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Lin CC, Liaw JJ, Li CH, Chen LC, Han CY. Nurse-led intervention to improve oral mucosal health of intubated patients in the intensive care unit: A prospective study. Am J Infect Control 2024:S0196-6553(24)00053-1. [PMID: 38301898 DOI: 10.1016/j.ajic.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 01/22/2024] [Accepted: 01/22/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND This prospective study aimed to explore the effectiveness of an oral care intervention with Tegaderm on the oral mucosal health of intubated patients. METHODS A total of 70 intubated patients were included and randomly assigned to 1 of 3 groups, clean water brushing teeth (n = 23), brushing teeth combined with mouthwash (BTM) (n = 23), and brushing teeth combined with mouthwash and Tegaderm (BTMT) (n = 24). The Oral Mucositis Assessment Scale (OMAS) was applied to evaluate the patient's oral mucosal health before and after oral care intervention. RESULTS The BTMT group had lower OMAS scores in almost all regions of the oral cavity, compared to the brushing teeth and BTM groups. The general linear model for repeated measurement indicated the BTMT group had the lowest total OMAS scores from Day 2 to Day 4 after the initiation of baseline OMAS evaluation. Of the 3 intervention groups, the BTMT group had the shortest length of endotracheal intubation. The BTMT group had the lowest incidence rate of ventilator-associated pneumonia; however, no significant between-group differences were found. CONCLUSIONS BTMT effectively reduced the decline in oral mucosal health that was caused by endotracheal intubation and shortened the length of endotracheal intubation.
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Affiliation(s)
- Ching-Ching Lin
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taiwan (R.O.C.); Department of Nursing, New Taipei Municipal TuCheng Hospital (Built and Operated by Chang Gung Medical Foundation), Taiwan (R.O.C.)
| | - Jen-Jiuan Liaw
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taiwan (R.O.C.).
| | - Chung-Hsing Li
- Division of Orthodontics and Pediatric Dentistry, Tri-Service General Hospital, Taiwan (R.O.C.); School of Dentistry and Institute of Dental Science, National Defense Medical Center, Taiwan (R.O.C.)
| | - Li-Chin Chen
- Department of Nursing, New Taipei Municipal TuCheng Hospital (Built and Operated by Chang Gung Medical Foundation), Taiwan (R.O.C.); Department of Nursing, Chang Gung University of Science and Technology, Taiwan (R.O.C.)
| | - Chin-Yen Han
- Department of Nursing, New Taipei Municipal TuCheng Hospital (Built and Operated by Chang Gung Medical Foundation), Taiwan (R.O.C.); Department of Nursing, Chang Gung University of Science and Technology, Taiwan (R.O.C.).
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Lin CC, Han CY, Chen LC, Huang YL, Hwang SL. Undergraduate nurses' reflections on visual thinking learning to construct inductive reasoning through situated patient pictures: A mixed-method study. Nurse Educ Today 2023; 131:105991. [PMID: 37865014 DOI: 10.1016/j.nedt.2023.105991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/21/2023] [Accepted: 10/15/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND/OBJECTIVE Deductive logic has often been used to develop critical thinking. However, inductive logical thinking, essential to care decision-making, has yet to be emphasized. This study aimed to explore visual thinking learning among undergraduate nursing students by asking them to draw situated patient pictures in order to integrate theoretical knowledge and promote inductive logical thinking. METHODS A mixed-methods research design was used to obtain quantitative and qualitative data from a convenience sample of 100 students. The study was conducted in a Taiwanese university from September 2022 to January 2023. In the quantitative component, learners' views of situated patient pictures were captured based on 15 paired identifiers and two questions: (a) What word should be used in describing the situated patient's picture? (b) How strongly do you feel about the selection? Written feedback was analyzed using qualitative content analysis. RESULTS Quantitative analysis identified specific, unpretentious, humorous, harmonious, conservative, realistic, rational, entire, image performance, professional performance, understandable, expressive, static performance, rigorous, and profuse with a reasonable degree of choice. Qualitative analysis identified four stages in participants' development of inductive reasoning through situated patient pictures and visual thinking learning. These were: exploration, intuition, theme, and logic and creation. CONCLUSIONS The results suggest that visual thinking learning is a practical pedagogical approach to increasing learners' communication abilities, group cooperation, theoretical knowledge integration, and logical thinking. Neither educators nor learners required any artistic skills. Nonetheless, participants demonstrated creativity and innovation through continuous visual thinking learning.
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Affiliation(s)
- Chun-Chih Lin
- Department of Nursing, Chang Gung University of Science and Technology, 2, West Sec. Jiapu Rd., Pu-tz City 613, Chiayi County, Taiwan; Research Fellow (joint appointment), New Taipei Municipal TuCheng Hospital, Built and Operated by Chang Gung Medical Foundation, 6, Sec., 2, Jincheng Rd., Tucheng Dist., New Taipei City 263, Taiwan.
| | - Chin-Yen Han
- Department of Nursing, Chang Gung University of Science and Technology, Linkou Campus, 261, Wenhua 1st Rd., Guishan Dist., Taoyuan City 33303, Taiwan; Research Fellow (joint appointment), New Taipei Municipal TuCheng Hospital, Built and Operated by Chang Gung Medical Foundation, 6, Sec., 2, Jincheng Rd., Tucheng Dist., New Taipei City 263, Taiwan.
| | - Li-Chin Chen
- Department of Nursing, New Taipei Municipal TuCheng Hospital, Built and Operated by Chang Gung Medical Foundation, No. 6, Sec. 2, Jincheng Rd., Tucheng Dist., New Taipei City 236, Taiwan.
| | - Ya-Ling Huang
- Faculty of Health (Nursing), Southern Cross University, Gold Coast Campus B7.47, Locked Mail Bag 4, Coolangatta (Southern Cross University), QLD 4225, Australia; Department of Emergency Medicine, Gold Coast Hospital and Health Service, Gold Coast University Hospital, Gold Coast Campus B7.47, Locked Mail Bag 4, Coolangatta (Southern Cross University), QLD 4225, Australia.
| | - Su-Lun Hwang
- Department of Nursing, Chang Gung University of Science and Technology, 2, West Sec. Jiapu Rd., Pu-tz City 613, Chiayi County, Taiwan; Associate Research Fellow (joint appointment), Chronic Diseases and Health Promotion Research Center, Chang Gung University of Science and Technology, 2, West Sec. Jiapu Rd., Pu-tz City 613, Chiayi County, Taiwan; Associate Research Fellow (joint appointment), Division of Thoracic Oncology, ChiaYi Chang Gung Memorial Hospital, Chang Gung Medical Foundation, 2, West Sec. Jiapu Rd., Pu-tz City 613, Chiayi County, Taiwan.
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Chen LC, Hung KH, Tseng YJ, Wang HY, Lu TM, Huang WC, Tsao Y. Self-Supervised Learning-Based General Laboratory Progress Pretrained Model for Cardiovascular Event Detection. IEEE J Transl Eng Health Med 2023; 12:43-55. [PMID: 38059127 PMCID: PMC10697297 DOI: 10.1109/jtehm.2023.3307794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 07/23/2023] [Accepted: 08/14/2023] [Indexed: 12/08/2023]
Abstract
OBJECTIVE Leveraging patient data through machine learning techniques in disease care offers a multitude of substantial benefits. Nonetheless, the inherent nature of patient data poses several challenges. Prevalent cases amass substantial longitudinal data owing to their patient volume and consistent follow-ups, however, longitudinal laboratory data are renowned for their irregularity, temporality, absenteeism, and sparsity; In contrast, recruitment for rare or specific cases is often constrained due to their limited patient size and episodic observations. This study employed self-supervised learning (SSL) to pretrain a generalized laboratory progress (GLP) model that captures the overall progression of six common laboratory markers in prevalent cardiovascular cases, with the intention of transferring this knowledge to aid in the detection of specific cardiovascular event. METHODS AND PROCEDURES GLP implemented a two-stage training approach, leveraging the information embedded within interpolated data and amplify the performance of SSL. After GLP pretraining, it is transferred for target vessel revascularization (TVR) detection. RESULTS The proposed two-stage training improved the performance of pure SSL, and the transferability of GLP exhibited distinctiveness. After GLP processing, the classification exhibited a notable enhancement, with averaged accuracy rising from 0.63 to 0.90. All evaluated metrics demonstrated substantial superiority ([Formula: see text]) compared to prior GLP processing. CONCLUSION Our study effectively engages in translational engineering by transferring patient progression of cardiovascular laboratory parameters from one patient group to another, transcending the limitations of data availability. The transferability of disease progression optimized the strategies of examinations and treatments, and improves patient prognosis while using commonly available laboratory parameters. The potential for expanding this approach to encompass other diseases holds great promise. CLINICAL IMPACT Our study effectively transposes patient progression from one cohort to another, surpassing the constraints of episodic observation. The transferability of disease progression contributed to cardiovascular event assessment.
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Affiliation(s)
- Li-Chin Chen
- Research Center for Information Technology InnovationAcademia SinicaTaipei11529Taiwan
| | - Kuo-Hsuan Hung
- Research Center for Information Technology InnovationAcademia SinicaTaipei11529Taiwan
| | - Yi-Ju Tseng
- Department of Computer ScienceNational Yang Ming Chiao Tung UniversityHsinchu30010Taiwan
| | - Hsin-Yao Wang
- Department of Laboratory MedicineLinkou Chang Gung Memorial HospitalTaoyuan City33342Taiwan
| | - Tse-Min Lu
- Division of CardiologyDepartment of Internal MedicineTaipei Veterans General HospitalTaipei112201Taiwan
- Department of Health Care CenterTaipei Veterans General HospitalTaipei112201Taiwan
- Department of Internal MedicineSchool of Medicine, College of MedicineNational Yang Ming Chiao Tung UniversityTaipei112304Taiwan
| | - Wei-Chieh Huang
- Division of CardiologyDepartment of Internal MedicineTaipei Veterans General HospitalTaipei112201Taiwan
- Department of Internal MedicineSchool of Medicine, College of MedicineNational Yang Ming Chiao Tung UniversityTaipei112304Taiwan
- Department of Biomedical EngineeringNational Taiwan UniversityTaipei10617Taiwan
| | - Yu Tsao
- Research Center for Information Technology InnovationAcademia SinicaTaipei11529Taiwan
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Chen LC, Yeh SL, Lee HL, Lin CC, Goopy S, Han CY. Professional Accountability of Caring for Patients with COVID-19: A Phenomenographic Study. Healthcare (Basel) 2023; 11:2269. [PMID: 37628467 PMCID: PMC10454943 DOI: 10.3390/healthcare11162269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/03/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023] Open
Abstract
The purpose of this study was to explore nurses' care experiences for COVID-19 patients during the pandemic in Taiwan. The qualitative approach of phenomenography was used. Thirty-four nurses were recruited from two assigned hospitals in which COVID-19 patients were treated in Taiwan from July to May 2021. The method of data collection in the study involved a semi-structured interview and drawing. Interviews were audio-recorded and transcribed verbatim. Phenomenographic analysis was used to analyze the qualitative data. Four categories of description of experiences of caring for COVID-19 patients were identified: facing uncountable stresses from all sides, strict implementation of infection control interventions to provide safe care, confronting ethical dilemmas and making difficult decisions, and reflecting on the meaning of care in nursing. Professional accountability was the core theme found to represent the central meaning of nurses caring for COVID-19 patients. Nurses were under enormous stress while caring for COVID-19 patients during the pandemic and were negatively affected physically, psychologically, and socially. Professional accountability in caring for COVID-19 patients can be enhanced through adequate support from nursing managers and by in-service training designed to update knowledge and skills related to infection control intervention.
