± 3.9%), wearing compression garments (from 29% to 0 %) in the VLNT group were statistically reduced than those in the CDT group (p = .01

OBJECTIVES An Asian Gynecologic Oncology Group phase III randomized trial was conducted to determine whether maintenance chemotherapy could improve progression-free survival (PFS) in stages III/IV ovarian cancer. METHODS Between 2007 and 2014, 45 newly-diagnosed ovarian cancer patients were enrolled after complete remission and randomized (1:1) to arm A (4-weekly carboplatin area under the curve 4 and pegylated liposomal doxorubicin [PLD] 30 mg/m², n=24) for 6 cycles or arm B (observation, n=21). The primary end-point was PFS. A post hoc translational study was conducted to deep sequence BRCA/homologous recombination deficiency (HRD) genes, because BRCA/HRD mutations (BRCA/HRDm) are known to be associated with better prognosis. RESULTS Enrollment was slow, accrual was closed when 7+ years had passed. With a median follow-up of 88.9 months, the median PFS was significantly better in arm A (55.5 months) than arm B (9.2 months) (hazard ratio [HR]=0.40; 95% confidence interval [CI]=0.19-0.87; p=0.020), yet the median overall survival was not significantly different in arm A (not reached) than arm B (95.1 months) (p=0.148). Overall grade 3/4 adverse events were more frequent in arm A than arm B (60.9% vs 0.0%) (p

Summary Purpose Urinary catheterization is a common technique in clinical practice. There is, however, no consensus on management prior to removal of the indwelling catheter for short-term patients. This systematic review examined the necessity of clamping before removal of an indwelling urinary catheter in short-term patients. Methods A systematic literature review was conducted using eight databases and predetermined keywords-guided searches. Some 2,515 studies were evaluated. Ten studies that met the inclusion criteria were selected. Results The quality of the studies was assessed using the Jadad scoring system. Only 40.0% of studies were rated as high quality. This review found that catheter clamping prior to removal was not necessary for the short-term patient. When made a comparison with the unclamping group, there was no significant difference in recatheterization risk, risk of urine retention, patients' subjective perceptions and rate of urinary tract infection. Conclusions This review indicated that bladder training by clamping prior to removal of urinary catheters is not necessary in short-term catheter patients. In addition, clamping carries the risk of complications such as prolonging urinary catheter retention and urinary tract injury. Further investigation requires higher quality methodologies and more diverse study designs.

Published research on discharge planning is written from the perspective of hospital wards and community services. Limited research focuses on discharge planning in the emergency department (ED). The objective of this study was to identify ED nurses’ perceptions of factors influencing the implementation of discharge planning. This qualitative study collected data from 25 ED nurses through in-depth interviews and a drawing task in which participants were asked to depict on paper the implementation of discharge planning in their practice. Factors influencing discharge planning were grouped into three categories: discharge planning as a neglected issue in the ED, heavy workload, and the negative attitudes of ED patients and their families. The study highlighted a need for effective discharge planning to be counted as an essential clinical competency for ED nurses and factored into their everyday workload. Nurses perceived that organizational culture, and parents’ and relatives’ attitudes were barriers to implementing discharge teaching in the ED.

Triage classifies and prioritizes patients’ care based on the acuity of the illness in emergency departments (EDs). In Taiwan, the five-level Taiwan Triage and Acuity Scale (TTAS) computerized system was implemented nationally in 2010. The purpose of this study was to understand which factors affect decision-making practices of triage nurses in the light of the implementation of the new TTAS tool and computerized system. The qualitative data were collected by in-depth interviews. Data saturation was reached with 16 participants. Content analysis was used. The results demonstrated that the factors affecting nurses’ decision making in the light of the newly implemented computerized system sit within three main categories: external environmental, patients’ health status, and nurses’ experiences. This study suggests ensuring the patient’s privacy while attending the triage desk, improving the critical thinking of triage nurses, and strengthening the public’s understanding of the ED visits. These will make ED triage more efficient.

