Medical Center In Southern Taiwan Research Articles

Willingness of intensive care unit patients’ family members to donate organs: A cross-sectional study

The large gap between the demand for, and the supply of organs worldwide makes promoting organ donation an important global social issue. Even after someone has signed a consent form or registered for organ donation, ethically, the hospital still requires a family member's written permission before organ donation can proceed. As a result, a family member rather than the patient makes the final decision. This study investigated the willingness of the family members of hypothetical patients in intensive care units (ICUs) suffering from an irreversible condition to sign an organ donation consent form. A cross-sectional survey was conducted among family members of ICU patients recruited from one medical center in southern Taiwan from April to October 2014, which followed the STROBE guidelines. Of 110 ICU family members, 71 (64.5%) were willing to donate the organs of hypothetical patients with irreversible conditions. Based on logistic regression, family support, attitude, and knowledge of organ donation significantly predicted 34% of the variance in willingness to sign consent. Attitude toward organ donation and behavioral knowledge of organ donation correlated significantly with a willingness to sign a consent form. This study found that family support and organ donation attitudes were important factors in predicting the willingness to sign a consent form for the organ donation of hypothetical patients. The study provides evidence that nurses and healthcare staff need to consider family support and educate families on organ donation to encourage potential donors to accept and agree to organ donation.

Opioid-Sparing Analgesic Effects from Interscalene Block Impact Anesthetic Management During Shoulder Arthroscopy: A Retrospective Observational Study.

Ultrasound-guided interscalene nerve block (UISB) is commonly used to alleviate postoperative pain during shoulder arthroscopy. This retrospective observational study aimed to evaluate the intraoperative advantages and analgesic effects of preoperative UISB. In this retrospective observational study, a total of 170 patients underwent shoulder arthroscopy at a tertiary medical center in southern Taiwan throughout 2019. After applying the exclusion criteria, 142 of these cases were included, with 74 and 68 in the UISB group and control groups, respectively. The primary outcome was the evaluation of intraoperative morphine milligram equivalent (MME) consumption. Secondary outcomes were sevoflurane consumption, the use of intraoperative antihypertensive drugs, and postoperative visual analog scale (VAS) scores in the post-anesthesia care unit (PACU) and in the ward at 24 h after surgery. Preoperative UISB effectively reduced opioids and volatile gases during surgery, supported by a 48.1% and 14.8% reduction in the median intraoperative MME and sevoflurane concentrations, respectively, and showed less need for antihypertensive drugs. The preoperative UISB group also showed significantly better performance on the VAS in both the PACU and ward. Taken together, the preoperative UISB reduced not only intraoperative MME and sevoflurane consumption but also had satisfactory VAS scores in both the PACU and ward without any symptomatic respiratory complications. In summary, preoperative UISB is a reliable adjuvant analgesic technique and a key factor in achieving opioid-sparing and sevoflurane-sparing anesthesia and multimodal analgesia during shoulder arthroscopy.

Using Healthcare Complaints Analysis Tool to Evaluate Patient Complaints during the COVID-19 Pandemic at a Medical Center in Taiwan.

