Medical Center In Taipei Research Articles

Sexual dysfunction predicts depressive symptoms during the first 2 years postpartum

BackgroundThe association between sexual function and depression has yet to be examined in a prospective cohort study with prolonged postpartum follow-up. AimWe investigated whether sexual dysfunction predicted depressive symptoms during the 24-month postpartum period and examined the influence of obstetric factors. MethodsThis prospective 2-year cohort study with repeated measures included 196 participants who were recruited in a medical center in Taipei, Taiwan (2010–2011). Data on participants’ personal characteristics, sexual function, and depression symptoms at 4–6 weeks and at 3, 6, 12, and 24 months postpartum were collected and then assessed using the Female Sexual Function Index and the Center for Epidemiologic Studies Depression Scale. ResultsAfter adjusting for time and covariates, women with sexual dysfunction had a 1.62-fold (95% confidence interval [CI]: 1.05–2.50-fold) higher estimated odds ratio (OR) for depressive symptoms during the entire 24 months after childbirth than did women without sexual dysfunction. Risk factors for depressive symptoms were a higher pain score (OR: 1.33, 95% CI: 1.13–1.57), a medical condition (OR: 1.65, 95% CI: 1.00–2.73), and severe perineal laceration (OR: 4.67, 95% CI: 1.37–15.92). Sexual satisfaction during the entire 24 months after childbirth (OR: 0.81, 95% CI: 0.70–0.95) and the highest personal income level (OR: 0.33, 95% CI: 0.11–0.99) were factors protecting against higher-scoring depressive symptoms. ConclusionsOur study provides robust evidence that sexual dysfunction and poor satisfaction, together with severe perineal laceration, greater pain, and a medical condition, predict depressive symptoms during the 24-month postpartum period.

Roles of the Hypoximir microRNA-424/322 on Acute Hypoxia and Hypoxia-Induced Pulmonary Vascular Leakage

Background: Acute mountain sickness (AMS) occurs in up to 25% of unacclimatized persons who ascend to 3000 m and can result in highaltitude pulmonary edema (HAPE) or cerebral edema (HACE). MicroRNAs (miRs) can regulate gene expression on the post-transcriptional level via translational repression of the target mRNA. Hypoxia selectively disrupts brain microvascular endothelial tight junction complexes through a HIF1α-dependent mechanism. While increased HIF-1α expression is associated with adaptation and protection from the development of AMS in the early stage of hypoxia, the downstream effector of HIF-1α, VEGF, can induce overzealous endothelial barrier dysfunction, increase vascular permeability and hence result in HAPE and HACE. We hypothesized that the fine-tuning of downstream effectors, such as VEGF, by hypoximirs is paramount for the preservation of endothelial barrier integrity and prevention of vascular leakage. Materials and Methods: RNA sequencing was performed, and miR-424 was selected as the target miR. Human pulmonary microvascular endothelial cells and human umbilical endothelial cells were used in the in vitro experiments. miR-424 mimics and inhibitors were used to test their effects on the putative target molecules, cell senescence and apoptosis. miR-322 (mouse analog of miR-424)-deficient mice and their littermates were also studied. Results: Several hypoximirs, including miR-210, miR-92a, miR-199, miR-193, miR-424 and miR-221, were elevated in healthy volunteers who were subjected to high-altitude conditions. Hypoxia-induced miR-424 overexpression is HIF-1α dependent. miR-424 could stabilize HIF-1α and decrease VEGF as well as induce the phosphorylation of VE-cadherin. miR424 could also attenuate hypoxia-induced endothelial cell (EC) senescence and apoptosis. As expected, miR-322 KO mice were susceptible to hypoxia- induced pulmonary vascular leakage. Finally, miR-322 mimics could attenuate hypoxia-induced pulmonary vascular leakage in vivo. Conclusions: Several hypoximirs were upregulated in healthy adult volunteers subjected to hypobaric hypoxemia. miR-424/322 could modulate the HIF-1α-VEGF axis and prevent hypoxia-induced pulmonary vascular leakage under hypoxic conditions. Funding Statement: This study was supported by a grant from the Tri-Service General Hospital of the National Defense Medical Center in Taipei, Taiwan (TSGH-C105-056, TSGH-C107-047), and the Ministry of Science and Technology (MOST 106-2314-B-016-031 and MOST 106-2314-B-016-008-MY3). Declaration of Interests: The authors declare that they have received no financial support and have no conflicts of interest. Ethics Approval Statement: The study was approved by the Institutional Research Board of the Tri-Service General Hospital in Taipei, Taiwan and was conducted in accordance with the Declaration of Helsinki and relevant guidelines. Written informed consent was obtained from each participant.