Questionnaires A. demographic and background information. (PDF 347 kb)

Questionnaires B. breastfeeding and baby care practices. (PDF 280 kb)

Background: Kidney transplant failures are caused primarily by lack of adherence to immunosuppressive medication regimens by patients after transplantation. A number of studies have indicated that health-related beliefs are an effective predictor of health-related behavior. Purpose: The aim of this study is to understand the influence of the personal characteristics and health-related beliefs of patients on adherence to treatment with immunosuppressive medication based on the Health Belief Model. Methods: This cross-sectional study distributed questionnaires to patients who had been recruited via purposive sampling at one medical center in Taipei. All of the potential participants had undergone kidney transplantation at least 6 months previously. The self-developed questionnaire collected data in three areas: personal characteristics, health-related beliefs regarding transplant rejection, and adherence to the immunosuppressive medication regimen. One hundred twenty-two valid questionnaires were received. The collected data were analyzed using descriptive statistics, independent t test, one-way analysis of variance, Pearson's correlation, and multiple regression. Results: Participants who had received dialysis treatment or had experienced rejection perceived susceptibility to rejection more strongly than those who had not. Participants who had undergone transplantation in Taiwan, had experienced more drug-related symptoms, or had contracted severe to extremely severe infections in the past showed lower rates of adherence to treatment with immunosuppressive medication. Adherence to medication regimens correlated negatively with length of time since transplantation. Length of time since transplantation, drug-related symptoms, perceived susceptibility to rejection, and perceived benefits of treatment were identified as major predictors of adherence to immunosuppressive medication regimens. Conclusions: The results partially conformed to the concepts of the Health Belief Model. Perceived susceptibility to rejection and perceived benefits of adherence to treatment were found to predict adherence rates. Patient education should be enhanced to reduce the risks of rejection and increase adherence rates to improve outcomes.

BACKGROUND: The investigation of hospital air quality has been conducted in wards, ICUs, operating theaters, and public areas. Few studies have assessed air quality in respiratory care centers (RCCs), especially in mechanically ventilated patients with open suctioning. METHODS: The RCC air quality indices (temperature, relative humidity, levels of CO2, total volatile organic compounds, particulate matter [PM], bacteria, and fungi) were monitored over 1 y. The air around the patient9s head was sampled during open suctioning to examine the probability of bioaerosol exposure affecting health-care workers. RESULTS: This investigation found that the levels of indoor air pollutants (CO2, PM, bacteria, and fungi) were below the indoor air quality standard set by the Taiwan Environmental Protection Agency. Meanwhile, the levels of total volatile organic compounds sometimes exceeded the indoor air quality standard, particularly in August. The identified bacterial genera included Micrococcus species, Corynebacterium species, and Staphylococcus species, and the predominant fungal genera included yeast, Aspergillus species, Scopulariopsis species, and Trichoderma species. Additionally, airborne PM2.5, PM1, and bacteria were clearly raised during open suctioning in mechanically ventilated patients. This phenomenon demonstrated that open suctioning may increase the bacterial exposure risk of health-care workers. CONCLUSIONS: RCC air quality deserves long-term monitoring and evaluation. Health-care workers must implement self-protection strategies during open suctioning to ensure their occupational health and safety in health-care settings.

We evaluated changes in psychosocial adjustment over time and its associated factors in prostate cancer patients. A total of 69 patients with prostate cancer were surveyed at pre-diagnosis, 1 month and 6 months post-treatment. The questionnaires distributed to the patients consisted of the Psychosocial Adjustment to Illness Scale and the UCLA Prostate Cancer Index. The generalized estimating equations were used to analyse the collected data. The results of adjustments to psychological distress, the domestic environment and the social environment worsened post-treatment. However, the adjustment to health-care orientation was worst at the time of pre-diagnosis and improved during post-treatment. Patients who perceived an unfavourable health status reported poor adjustment in psychological distress. Patients exhibiting poor urinary function poorly adjusted to the domestic environment. Patients with sexual dysfunction exhibited poor adjustment to the social environment. Patients with low education demonstrated poor adjustment to health-care orientation. Further studies should assess the psychosocial adjustment among prostate cancer patients and provide interventions following pre-diagnosis.