The purpose of this study is to evaluate patient complaints using the Healthcare Complaints Analysis Tool (HCAT) during the COVID-19 pandemic in 2021 in Taiwan. Additionally, the study examines the distribution and type of patient complaints before and during the COVID-19 pandemic to provide a better clinical procedure, hospital management and patient relationship. This study utilizes a cross-sectional design. We collected patient complaints from January 2021 to December 2021 at a medical center in Southern Taiwan. Using the Healthcare Complaints Analysis Tool (HCAT), the patient complaints are classified and coded into three major domains (clinical, management and relationship), and seven problem categories (quality, safety, environment, institutional process, respect and patient rights, listening and communication). We further compared and categorized the complaints based on whether they were COVID-19-related or not and whether it was before or during the COVID-19 pandemic to understand the differences in patient complaints. In total, we collected 584 events of patient complaints. Based on the HCAT domains, the complaints about management were the highest, at 52.9%, followed by complaints about relationship, about 37.7%. According to the types of problem, the complaints about the environment were the highest, about 32.5% (190/584), followed by communication at about 29.6% (173/584), and institutional process at about 20.4% (119/584). There were 178 COVID-19-related complaints and they were made more frequently during Q3 and Q4 (from mid-June to December) which was the pandemic period in 2021 in Taiwan. Among the COVID-19-related complaints, the most frequent were in the environment domain with 114 cases (about 65.7% of COVID-19-related complaints). The domains of patient complaints were statistically different between COVID-19-related and non-related (p < 0.001). During the COVID-19 pandemic, the proportion of COVID-19-related complaints increased 1.67 times (117/312 vs. 61/272, p < 0.001). Both prior to and during the COVID-19 pandemic, management-related complaints represented the highest domain. During the COVID-19 pandemic, the implementation of infectious disease prevention and control policies and actions may have developed some inconvenience and difficulty in seeking medical practice and process. These characteristics (complaints) are more prominent, and timely and patient-first consideration is required immediately to build up better clinical procedures, the healthcare environment and comprehensive communication. Using the HCAT can allow health centers or health practitioners to understand the needs and demands of patients through complaints, provide friendly medical and health services, avoid unequal information transmission, build trust in doctor−patient relationships and improve patients’ safety.

A Correlational Study of Leadership Styles and Nurses' Morale and Intention to Stay

The leadership style of head nurses affects the organizational atmosphere of nursing teams. The aim of this study was to analyze the correlation between head nurse leadership styles and nurses' morale and intention to stay, as well as the explained variance for each. The descriptive correlational design employed in this study used a convenience sample of 790 nursing staff working at a medical center in southern Taiwan. We cross-sectionally surveyed each participant's intention to stay, morale, and perception of their head nurse's leadership style. The participants perceived their head nurses as having both transformational and transactional leadership styles. A moderate to highly positive correlation was identified among leadership style, morale, and intention to stay. One-way analyses of variance found that the participants who were seniors, were married, had children, were at clinical ladder N3 or above, had rotation experience, and held a public servant position had relatively higher morale and intention to stay. After controlling for potentially confounding factors, hierarchical regression analyses revealed that the explained variance of leadership styles on intention to stay and morale was 22% and 28%, respectively. Transformational leadership was found to significantly predict intention to stay and morale. However, transactional leadership significantly impacted morale only, albeit at a lower level than transformational leadership. How nurses perceive the leadership style of their head nurses may affect their intention to stay and morale while at work. Advanced training to strengthen and internalize leadership styles for head nurses is suggested. Creating a positive and friendly working environment is conducive to improving the morale of nurses and retention rates in the nursing workplace.

Relationships Among Trajectories of Sleep Disturbance, Depression, and Antiretroviral Therapy in Persons Newly Diagnosed with HIV: A One-and-a-Half-Year Observational Longitudinal Study.

Sleep disturbance is one of the most prevalent symptoms among persons living with HIV (PLWH). However, the trajectory of sleep patterns in persons newly diagnosed with HIV remains underrecognized. The current study aimed to estimate the trajectory of sleep quality and its associated factors among newly diagnosed PLWH. A prospective study was conducted in the outpatient clinic of a medical center in southern Taiwan from January 2015 to December 2017. Our primary outcome was sleep quality using the Chinese version of the Pittsburgh Sleep Quality Index (CPSQI). Participants completed the questionnaire at baseline and at four follow-up interval visits: at 3-6, 6-9, 9-12 and 12-15 months. A generalized equation estimation (GEE) model was applied to analyze the relationships among poor sleep quality, depression and antiretroviral therapy among persons newly diagnosed with HIV. A total of 217 PLWH were included. The mean age of the sample was 29.3 years, and males (98.6%) were predominant. A total of 56.2% of HIV-infected persons were considered to have poor sleep quality at baseline. After controlling for the confounding effects of demographic characteristics, the following factors increased the risk of poor sleep quality: older age (ß= 0.07, CI: 0.03-0.11, p=0.001), level of depression (ß= 0.32, CI: 0.27-0.37, p<0.001) and detectable viral load (ß= 0.61, CI: 0.04 - 1.18, p= 0.037). However, there was no significant difference in BMI, CD4 counts, HIV viral load, disclosure status, or highly active antiretroviral therapy (HAART) regimen. Our results demonstrate that one in two persons with newly diagnosed HIV had poor sleep quality. Being older, having higher levels of depression, and having detectable HIV viral loads were identified as risk factors for developing poor sleep quality in persons living with HIV.