Explore patient-specific needs for mHealth solutions in Taiwan: a mixed study

Background: Significant advances have been made over the past 2 decades in the use of mobile devices. So-called smart devices (e.g., smartphones, tablet computers) allow people greater access to information on the Internet and at any time. Furthermore, most smart devices now incorporate sensors such as accelerometers, global positioning satellite components, Bluetooth technology, and cameras, which have greatly impacted their scope and utilization as a result of their multi-functional capacity. In the past, mobile medical platforms or applications were considered tools that care providers could use to improve patient care. However, health information technology should also provide convenient assistance to individuals for their own health and wellness management, enabling them to better communicate with doctors, learn and share information about their own health, and take actions that will improve their quality of life. The aims of this quantitative and qualitative study are as follows: to explore the functionality patients want, and to better understand individuals’ opinions, behaviors, and motivations, as well as the barriers to utilizing mobile mHealth applications. Methods: We conducted a quantitative and qualitative semi-structured in-depth interview study on October 13, 15 and 16, 2017, with 220 patients from a medical center in Taipei. Ten of the 220 patients were audiotaped, transcribed verbatim and analyzed using a directed content analysis. We report our findings following the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. Results: The top three functions requested by patients were as follows: outpatient department real-time progress (58%); the adverse effects of medicine (49%); and personal prescription lists and records (48%). Together, 83.2% patients were willing to use a hospital application if it offered the functionality they required, and 75% indicated they would do so for their family. The five major themes related to the influence of eHealth technology, as indicated by respondents, are as follows: notify patients and minimize prescription wastage; record patients’ daily medication adherence; convenient access to medication information on the mobile application; big data analyses of the data collected; and interaction between the patient and healthcare professionals, as well as with family and other patients. Conclusions: While many mobile health applications are being developed, large hospitals are lagging in building application that resonate with patients. Patients complain of a poor user experience with hospitals, and functionality of proprietary mobile applications often fails to individuals’ needs. The technological ability of different age group varies. Thus, understanding consumers’ experiences and expectations can encourage better mobile health application design and improve patients’ motivation to use such applications.

Non-nutritive sucking, oral breast milk, and facilitated tucking relieve preterm infant pain during heel-stick procedures: A prospective, randomized controlled trial

BackgroundPreterm infant pain can be relieved by combining non-nutritive sucking (sucking), oral sucrose, and facilitated tucking (tucking), but the pain-relief effects of oral expressed breast milk (breast milk) are ambiguous. AimsWe compared the effects of combined sucking+ breast milk, sucking+breast milk+tucking, and routine care on preterm infant pain during and after heel-stick procedures. DesignA prospective, randomized controlled trial. SettingsLevel III neonatal intensive care unit and a neonatal unit at a medical center in Taipei. Participants/subjectsPreterm infants (N=109, gestational age 29–37 weeks, stable disease condition) needing procedural heel sticks were recruited by convenience sampling and randomly assigned to three treatment conditions: routine care, sucking+ breast milk, and sucking+breast milk+ tucking. MethodsPain was measured by watching video recordings of infants undergoing heel-stick procedures and scoring pain at 1-min intervals with the Premature Infant Pain Profile. Data were collected over eight phases: baseline (phase 1, 10min without stimuli before heel stick), during heel stick (phases 2 and 3), and a 10-min recovery (phases 4–8). ResultsFor infants receiving sucking+ breast milk, pain-score changes from baseline across phases 2–8 were 2.634, 4.303, 2.812, 2.271, 1.465, 0.704, and 1.452 units lower than corresponding pain-score changes of infants receiving routine care (all p-values <0.05 except for phases 6 and 7). Similarly, for infants receiving sucking +breast milk+ tucking, pain-score changes from baseline were 2.652, 3.644, 1.686, 1.770, 1.409, 1.165, and 2.210 units lower than corresponding pain-score changes in infants receiving routine care across phases 2–8 (all p-values <0.05 except for phase 4). After receiving sucking +breast milk +tucking and sucking +breast milk, infants’ risk of mild pain (pain score ≥6) significantly decreased 67.0% and 70.1%, respectively, compared to infants receiving routine care. After receiving sucking +breast milk +tucking and sucking +breast milk, infants’ risk of moderate-to-severe pain (pain score ≥12) decreased 87.4% and 95.7%, respectively, compared to infants receiving routine care. ConclusionThe combined use of sucking+breast milk +tucking and sucking+breast milk effectively reduced preterm infants’ mild pain and moderate-to-severe pain during heel-stick procedures. Adding facilitated tucking helped infants recover from pain across eight phases of heel-stick procedures. Our findings advance knowledge on the effects of combining expressed breast milk, sucking, and tucking on preterm infants’ procedural pain.