Background: Teaching Evidence-based practice (EBP) should be evaluated and guided by evidence of its own effectiveness. As educators implementing EBP training, they need instruments to evaluate the learning outcomes of trainees. For that reason, to develop a reliable and minimal time-consuming instrument is necessary. Purpose: The aim of this study was to examine the reliability and validity of an EBP evaluation instrument, the Taipei Evidence-Based Practice Questionnaire (TEBPQ). Methods: The content validity index (CVI) and Cronbach's αwere used to analyze the validity and reliability of the questionnaire. After that, a two parallel group (novice and experienced learner) study design for was designed to determine the construct validity of the instrument. Results: Taipei Evidence-Based Practice Questionnaire (TEBPQ) contained 26 self-report questions, which includes domain of ‘Ask’ (5 items), ‘Acquire’ (7 items), ‘Appraisal’ (4 items), ‘Apply’ (6 items) and ‘Attitude’ (4 items) of evidence-based practice, and learners’ basic characteristics. The overall CVI of TEBPQ was 0.9; while Cronbach's α was 0.87. The construct validity showed that all p values were significant (p

Background: The development of clinical expertise depends not only on abundant practice but also on guidance through good feedback. Clinical teachers can improve learners’ skills by providing specific, performance-based feedback. In Taiwan, evidence-based practice (EBP) education has been taught through workshops, hands-on practice and small group discussion. However, the impact of feedback in EBP is still unknown. Aim: The aim of this study was to determine the effectiveness of structured assessment stations with immediate feedback in EBP education among nurses. Methods: The study was a quasi-experimental with repeated measures. Convenience sampling was used in two university hospitals. The intervention involved four immediate feedback structured assessment stations one week after a four-hour EBP workshop. The outcomes were measured by Taipei Evidence-Based Practice Questionnaire (TEBPQ), which contains 26 self-report questions, completed three times to evaluate learning efficiency of EBP. At the end of the program, qualitative data on the learners’ feelings, perceptions, and experiences toward the training process were also collected for analysis. Results: Sixty-one of the seventy participants (87.1%; 61/70) completed the study. In this research, the mean scores of Taipei Evidence-Based Practice Questionnaire (TEBPQ) for ‘Ask’, ‘Acquire’, ‘Appraisal’, ‘Apply’, and ‘Attitude’ domains all increased significantly after the participants attended the four assessment stations with immediate feedback (all p

To identify the changes and associated factors in decisional conflict and regret in patients with localised prostate cancer up to six months postprimary treatment.Various treatments of differing qualities can be used for patients with localised prostate cancer; these treatments may cause conflicts in treatment decision-making and post-treatment regret.A quantitative longitudinal study.A total of 48 patients were recruited from a 3700-bed medical centre in northern Taiwan and assessed at pretreatment and one and six months post-treatment. Demographic characteristics, clinical information and results from the psychosocial adjustment to illness scale, decisional conflict scale and decision regret scale were collected. Data were analysed based on the generalised estimating equations models.The overall decisional conflict substantially improved over time. However, the feeling of being less informed was high and did not improve considerably during the study period. Education level, decision preferences and psychosocial adjustment were associated with decisional conflict and influenced decision-making. The feeling of ineffective decision-making and decisional regret was low, post-treatment. Psychosocial adjustment was associated with effective decision-making and decisional regret.In patients with localised prostate cancer, decisional conflict reduced considerably up to six months post-treatment. Moreover, the patients were satisfied with their treatment decision-making and believed that they had made the correct choice up to six months post-treatment. However, patients may have experienced feelings of being less informed pre- and post-treatment, particularly those with lower education levels, a preference for passive roles, or inferior psychosocial adjustment. Consequently, health professionals must provide adequate medical information and psychosocial intervention to help patients in the decision-making process.Nurses and healthcare providers must provide localised prostate cancer patients with adequate information and psychosocial intervention to reduce decisional conflict.