Peptic Ulcer Disease Associated with Central Obesity.

This retrospective cross-sectional study aimed to evaluate associations between peptic ulcer disease (PUD), bone mineral density, and metabolic syndrome (MetS) and its components in healthy populations. Data were collected from the health examination database of a tertiary medical center in southern Taiwan from January 2015 to December 2016. Subjects who had undergone metabolic factors assessment, upper gastrointestinal endoscopy, and dual energy X-ray absorptiometry scans were enrolled. In total, 5102 subjects were included, with mean age 52.4 ± 12.0 years. Among them, 1332 (26.1%) had PUD. Multivariate logistic regression analysis showed that age (OR 1.03, p &lt; 0.001), male (OR 1.89, p &lt; 0.001), diabetes (OR 1.23, p = 0.004), BMI (OR 1.03, p = 0.001), and GOT (OR 1, p = 0.003) are risk factors for PUD. Regarding MetS parameters, larger waist circumference (OR 1.26, p = 0.001) is associated with PUD, and high triglycerides (OR 1.20, 95% CI 1.01-1.43) is associated with gastric ulcer, while low HDL (OR 1.31, 95% CI 1.07-1.59) and osteoporosis (OR 1.44, 95% CI 1.08-1.91) are associated with duodenal ulcer. In conclusion, central obesity is associated with PUD in a middle-aged healthy population. Subjects with high triglycerides are prone to gastric ulcers, and those with osteoporosis and low HDL are prone to duodenal ulcers.

Cumulative risk assessment of phthalates exposure for recurrent pregnancy loss in reproductive-aged women population using multiple hazard indices approaches

Background and aim: Phthalates, which are commonly used in flexible plastics and consumer products, have been reported to be toxic to reproductive and developmental function in mammals. Past studies have focused on the toxic effects on male reproduction, with only a few studies conducted on the risks that cumulative exposure to phthalates have on the female reproductive system. Methods: We recruited 260 patients with recurrent pregnancy loss (RPL) of unknown etiology and 203 controls from the clinics of Obstetrics and Gynecology at a medical center in southern Taiwan from 2013 to 2020. The daily intake of phthalates was estimated from urine samples using the back-calculation method, after which the cumulative risk was determined using multiple hazard indices, including a dose-addition model, a receptor effect model, and a hazard index approach. Results: The patients with RPL had a significantly higher cumulative exposure to phthalates (p &amp;#x3c; 0.05) than did the controls with a hazard index above one. After adjusted logistic regression analysis, we found that the risk of RPL was strongly related to the higher quartiles of DEHP, the DEHPTEQ for the antiandrogenic effect and adverse effects of the female reproductive system and the ERα binding effect (p &amp;#x3c; 0.05). Conclusions: Our work suggests that more attentions should be paid to the adverse effects induced by phthalates on female reproduction, especially the effects caused by the cumulative exposure to phthalates in women of reproductive age. Keywords: Phthalates; Cumulative risk assessment; Relative potency factor; Recurrent pregnancy loss

Hospital-Based Case Management Model for Child Protection Teams in Taiwan: An Action Research Approach.