Renal Transplant Recipients: The Factors Related to Immunosuppressive Medication Adherence Based on the Health Belief Model.

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. 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. 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. 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. 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.

Effect of a Modified Hospital Elder Life Program on Delirium and Length of Hospital Stay in Patients Undergoing Abdominal Surgery

Older patients undergoing abdominal surgery commonly experience preventable delirium, which extends their hospital length of stay (LOS). To examine whether a modified Hospital Elder Life Program (mHELP) reduces incident delirium and LOS in older patients undergoing abdominal surgery. This cluster randomized clinical trial of 577 eligible patients enrolled 377 older patients (≥65 years of age) undergoing gastrectomy, pancreaticoduodenectomy, and colectomy at a 2000-bed urban medical center in Taipei, Taiwan, from August 1, 2009, through October 31, 2012. Consecutive older patients scheduled for elective abdominal surgery with expected LOS longer than 6 days were enrolled, with a recruitment rate of 65.3%. Participants were cluster randomized by room to receive the mHELP or usual care. The intervention (implemented by an mHELP nurse) consisted of 3 protocols administered daily: orienting communication, oral and nutritional assistance, and early mobilization. Intervention group participants received all 3 mHELP protocols postoperatively, in addition to usual care, as soon as they arrived in the inpatient ward and until hospital discharge. Adherence to protocols was tracked daily. Presence of delirium was assessed daily by 2 trained nurses who were masked to intervention status by using the Confusion Assessment Method. Data on LOS were abstracted from the medical record. Of 577 eligible patients, 377 (65.3%) were enrolled and randomly assigned to the mHELP (n = 197; mean [SD] age, 74.3 [5.8] years; 111 [56.4%] male) or control (n = 180; mean [SD] age, 74.8 [6.0] years; 103 [57.2%] male) group. Postoperative delirium occurred in 13 of 196 (6.6%) mHELP participants vs 27 of 179 (15.1%) control individuals, representing a relative risk of 0.44 in the mHELP group (95% CI, 0.23-0.83; P = .008). Intervention group participants received the mHELP for a median of 7 days (interquartile range, 6-10 days) and had a shorter median LOS (12.0 days) than control participants (14.0 days) (P = .04). For older patients undergoing abdominal surgery who received the mHELP, the odds of delirium were reduced by 56% and LOS was reduced by 2 days. Our findings support using the mHELP to advance postoperative care for older patients undergoing major abdominal surgery. clinicaltrials.gov Identifier: NCT01045330.