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Affiliation(s)
- Li-Chin Chen
- Department of Nursing, New Taipei Municipal TuCheng Hospital, Chang Gung Medical Foundation, New Taipei City 236, Taiwan; (L.-C.C.); (C.-C.L.)
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan 333, Taiwan;
- Department of Nursing, Taipei Medical University, Taipei 110, Taiwan
| | - Shu-Ling Yeh
- Department of Nursing, Chang Gung Memorial Hospital at Keelung, Keelung 20401, Taiwan;
| | - Hui-Ling Lee
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan 333, Taiwan;
| | - Chun-Chih Lin
- Department of Nursing, New Taipei Municipal TuCheng Hospital, Chang Gung Medical Foundation, New Taipei City 236, Taiwan; (L.-C.C.); (C.-C.L.)
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan 333, Taiwan;
| | - Suzanne Goopy
- Usher Institute, University of Edinburgh, Edinburgh EH8 9AG, UK;
| | - Chin-Yen Han
- Department of Nursing, New Taipei Municipal TuCheng Hospital, Chang Gung Medical Foundation, New Taipei City 236, Taiwan; (L.-C.C.); (C.-C.L.)
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan 333, Taiwan;
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Chen LC, Huang WC, Peng KY, Chen YY, Li SC, Syed Mohammed Nazri SK, Lin YH, Lin LY, Lu TM, Kim JH, Azizan EA, Hu J, Li Q, Chueh JS, Wu VC. Identifying KCNJ5 Mutation in Aldosterone-Producing Adenoma Patients With Baseline Characteristics Using Machine Learning Technology. JACC Asia 2023; 3:664-675. [PMID: 37614534 PMCID: PMC10442871 DOI: 10.1016/j.jacasi.2023.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 03/08/2023] [Accepted: 03/12/2023] [Indexed: 08/25/2023]
Abstract
Background Primary aldosteronism is characterized by inappropriate aldosterone production, and unilateral aldosterone-producing adenoma (uPA) is a common type of PA. KCNJ5 mutation is a protective factor in uPA; however, there is no preoperative approach to detect KCNJ5 mutation in patients with uPA. Objectives This study aimed to provide a personalized surgical recommendation that enables more confidence in advising patients to pursue surgical treatment. Methods We enrolled 328 patients with uPA harboring KCNJ5 mutations (n = 158) or not (n = 170) who had undergone adrenalectomy. Eighty-seven features were collected, including demographics, various blood and urine test results, and clinical comorbidities. We designed 2 versions of the prediction model: one for institutes with complete blood tests (full version), and the other for institutes that may not be equipped with comprehensive testing facilities (condensed version). Results The results show that in the full version, the Light Gradient Boosting Machine outperformed other classifiers, achieving area under the curve and accuracy values of 0.905 and 0.864, respectively. The Light Gradient Boosting Machine also showed excellent performance in the condensed version, achieving area under the curve and accuracy values of 0.867 and 0.803, respectively. Conclusions We simplified the preoperative diagnosis of KCNJ5 mutations successfully using machine learning. The proposed lightweight tool that requires only baseline characteristics and blood/urine test results can be widely applied and can aid personalized prediction during preoperative counseling for patients with uPA.
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Affiliation(s)
- Li-Chin Chen
- Research Center for Information Technology Innovation, Academia Sinica, Taipei, Taiwan
| | - Wei-Chieh Huang
- Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Kang-Yung Peng
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ying-Ying Chen
- Division of Nephrology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Szu-Chang Li
- Department of International Business, National Taipei University of Business, Taipei, Taiwan
| | | | - Yen-Hung Lin
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan
- TAIPAI, Taiwan Primary Aldosteronism Investigation Study Group, Taiwan
| | - Liang-Yu Lin
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tse-Min Lu
- Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jung Hee Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Elena Aisha Azizan
- Endocrine Unit, Faculty of Medicine, The National University of Malaysia (UKM) Medical Centre, Cheras, Kuala Lumpur, Malaysia
| | - Jinbo Hu
- Division of Endocrinology, the First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Qifu Li
- Division of Endocrinology, the First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Jeff S. Chueh
- TAIPAI, Taiwan Primary Aldosteronism Investigation Study Group, Taiwan
- Glickman Urological and Kidney Institute, and Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio
- Department of Urology, National Taiwan University Hospital, Taipei, Taiwan
| | - Vin-Cent Wu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan
- TAIPAI, Taiwan Primary Aldosteronism Investigation Study Group, Taiwan
- Primary Aldosteronism Center at National Taiwan University Hospital, Taipei, Taiwan
| | - TAIPAI Study Groupi
- Research Center for Information Technology Innovation, Academia Sinica, Taipei, Taiwan
- Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of International Business, National Taipei University of Business, Taipei, Taiwan
- Department of Medicine, The National University of Malaysia (UKM) Medical Centre, Selangor, Malaysia
- TAIPAI, Taiwan Primary Aldosteronism Investigation Study Group, Taiwan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Endocrine Unit, Faculty of Medicine, The National University of Malaysia (UKM) Medical Centre, Cheras, Kuala Lumpur, Malaysia
- Division of Endocrinology, the First Affiliated Hospital, Chongqing Medical University, Chongqing, China
- Glickman Urological and Kidney Institute, and Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio
- Department of Urology, National Taiwan University Hospital, Taipei, Taiwan
- Primary Aldosteronism Center at National Taiwan University Hospital, Taipei, Taiwan
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Chen LC, Lin CC, Han CY, Huang YL. Clinical Instructors' Perspectives on the Assessment of Clinical Knowledge of Undergraduate Nursing Students: A Descriptive Phenomenological Approach. Healthcare (Basel) 2023; 11:1851. [PMID: 37444685 DOI: 10.3390/healthcare11131851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/10/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
This study aimed to determine clinical instructors' perceptions of the assessments used to evaluate the clinical knowledge of undergraduate nursing students. This study uses a descriptive phenomenological approach. Purposive sampling was used to recruit sixteen clinical instructors for semi-structured interviews between August and December 2019. All interviews were audio recorded and transcribed verbatim. Data were analyzed using a modified Colaizzi's seven-step method. Four criteria were used to ensure the study's validity: credibility, transferability, dependability, and confirmability. Three themes were identified in the clinical instructors' views on evaluating the clinical performance of student nurses: familiarity with students, patchwork clinical learning, and differing perceptions of the same scoring system. The study results suggest a need for a reliable, valid, and consistent approach to evaluating students' clinical knowledge. If the use of patchwork clinical internships for student nurses is unavoidable, a method for assessing student nurses' clinical performance that requires instructor consensus is necessary.
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Affiliation(s)
- Li-Chin Chen
- Department of Nursing, New Taipei Municipal TuCheng Hospital (Built and Operated by Chang Gung Medical Foundation), New Taipei City 236, Taiwan
| | - Chun-Chih Lin
- School of Nursing, Chang Gung University of Science and Technology, Puzi City 61363, Taiwan
- New Taipei Municipal TuCheng Hospital (Built and Operated by Chang Gung Medical Foundation), New Taipei City 236, Taiwan
| | - Chin-Yen Han
- New Taipei Municipal TuCheng Hospital (Built and Operated by Chang Gung Medical Foundation), New Taipei City 236, Taiwan
- School of Nursing, Chang Gung University of Science and Technology, Taoyuan City 33303, Taiwan
| | - Ya-Ling Huang
- Faculty of Health (Nursing), Southern Cross University, Gold Coast, QLD 4225, Australia
- Visiting Research Fellow, Department of Emergency Medicine, Gold Coast Hospital and Health Service, Gold Coast, QLD 4215, Australia
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Li L, Zhou ZH, Ju W, Deng W, Chen LC, Li CS, Xia YH, Ju JH. [Clinical effects of free anterolateral thigh perforator flap pedicled with descending genicular artery in repairing wounds after lower leg limb-sparing surgery]. Zhonghua Shao Shang Yu Chuang Mian Xiu Fu Za Zhi 2023; 39:450-455. [PMID: 37805754 DOI: 10.3760/cma.j.cn501225-20220725-00308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 10/09/2023]
Abstract
Objective: To explore the clinical effects of free anterolateral thigh perforator flap pedicled with descending genicular artery in repairing wounds after lower leg limb-sparing surgery. Methods: A retrospective observational study was conducted. From January 2019 to June 2021, 12 patients with wounds after lower leg limb-sparing surgery who met the inclusion criteria were admitted to Suzhou Ruihua Orthopedic Hospital, including 6 males and 6 females, aged 17 to 74 years, with original wound area ranging from 17 cm×9 cm to 40 cm×15 cm. Five patients had infection in wounds. The wounds were all repaired by free anterolateral thigh perforator flap from contralateral thigh, with area of 18 cm×10 cm to 37 cm×9 cm. The artery of flap was anastomosed with the descending genicular artery, and the wounds in donor areas were sutured directly. Seven patients were transplanted with split-thickness skin grafts from the contralateral thigh to cover the remaining wounds that can not be covered by flap and the wounds in donor areas were covered with gauze. During the operation, the types of perforating branch carried by flap and the types of arteries and veins in recipient areas were recorded. The survival and occurrence of vascular crisis of flap, the survival of skin graft, the wound healing in donor and recipient areas, and the length of hospital stay after flap transplant surgery were recorded. During follow-up, the color and texture of flap, reinfection in lower leg, and fracture healing were recorded. At the last follow-up, the limb salvage function of patients was evaluated according to the functional evaluation criteria of Chen Zhongwei's amputated limb replantation. Results: The types of perforating branches carried by flaps were as follows: 6 cases of only carrying the descending branch of the lateral circumflex femoral artery, 3 cases of only carrying the oblique branch of the lateral circumflex femoral artery, and 3 cases of carrying the descending branch of the lateral circumflex femoral artery and oblique branch of the lateral circumflex femoral artery after internal pressurization anastomosis. The types of arteries in the recipient area of flap were as follows: one case of main trunk of the descending genicular artery, 8 cases of the saphenous branch of the descending genicular artery, and 3 cases of the articular branch of the descending genicular artery. The types of veins in the recipient area of flap were as follows: 8 cases of one accompanying vein of the descending genicular artery and one branch of the great saphenous vein, and 4 cases of two branches of the great saphenous vein. All the flaps survived without vascular crisis, and all the skin grafts also survived. The wounds in the donor and recipient areas were all healed. The length of hospital stay of patient after flap transplant surgery ranged from 13 to 79 days. During the follow-up of 6 to 23 months, the color and texture of flap were both good, with no infection in lower leg wound. Internal or external fixation were removed after fracture healing in 5 patients, and bone graft internal fixation was performed in 7 patients whose fractures were not healed after surgery and all the incisions healed without infection. At the last follow-up, the limb salvage effect of patients was evaluated as followings: excellent in 7 patients, good in 4 patients, and fair in one patient. Conclusions: Free anterolateral thigh flap pedicled with descending genicular artery can effectively repair the wounds after lower leg limb-sparing surgery and control infection with short length of hospital stay, while not increasing the risk of secondary injury of distal limb vessels. Thus, it can obtain satisfactory limb salvage effect which is worthy of clinical promotion.