Hospital-based child protection teams play an important role in the multidisciplinary assessment, treatment, care, and rehabilitation of abused children and their families. However, the process by which these teams are built and promoted has not been explored adequately in the literature. This study was developed to examine the process used to promote child protection team case management and to evaluate the related results. An action research model was adopted in this study. The participants and the investigator were members of a child protection team at a medical center in southern Taiwan. Qualitative and quantitative assessments were used to identify problems related to organizational structure, intervention procedures, and evaluation effectiveness. Thereafter, the study program was implemented, and the results were evaluated. Content analysis of the qualitative data, including transcribed interviews with external benchmark members and members of the hospital's team and text entries from the investigator's reflective journal, was conducted. Quantitative data, including monitoring indicators for team case management, were analyzed using descriptive statistics. Three important concepts emerged related to changes in the promotion of case management by hospital child protection teams. These included formulation of a team operation model through visits to benchmark hospitals, establishment of the case management and monitoring mechanism based on team consensus, and expansion of collaboration with external agencies through the establishment of a child and adolescent protection medical regional integration center. The results of the promotion process were affected by factors that included member willingness, teamwork, hospital support, and national policy. Use of the hospital child protection team case management model developed in this study was shown to facilitate the provision of consultation services, integrate the opinions and resources of experts from various fields, and allow the timely provision of acute care, follow-up family environment support, and social resources required by children and their family members. These measures help prevent the reoccurrence of child abuse and enable children to grow up healthily and free from violence.

Analgesic and Anesthetic Efficacy of Rocuronium/Sugammadex in Otorhinolaryngologic Surgery: A Propensity Score-Matched Analysis.

The use of rocuronium/sugammadex in otorhinolaryngologic surgery improves intubation conditions and surgical rating scales. This study primarily aimed to evaluate the effect of the combination of rocuronium and sugammadex on intraoperative anesthetic consumption. The secondary outcomes were the intraoperative and postoperative morphine milligram equivalent (MME) consumption, duration of intraoperative hypertension, extubation time, incidence of delayed extubation and postoperative nausea and vomiting, pain score, and length of stay. A total of 2848 patients underwent otorhinolaryngologic surgery at a tertiary medical center in southern Taiwan. After applying the exclusion criteria, 2648 of these cases were included, with 167 and 2481 in the rocuronium/sugammadex and cisatracurium/neostigmine groups, respectively. To reduce potential bias, 119 patients in each group were matched by propensity scores for sex, age, body weight, and type of surgery. We found that the rocuronium/sugammadex group was associated with significant preservation of the intraoperative sevoflurane and MME consumption, with reductions of 14.2% (p = 0.009) and 11.8% (p = 0.035), respectively. The use of the combination of rocuronium and sugammadex also significantly increased the dose of intraoperative labetalol (p = 0.002), although there was no significant difference in intraoperative hypertensive events between both groups. In conclusion, our results may encourage the use of the combination of rocuronium and sugammadex as part of volatile-sparing and opioid-sparing anesthesia in otorhinolaryngologic surgery.

Factors Associated with Colorectal Polyps in Middle-Aged and Elderly Populations.

Colorectal polyps are the precursor lesions of most colorectal cancers. This study aimed to evaluate associations between bone mineral density (BMD), metabolic syndrome (MetS), and gastrointestinal diseases with colorectal polyps in middle-aged and elderly populations. A retrospective cross-sectional study was performed using data from the health examination database of a tertiary medical center in southern Taiwan in 2015. Subjects aged 50 years and older who had been assessed for metabolic factors and had undergone colonoscopy, upper gastrointestinal endoscopy, and dual energy X-ray absorptiometry scan (DEXA) were included. Factors associated with colorectal polyps were evaluated using univariate and multivariate logistic regression. In total, 1515 subjects were included, with mean age 60.1 years. Among them, 710 (46.9%) had colorectal polyps. Multivariate logistic regression analysis showed that high fasting glucose (OR = 1.08, p = 0.001), high triglycerides (OR = 1.02, p = 0.008), high total cholesterol (OR = 1.004, p = 0.009), reflux esophagitis (OR = 1.44, p = 0.002), duodenal polyps (OR = 1.75, p = 0.026), gastric ulcer (OR = 1.38, p = 0.024), duodenal ulcers (OR = 1.45, p = 0.028), osteopenia (OR = 1.48, p = 0.001), and MetS (OR = 1.46, p < 0.001) were independently associated with colorectal polyps. In conclusion, hyperglycemia, hypercholesterolemia, hypertriglyceridemia, MetS, duodenal polyps, gastric and duodenal ulcers, reflux esophagitis, and low BMD are independent risk factors associated with colorectal polyps in the middle-aged and elderly Taiwanese population.