Clinical practice guidelines (CPGs), representing the current best-practice guidelines and recommendations for care, are supported by systematic review and evidence-based research. CPGs provide an effective and efficient approach to caring for patients and improving quality of care. Recently, the National Health Insurance Administration and National Institutes of Health developed CPGs for major diseases in Taiwan. This paper introduces the process that was used to develop one of these CPGs, the Taiwan Chronic Kidney Disease Clinical Guidelines, which was published in 2015. Further, we introduce the general development of published nursing guidelines in Taiwan. These CPGs are expected to initiate various renal-care guidelines and to promote the quality of renal care in the country.臨床診療指引的發展過程—以「台灣慢性腎臟病臨床診療指引」為例.臨床診療指引（clinical practice guidelines, CPGs），係透過系統性文獻回顧來綜整與實證相關之最佳疾病照護方式，以協助醫療團隊及病人做最適當的醫療決策，並提供具效能（effective）及效率（efficient）之照護模式，進而增進臨床照護品質。近年來，中央健康保險署與國家衛生研究院已分別針對國人常見之重大疾病出版相關之臨床指引，2015年發行之「台灣慢性腎臟病臨床診療指引」（Taiwan Chronic Kidney Disease Clinical Guidelines）即為一例。因此，本文藉簡介此臨床診療指引之重點，來說明臨床診療指引的發展過程。此外，亦介紹台灣現有之本土護理相關指引及其發展過程，期能拋磚引玉，催生腎臟護理相關指引，以提升國內腎臟照護之水準。.

Aims and objectives - The purpose of this research was to explore the medical decision-making processes of patients in emergency departments. Background - Studies indicate that patients should be given enough time to acquire relevant information and receive adequate support when they need to make medical decisions. It is difficult to satisfy these requirements in emergency situations. Limited research has addressed the topic of decision-making among emergency patients. Design - This qualitative study used a broadly defined grounded theory approach to explore decision-making in an emergency department in Taiwan. Methods - Thirty emergency patients were recruited between June and December 2011 for semi-structured interviews that were audio-taped and transcribed verbatim. Results - The study identified three stages in medical decision-making by emergency patients: predecision (interpreting the problem); decision (a balancing act) and postdecision (reclaiming the self). Transference was identified as the core category and pattern of behaviour through which patients resolved their main concerns. This transference around decision-making represents a type of bricolage. Conclusions - The findings fill a gap in knowledge about the decision-making process among emergency patients. Relevance to clinical practice - The results inform emergency professionals seeking to support patients faced with complex medical decision-making and suggest an emphasis on informed patient decision-making, advocacy, patient-centred care and in-service education of health staff.

Sleep disturbance is a major problem for older adults, calling for the development of alternative medicine techniques to help improve sleep quality in this population.The purpose of this study was to explore the effectiveness of a Baduanjin exercise program on sleep quality in Taiwanese elderly.A randomized controlled trial, longitudinal research design was employed.This study was conducted in an urban area of northern Taiwan. The inclusion criteria for participants were as follows: (1) community-dwelling older adults age 60 years or older; (2) no regular exercise within 6 months; (3) able to communicate; and (4) independent in self-care. Subjects were excluded if they had (1) depression tendency as demonstrated by the Chinese version of the Geriatric Depression Score of eight or higher; (2) impaired mobility; or (3) unstable health status. A total of 202 older people were screened for this study, 87 of whom were eligible according to the inclusion criteria. Of these, 55 completed the 12-week study.Fifty-five participants were randomly assigned to the exercise group (27) or the control group (28). Those in the exercise group received 12 weeks of Baduanjin exercise training, while those in the control group had no intervention. The Pittsburg Sleep Quality Index was administered to subjects at four time points: before the intervention, and at the 4th, 8th, and 12th week after intervention.Subjects in the Baduanjin exercise group had significantly improved overall sleep quality, subjective sleep quality, sleep latency, sleep duration, sleep efficiency, and daytime dysfunction after 12 weeks of intervention (p0.001), while those in control group showed no significant difference in sleep quality. Compared with the control group, the Baduanjin exercise group reported significantly better sleep quality after four weeks of intervention which was maintained throughout the 12-week exercise period.This study confirmed that the Baduanjin exercise program can improve sleep quality for Taiwanese community-dwelling older adults. We recommend application of this simple, gentle exercise program in older persons to improve their sleep quality.