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Affiliation(s)
- L Li
- Department of Orthopaedics Trauma, Suzhou Ruihua Orthopedic Hospital, Suzhou 215104, China
| | - Z H Zhou
- Department of Orthopaedics Trauma, Suzhou Ruihua Orthopedic Hospital, Suzhou 215104, China
| | - W Ju
- Department of Orthopaedics Trauma, Suzhou Ruihua Orthopedic Hospital, Suzhou 215104, China
| | - W Deng
- Department of Orthopaedics Trauma, Suzhou Ruihua Orthopedic Hospital, Suzhou 215104, China
| | - L C Chen
- Department of Orthopaedics Trauma, Suzhou Ruihua Orthopedic Hospital, Suzhou 215104, China
| | - C S Li
- Department of Orthopaedics Trauma, Suzhou Ruihua Orthopedic Hospital, Suzhou 215104, China
| | - Y H Xia
- Department of Orthopaedics Trauma, Suzhou Ruihua Orthopedic Hospital, Suzhou 215104, China
| | - J H Ju
- Department of Orthopaedics Trauma, Suzhou Ruihua Orthopedic Hospital, Suzhou 215104, China
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Lai CC, Chen SY, Chen HW, Li HY, Hsu HH, Chen LC, Tang WR. Experiences of oncology healthcare personnel in international medical service quality: a phenomenological study. BMC Nurs 2023; 22:92. [PMID: 37004029 PMCID: PMC10064582 DOI: 10.1186/s12912-023-01249-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 03/14/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND With the globalization of medical services on the rise, Asia has ascended to a destination of choice for its high-quality medical services at very reasonable rates. Monitoring the quality of the international medical industry is vital to maintain service demand. The experiences of healthcare personnel (HCP) involved in international medical services (IMS) regarding the provision of services to international cancer patients have not yet been discussed. This study aimed to explore oncology HCP experiences of IMS quality in caring for international cancer patients in Taiwan. METHODS Descriptive phenomenological method and were analyzed through Colaizzi's seven-step approach. In this study, 19 respondents were collected data by using in-depth semi-structured interviews. An average interview lasted approximately 45 min. RESULTS Four major themes were identified from the interviews: patient selection, psycho-oncology care, predicaments, and promoting suggestions. Additionally, thirteen subthemes emerged, including necessary selection of patients, reasons for unwillingness to enroll international patients, helpless patients, emotional distress, care with warmth, insufficient manpower, an unfair reward mechanism, poor hardware equipment, the predicaments of oncology care, various publicity strategies, one-on-one service model, design of a designated area, and reasonable benefit distribution. CONCLUSIONS This study explored oncology HCP experiences of IMS quality in caring for international cancer patients, with implications for hospitals in developing high-quality IMS. Due to the fact that IMS is a global trend, HCPs, administrators, and policy-makers are advised to improve the quality of IMS in the oncology department, which has been the least studied field in IMS quality.
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Affiliation(s)
- Chi-Chun Lai
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan
- International Medical Center, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Shih-Ying Chen
- School of Nursing, College of Medicine, Chang Gung University, No.259, Wenhua 1st Rd., Guishan Dist, Taoyuan, 33302, Taiwan
| | - Hsien-Wei Chen
- International Medical Center, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Hsueh-Yu Li
- International Medical Center, Chang Gung Memorial Hospital, Linkou, Taiwan
- Department of Otolaryngology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Hsiang-Hao Hsu
- International Medical Center, Chang Gung Memorial Hospital, Linkou, Taiwan
- Department of Nephrology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Li-Chin Chen
- Department of Nursing, New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan
| | - Woung-Ru Tang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan.
- School of Nursing, College of Medicine, Chang Gung University, No.259, Wenhua 1st Rd., Guishan Dist, Taoyuan, 33302, Taiwan.
- Department of Pediatric Hematology-Oncology, Chang Gung Memorial Hospital, Linkou, Taiwan.
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Lin CC, Thorberg FA, Huang YL, Han CY, Su CC, Chen LC. An Exploration of Psychological Resilience among Undergraduate Nursing Students Undertaking an Adult Nursing Virtual Practicum during the Coronavirus Pandemic in Taiwan: A Qualitative Study. Int J Environ Res Public Health 2023; 20:1264. [PMID: 36674017 PMCID: PMC9858614 DOI: 10.3390/ijerph20021264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/07/2023] [Accepted: 01/08/2023] [Indexed: 06/17/2023]
Abstract
This qualitative study aimed to explore the psychological resilience of undergraduate nursing students partaking in a virtual practicum during the coronavirus pandemic (COVID-19) in Taiwan. The virtual practicum, a form of online learning, creates challenges compared to the traditional teaching-learning experience of an actual clinical placement. Exploring how students overcome learning difficulties and build resilience is necessary for a new learning environment or for future online learning. Constructivist grounded theory and the Standards for Reporting Qualitative Research checklist were followed. Purposive and theoretical sampling were used to recruit 18 student nurses for data saturation. Semi-structured, face-to-face interviews were conducted individually to collect data. Initial, focused, and theoretical coding and constant comparative data analysis were performed. Credibility, originality, resonance, and usefulness guided the assessment of the study's quality. The core category of psychological resilience in the virtual practicum was constructed to reflect Taiwanese nursing students' progress and experiences of learning during the virtual practicum. This core category consisted of three subcategories: (i) learning difficulties within one's inner self; (ii) staying positive and confident; and (iii) knowing what is possible. The findings identified psychological resilience as an important factor for students to adjust to the adverse experiences of a rapidly changing learning environment, such as the virtual practicum. The substantive theory of psychological resilience provided a frame of reference for coping with possible future difficulties. Correspondingly, psychological resilience reflected individuals' potential characteristics and may help students to enter and remain in the nursing profession.
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Affiliation(s)
- Chun-Chih Lin
- Department of Nursing, Chang Gung University of Science and Technology, No.2., Sec. W., Jiapu Rd., Puzi City 61363, Taiwan
- New Taipei Municipal TuCheng Hospital, Chang Gung Medical Foundation, No.6, Sec. 2, Jincheng Rd., Tucheng Dist., New Taipei City 236017, Taiwan
| | - Fred Arne Thorberg
- School of Psychology, Bone University, 14 University Drive, Robina, Gold Coast, QLD 4226, Australia
| | - Ya-Ling Huang
- Faculty of Health (Nursing), Southern Cross University, Gold Coast Campus B7.47, Coolangatta, Gold Coast, QLD 4225, Australia
| | - Chin-Yen Han
- Department of Nursing, Chang Gung University of Science and Technology, No.2., Sec. W., Jiapu Rd., Puzi City 61363, Taiwan
- New Taipei Municipal TuCheng Hospital, Chang Gung Medical Foundation, No.6, Sec. 2, Jincheng Rd., Tucheng Dist., New Taipei City 236017, Taiwan
| | - Ching-Ching Su
- Department of Nursing, Chang Gung University of Science and Technology, No.2., Sec. W., Jiapu Rd., Puzi City 61363, Taiwan
| | - Li-Chin Chen
- New Taipei Municipal TuCheng Hospital, Chang Gung Medical Foundation, No.6, Sec. 2, Jincheng Rd., Tucheng Dist., New Taipei City 236017, Taiwan
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Lee WP, Wu PY, Chen LC, Shih WM. Using a Motivational Paradigm to Develop an Exercise Program for Nurses with High Risk of Metabolic Syndrome. Healthcare (Basel) 2022; 11:healthcare11010005. [PMID: 36611465 PMCID: PMC9818651 DOI: 10.3390/healthcare11010005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 12/08/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
Nurses are frontline care providers whose health is vital to providing good quality of care to patients. The purpose of this study was to develop an exercise program for high-risk metabolic syndrome nurses based on the transtheoretical model. The transtheoretical model was used in this study due to its popular use in exercise behavior change and it can clearly identify the stage of exercise so as to plan an effective program to promote health. This was a quasi-experimental pilot study with a total of 40 participants who met the inclusion criteria. Exercise programs were developed for three groups distinguished by their commitment to exercising for health. Sixteen (40%) nurses moved one step forward, six (15%) nurses moved backward, and eighteen (45%) nurses maintained at the same stage over time (stable sedentary, 40%; stable active, 5%). Bowker’s test of symmetry, χ2 = 14.00 (p < 0.01), revealed that the population exercising increased significantly after the intervention. After the program, the perceived benefits from exercise in the decisional balance significantly increased to 1.53 (t = 2.223, p < 0.05), perceived exercise barriers significantly decreased to 3.10 (t = −3.075, p < 0.05), and self-efficacy significantly increased to 2.90 (t = 3.251, p < 0.01), respectively. Applying the transtheoretical model to health behavior enables significant change. The benefits of applying the transtheoretical model for promoting exercise include increasing perceived exercise benefits and self-efficacy, decreasing perceived exercise barriers, and increasing physical activity levels.
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Affiliation(s)
- Wen-Ping Lee
- Department of Nursing, New Taipei Municipal Tucheng Hospital (Built and Operated by Chang Gung Medical Foundation), New Taipei City 236, Taiwan
| | - Pao-Yuan Wu
- Department of Nursing, New Taipei Municipal Tucheng Hospital (Built and Operated by Chang Gung Medical Foundation), New Taipei City 236, Taiwan
- Department of Nursing, University of Kang Ning, Taipei City 114, Taiwan
| | - Li-Chin Chen
- Department of Nursing, New Taipei Municipal Tucheng Hospital (Built and Operated by Chang Gung Medical Foundation), New Taipei City 236, Taiwan
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan 333, Taiwan
| | - Whei-Mei Shih
- Department of Nursing, New Taipei Municipal Tucheng Hospital (Built and Operated by Chang Gung Medical Foundation), New Taipei City 236, Taiwan
- Graduate Institute of Gerontology and Health Care Management, Chang Gung University of Science and Technology, Taoyuan 333, Taiwan
- Correspondence: ; Tel.: +886-953313075; Fax: +886-32118866
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Chen LC. [Study on mesentary margin in supply vessel-oriented radical resection of colorectal cancer]. Zhonghua Wei Chang Wai Ke Za Zhi 2022; 25:1029-1032. [PMID: 36396380 DOI: 10.3760/cma.j.cn441530-20220121-00030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The concept of radical surgery has experienced from vascular anatomy guidance, lymph node dissection guidance to en-bloc resection guidance. At present, the mesentery guided surgery has developed to a new level of understanding. There are many classical theories on the understanding of the mesentery, from "the mesentery is a wrapped composite structure" to "the mesentery is an organ" and then to "the generalized mesentery theory", but they do not clearly put forward the boundary mark of the mesentery. On the basis of various membrane anatomy theories at home and abroad, we summarized and defined three boundaries of mesenteric excision in radical resection of colorectal cancer. The lateral boundary of the mesentery is the intestinal resection boundary and its mesentery oriented by supplyvessel, the bottom boundary is the mesentery bed, and the central boundary is the degree of lymph node radical resection. Through the detailed description of the mesentery excision, it is helpful to accurately define the mesenteric margin in different stages of radical resection of tumors.
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Affiliation(s)
- L C Chen
- Department of Gastrointestinal Surgery, Fujian Cancer Hospital & Affiliated Cancer Hospital, Fujian Medical University, Fuzhou 350014, China
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12
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Han CY, Lin CC, Chen LC, Liu SH, Goopy S, Chang W. Family Caregivers' Experiences of Preventing Harm to Older People during Hospitalization: A Phenomenographic Study. Int J Environ Res Public Health 2022; 19:15375. [PMID: 36430089 PMCID: PMC9693274 DOI: 10.3390/ijerph192215375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 11/15/2022] [Accepted: 11/19/2022] [Indexed: 06/16/2023]
Abstract
Hospital admission is associated with a high risk of harm, particularly for older people, and family members play a critical role in providing care. The aim of this study was to explore family caregivers' experiences in preventing harm to older people during hospitalization. The phenomenographic approach was applied. Thirty family caregivers were asked to describe their experiences of preventing harm to older people. Semi-structured interviews were audiotaped and transcribed. Participants described preventing harm as "essential care", "an important step toward recovery", "a load off the mind", "outcomes of collaboration among caregivers and health professionals", and "improvement in the quality of life after discharge". The core theme was to achieve the goal of integrated care for older people. The results can help improve caregiving processes and prevent harm to older people during hospitalizations. They can assist in developing strategies for the delivery of safe care for older people.