Healthcare professionals’ encountering Experience of the Youths with Non-suicidal Self-injury in Acute Psychiatric Ward

Introduction Non-suicidal Self-Injury (NSSI) refers to causing damage on body tissue without attending to death. It is mostly presented among the youths and not approved by the society. Studies nowadays have explored the perspectives, feelings or experience of the youths or healthcare professionals. However, negative feelings and misunderstandings toward each other remain from both sides.ObjectivesThe aim was to explore the encountering experience of the youths with NSSI and the healthcare professionals during the same hospitalization in a psychiatric acute ward.MethodsQualitative study was employed by using narrative approach. In-depth interview was conducted for the youths with NSSI and their primary nurse and resident from a medical center in southern Taiwan.Results Narratives from the patients and healthcare professionals showed that the youths seemed to be comfortable as encountering with the healthcare professionals’ caring. In contrast, the healthcare professionals’ struggles had been hidden inside and remained uneasy and unsolved. Two extreme experiences have been reported by the youths with NSSI: felt satisfied and understood about being cared vs. felt numbness and not been understood. Four kinds of experience were identified as: struggling on caring them, feeling confused and helpless, keeping a safe distance, and having contradicted values.Conclusions This study found that the healthcare professionals suffer from varied aspects when encountering the youths with NSSI, which they often hid inside without expressing. Future improvement such as care guideline or staff’s support system should be built to decrease the negative effects inside the healthcare professionals’ mind.DisclosureNo significant relationships.

Analysis of adult dental emergencies at a medical center in southern Taiwan

Background/purposeThe need for dental emergency (DE) services has increased in recent years. This study therefore investigated the characteristics of patients presenting with DEs in a medical center in southern Taiwan. Materials and methodsThis was a retrospective study of 1964 adult patients who presented with a DE at the Kaohsiung Medical University Hospital in 2018. Medical records providing age, sex, time, day, past visit history, chief complaint, diagnosis, and treatment were collected and analyzed. ResultsThe results revealed that men constituted 52.4% of the patients with DEs, the average age was 45.6 years, and the age distribution peak was 20–29 years (26.5%). The peak period for the DE visit was between 17:00 and 24:00 (42.1%), and the peak day of the week was Sunday (27.4%), followed by Saturday (18.0%). The most common chief complaint was pain (49.8%), and the diagnoses were as follows: pulp-related problems (36.7%), periodontal-related problems (22.9%), trauma (22.2%), odontogenic infection (15.3%), postoperative complications (9.2%), and temporomandibular disorders (3.7%). Dental treatment and medication were prescribed for 51.9% of the patients with DE. The rate of patients recommended for further dental treatment was 86.8%, and the actual return rate was 40.1%. ConclusionThis study revealed that the top three reasons for adult DE visits were pulp-related problems, periodontal-related problems, and trauma. These results may be used as a reference for dentists who provide DE services.

A Study on Job Satisfaction of Clinical Nurses: Using a Medical Center in Southern Taiwan as an Example

Abstract The purpose of this study is to explore the correlation and influencing factors of job satisfaction among nurses. This study is a cross-sectional correlation study, in which convenience sampling is adopted and the subjects are clinical nurses serving in a medical center in Taiwan. This study was conducted by census, in which a total of 750 questionnaires were issued, with the effective recovery rate 79.5%. The structured questionnaire was adopted, with the contents including personal basic data sheet and job satisfaction scale. The obtained data were analyzed by t-test, oneway ANOVA, Scheffe’s post-hoc test, and Pearson’s product-moment correlation. It is found in the results of the study that the average score of job satisfaction among clinical nurses is 72.3 (out of 100, with a score range of 34 to 100). In terms of influencing factors of job satisfaction, having children or not, marital status, position, and service unit are significantly correlated with “inner satisfaction,” “external satisfaction,” and “overall satisfaction.” Based on the results of the study, the researchers made relevant recommendations for nursing administrators and future research. JEL classification numbers: C83, M15, O3. Keywords: Clinical nurses, Job satisfaction.

A Culture-Based Strategy Is More Cost Effective Than an Empiric Therapy Strategy in Managing Pediatric Helicobacter pylori Infection.