Long-term Surveillance Following Intralesional Steroid Injection for Benign Vocal Fold Lesions

ImportanceThe short-term outcomes of vocal fold steroid injection (VFSI) are well documented. However, few studies have reported the long-term outcomes following VFSI.ObjectiveTo investigate the incidence rates of symptom recurrence and secondary interventions following VFSI for benign vocal fold lesions.Design, Setting, and ParticipantsThis prospective cohort study was conducted at a tertiary referral medical center in Taipei, Taiwan. The cohort included 189 patients with vocal fold lesions who had received VFSI as the primary treatment between August 2011 and September 2013.ExposuresAll participants underwent VFSI.Main Outcomes and MeasuresLong-term surveillance was conducted through structured telephonic interviews and by reviewing medical charts every 6 months over a 2-year period. We assessed the 10-item voice handicap index, dysphonic symptoms, and whether the patients had received any additional interventions after the initial VFSI.ResultsThe 189 participants (32 men and 157 women; mean [SD] age, 39 [10] years [range, 20-74 years] included patients who had undergone VFSI for vocal fold nodules (n = 72), polyps (n = 72), or mucus-retention cysts (n = 45). Following VFSI, 141 patients (74.6%; 23 men and 118 women; mean age, 39 years [range, 20-70 years]) showed positive response (ie, clinically significant symptom resolution without the need for additional procedures) and received long-term surveillance. The median follow-up period was 19.4 months, and 2 patients were lost to follow-up postoperatively within 1 year. The cumulative failure rates (subjective symptom recurrence plus secondary treatments) at 6, 12, 18, and 24 months after VFSI were 12%, 17%, 24%, and 32%, respectively. When the initial response rate to VFSI (141 of 189, 74.6%) was considered altogether, VFSI remained effective after 2 years in 50% of the initially recruited 189 patients. The highest rate of long-term effectiveness of VFSI occurred in vocal polyps (54%), followed by nodules (49%) and cysts (43%).Conclusions and RelevanceThis study demonstrates that VFSI can be beneficial in managing benign vocal lesions, especially when first-line treatments are unsuitable. However, the long-term results of this study clarify that a substantial number of patients experience symptom recurrence or receive subsequent interventions within 2 years after VFSI; this should be considered in medical decision making.

Persistent and new-onset daytime sleepiness in pregnant women: A prospective observational cohort study

BackgroundDaytime sleepiness is a frequent complaint in women during pregnancy. It has also been linked to negative obstetric consequences. Although high prevalence of excessive daytime sleepiness throughout pregnancy is well-documented, neither the causes of persistent daytime sleepiness nor new-onset daytime sleepiness during pregnancy have been investigated. Identifying predictive factors may play an important role in the management of daytime sleepiness in pregnant women and improve prenatal care and maternal-fetal outcomes. ObjectivesTo examine first-trimester maternal characteristics associated with the persistence and new-onset daytime sleepiness in pregnant women. DesignA longitudinal, prospective cohort design. SettingOne medical center in Taipei, Taiwan and participating women’s homes. ParticipantsA total of 204 pregnant women. MethodsFirst-trimester pregnant women recruited from an outpatient obstetric clinic at a medical center provided socio-demographic and health information, wore an actigraphy monitor for 7 days, and completed sleep, mood, and daytime sleepiness questionnaires. Data were collected again when the women were in the second and third trimester. ResultsThirty-one (15.2%) women experienced excessive daytime sleepiness that persisted across all three trimesters. Nulliparous women and women who snored in the first trimester were 2.28 and 2.10 times more at risk of being classified of persistent daytime sleepiness than multiparous women and women who did not snore in the first trimester, respectively. Thirty-one (15.2%) women developed new-onset daytime sleepiness with advancing gestation. Women were more likely to develop new-onset daytime sleepiness if they worked longer hours per week (OR=1.04, p<0.001), if they reported snoring (OR=6.75, p<0.001), and if they had elevated depressive symptoms in the first trimester of pregnancy (OR=1.09, p=0.01). ConclusionsSnoring in the first trimester is involved in both the persistence and new-onset of daytime sleepiness with elevated depressive symptoms related to new-onset daytime sleepiness in pregnant women. Findings suggest that intervention strategies for alleviating daytime sleepiness in pregnant women should focus on managing snoring and symptoms of depression in early trimesters with special attention to nulliparous and employed women.

Validation of the Chinese Version of the Functional Outcomes of Sleep Questionnaire-10 in Pregnant Women.