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Affiliation(s)
- Chin-Yen Han
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan 33303, Taiwan
- New Taipei Municipal TuCheng Hospital, Chang Gung Medical Foundation, New Taipei City 236017, Taiwan
| | - Chun-Chih Lin
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan 33303, Taiwan
- New Taipei Municipal TuCheng Hospital, Chang Gung Medical Foundation, New Taipei City 236017, Taiwan
| | - Li-Chin Chen
- New Taipei Municipal TuCheng Hospital, Chang Gung Medical Foundation, New Taipei City 236017, Taiwan
| | - Shou-Hsuan Liu
- Department of Nephrology, Chang Gung Memorial Hospital at Linkou, Taoyuan 33303, Taiwan
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan 33303, Taiwan
| | - Suzanne Goopy
- Usher Institute, University of Edinburgh, Edinburgh EH8 9YL, UK
| | - Wen Chang
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan 33303, Taiwan
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Xi JY, Chen YY, Lin X, Dong H, Liang BH, Zhang YQ, Chen LC, Luo A, Qin PZ, Hao Y. [Health-adjusted life expectancy in residents in Guangzhou, 2010-2019]. Zhonghua Liu Xing Bing Xue Za Zhi 2022; 43:1415-1422. [PMID: 36117348 DOI: 10.3760/cma.j.cn112338-20220207-00098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Objective: To analyze the spatiotemporal distribution of life expectancy (LE) and health-adjusted life expectancy (HALE) in Guangzhou from 2010 to 2019, and quantize the comprehensive impact of different causes and sequelae on health. Methods: The LE, HALE, and cause-excluded health adjusted life expectancy (CEHALE) were estimated using cause-of-death surveillance datasets from Guangzhou Municipal Center for Disease Control and Prevention from 2010 to 2019 and open data from the Global Burden of Disease Study. Joinpoint log-linear regression model was used to analyze the temporal trend and described spatial distribution. Results: In 2019, the LE in residents in Guangzhou was 82.9 years (80.1 years in men and 85.9 years in women), and the HALE was 75.6 years (74.0 years in men and 77.3 years in women). Compared with the urban fringe, the central urban area had higher LE and HALE, and the differences between LE and HALE were small. The LE and HALE in Guangzhou showed an increasing trend from 2010 to 2019. The LE increased by 2.8 years (AAPC=0.4, 95%CI: 0.3-0.4), with the increase of 2.8 years in men and 2.9 years in women. The HALE increased by 2.4 years (AAPC=0.3, 95%CI: 0.3-0.4), with the increase of 2.5 years in men and 2.2 years in women. The median healthy life lost due to communicable, maternal, neonatal, and nutritional diseases was 6.2 years (AAPC=-4.2, 95%CI: -5.3--3.1), while the median healthy life lost due to non-communicable diseases was 14.7 years (AAPC=1.6, 95%CI: 0.9-2.3), the median healthy life expectancy reduced by injury was 6.3 years (AAPC=-3.5, 95%CI: -4.5--2.6). Musculoskeletal disorders, skin and subcutaneous diseases, cardiovascular diseases, nutritional deficiencies, diabetes and kidney diseases were the top five diseases causing healthy life expectancy loss. Conclusion: The LE and HALE in residents in Guangzhou increased steadily from 2010 to 2019, but the quality of life in the urban fringe was lower than that of the central urban area. Non-communicable diseases were the leading causes of healthy life expectancy loss. Health policies and prevention measures should be developed according to area specific characteristics, and social medical resources should be rationally allocated to key diseases to reduce their disease burden.
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Affiliation(s)
- J Y Xi
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Y Y Chen
- Department of Chronic Non-communicable Disease Control and Prevention, Guangzhou Municipal Center for Disease Control and Prevention, Guangzhou 510440, China
| | - X Lin
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - H Dong
- Department of Chronic Non-communicable Disease Control and Prevention, Guangzhou Municipal Center for Disease Control and Prevention, Guangzhou 510440, China
| | - B H Liang
- Department of Chronic Non-communicable Disease Control and Prevention, Guangzhou Municipal Center for Disease Control and Prevention, Guangzhou 510440, China
| | - Y Q Zhang
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - L C Chen
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - A Luo
- Institute for Infectious Disease Control and Prevention, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - P Z Qin
- Department of Chronic Non-communicable Disease Control and Prevention, Guangzhou Municipal Center for Disease Control and Prevention, Guangzhou 510440, China
| | - Yuantao Hao
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing 100191, China Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou 510080, China Center for Health Information Research, Sun Yat-sen University, Guangzhou 510080, China
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Lin C, Han C, Huang Y, Chen L, Su CC. Effectiveness of the use of concept maps and simulated cases as a teaching-learning strategy in enhancing the learning confidence of baccalaureate nursing students: A qualitative approach. Nurse Educ Today 2022; 115:105418. [PMID: 35636244 DOI: 10.1016/j.nedt.2022.105418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 05/02/2022] [Accepted: 05/23/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Didactic lectures and exam-oriented learning can lead to students becoming passive learners who rely on rote memory. This learning style negatively impacts their ability to cultivate the core nursing values and critical thinking. OBJECTIVES This study aimed to investigate the impact of a concept mapping teaching-learning strategy on undergraduate nursing students' ability to integrate theoretical biosciences knowledge into care practice and on their skills in critical thinking and teamwork. METHODS A qualitative research design was adopted. A course entitled Evaluation and Analysis of Adult Nursing Cases was developed based on a concept mapping strategy involving 24 simulated cases relevant to medical and surgical nursing. The participants were students from the two-year undergraduate nursing programme at a university in Taiwan. Data were collected from September 2020 to February 2021. Qualitative data were collected from semi-structured face-to-face interviews with 20 students and from 100 reflective reports on students' learning journeys. The data were analysed using qualitative content analysis. RESULTS Two major themes were identified: (1) changes in learning style and thinking and (2) rewards from learning. The participants reported that their learning style had changed from reliance on rote learning to image memory, and their thinking process from linear (cause-effect) to multifaceted thinking at different levels. The teaching and learning strategies contributed to feelings of ability advancement and psychological safety, which led to learning achievement and confidence. CONCLUSION The use of a concept mapping strategy and simulated cases enhanced students' learning by enabling them to integrate theoretical knowledge and improve their thinking abilities. The teaching and learning strategies helped participants in learning about psychological safety and increased their learning confidence.
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Affiliation(s)
- ChunChih Lin
- Department of Nursing, Chang Gung University of Science and Technology, 2, Jiapu Rd, West Sec. Pu-tz, ChiaYi 613, Taiwan; Chang Gung Memorial Hospital at Linkou, 2, Jiapu Rd, West Sec. Pu-tz, ChiaYi 613, Taiwan.
| | - ChinYen Han
- Department of Nursing and Clinical Competency Center, Chang Gung University of Science and Technology, 261 Wenhua 1 st Rd., Guishan Dist., Tauyuan 333, Taiwan; Chang Gung Memorial Hospital at Linkou, 261 Wenhua 1 st Rd., Guishan Dist., Tauyuan 333, Taiwan.
| | - YaLing Huang
- Faculty of Health (Nursing), Southern Cross University, Gold Coast, Queensland, Australia Gold Coast Campus B7.47, Locked Mail Bag 4, Coolangatta (Southern Cross University) QLD 4225; Department of Emergency Medicine, Gold Coast Hospital and Health Service, Gold Coast University Hospital, Gold Coast, Queensland, Australia, Gold Coast Campus B7.47, Locked Mail Bag 4, Coolangatta (Southern Cross University) QLD 4225.
| | - LiChin Chen
- Department of Nursing, New Taipei Municipal TuCheng Hospital, No.6, Sec.2, Jincheng Rd., Tucheng Dist., New Taipei City 236, Taiwan.
| | - Ching-Ching Su
- Department of Nursing, Chang Gung University of Science and Technology, 2, Jiapu Rd, West Sec. Pu-tz, ChiaYi 613, Taiwan.
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15
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Jerng JS, Chen LC, Chen SY, Kuo LC, Tsan CY, Hsieh PY, Chen CM, Chuang PY, Huang HF, Huang SF. Effect of Implementing Decision Support to Activate a Rapid Response System by Automated Screening of Verified Vital Sign Data: A Retrospective Database Study. Resuscitation 2022; 173:23-30. [DOI: 10.1016/j.resuscitation.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/23/2022] [Accepted: 02/04/2022] [Indexed: 11/16/2022]
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Abstract
BACKGROUND Newly Graduated Nurses in different socio-cultural contexts confront dissimilar situations and influences on role transfer. It is important to understand how newly graduated nurses reconstruct their own professional concept of clinical nurses. OBJECTIVES This study aimed to explore how Taiwanese newly graduated nurses perceived their new role and the process through which they transition into the professional role. METHODS Charmaz's constructivist grounded theory guided the study's design and implementation. Purposive and theoretical sampling and the snowball technique were used to recruit 30 participants from 3 tertiary and 2 community hospitals in Taiwan. Interviews were audio-recorded and transcribed verbatim into a readable format. Initial, focused and theoretical coding was utilized for data analysis. The criteria of credibility, originality, resonance and usefulness guided assessment of the study's quality and ensured the trustworthiness of the study process. RESULTS The process of role transition to become a nurse comprised four stages: hesitation, psychological preparation, development and appreciation. The hesitation stage was interpreted as a phase of passive learning. In the psychological preparation, newly graduate nurses began to take full work responsibility. The development stage saw them gain work confidence and, in the appreciation stage, they acquired a full picture of their roles. CONCLUSION To bridge the gap between theoretical learning and practice and reduce the time new graduate nurses need for role adjustment contributes to an early stage of Hesitation rather than the Appreciation stage of role transition. The findings suggest the need for further research to explore newly graduated nurses' needs during the process of role transition.