Background Implementation of clinical practice guidelines (CPGs) can reduce medical practice variations and enhance effectiveness. In 2008, the Taiwan Department of Health delegated the development of CPGs on six health topics. By February 2010, these CPGs had been completed. Methods The Appraisal of Guidelines Research and Evaluation (AGREE) instrument was used to assess the quality of the guidelines. We organized groups to develop CPGs and called on 131 experts with various specialties. Results The average AGREE scores for the six major domains were 86% (scope and purpose), 63% (stakeholder involvement), 77% (rigor of development), 72% (clarity and presentation), 53% (applicability), and 69% (editorial independence). Conclusion We recommend the following: (1) opinions from all stakeholders, especially patients, should be considered to improve the content of the guidelines; and (2) health education resources, audit forms, and other tools should be emphasized more in the development of CPGs.

BackgroundWhen new mothers do not understand how to interact with their newborn babies, they would increase anxiety, even decrease the quality of parent-infant interactions. Previous studies indicate that the postpartum parenting education for first-time-mothers can improve the quality of mother-infant interactions in first two months. This study aimed to evaluate the long-term effectiveness of parenting education for postpartum women during the first year.MethodsThe study recruited 81 healthy first-time-mother infant dyads from the medical center in Taipei city. The experimental and control groups received extra education by way of a 40-minute videotape and normal postpartum care, respectively. Data from around first week (T1), followed by the third (T2), sixth (T3), ninth (T4), and twelfth (T5) month postpartum are collected. Assessment scales such as the Edinburgh perinatal depression scale (EPDS), the Chinese version of the parenting sense of competence scale (C-PSOC), and the Nursing child assessment teaching scale (NCATS) used for videotaped mother-infant interactions measurement were used in the study.ResultsThe analytical results show that the quality of mother-infant interaction increased at T2, T3, T4, and T5 in the experimental group (Fig. 1). No different change in maternal sense of competency was found in the experimental and control groups from T1 to T4. However, a positive change in sense of parenting competency at T5 was found in the experimental group (Fig. 2). No difference in postpartum depression was found between the two groups (Fig. 3).ConclusionsThe first-time-mothers parent education has long-term effectiveness in the mother-infant dyad interaction quality.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Aim. The aim of this study was to describe and understand the lived experience of people with lower extremity amputation. Background. The loss of a body part can cause physical, psychological and social disturbances. The majority of previous studies in this area focus on the impact of amputation or the effectiveness of rehabilitation programmes. This is the first study in Taiwan exploring the holistic experiences of persons with amputation. Design. A phenomenological research design was used. Methods. Semi-structured interviews were performed with 22 people with lower extremity amputation. Interviews were tape-recorded and transcribed verbatim. Data were analysed using Colaizzi’s phenomenological analysis method. Results. The lived experience of persons with lower extremity amputation could be categorised into the following four themes: ‘lost in the dark woods’, ‘emotional collapse’, ‘difficulty in passing through the shadow’ and ‘igniting a gleam of hope’. Conclusions. Participants described suffering in physical, psychological and sociocultural realms and the ways they strived to cope with these challenges. The findings of this study provide an enhanced understanding of the experiences of people with lower extremity amputation and underscore the importance of truly listening and responding to their concerns. The need to appreciate cultural context and to develop the peer-based support programme was highlighted. Relevance to clinical practice. Health professionals need to acknowledge the real needs of people with lower extremity amputation and provide them a clear explanation regarding the short-term and long-term health issues associated with amputation during the pre- and post-amputation phase. Health professionals also need to expand the scope of services beyond a physical and prosthetic focus. Supportive psychological and social interventions such as formal support groups and peer support programmes may provide a powerful and inexpensive addition to routine care. Currently, such programmes are unavailable in Taiwan.