We evaluated the psychometric properties of a Mandarin Chinese version of the Functional Outcomes of Sleep Questionnaire-10 (FOSQ-10) in pregnant women. A total of 228 first-trimester pregnant women participated in the study, which was conducted in an outpatient obstetric clinic at a medical center in Taipei, Taiwan. The Chinese version of the FOSQ-10 demonstrated satisfactory internal consistency (Cronbach alpha = .85), adequate corrected item-total correlations (from .40 to .67), and acceptable test-retest reliability over 7 days (ICC = .73). Construct validity was supported by exploratory factor analysis showing a one-factor structure with item loadings between .49 and .77. Significant associations with the Medical Outcomes Study Short-Form Health Survey 12 version 2 and Pittsburgh Sleep Quality Index supported criterion-related and convergent validity. Significant differences in the Chinese version of the FOSQ-10 total scores were found between women with clinically significant daytime sleepiness and those without, suggesting adequate discriminant validity. Ceiling effects were observed for all items, but no floor or ceiling effects were found for total scores. Findings suggest that the Chinese version of the FOSQ-10 is a valid and reliable instrument to identify important effects of sleep-related impairment in Chinese women during pregnancy. Further testing is needed in more diverse pregnant women, such as women with complicated pregnancies and those with sleep disorders. © 2016 Wiley Periodicals, Inc.

Effects of systematic nursing instruction on a low-phosphorus diet, serum phosphorus level and pruritus of patients on haemodialysis.

To investigate the effectiveness of systematic nursing instruction on a low-phosphorus diet, serum phosphorus level and pruritus of haemodialysis patients. A high number of end-stage renal disease patients on haemodialysis are bothered by pruritus. Hyperphosphataemia was reported to be related to pruritus. An experimental design was applied. Ninety-four patients who received haemodialysis between September 2013 and December 2013 at a medical centre in Taipei, Taiwan, were recruited. An experimental group received individual systematic nursing instruction by the investigator through a nursing instruction pamphlet and reminder card for taking medication. A control group received traditional nursing instruction. The pruritus, blood phosphorus level and five-day diet records were evaluated before and after intervention. The experimental group had a low-phosphorus diet intake compared with the control group (p<0·001). A significant difference in serum phosphorus level was observed between the experimental and control groups (p=0·002). Incidence of pruritus was lower in the experimental group than in the control group (p<0·001). A systematic nursing instruction included using a pamphlet, pictures and reminder cards, the patients' blood phosphorus levels decreased, the patients consumed more low-phosphorus food, and pruritus decreased. This study recommends that clinical nursing staff include systematic nursing instruction as a routine practice for dialysis patients.

Tailored educational supportive care programme on sleep quality and psychological distress in patients with heart failure: A randomised controlled trial

BackgroundUp to 74% of patients with heart failure report poor sleep in Taiwan. Poor symptom management or sleep hygiene may affect patients’ sleep quality. An effective educational programme was important to improve patients’ sleep quality and psychological distress. However, research related to sleep disturbance in patients with heart failure is limited in Taiwan. ObjectivesTo examine the effects of a tailored educational supportive care programme on sleep disturbance and psychological distress in patients with heart failure. Designrandomised controlled trial. Participants and settingEighty-four patients with heart failure were recruited from an outpatient department of a medical centre in Taipei, Taiwan. Patients were randomly assigned to the intervention group (n=43) or the control group (n=41). MethodsPatients in the intervention group received a 12-week tailored educational supportive care programme including individualised education on sleep hygiene, self-care, emotional support through a monthly nursing visit at home, and telephone follow-up counselling every 2 weeks. The control group received routine nursing care. Data were collected at baseline, the 4th, 8th, and 12th weeks after patients’ enrollment. Outcome measures included sleep quality, daytime sleepiness, anxiety, and depression. ResultsThe intervention group exhibited significant improvement in the level of sleep quality and daytime sleepiness after 12 weeks of the supportive nursing care programme, whereas the control group exhibited no significant differences. Anxiety and depression scores were increased significantly in the control group at the 12th week (p<.001). However, anxiety and depression scores in the intervention group remained unchanged after 12 weeks of the supportive nursing care programme (p>.05). Compared with the control group, the intervention group had significantly greater improvement in sleep quality (β=−2.22, p<.001), daytime sleepiness (β=−4.23, p<.001), anxiety (β=−1.94, p<.001), and depression (β=−3.05, p<.001) after 12 weeks of the intervention. ConclusionThis study confirmed that a supportive nursing care programme could effectively improve sleep quality and psychological distress in patients with heart failure. We suggested that this supportive nursing care programme should be applied to clinical practice in cardiovascular nursing.