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Affiliation(s)
- PingRu Hsiao
- Assistant Professor, Department of Nursing, Chang Gung University of Science and Technology; Assistant Research Fellow (joint appointment), Chang Gung Memorial Hospital at Linkou, Taiwan
| | - ChunChih Lin
- Assistant Professor, Department of Nursing, Chang Gung University of Science and Technology; Assistant Research Fellow (joint appointment), Chang Gung Memorial Hospital at Linkou, Taiwan
| | - ChinYen Han
- Assistant Professor, Department of Nursing, Chang Gung University of Science and Technology; Assistant Research Fellow (joint appointment), Chang Gung Memorial Hospital at Linkou, Taiwan
| | - LiChin Chen
- Director, Department of Nursing, New Taipei Municipal TuCheng Hospital
| | - LiHsiang Wang
- Department of Nursing, Chang Gung University of Science and Technology; Assistant Research Fellow (joint appointment)Chang Gung Memorial Hospital, Taiwan
| | - Ching-Ching Su
- Assistant professor, Department of Nursing, Chang Gung University of Science and Technology, Taiwan
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Fang CL, Tian YF, Lin SS, Hung ST, Hseu YC, Chang CC, Chou CL, Chen LC, Wang WC, Lin KY, Sun DP. GRK3 as a Prognosis Biomarker in Gastric Cancer. J Cancer 2022; 13:1299-1306. [PMID: 35281865 PMCID: PMC8899382 DOI: 10.7150/jca.64748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 01/08/2022] [Indexed: 12/03/2022] Open
Abstract
Background: Globally, gastric cancer is ranked 4th and 3rd in terms of incidence and mortality rate among all cancer types. This study aimed to examine the relationship between G protein-coupled receptor kinase 3 (GRK3) and gastric cancer prognosis and investigate the role of GRK3 in gastric cancer carcinogenesis. Methods: GRK3 level in gastric tissues and cells were determined using immunohistochemistry and immunoblotting. Kaplan-Meier analysis with the log-rank test was employed to evaluate the relationship between GRK3 expression and gastric cancer prognosis. RNAi technology was applied to examine the effects of GRK3 inhibition on gastric cancer proliferation and spread. Results: GRK3 overexpression was correlated significantly with lymphatic metastasis (P = 0.0011), distant metastasis (P < 0.0001), TNM stage (P = 0.0035), and vascular invasion (P = 0.0025). Kaplan-Meier survival analysis showed that the disease-free survival and overall survival of patients with high GRK3 expression were significantly shorter than those of patients with low GRK3 expression. Multivariate Cox regression analysis also showed that the overexpression of GRK3 was an independent prognostic biomarker of gastric cancer (P = 0.029). In cultured gastric cancer cells, GRK3 knockdown inhibited cell proliferation, migration, and invasion. Further analysis revealed that more GRK3-knockdown cells were in G0/G1 phase and few cells were in S phase, thereby inhibiting cell proliferation. Conclusions: GRK3 overexpression can be a candidate biomarker for gastric cancer prognosis. GRK3 is also a potential therapeutic target for gastric cancer.
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Chen LC, Sheu JT, Chuang YJ, Tsao Y. Predicting the Travel Distance of Patients to Access Healthcare Using Deep Neural Networks. IEEE J Transl Eng Health Med 2021; 10:4900411. [PMID: 35141054 PMCID: PMC8809644 DOI: 10.1109/jtehm.2021.3134106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 11/17/2021] [Accepted: 11/22/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Improving geographical access remains a key issue in determining the sufficiency of regional medical resources during health policy design. However, patient choices can be the result of the complex interactivity of various factors. The aim of this study is to propose a deep neural network approach to model the complex decision of patient choice in travel distance to access care, which is an important indicator for policymaking in allocating resources. METHOD We used the 4-year nationwide insurance data of Taiwan and accumulated the possible features discussed in earlier literature. This study proposes the use of a convolutional neural network (CNN)-based framework to make predictions. The model performance was tested against other machine learning methods. The proposed framework was further interpreted using Integrated Gradients (IG) to analyze the feature weights. RESULTS We successfully demonstrated the effectiveness of using a CNN-based framework to predict the travel distance of patients, achieving an accuracy of 0.968, AUC of 0.969, sensitivity of 0.960, and specificity of 0.989. The CNN-based framework outperformed all other methods. In this research, the IG weights are potentially explainable; however, the relationship does not correspond to known indicators in public health. CONCLUSIONS Our results demonstrate the feasibility of the deep learning-based travel distance prediction model. It has the potential to guide policymaking in resource allocation. Clinical and Translational Impact Statement- Deep learning technology is feasible in investigating the distance that patients would travel while accessing care. It is a tool that integrates complex interactive variables with highly imbalanced data distributions.
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Affiliation(s)
- Li-Chin Chen
- Research Center for Information Technology InnovationAcademia Sinica, NankangTaipei115Taiwan
| | - Ji-Tian Sheu
- Department of Health Care ManagementChang Gung University, GuishanTaoyuan333Taiwan
| | - Yuh-Jue Chuang
- Department of Health Care ManagementChang Gung University, GuishanTaoyuan333Taiwan
| | - Yu Tsao
- Research Center for Information Technology InnovationAcademia Sinica, NankangTaipei115Taiwan
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Hsu FS, Huang SR, Huang CW, Huang CJ, Cheng YR, Chen CC, Hsiao J, Chen CW, Chen LC, Lai YC, Hsu BF, Lin NJ, Tsai WL, Wu YL, Tseng TL, Tseng CT, Chen YT, Lai F. Benchmarking of eight recurrent neural network variants for breath phase and adventitious sound detection on a self-developed open-access lung sound database-HF_Lung_V1. PLoS One 2021; 16:e0254134. [PMID: 34197556 PMCID: PMC8248710 DOI: 10.1371/journal.pone.0254134] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/20/2021] [Indexed: 01/15/2023] Open
Abstract
A reliable, remote, and continuous real-time respiratory sound monitor with automated respiratory sound analysis ability is urgently required in many clinical scenarios-such as in monitoring disease progression of coronavirus disease 2019-to replace conventional auscultation with a handheld stethoscope. However, a robust computerized respiratory sound analysis algorithm for breath phase detection and adventitious sound detection at the recording level has not yet been validated in practical applications. In this study, we developed a lung sound database (HF_Lung_V1) comprising 9,765 audio files of lung sounds (duration of 15 s each), 34,095 inhalation labels, 18,349 exhalation labels, 13,883 continuous adventitious sound (CAS) labels (comprising 8,457 wheeze labels, 686 stridor labels, and 4,740 rhonchus labels), and 15,606 discontinuous adventitious sound labels (all crackles). We conducted benchmark tests using long short-term memory (LSTM), gated recurrent unit (GRU), bidirectional LSTM (BiLSTM), bidirectional GRU (BiGRU), convolutional neural network (CNN)-LSTM, CNN-GRU, CNN-BiLSTM, and CNN-BiGRU models for breath phase detection and adventitious sound detection. We also conducted a performance comparison between the LSTM-based and GRU-based models, between unidirectional and bidirectional models, and between models with and without a CNN. The results revealed that these models exhibited adequate performance in lung sound analysis. The GRU-based models outperformed, in terms of F1 scores and areas under the receiver operating characteristic curves, the LSTM-based models in most of the defined tasks. Furthermore, all bidirectional models outperformed their unidirectional counterparts. Finally, the addition of a CNN improved the accuracy of lung sound analysis, especially in the CAS detection tasks.
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Affiliation(s)
- Fu-Shun Hsu
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
- Department of Critical Care Medicine, Far Eastern Memorial Hospital, New Taipei, Taiwan
- Heroic Faith Medical Science Co., Ltd., Taipei, Taiwan
| | | | | | - Chao-Jung Huang
- Joint Research Center for Artificial Intelligence Technology and All Vista Healthcare, National Taiwan University, Taipei, Taiwan
| | - Yuan-Ren Cheng
- Heroic Faith Medical Science Co., Ltd., Taipei, Taiwan
- Department of Life Science, College of Life Science, National Taiwan University, Taipei, Taiwan
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | | | - Jack Hsiao
- HCC Healthcare Group, New Taipei, Taiwan
| | - Chung-Wei Chen
- Department of Critical Care Medicine, Far Eastern Memorial Hospital, New Taipei, Taiwan
| | - Li-Chin Chen
- Research Center for Information Technology Innovation, Academia Sinica, Taipei, Taiwan
| | - Yen-Chun Lai
- Heroic Faith Medical Science Co., Ltd., Taipei, Taiwan
| | - Bi-Fang Hsu
- Heroic Faith Medical Science Co., Ltd., Taipei, Taiwan
| | - Nian-Jhen Lin
- Heroic Faith Medical Science Co., Ltd., Taipei, Taiwan
- Division of Pulmonary Medicine, Far Eastern Memorial Hospital, New Taipei, Taiwan
| | - Wan-Ling Tsai
- Heroic Faith Medical Science Co., Ltd., Taipei, Taiwan
| | - Yi-Lin Wu
- Heroic Faith Medical Science Co., Ltd., Taipei, Taiwan
| | | | | | - Yi-Tsun Chen
- Heroic Faith Medical Science Co., Ltd., Taipei, Taiwan
| | - Feipei Lai
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
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Lin CC, Han CY, Wu MLW, Hsiao PR, Wang LH, Chen LC. Enhancing reflection on medical and surgical nursing among nursing students: A participatory action research study. Nurse Educ Today 2021; 102:104935. [PMID: 33957396 DOI: 10.1016/j.nedt.2021.104935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 03/28/2021] [Accepted: 04/19/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Medical and Surgical Nursing (MSN) is a core course in baccalaureate nursing programs that requires active and effective teaching and learning strategies to enhance students' engagement. OBJECTIVE To develop and implement an effective learning process for students undertaking the MSN course. DESIGN This participatory action research study used reflection as the center of action in the cycle of planning, acting, observing and reflecting and re-planning. SETTING The study was conducted at a University in southern Taiwan. PARTICIPANTS Thirty nursing students in their second year of a bachelor program in nursing, aged 19 to 20 years, were recruited via email and completed the study. METHODS The data were collected from February to June 2019 through reflective workshops, group discussions, individual interviews, and field notes. A qualitative content analysis was performed. Four criteria were considered to ensure the trustworthiness of the study process: reliability, validity, transferability, and authentic citations. RESULTS Four key themes - two challenges and two adaptive strategies - emerged in relation to the spiral process of improving teaching and learning in the MSN course. Participants experienced two main challenges: the large amount of multidisciplinary knowledge expected, and the rapid pace of the course. The two adaptive strategies were: recognizing their own unique way of learning and becoming an active learner and achiever. CONCLUSIONS The project helped students to identify their own learning challenges, recognize the need to modify their attitudes and approaches to learning, improve teaching and learning in the MSN course, and identify the characteristics relevant to becoming an active learner and achiever.
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Affiliation(s)
- Chun-Chih Lin
- Department of Nursing, Chang Gung University of Science and Technology, Chang Gung Memorial Hospital at Linkou, 2, Jiapu Rd, West Sec. Pu-tz, ChiaYi 613, Taiwan.
| | - Chin-Yen Han
- Department of Nursing and Clinical Competency Center, Chang Gung University of Science and Technology, Chang Gung Memorial Hospital at Linkou, 261 Wenhua 1 st Rd., Guishan Dist., Tauyuan 333, Taiwan.
| | - Min-Lin Winnie Wu
- School of Nursing and Midwifery, Griffith University, 170 Kessels road, Nathan, Queensland 4111, Australia.
| | - Ping-Ru Hsiao
- Department of Nursing, Chang Gung University of Science and Technology, Chang Gung Memorial Hospital at Linkou, 261 Wenhua 1 st Rd., Guishan Dist., Tauyuan 333, Taiwan.
| | - Li-Hsiang Wang
- Department of Nursing, Chang Gung University of Science and Technology, Chang Gung Memorial Hospital at Linkou, 261 Wenhua 1 st Rd., Guishan Dist., Tauyuan 333, Taiwan.
| | - Li-Chin Chen
- Department of Nursing, New Taipei Municipal TuCheng Hospital No.6, Sec.2, Jincheng Rd., Tucheng Dist., New Taipei City, 236, Taiwan.