BackgroundHelicobacter pylori infection is a major cause of peptic ulcers and gastric cancer. This study aimed to compare the eradication rate and essential costs of culture-based and empiric therapy strategies in treating pediatric H. pylori infection.MethodsWe retrospectively enrolled patients aged <18 years with a diagnosis of H. pylori infection who received esophagogastroduodenoscopy at two medical centers in southern Taiwan from 1998 to 2018. Patients with positive cultures and minimum inhibitory concentration test results were allocated to a culture-based strategy, and those with negative cultures or without culture as an empiric therapy strategy. We collected demographic data and eradication rates, and calculated the total essential costs of treating a hypothetical cohort of 1,000 pediatric patients based on the two strategies.ResultsNinety-six patients were enrolled, of whom 55 received a culture-based strategy and 41 received an empiric therapy strategy. The eradication rates with the first treatment were 89.1 and 75.6% in the culture-based and empiric therapy strategy, respectively. There were no significant differences in age, sex, and endoscopic diagnosis between the two strategies. For every 10% increase in those receiving a culture-based strategy, the total cost would have been reduced by US$466 in a hypothetical cohort of 1,000 patients. For every 10% increase in successful eradication rate, the total cost was reduced by US$24,058 with a culture-based strategy and by US$20,241 with an empiric therapy strategy.ConclusionsA culture-based strategy was more cost effective than an empiric therapy strategy in treating pediatric H. pylori-infected patients.

Causes for Unplanned Readmission to the Intensive Care Unit among Patients Receiving Intestinal Surgery

&lt;p&gt;目的：分析消化道手術重症病人非預期重返加護病房在病人本身、加護病房轉出前及轉出後之成因。&lt;/p&gt; &lt;p&gt;材料與方法：研究收集南部某準醫學中心外科加護病房於2018至2019年接受消化道手術後入住外科加護病房重症病人之個人及住院過程相關資訊，進行統計分析。&lt;/p&gt; &lt;p&gt;結果：共收集545位病人，其中有42位發生非預期重返加護病房事件。轉出至普通病房後，格拉斯哥昏迷指數(Glasgow Coma Scale, GCS)≦14分、使用高流量氧氣設備、呼吸道清除功能失效、無法早期活動及無家屬陪病的病人有較高的比例發生非預期性重返事件。&lt;/p&gt; &lt;p&gt;結論：消化道手術重症病人轉出加護病房後，須注意意識、呼吸、活動狀態及家屬照護功能，有助於降低非預期重返加護病房的比例。&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;&lt;p&gt;Objective: Analyzing causes for the unplanned readmission to the intensive care unit (ICU) in critically-ill patients receiving gastrointestinal surgery, and categorizing the causes into ones that lie in the patients themselves, events before being discharged from the ICU, and events after being discharged from the ICU.&lt;/p&gt; &lt;p&gt;Materials and Methods: The demographic and hospitalization-related data of patients in the surgical ICU of a medical center in southern Taiwan between 2018 and 2019 were collected for statistical analysis. The inclusion criterium was patients who were readmitted into the ICU after receiving gastrointestinal surgery.&lt;/p&gt; &lt;p&gt;Results: The data of 545 patients were collected. Among these patients, 42 experienced unplanned readmission to the ICU. After being transferred from the ICU into general wards, patients who had a Glasgow Coma Scale score of &amp;le; 14, required the use of high-flow oxygen devices, developed ineffective airway clearance, were incapable of early postoperative mobilization, and lacked family accompaniment were found to experience unplanned readmission to the ICU in a relatively higher percentage.&lt;/p&gt; &lt;p&gt;Conclusion: To reduce unplanned readmission to the ICU, after critically-ill patients receiving gastrointestinal surgery are transferred from ICUs to general wards, medical personnel shall pay attention to the patients’ consciousness, breath, mobility, and family accompaniment.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Self-Perceived Long-Term Care Competency and Its Related Factors Among Nurses Working in cute Care Facilities