The Transformation Process in Nurses Caring for Dying Patients.

Despite the recent increase in attention to end-of-life hospice care, little empirical evidence regarding the process of emotional or mental transformation in caregivers is available. This study explores the transformative process that occurs in nurses because of the spiritual suffering and conflict associated with after caring for dying patients. A phenomenological approach was used to investigate eight nurses (27-40 years old) working in the hospice ward of a medical center in Taipei. Data were collected through open-ended questions using semistructured interviews and were analyzed reflectively. A three-stage transformation in the emotional processes of participants was observed. In the first stage, the participants experienced acute emotional suffering because of facing the death of their patients, potentially exacerbated by their own memories of losing family members. In the second stage, the participants adopted coping strategies to improve self-care. These strategies included attempting to soothe patients, helping patients face or deal with unfulfilled business, and participating in funeral or memorial services. In the third stage, the participants learned to provide better care through emancipatory reflection and a reassertion of responsibilities toward the self, patients, and patient families. After the third stage, the initial emotional impact morphed into a medium for self-strengthening, and participants became more adept at detecting patient needs and at providing care to complete the transformational process fully. Emotional suffering was the primary factor that induced participants to transform their personal and professional selves. Adequate emotional self-management, dialogue with other nurses, and personal reflection are crucial actions that nurses may use to cultivate personal growth, implement ethical practice, interact with other nurses, and engage in personal reflection. Strategies such as caring for patients, implementing reflective nursing practices, focusing on patient needs, and utilizing past experiences enable nurses to develop a heightened sense of responsibility and awareness, thus empowering them to take better care of themselves and their patients.

The Relationship Between Coping Strategies and Type D Personality in Non Late Stage Hepatocellular Carcinoma Survivors

BackgroundOwing to the high recurrence rate of hepatocellular carcinoma, coping with the disease in the survival period can be challenging. The aims of this study were to explore the association between coping strategies and personality and to identify factors associated with coping strategies. MethodsA cross-sectional correlated design was used and patients were recruited by convenience sampling from wards and outpatient departments at a medical center in Taipei. A set of structured questionnaires was used to collect data including patients’ demographic and disease information, Symptom Distress Scale, Type D Scale-14 and the brief COPE scale. Data were analyzed by descriptive statistics and generalized estimating equations. ResultsEmotion-focused strategies were the most frequently used strategies. Among the 163 participants, 31 patients had type D personality (19%) and tended not to use emotion-focused strategies. Factors associated with patients using emotion-focused strategies included female gender, non-type D personality, younger age, higher level of education, Christian/Catholic, longer duration as HBV carrier, and lower level of symptom distress. Factors associated with patients using problem-focused strategies included younger age, higher level of education, longer duration as HBV carrier, and lower level of symptom distress. Younger age was also associated with patients using malfunction strategies. ConclusionsThis study showed that different factors were associated with the three types of coping strategies. We recommend that patients be screened for type D personality, so that those with higher levels of distress when managing their symptoms can be helped to have a positive coping process. Health care providers should also proactively take care of younger patients with mal-adaptation.

Development of a situational initiation training program for preceptors to retain new graduate nurses: Process and initial outcomes

Most preceptor training programs consist of classroom-based courses, and only a few programs are conducted using films. Preceptors have identified most training courses as inapplicable in various clinical situations. To describe the systematic development of a situational initiation training program (SITP) for preceptors and to evaluate its impacts on the stress levels of preceptors and new graduate nurses (NGNs), the preceptor-NGN relationship, support provided by preceptors to NGNs, and the intention to leave among NGNs during a 1-year preceptorship. The conceptual framework of development, implementation, and evaluation was used for program completion. Preceptors and NGNs working at a teaching medical center in Taipei participated. The 1-day SITP workshop comprised four films, reflection time, and four classroom-based courses. Training outcomes were evaluated using a questionnaire survey for preceptors and NGNs at months 3, 6, 9, and 12 after employing the NGNs. Data were analyzed using descriptive statistics and analysis of variance with repeated measures. The annual turnover rate of NGNs was 10.5%. During the first preceptorship year, the NGNs reported moderate stress levels, good to excellent relationships with their preceptors, moderate to excellent support from their preceptors, and low intention to leave their current jobs. Similarly, preceptors reported moderate stress levels, except at month 12 (mean=4.8), and good to excellent relationships with their NGNs. The SITP considerably improved the preceptor-NGN relationship for both NGNs and preceptors, whereas no improvement was observed in the stress levels, except in the stress levels of preceptors. The SITP is clinically effective for preceptors; thus, nurse educators may apply the SITP for redesigning the existing preceptor training programs to develop highly skilled preceptors and improve training outcomes.