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Tung FI, Chen LC, Wang YC, Chen MH, Shueng PW, Liu TY. Using a Hybrid Radioenhancer to Discover Tumor Cell-targeted Treatment for Osteosarcoma: An In Vitro Study. Curr Med Chem 2021; 28:3877-3889. [PMID: 33213306 DOI: 10.2174/0929867327666201118155216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/30/2020] [Accepted: 10/07/2020] [Indexed: 11/22/2022]
Abstract
Osteosarcoma is insensitive to radiation. High-dose radiation is often used as a treatment but causes side effects in patients. Hence, it is important to develop tumor cell-- targeted radiotherapy that could improve radiotherapy efficiency on tumor cells and reduce the toxic effect on normal cells during radiation treatment. In this study, we developed an innovative method for treating osteosarcoma by using a novel radiation-enhancer (i.e., carboxymethyl-hexanoyl chitosan-coated self-assembled Au@Fe3O4 nanoparticles; CSAF NPs). CSAF NPs were employed together with 5-aminolevulinic acid (5- ALA) to achieve tumor cell-targeted radiotherapy. In this study, osteosarcoma cells (MG63) and normal cells (MC3T3-E1) were used for an in vitro investigation, in which reactive oxygen species (ROS) assay, cell viability assay, clonogenic assay, and western blot were used to confirm the treatment efficiency. The ROS assay showed that the combination of CSAF NPs and 5-ALA enhanced radiation-induced ROS production in tumor cells (MG63); however, this was not observed in normal cells (MC3T3-E1). The cell viability ratio of normal cells to tumor cells after treatment with CSAF NPs and 5-ALA reached 2.79. Moreover, the clonogenic assay showed that the radiosensitivity of MG63 cells was increased by the combination use of CSAF NPs and 5-ALA. This was supported by performing a western blot that confirmed the expression of cytochrome c (a marker of cell mitochondria damage) and caspase-3 (a marker of cell apoptosis). The results provide an essential basis for developing tumor-cell targeted radiotherapy by means of low-- dose radiation.
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Affiliation(s)
- Fu-I Tung
- Department of Orthopaedic Surgery, Taipei City Hospital, Taipei, Taiwan, China
| | - Li-Chin Chen
- Department of Biomedical Engineering, National Yang-Ming University, Taipei, Taiwan, China
| | - Yu-Chi Wang
- Department of Biomedical Engineering, National Yang-Ming University, Taipei, Taiwan, China
| | - Ming-Hong Chen
- Department of Neurosurgery, Taipei Municipal Wanfang Hospital, Taipei, Taiwan, China
| | - Pei-Wei Shueng
- Division of Radiation Oncology, Far Eastern Memorial Hospital, New Taipei City, Taiwan, China
| | - Tse-Ying Liu
- Department of Biomedical Engineering, National Yang-Ming University, Taipei, Taiwan, China
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Han CY, Redley B, Lin CC, Chen LC, Ng CJ, Wang LH. Standard risk assessment forms help reduce preventable harm in older adult inpatients: A retrospective chart review study. J Adv Nurs 2021; 77:4439-4450. [PMID: 34133782 DOI: 10.1111/jan.14931] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 04/16/2021] [Accepted: 05/24/2021] [Indexed: 11/29/2022]
Abstract
AIMS To examine nurse documentation of assessments using standard risk assessment forms in older inpatients, and to determine the value of such assessment. DESIGN Cross-sectional retrospective chart review. METHODS This retrospective review of risk evaluation documentation in patients' medical records focused on skin, continence, medical complications, nutrition, cognition, mobility, medications and pain. RESULTS A total of 1000 medical records from Taiwan hospitals were reviewed from January 2016 to December 2017, and 379 from Australian hospitals were reviewed from March 2011 to February 2012. Taiwanese patients with documented assessment of skin (aOR =2.94, 95%CI =1.88-4.54), nutrition (aOR =3.22, 95%CI =1.08-9.59), cognition (aOR =2.61, 95%CI =1.32-5.16) and pain (aOR =5.01, 95%CI=1.63-15.38) had significantly higher odds of developing new problems; while Australian patients with documented assessments of continence (aOR =11.55, 95%CI =1.48-90.45) and nutrition (aOR =12.90, 95%CI =1.67-99.06) had significantly higher odds of developing new problems. DISCUSSION Nursing assessments and interventions documented in standard risk assessment forms help clinical nurses detect new preventable problems and prevent harm in older hospital inpatients across geographic locations and hospital types. Standard nursing forms can be used in clinical practice to guide proactive care by nurses to prevent harm during hospitalisation. IMPACT Older inpatients are at risk of preventable harm and new health problems. The present study found that incorporating eight factors sensitive to nursing care into standard risk assessment forms can help reduce preventable harm in older inpatients. In addition, these forms guide assessment and intervention effectively in different countries.
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Affiliation(s)
- Chin-Yen Han
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan City, Taiwan.,Clinical Competency Center, Chang Gung University of Science and Technology, Taoyuan City, Taiwan.,Department of Nursing, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan
| | - Bernice Redley
- Centre for Quality and Patient Safety Research-Monash Health Partnership, School of Nursing and Midwifery, Deakin University, Waurn Ponds, VIC, Australia
| | - Chun-Chih Lin
- Department of Nursing, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan.,Department of Nursing, Chang Gung University of Science and Technology, Puzi City, Chiayi County, Taiwan
| | - Li-Chin Chen
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan City, Taiwan.,Department of Nursing, New Taipei Municipal TuCheng Hospital, Chang Gung Memorial Hospital, New Taipei City, Taiwan
| | - Chip Jin Ng
- Department of Emergency Medicine, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Li-Hsiang Wang
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan City, Taiwan.,Department of Nursing, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan
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Ding XW, Zheng ZC, Zhao Q, Zhai G, Liang H, Wu X, Zhu ZG, Wang HJ, He QS, He XL, Du YA, Chen LC, Hua YW, Huang CM, Xue YW, Zhou Y, Zhou YB, Wu D, Fang XD, Dai YG, Zhang HW, Cao JQ, Li LP, Chai J, Tao KX, Li GL, Jie ZG, Ge J, Xu ZF, Zhang WB, Li QY, Zhao P, Ma ZQ, Yan ZL, Zheng GL, Yan Y, Tang XL, Zhou X. [A multi-center retrospective study of perioperative chemotherapy for gastric cancer based on real-world data]. Zhonghua Wei Chang Wai Ke Za Zhi 2021; 24:403-412. [PMID: 34000769 DOI: 10.3760/cma.j.cn.441530-20200111-00014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To explore the effect of perioperative chemotherapy on the prognosis of gastric cancer patients under real-world condition. Methods: A retrospective cohort study was carried out. Real world data of gastric cancer patients receiving perioperative chemotherapy and surgery + adjuvant chemotherapy in 33 domestic hospitals from January 1, 2014 to January 31, 2016 were collected. Inclusion criteria: (1) gastric adenocarcinoma was confirmed by histopathology, and clinical stage was cT2-4aN0-3M0 (AJCC 8th edition); (2) D2 radical gastric cancer surgery was performed; (3) at least one cycle of neoadjuvant chemotherapy (NAC) was completed; (4) at least 4 cycles of adjuvant chemotherapy (AC) [SOX (S-1+oxaliplatin) or CapeOX (capecitabine + oxaliplatin)] were completed. Exclusion criteria: (1) complicated with other malignant tumors; (2) radiotherapy received; (3) patients with incomplete data. The enrolled patients who received neoadjuvant chemotherapy and adjuvant chemotherapy were included in the perioperative chemotherapy group, and those who received only postoperative adjuvant chemotherapy were included in the surgery + adjuvant chemotherapy group. Propensity score matching (PSM) method was used to control selection bias. The primary outcome were overall survival (OS) and progression-free survival (PFS) after PSM. OS was defined as the time from the first neoadjuvant chemotherapy (operation + adjuvant chemotherapy group: from the date of operation) to the last effective follow-up or death. PFS was defined as the time from the first neoadjuvant chemotherapy (operation + adjuvant chemotherapy group: from the date of operation) to the first imaging diagnosis of tumor progression or death. The Kaplan-Meier method was used to estimate the survival rate, and the Cox proportional hazards model was used to evaluate the independent effect of perioperative chemo therapy on OS and PFS. Results: 2 045 cases were included, including 1 293 cases in the surgery+adjuvant chemotherapy group and 752 cases in the perioperative chemotherapy group. After PSM, 492 pairs were included in the analysis. There were no statistically significant differences in gender, age, body mass index, tumor stage before treatment, and tumor location between the two groups (all P>0.05). Compared with the surgery + adjuvant chemotherapy group, patients in the perioperative chemotherapy group had higher proportion of total gastrectomy (χ(2)=40.526, P<0.001), smaller maximum tumor diameter (t=3.969, P<0.001), less number of metastatic lymph nodes (t=1.343, P<0.001), lower ratio of vessel invasion (χ(2)=11.897, P=0.001) and nerve invasion (χ(2)=12.338, P<0.001). In the perioperative chemotherapy group and surgery + adjuvant chemotherapy group, 24 cases (4.9%) and 17 cases (3.4%) developed postoperative complications, respectively, and no significant difference was found between two groups (χ(2)=0.815, P=0.367). The median OS of the perioperative chemotherapy group was longer than that of the surgery + adjuvant chemotherapy group (65 months vs. 45 months, HR: 0.74, 95% CI: 0.62-0.89, P=0.001); the median PFS of the perioperative chemotherapy group was also longer than that of the surgery+adjuvant chemotherapy group (56 months vs. 36 months, HR=0.72, 95% CI:0.61-0.85, P<0.001). The forest plot results of subgroup analysis showed that both men and women could benefit from perioperative chemotherapy (all P<0.05); patients over 45 years of age (P<0.05) and with normal body mass (P<0.01) could benefit significantly; patients with cTNM stage II and III presented a trend of benefit or could benefit significantly (P<0.05); patients with signet ring cell carcinoma benefited little (P>0.05); tumors in the gastric body and gastric antrum benefited more significantly (P<0.05). Conclusion: Perioperative chemotherapy can improve the prognosis of gastric cancer patients.