In response to the promotion of long-term care policies, nurses in hospitals must not only have professional knowledge related to disease care but also be equipped with care competencies related to long-term care. The purpose of this study was to explore the self-perceived competencies of nurses working in acute care facilities with regard to long-term-care and related factors. A cross-sectional research design with quota sampling was used. The participants were recruited from registered nurses employed at a medical center in southern Taiwan, and data from 159 valid, returned questionnaires were used in the analysis. The research instruments used included the long-term care competency scale and long-term care-related knowledge, and care intention. T test, Chi-square, ANOVA, and Pearson correlation coefficient were used to examine the relationship between the targeted variables and long-term care competency. Regression analysis was used to determine the important determinants of long-term care competency. The average age of the participants was 30.86 years (± 3.38). Most currently worked in the internal medicine department, 93.1% were educated to the university level, 44% had worked for fewer than 5 years, and 32.7% were N3 level nurses. Long-term care competency was found to be significantly and positively correlated with gender (t = 2.06, p = .041), seniority at the facility (F = 2.49, p = .046), job satisfaction (r = .28, p < .001), and long-term care service practices (r = .227, p < .001). After the regression analysis, self-perceived long-term care competency was found to be positively related to job satisfaction and long-term care service practices. The results of this study suggest that a long-term care training should be incorporated into the regular in-service education program to improve the knowledge and attitudes of nurses with regard to older and disabled patients and to develop their professional role in long-term care. Furthermore, the results may be referenced by nursing supervisors in acute care facilities when making arrangements for nurses to participation in the Clinical Nursing Ladder Program and when arranging nursing staff training and setting the direction of long-term care-related education and training in healthcare facilities.

Association between Chronic Disease Self-Management, Health Status, and Quality of Life in Older Taiwanese Adults with Chronic Illnesses.

Aging is accompanied by many chronic comorbidities and disabilities, and entails medical expenses, which affects the quality of life among older adults. The purpose of this study was to investigate whether the health status of older adults with chronic diseases mediates chronic disease self-management to predict quality of life. Methods: This research adopted a cross-sectional correlation study design. Convenient sampling was performed in outpatient departments commonly visited by older adults in a medical center in Southern Taiwan. The following measures were collected: (1) Physiological measurement: left handgrip, right handgrip, and lower extremities’ muscle strength. (2) Questionnaires: cognitive function was measured by the Alzheimer’s disease (AD)-8 scale, possible frailty with the Kihon Checklist (KCL), functional status with the Barthel Index (BI) and the Lawton and Brody Instrumental Activities of Daily Living (IADL) scales, and self-management for chronic disease and quality of life with the (WHOQOL)-BREF, Taiwan version. Results: Chronic disease self-management is correlated with health status and is directly related to quality of life. Chronic disease self-management also indirectly affects quality of life through health status (cognitive status and risk of frailty), showing that health status partly mediates the correlation between chronic disease self-management and quality of life. Conclusions: A health status feedback system should be introduced in related chronic disease self-management measures for older adults so that they can be aware of their own health status and so that their quality of life is improved. Custom-made nursing interventions are necessary for the reduction in or delay of disability or risk of frailty in older adults, thereby enhancing their quality of life.

Orbital Apex Syndrome: A Case Series in a Tertiary Medical Center in Southern Taiwan.

BackgroundOrbital apex syndrome (OAS) is a rare ocular complication following by infection, inflammation, trauma, neoplasms, and vascularity. The epidemiological features of OAS remained limited, so this study aimed to present ophthalmic clinical features, determine the causes to evaluate the visual prognosis of orbital apex syndrome (OAS) patients in Taiwan.MethodsThis was a retrospective study by reviewing the electronic medical records from National Cheng Kung University Hospital in Taiwan during 2017–2019. We included patients diagnosed with OAS to review their ocular symptoms and signs, visual acuity, ocular images, etiologies, treatment and visual prognosis.ResultsTwenty cases (mean age: 65.55 ± 13.06; male: 75%) with the diagnosis of OAS were included in this study. All patients presented as unilateral involvement, but the initial ocular presentations and etiologies varied. For example, blurred vision was reported in 80% of these patients, and tumor-related compression (55%) and infection (15%) were the most frequent causes for the OAS. After the follow-up, we found 35% of patients' visions declined or worsened to the blindness, 15% of patients' visions remained stable, 20% of patients' visions had mild improvement, and 35% of patients' visions were not measured because of debilitating clinical condition. We identified three OAS patients with mortality (15%), and all of them were attributed to the underlying malignancies.ConclusionThe clinical magnifications and etiologies of OAS are heterogeneous in Taiwan. Our findings indicated the tumor-related compression is the most frequent causes of OAS in Taiwan, and it is also related to poor clinical outcomes.