Inverse association of β-lactam-resistant Haemophilus influenzae with adenoid biofilm formation in patients with adenoidectomy surgery

Methods: We design two-phase prospective intervention study in public 1800-bed medical center in Taipei, Taiwan. Cleaning efficacy was monitored by ATP bioluminescence after the daily morning cleaning program completed in a CICU and a MICU. The following high-touch surfaces were monitored: bed rails, surfaces of vital monitors, intravenous injection sets, bed tables, and handles of the nursing care cart. The threshold for cleanliness was set at a level of 250 relative light units (RLU). The intervention included an infection control education program, use of disposable wipes rather than a reusable microfiber towel, and feedback the monitoring result. Results: In phase I, only 43.9% of surfaces were clean (RLU < 250) after the daily cleaning process, and some of the surfaces were even more contaminated. In phase II, 88.1% of surfaces were clean after the daily cleaning process, significantly from phase I. The infection rate also declined after the intervention, from 21.0& to 10.7& in the MICU (p Z 0.047) and from 15.6& to5.6& in the CICU (p Z 0.028). Conclusions: Implementation of a new cleaning program that included use of disposable wipes and monitoring by ATP levels significantly reduced contamination of surfaces and infection rate in our ICUs.

Impact of Knowledge and Behavior of Medical Personnel Towards Speech Therapy for Tracheostomized Patients

Background Tracheostomized patients suffer from communication difficulty, physical pain, swallowing difficulty, and decreased quality of life. In this study, we investigated the current status of communication and swallowing difficulties in tracheostomized patients in Taiwan, and the knowledge of medical personnel about tracheostomized patients and the perceived benefits of referring them to speech therapy. Methods We analyzed both the national data from The Collaboration Center of Health Information Application, and medical insurance data of a medical center in Taipei. We also administered a questionnaire survey to 80 medical personnel before and after an education program was given for patients and medical personnel. Results Treatment referral rates of inpatients with tracheostomy for speech therapy were found to be at 4.87% and 10%, from national and medical center data, respectively, and only a few patients received both communication and swallowing training. Over 50% of the medical personnel never referred any tracheostomized inpatients for speech therapy. The rate of referral was not significantly affected by experience and knowledge of medical personnel of tracheostomy. Conclusion Fundamental education about the availability of speech therapy and speech-language therapists for medical personnel would be the best way to help tracheostomized patients obtain entitled proper speech therapy in Taiwan.

Hospital-acquired Urinary Tract Infections in Patients with Diabetes and Urinary Catheterization

Objective Urinary tract infection (UTI) is the most common hospital-acquired infection. Foley catheter-related UTI is associated with increased mortality, morbidity, length of hospital stay, and costs. Few studies have compared the pathogens by bacterial strains, resistance to antibiotics, comorbidities, and related risk factors in hospital-acquired UTI patients with or without diabetes and with or without a Foley catheter. The objective of this study was to compare the variables of hospital-acquired UTI between these two groups. Methods In this retrospective chart review study, we included hospital-acquired UTI patients (hospitalization time > 48 hours) with either diabetes or a Foley catheter from a medical center in Taipei (Taiwan) between January 1, 2011 and December 31, 2012. We excluded patients with positive urine culture for bacteria within 48 hours of admission. Clinically related information was collected using case data sheets. Results We analyzed 595 patients with hospital-acquired UTI; the infection rate of hospital-acquired UTI in our study was significantly higher in patients with a urinary catheter (n = 497) than in those without (p Conclusion Unlike having diabetes, having a urinary catheter was a significant risk factor for hospital-acquired UTI (p