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Affiliation(s)
- X W Ding
- Department of Gastric surgery, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer Prevention and Therapy, Tianjin 300060, China
| | - Z C Zheng
- Department of Gastric Surgery, Cancer Hospital of China Medical University (Liaoning Cancer Hospital and Institute), Shenyang 110042, China
| | - Q Zhao
- The Third Department of Surgery, The Fourth Hospital, Hebei Medical University, Shijiazhuang 050011, China
| | - G Zhai
- Department of General Surgery, Shanxi Provincial Tumor Hospital, Taiyuan 030013, China
| | - H Liang
- Department of Gastric surgery, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer Prevention and Therapy, Tianjin 300060, China
| | - X Wu
- Department of General Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Z G Zhu
- Department of Surgery, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai Institute of Digestive Surgery, Shanghai Key Laboratory of Gastric Neoplasms, Shanghai 200025, China
| | - H J Wang
- Department of Gastrointestinal Surgery, Affiliated Tumor Hospital, Xinjiang Medical University, Urumqi 830011, China
| | - Q S He
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan 250012, China
| | - X L He
- Department of General Surgery, Tangdu Hospital, The Air Force Medical University, Xi'an 710038, China
| | - Y A Du
- Department of Gastric Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, China
| | - L C Chen
- Department of Gastrointestinal Surgery, Fujian Provincial Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou 350014, China
| | - Y W Hua
- Department of General Surgery, The Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou 450008, China
| | - C M Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou 350004, China
| | - Y W Xue
- Department of Gastrointestinal Surgery, Harbin Medical University Cancer Hospital, Harbin 150081, China
| | - Y Zhou
- Department of Gastic Surgery, Afiliated CancerHospital, Fudan University, Shanghai 200030, China
| | - Y B Zhou
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, Qingdao 266003, China
| | - D Wu
- Department of Gastrointestinal Surgery, Second Affiliated Hospital, Zhejiang University, Hangzhou 310009, China
| | - X D Fang
- Department of Gastrointestinal Colorectal And Anal Surgery, China-Japan Union Hospital of Jilin University, Changchun 130033, China
| | - Y G Dai
- Department of Gastrointestinal Surgery, Yunnan Cancer Hospital, Kunming 650118, China
| | - H W Zhang
- Diagnosis and Treatment Center of Digestive Disease, Wuxi Mingci cardiovascular Hospital, Wuxi 214101, China
| | - J Q Cao
- Department of Gastrointestinal Surgery, Second Affiliated Hospital, Nanchang University, Nanchang 330006, China
| | - L P Li
- Department of Gastrointestinal Surgery, The Affiliated Provincial Hospital, Shandong First Medical University, Jinan 250021, China
| | - J Chai
- Department of Gastric Surgery, The Affiliated Shandong Tumor Hospital, Shandong University, Jinan 250117, China
| | - K X Tao
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - G L Li
- Department of General Surgery, Jinling Hospital/General Hospital of Eastern Theater Command, School of Medicine, Nanjing University, Nanjing 210002, China
| | - Z G Jie
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - J Ge
- Department of Gastrointestinal Surgery Xiangya Hospital of Central South University, Changsha 410008, China
| | - Z F Xu
- Department of General Surgery, The Affiliated Hospital, Shandong Academy of Medical Sciences, Jinan 250031, China
| | - W B Zhang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830000, China
| | - Q Y Li
- Departerment of Abdominal Surgery, Jiangxi Cancer Hospital, Nanchang 330029, China
| | - P Zhao
- Departerment of Gastrointestinal Surgery, Sichuan Tumor Hospital, Chengdu 610041, China
| | - Z Q Ma
- Department of General Surgery, Peking Uninon Medical College (PUMC) Hospital, Chinese Academy of Medical Sciences (CAMS) and PUMC, Beijing 100730, China
| | - Z L Yan
- Department of Gastrointestinal Surgery, Ningbo First Hospital, Ningbo 315000, China
| | - G L Zheng
- Department of Gastric surgery, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer Prevention and Therapy, Tianjin 300060, China
| | - Y Yan
- Department of General Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - X L Tang
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan 250012, China
| | - X Zhou
- The Third Department of Surgery, The Fourth Hospital, Hebei Medical University, Shijiazhuang 050011, China
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Han CY, Chen LC, Lin CC, Goopy S, Lee HL. How Emergency Nurses Develop Resilience in the Context of Workplace Violence: A Grounded Theory Study. J Nurs Scholarsh 2021; 53:533-541. [PMID: 33960107 PMCID: PMC8518509 DOI: 10.1111/jnu.12668] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2021] [Indexed: 11/28/2022]
Abstract
Purpose To understand how emergency nurses develop resilience in the context of workplace violence. Design This study employed grounded theory methodology. Thirty nurses from three hospital emergency departments in Taiwan were interviewed between August and December 2018. Methods Semistructured interviews were used to collect data. Interviews were audio‐recorded and transcribed verbatim. Findings The process through which emergency nurses who had experienced workplace violence developed resilience took place in three stages: the release of emotions after the assault; the interpretation of conflicting thoughts and actions; and the establishment of strategies to cope with workplace violence in the future. The core theme was the motivating role of professional commitment to emergency patient care. Conclusions The results of this study can inform the development of support systems to enhance the resilience of nurses experiencing workplace violence by alerting healthcare administrators and governing institutions to their needs. Clinical Relevance Emergency nurses viewed professional growth and professional commitment as an invisible motivator in the development of resilience following an encounter with workplace violence.
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Affiliation(s)
- Chin-Yen Han
- Associate Professor, Department of Nursing, and Clinical Competency Center Chang Gung University of Science and Technology; Associate Research Fellow (joint appointment) Department of Nursing, Chang Gung Memorial Hospital at Linkou, Taiwan, Republic of China
| | - Li-Chin Chen
- Director, Department of Nursing, New Taipei Municipal Tuncheng Hospital, Chang Gung Memorial Hospital; Assistant Professor, Department of Nursing, Chang Gung University of Science and Technology, Taiwan, Republic of China
| | - Chun-Chih Lin
- Associate Professor, Department of Nursing, Chang Gung University of Science and Technology; Associate Research Fellow (joint appointment) Department of Nursing, Chang Gung Memorial Hospital at Linkou, Taiwan, Republic of China
| | - Suzanne Goopy
- Senior Teaching Fellow and Programme Coordinator, Usher institute, University of Edinburgh, UK, and Adjunct Associate Professor at University of Calgary, Canada
| | - Hui-Ling Lee
- Lecturer, Department of Nursing, Chang Gung University of Science and Technology, Taiwan, Republic of China
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Hsiao P, Lin C, Han C, Wang L, Chen L. An enjoyable involvement: A qualitative study of short-term study abroad for nursing students. PLoS One 2021; 16:e0249629. [PMID: 33798250 PMCID: PMC8018622 DOI: 10.1371/journal.pone.0249629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 03/23/2021] [Indexed: 11/18/2022] Open
Abstract
This study aimed to explore the experiences of nursing students who have undertaken a short course in an overseas educational system to generate theoretical understanding of the experience of studying abroad. Learning in the health professions needs to considered in the context of globalization as a way of sharing knowledge and taking responsibility as world citizens. Studying abroad provides students with an opportunity to develop global health care competencies. A symbolic interactionist approach was adopted to gain insight into how the students constructed the meaning of studying abroad. The study was conducted at a university with 2 campuses in Taiwan. A purposive sampling strategy was employed to recruit 14 participants. Data were collected from August to November 2017 via individual in-depth interviews. A semi-structured interview guide was used. Qualitative content analysis was employed to analyse the data. Each interview was audiotaped and transcribed verbatim. Most students identified both positive and negative experiences related to their professional and personal development and needs. They demonstrated motivation to leave their comfort zone and enter a challenging environment as well as a high level of adaptability. The experience enabled them to see themselves as part of the world and expanded their learning in positive ways. On completion of their course, they encouraged others to experience this enjoyable once-in-a-lifetime opportunity.
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Affiliation(s)
- PingRu Hsiao
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - ChunChih Lin
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan
- Chang Gung Memorial Hospital, Taoyuan, Taiwan
- * E-mail:
| | - ChinYen Han
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan
- Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - LiHsiang Wang
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - LiChin Chen
- New Taipei Municipal TuCheng Hospital, Taipei, Taiwan
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Ye ZS, Zeng Y, Wei SH, Wang Y, Chen S, Lin ZT, Wang ZW, Chen XL, Chen LC. [Safety and short-term efficacy of apatinib combined with oxaliplatin and S-1 in the conversion treatment for gastric cancer with peritoneal metastasis]. Zhonghua Wei Chang Wai Ke Za Zhi 2021; 24:240-247. [PMID: 34645168 DOI: 10.3760/cma.j.cn.441530-20200530-00326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the safety and short-term efficacy of apatinib combined with oxaliplatin and S-1 in the conversion treatment for gastric cancer with different types of peritoneal metastasis. Methods: A prospective study "one arm exploratory clinical study of conversion therapy of apatinib with S-1 and oxaliplatin in the treatment of advanced gastric cancer" (clinical registration ChiCTR-ONC-17010430) from medical record database was retrospectively analyzed. Patients aged 18-70 years with gastric cancer peritoneal metastasis confirmed by histology and laparoscopic exploration, and had not receive radiotherapy, chemotherapy, targeted therapy or immunotherapy before were enrolled. Before operation, the patients received 6 cycles of S-1 (80-120 mg/d, d1-d14) and oxaliplatin (130 mg/m(2), d1), and 5 cycles of apatinib (500 mg/d, d1-d21) conversion regimen. Three weeks after chemotherapy, whether the operation was performed or not depending on re-evaluation and patient preference. The main outcome were adverse reactions, and the secondary outcome were objective remission rate (ORR), disease control rate (DCR), and overall survival (OS) rate. The follow-up period was up to May 2020. Results: A total of 27 patients with gastric cancer peritoneal metastasis were enrolled in this study. There were 13 males and 14 females, with a median age of 58 (30-68) years old. There were 9 cases of P1a, 5 cases of P1b, and 13 cases of P1c. There were 14 cases with 1-5 scores of PCI (peritoneal cancer index), and 13 cases with 6 scores or above. The incidence of adverse reactions was 100%. The most common adverse reactions were hematological events including leucopenia (70.4%, 19/27) and granulocytopenia (74.1%, 20/27). Non-hematological adverse events included fatigue (51.9%, 14/27) and oral mucositis (37.0%, 10/27). One patient was withdrawn due to grade 4 thrombocytopenia. Among 26 patients with feasible efficacy evaluation, 18 (69.2%) achieved partial remission, 3 (11.5%) achieved stable disease, and 5 (19.2%) disease progression. The objective remission rate was 69.2% (18/26) and the disease control rate was 80.8% (21/26). Fourteen patients underwent surgery, including 6 patients undergoing R0 resection with the R0 resection rate of 42.9% (6/14). The postoperative pathological response rate was 64.3% (9/14). The follow-up time was 12-40 months, and the follow-up rate was 100%. The 1-year OS rate was 65.2% and the survival time was (14.0±1.7) months. The 1-year OS rates of P1a/P1b group and P1c group were 81.8% and 42.0% respectively, whose difference was statistically significant (P=0.041). The 1-year OS rates of PCI 1-5 group and PCI ≥6 group were 67.3% and 38.5% respectively, whose difference was statistically significant (P=0.022). Conclusion: In the conversion treatment of gastric cancer peritoneal metastasis, the safety of apatinib combined with oxaliplatin and S-1 is acceptable, and this regimen shows a good short-term survival efficacy in patients with P1a/P1b and PCI of 1-5.