Background. Laparoscopic donor nephrectomy (LDN) has become the method of choice for living-donor kidney transplantation. However, LDN may result in decreased renal function in the donor, and risk of end-stage renal failure has been reported. Objective. To evaluate changes in renal function after LDN. Patients and Methods. The study included 51 living donors of renal transplants between March 2002 and December 2008. Before kidney donation, we computed the initial function of the kidney preserved in the donor using 24-hour creatinine clearance (Ccr) and functional ratio as revealed at technetium 99m dimercaptosuccinic acid renal scanning. After kidney donation, serum creatinine concentration (sCr) and Ccr were calculated on postoperative day 2 and every 3 months thereafter. Results. After LDN, mean sCr increased immediately, from 0.90 to 1.31, as did Ccr of the kidney preserved in the donor, from 58.2 to 79.6, a 36.9% increase. A greater percent increase in function was observed in younger donors and those with lower initial Ccr of the preserved kidney. Although 9.8% of donors demonstrated slightly decreased renal function of the preserved kidney at last follow-up, renal function was adequately preserved in most donors. Conclusion. Younger donors and those with lower initial function of the preserved kidney before nephrectomy demonstrate a greater increase in function after nephrectomy. Age might be a risk factor for decreased renal function after LDN. Older potential living donors may need more careful evaluation before kidney donation.

Needle-protective devices have been investigated for decades for preventing health-care workers from infecting blood-borne pathogens. This initial evaluation of a new safety needle system in a disposable conventional syringe (new safety syringe) in a clinical setting was to see how nurses view its safety, usability and compatibility. A convenient sample of 205 nurses was involved and completed a user evaluation questionnaire. The results showed 163 nurses (88.1%) would use the safety syringes if the hospital provided safety syringes. Over 50% agreed that the new device was able to maintain the sterile principles and was easy to operate. Less than 25% disagreed that the new device ‘does not spend more work time’ and ‘does not affect the standard procedure while changing needle’. Positive attitude towards the new device associated with higher ‘job position’ and more ‘work experience’. Further evaluation of reducing incidence of needle-stick injuries is required.

The aim of the present study was to scrutinize the evidence on the use of acupoint stimulation for managing therapy-related adverse events in breast cancer. A comprehensive search was conducted on eight English and Chinese databases to identify clinical trials designed to examine the efficacy of acupressure, acupuncture, or acupoint stimulation (APS) for the management of adverse events due to treatments of breast cancer. Methodological quality of the trials was assessed using a modified Jadad scale. Using pre-determined keywords, 843 possibly relevant titles were identified. Eventually 26 papers, 18 in English and eight in Chinese, satisfied the inclusion criteria and entered the quality assessment stage. The 26 articles were published between 1999 and 2008. They assessed the application of acupoint stimulation on six disparate conditions related to anticancer therapies including vasomotor syndrome, chemotherapy-induced nausea and vomiting, lymphedema, post-operation pain, aromatase inhibitors-related joint pain and leukopenia. Modalities of acupoint stimulation used included traditional acupuncture, acupressure, electroacupuncture, and the use of magnetic device on acupuncture points. Overall, 23 trials (88%) reported positive outcomes on at least one of the conditions examined. However, only nine trials (35%) were of high quality; they had a modified Jadad score of 3 or above. Three high quality trials revealed that acupoint stimulation on P6 (NeiGuang) was beneficial to chemotherapy-induced nausea and vomiting. For other adverse events, the quality of many of the trials identified was poor; no conclusive remarks can be made. Very few minor adverse events were observed, and only in five trials. APS, in particular acupressure on the P6 acupoint, appears beneficial in the management of chemotherapy-induced nausea and vomiting, especially in the acute phase. More well-designed trials using rigorous methodology are required to evaluate the effectiveness of acupoint stimulation interventions on managing other distress symptoms.

This study investigates the transient temperature response in biological tissue immersed in warm and cold water alternately with a sinusoidal temperature oscillation on the skin surface to simulate the contrast therapy which uses alternatively heat and cold modalities in subacute and chronic conditions. In addition, this type of analysis is also applied to assessing the blood perfusion rate in the skin through noninvasive technology by imposing a periodic temperature load onto the skin surface and then measuring the phase shift of the resulting surface heat flux. Based on the Pennes bio-heat transfer equation, the Laplace transform is used to derive an exact solution to the temperature variation in the tissue from the initial oscillation to the final steady periodic oscillation. Furthermore, the solutions to special cases under no perfusion rate, constant temperature, and the combination of these two assumptions are demonstrated in this study. The results show that both a larger perfusion rate and a greater tissue depth decrease the amplitude of the sinusoidal temperature response. Meanwhile, a larger perfusion rate can reduce the phase angle related to the sinusoidal surface temperature oscillation and surface heat flux.