Risk Factors for Healthcare-Associated Extensively Drug-Resistant Acinetobacter baumannii Infections: A Case-Control Study

The emergence of extensively drug-resistant Acinetobacter baumannii (XDRAB) is a serious threat to hospitalized patients. From 2008 to 2010, surveillance detected 25 hospital-acquired infection (HAI) cases caused by XDRAB at a medical center in Taipei. The site of XDRAB infection was bloodstream (n = 8), urinary tract (n = 12), lower respiratory tract (n = 3), surgical site (n = 1), and cardiovascular (n = 1). The isolates were resistant to all currently available antibiotics except for colistin. The XDRAB isolates are genetically diverse, shown by pulsed-field gel electrophoresis, but 23 of 25 harbored class 1 integron with a 2.3-kb gene cassette. Most of these isolates carry OXA-23 (n = 21) and OXA-51-like carbapenemase genes (n = 25). To identify the risk factors, a case-control study was conducted. The 25 cases were compared with 100 controls randomly selected from hospitalized patients without XDRAB-HAIs, matched by the onset date, ward, and age, at a ratio of 1∶4. Prior use of imipenem, meropenem, piperacillin/tazobactam or fourth-generation cephalosporins (adjusted OR: 3.2, 95% CI: 1.03–10.2, P = 0.04) and >30 days bed-ridden (adjusted OR: 6.0, 95% CI: 1.3–27.6, P = 0.02) were found to be the independent risk factors for XDRAB-HAIs. These findings highlight that, even in the absence of clonal dissemination, XDRAB can emerge under the selective pressure of broad-spectrum antibiotics and causes subsequent HAIs in compromised hosts. An appropriate response to the XDRAB threat therefore should include a component of prudent use of broad-spectrum antibiotics active against gram-negative bacteria.

Incidence and Predicted Risk Factors of Pressure Ulcers in Surgical Patients: Experience at a Medical Center in Taipei, Taiwan

Purpose. To explore the context of incidence of and associated risk factors for pressure ulcers amongst the population of surgical patients. Methods. The initial study cohort was conducted with a total of 297 patients admitted to a teaching hospital for a surgical operation from November 14th to 27th 2006 in Taipei, Taiwan. The Braden scale, pressure ulcers record sheet, and perioperative patient outcomes free from signs and symptoms of injury related to positioning and related nursing interventions and activities were collected. Results. The incidence of immediate and thirty-minute-later pressure ulcers is 9.8% (29/297) and 5.1% (15/297), respectively. Using logistic regression model, the statistically significantly associated risk factors related to immediate and thirty-minute-later pressure ulcers include operation age, type of anesthesia, type of operation position, type of surgery, admission Braden score, and number of nursing intervention after adjustment for confounding factors. Conclusion. Admission Braden score and number of nursing intervention are well-established protected factors for the development of pressure ulcers. Our study shows that older operation age, type of anesthesia, type of operation position, and type of surgery are also associated with the development of pressure ulcers.

Changes in clinical presentation of children with autistic disorder, at an autism clinic in Taiwan from 1987 to 1995

Autistic disorder was originally viewed as a distinct, rare, and severe childhood mental disorder that caused life-long disability. However, since the late 1990s autistic disorder was found to have a high prevalence rate and to affect children on a spectrum from mild to severe dysfunction. The purpose of this retrospective, descriptive study was to examine changes in the characteristics of patients with autistic disorder in Taiwan from 1987 to 1995. To that end, we examined the characteristics, age at diagnosis, symptoms, and developmental condition of affected children and the educational background of their parents who visited an autism clinic at the children's mental health center of a medical center in Taipei. This clinic was the first, largest, and for many years the only autistic disorder clinic in Taiwan. Across the 9-year study period, we observed trends in decreasing age at first visit, increasing age at assessment, rising maternal educational level, lessening autistic disorder symptomatology, and increasing developmental quotients. These changes may have been due to improved diagnostic criteria, government policy, and healthcare professionals’ and parents’ increased awareness of autistic disorder. Clinical implications and related policy making toward these changes are proposed.