Prognostic Role of Subsequent Thrombocytopenia in Necrotizing Fasciitis Without Liver Disease.

Necrotizing fasciitis (NF) is a life-threatening disease with a fulminant presentation. Although early diagnosis can be aided by combining physical examination, the Laboratory Risk Indicator for Necrotizing Fasciitis score, and computed tomography, a mortality rate of 30% is still reported. In the modern times, an economical and efficient biomarker for predicting mortality in NF patients is still lacking. Platelet count is typically measured in routine blood tests and aids in predicting disease severity. We aimed to clarify the role of platelet count as a predictive factor for aspects of prognosis, such as mortality and surgical outcomes, in patients with NF. We identified 285 patients with NF between 2018 and 2020 in a single medical center in southern Taiwan. Medical records were collected for the evaluation of patients with thrombocytopenia. Univariate and multivariate analyses were performed for different outcomes. We included 115 patients with confirmed diagnoses of NF. Twelve patients died with a mortality rate of 10.4%. Patients with thrombocytopenia exhibited a higher mortality rate (20.9% vs 4.2%, P = 0.006), more shock episodes (51.2% vs 11.1%, P < 0.001), higher intensive care unit admission rate (46.5% vs 13.9%, P < 0.001), and longer hospital length of stay (37.49 ± 24.12 days vs 28.82 ± 14.63 days, P = 0.037) than those without thrombocytopenia. All patients infected with Vibrio species exhibited thrombocytopenia. In multivariate analysis, independent risk factors for mortality were thrombocytopenia (odds ratio, 4.57; 95% confidence interval, 1.08-19.25) and single gram-negative bacterial culture from the wound (odds ratio 6.88; 95% confidence interval, 1.58-29.96). In patients with NF and subsequent thrombocytopenia, a higher mortality rate, greater numbers of shock episodes, higher demand for intensive care unit, and longer hospital length of stay were observed than in those without thrombocytopenia. In patients with NF, platelet count is a valuable and economic indicator of prognosis. Once thrombocytopenia developed in patients with necrotizing fasciitis, aggressive antibiotic treatment and surgical management are required to improve the chances of recovery.

Psychometric Testing of the Newly Developed Competence Scale for Clinical Nurses.

Nursing competence is an essential element in ensuring high-quality nursing care and positive patient outcomes. Valid and reliable assessment tools for assessing nurse competence are needed to help nurse supervisors measure whether nurses are performing their job well and to provide a baseline for improving the competences of nurses. This study was designed to develop and psychometrically validate the Competence Scale for Clinical Nurses (CSCN). The CSCN was developed in three steps: (a) generalize assessment items from nursing competence-related scales and a review of the relevant literature, (b) determine the content validity of the developed scale, and (c) psychometrically test the developed scale. Five hundred nurses were recruited from a medical center in southern Taiwan. Exploratory and confirmatory factor analyses were executed to analyze construct validity and internal consistency reliability. The scale-content validity index was .87, as determined by five experts. Two thirds (63.29%) of the variance was explained by three factors: basic care skills (nine items), being dedicated to work (five items), and patient-centered and ethical considerations (four items). A second-order confirmatory factor analysis indicated that the data fit the model well. The Cronbach's alpha coefficients for each of the three factors and the total scale were .84-.91. The 18-item CSCN is a feasible and time-efficient tool for assessing competence in clinical nurses. Nursing supervisors may use this tool to explore nurses' competency and routinely track the effect of continuing education on competence. Continuous evaluation of nurses' clinical-based competence using the CSCN is recommended.