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Affiliation(s)
- Z S Ye
- Department of Gastrointestinal Surgery, Key Laboratory of Tumor Biological Treatment of Fujian Province, Fujian Cancer Hospital & Affiliated Cancer Hospital, Fujian Medical University, Fuzhou 350014, China
| | - Y Zeng
- Department of Gastrointestinal Surgery, Key Laboratory of Tumor Biological Treatment of Fujian Province, Fujian Cancer Hospital & Affiliated Cancer Hospital, Fujian Medical University, Fuzhou 350014, China
| | - S H Wei
- Department of Gastrointestinal Surgery, Key Laboratory of Tumor Biological Treatment of Fujian Province, Fujian Cancer Hospital & Affiliated Cancer Hospital, Fujian Medical University, Fuzhou 350014, China
| | - Y Wang
- Department of Gastrointestinal Surgery, Key Laboratory of Tumor Biological Treatment of Fujian Province, Fujian Cancer Hospital & Affiliated Cancer Hospital, Fujian Medical University, Fuzhou 350014, China
| | - S Chen
- Department of Gastrointestinal Surgery, Key Laboratory of Tumor Biological Treatment of Fujian Province, Fujian Cancer Hospital & Affiliated Cancer Hospital, Fujian Medical University, Fuzhou 350014, China
| | - Z T Lin
- Department of Gastrointestinal Surgery, Key Laboratory of Tumor Biological Treatment of Fujian Province, Fujian Cancer Hospital & Affiliated Cancer Hospital, Fujian Medical University, Fuzhou 350014, China
| | - Z W Wang
- Department of Gastrointestinal Surgery, Key Laboratory of Tumor Biological Treatment of Fujian Province, Fujian Cancer Hospital & Affiliated Cancer Hospital, Fujian Medical University, Fuzhou 350014, China
| | - X L Chen
- Department of Gastrointestinal Surgery, Key Laboratory of Tumor Biological Treatment of Fujian Province, Fujian Cancer Hospital & Affiliated Cancer Hospital, Fujian Medical University, Fuzhou 350014, China
| | - L C Chen
- Department of Gastrointestinal Surgery, Key Laboratory of Tumor Biological Treatment of Fujian Province, Fujian Cancer Hospital & Affiliated Cancer Hospital, Fujian Medical University, Fuzhou 350014, China
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Lin SJ, Tsan CY, Su MY, Wu CL, Chen LC, Hsieh HJ, Hsiao WL, Cheng JC, Kuo YW, Jerng JS, Wu HD, Sun JS. Improving patient safety during intrahospital transportation of mechanically ventilated patients with critical illness. BMJ Open Qual 2021; 9:bmjoq-2019-000698. [PMID: 32317274 PMCID: PMC7202726 DOI: 10.1136/bmjoq-2019-000698] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 04/04/2020] [Accepted: 04/07/2020] [Indexed: 01/24/2023] Open
Abstract
Aim Intrahospital transportation (IHT) of patients under mechanical ventilation (MV) significantly increases the risk of patient harm. A structured process performed by a well-prepared team with adequate communication among team members plays a vital role in enhancing patient safety during transportation. Design and implementation We conducted this quality improvement programme at the intensive care units of a university-affiliated medical centre, focusing on the care of patients under MV who received IHT for CT or MRI examinations. With the interventions based on the analysis finding of the IHT process by healthcare failure mode and effects analysis, we developed and implemented strategies to improve this process, including standardisation of the transportation process, enhancing equipment maintenance and strengthening the teamwork among the transportation teammates. In a subsequent cycle, we developed and implemented a new process with the practice of reminder-assisted briefing. The reminders were printed on cards with mnemonics including ‘VITAL’ (Vital signs, Infusions, Tubes, Alarms and Leave) attached to the transportation monitors for the intensive care unit nurses, ‘STOP’ (Secretions, Tubes, Oxygen and Power) attached to the transportation ventilators for the respiratory therapists and ‘STOP’ (Speak-out, Tubes, Others and Position) attached to the examination equipment for the radiology technicians. We compared the incidence of adverse events and completeness and correctness of the tasks deemed to be essential for effective teamwork before and after implementing the programme. Results The implementation of the programme significantly reduced the number and incidence of adverse events (1.08% vs 0.23%, p=0.01). Audits also showed improved teamwork during transportation as the team members showed increased completeness and correctness of the essential IHT tasks (80.8% vs 96.5%, p<0.001). Conclusion The implementation of reminder-assisted briefings significantly enhanced patient safety and teamwork behaviours during the IHT of mechanically ventilated patients with critical illness.
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Affiliation(s)
- Shwu-Jen Lin
- Division of Respiratory Therapy, Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, Taipei, Taiwan
| | - Chin-Yuan Tsan
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Mao-Yuan Su
- Department of Radiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chao-Ling Wu
- Division of Respiratory Therapy, Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, Taipei, Taiwan
| | - Li-Chin Chen
- Center for Quality Management, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsiu-Jung Hsieh
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Ling Hsiao
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Jui-Chen Cheng
- Division of Respiratory Therapy, Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, Taipei, Taiwan
| | - Yao-Wen Kuo
- Division of Respiratory Therapy, Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, Taipei, Taiwan
| | - Jih-Shuin Jerng
- Center for Quality Management, National Taiwan University Hospital, Taipei, Taiwan .,Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Huey-Dong Wu
- Division of Respiratory Therapy, Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, Taipei, Taiwan
| | - Jui-Sheng Sun
- Center for Quality Management, National Taiwan University Hospital, Taipei, Taiwan.,Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan
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28
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Tiao CH, Tsai LC, Chen LC, Liao YM, Sun LC. Healthcare Failure Mode and Effect Analysis (HFMEA) as an Effective Mechanism in Preventing Infection Caused by Accompanying Caregivers During COVID-19-Experience of a City Medical Center in Taiwan. Qual Manag Health Care 2021; 30:61-68. [PMID: 33306657 DOI: 10.1097/qmh.0000000000000295] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES In response to the COVID-19 pandemic outbreak and to ensure the safety of epidemic prevention in the hospital, the hospital has established mitigation strategies in advance including risk assessment and effect analysis to control hospital visitors and accompanying persons. The study aims to assess the effectiveness of mitigation strategies implemented to effectively prevent the invasion and spread of the virus. METHOD Conduct a status analysis in accordance with the Healthcare Failure Mode and Effect Analysis (HFMEA) 4-step model, construct a response workflow, confirm the failure mode and potential causes, perform hazard matrix analysis and decision tree analysis, and formulate risk control management measures. RESULTS For the 4 main processes and 9 subprocesses of the accompanying carers and contract caregivers entering the hospital, 26 potential failure modes and 42 potential causes of failure were analyzed. Following implementing improvement measures including strategies targeting the accompanying person, mitigation workflow failure rates decreased from 42 to 13 items, the pass rate for the maximum body temperature cutoff increased from 53.1% to 90.8%, and the compliance rate of hand washing increased from 89.5% to 100%. CONCLUSION The HFMEA model can effectively implement preventive risk assessment and workflow management of high-risk medical procedures. The model can adjudicate the health of hospital visitors during the epidemic/pandemic, provide epidemic/pandemic education training and preventive measure health education guidance for hospital visits, and improve their epidemic prevention cognition. When combined, these strategies can prevent nosocomial infection to achieve the best anti-epidemic effect.
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Affiliation(s)
- Chi-Hui Tiao
- Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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29
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Wu YH, Chen CJ, Wu HY, Chen I, Chang YH, Yang PH, Wang TY, Chen LC, Liu KT, Yeh IJ, Wu DC, Hou MF, Liu HL, Su WH. Plastic wrap combined with alcohol wiping is an effective method of preventing bacterial colonization on mobile phones. Medicine (Baltimore) 2020; 99:e22910. [PMID: 33126347 PMCID: PMC7598847 DOI: 10.1097/md.0000000000022910] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Using mobile phones for communication in emergency departments is a common practice; however, several studies have demonstrated that they may act as vectors for bacteria and viruses. This study evaluated the effectiveness of plastic wrapping in decreasing bacterial contamination on mobile phone surfaces. METHOD We used culture dishes and a luminometer to detect bacterial colonies and contamination on the phone surfaces. RESULT Our experiment showed that bacterial colonies exist on mobile phones before and after work. We found that wiping with 75% alcohol sanitizers effectively reduces the number of colonies on either a mobile phone or a temporary plastic covering. In addition, we found that bacterial colonies do not contaminate or adhere to plastic wrap any easier than to mobile phones. CONCLUSION These results demonstrated the effectiveness of plastic wrap for protecting mobile phone surfaces against bacterial colonization. In addition, applying a layer of plastic wrap protects the phone from potential damage due to the alcohol.
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Affiliation(s)
- Yen-Hung Wu
- Department of Emergency Medicine, Kaohsiung Medical University Hospital
- Graduate Institute of Clinical Medicine, College of Medicine
| | | | | | - I Chen
- Division of Financial Management
| | | | - Pei-Hsuan Yang
- Department of Nursing, Department of Renal Care, School of Nursing, Fooyin University
| | - Tzu-Yi Wang
- Department of Emergency Medicine, Kaohsiung Medical University Hospital
| | - Li-Chin Chen
- Department of Nursing, Kaohsiung Medical University
| | - Kuan-Ting Liu
- Department of Emergency Medicine, Kaohsiung Medical University Hospital
| | - I-Jeng Yeh
- Department of Emergency Medicine, Kaohsiung Medical University Hospital
- Graduate Institute of Clinical Medicine, College of Medicine
| | - Deng-Chyang Wu
- Division of Gastroenterology, Department of Internal Medicine
- Cell Therapy and Research Center, Kaohsiung Medical University Hospital
- Regenerative Medicine and Cell Therapy Research Center
| | - Ming-Feng Hou
- Department of Superintendent office, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsin-Liang Liu
- Department of Emergency Medicine, Kaohsiung Medical University Hospital
| | - Wen-Hui Su
- Department of Superintendent office, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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30
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Chen HC, Chen MH, Shen CW, Hsieh MH, Wu LK, Chen LC, Cheng TJ, Chen LS, Tsai JR, Hsiao SH. Secure Health Care Workers' Health and Safety Methodically During COVID-19 Epidemic in Taiwan. Asia Pac J Public Health 2020; 32:485-488. [PMID: 33063525 DOI: 10.1177/1010539520963629] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Huang-Chi Chen
- Kaohsiung Municipal Siao-Gang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Mei-Hsing Chen
- Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chun-Wei Shen
- Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Meng-Hsuan Hsieh
- Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Kaohsiung Medical University, Kaohsiung, Taiwan.,Taiwan College of Healthcare Executives, Taipei, Taiwan
| | - Lin-Kun Wu
- Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Li-Chin Chen
- Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tsun-Jen Cheng
- Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ling-Sui Chen
- Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Kaohsiung Municipal Cijin Hospital, Kaohsiung Medical University Kaohsiung, Taiwan
| | - Jong-Rung Tsai
- Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Kaohsiung Municipal Cijin Hospital, Kaohsiung Medical University Kaohsiung, Taiwan
| | - Shih-Huai Hsiao
- Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Kaohsiung Medical University, Kaohsiung, Taiwan.,Taiwan College of Healthcare Executives, Taipei, Taiwan
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31
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Chen LC, Wu LK, Chen MH. Suspending cross-team nursing care is necessary to prevent health care-associated infection during COVID-19 epidemic. Kaohsiung J Med Sci 2020; 36:955-956. [PMID: 32882107 DOI: 10.1002/kjm2.12289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 07/13/2020] [Accepted: 07/15/2020] [Indexed: 11/08/2022] Open
Affiliation(s)
- Li-Chin Chen
- Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Lin-Kun Wu
- Administration Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Mei-Hsing Chen
- Quality and Patient Safety Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Superintendent Office, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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32
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Kuo FL, Yang PH, Hsu HT, Su CY, Chen CH, Yeh IJ, Wu YH, Chen LC. Survey on perceived work stress and its influencing factors among hospital staff during the COVID-19 pandemic in Taiwan. Kaohsiung J Med Sci 2020; 36:944-952. [PMID: 32815248 PMCID: PMC7461417 DOI: 10.1002/kjm2.12294] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 07/04/2020] [Accepted: 07/23/2020] [Indexed: 12/20/2022] Open
Abstract
This study aimed to investigate the perceived work stress and its influencing factors among hospital staff during the novel coronavirus (COVID‐19) pandemic in Taiwan. A web‐based survey was conducted at one medical center and two regional hospitals in southern Taiwan, targeting physicians, nurses, medical examiners, and administrators. The questionnaire included items on the demographic characteristics of hospital staff and a scale to assess stress among healthcare workers caring for patients with a highly infectious disease. A total of 752 valid questionnaires were collected. The hospital staff reported a moderate level of stress and nurses had a highest level of stress compared to staff in the other three occupational categories. The five highest stress scores were observed for the items “rough and cracked hands due to frequent hand washing and disinfectant use,” “inconvenience in using the toilet at work,” “restrictions on eating and drinking at work,” “fear of transmitting the disease to relatives and friends,” and “fear of being infected with COVID‐19.” Discomfort caused by protective equipment was the major stressor for the participants, followed by burden of caring for patients. Among participants who experienced severe stress (n = 129), work stress was higher among those with rather than without minor children. The present findings may serve as a reference for future monitoring of hospital staff's workload, and may aid the provision of support and interventions.
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Affiliation(s)
- Fang-Li Kuo
- Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Emergency Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Pei-Hsuan Yang
- Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,School of Nursing, Fooyin University, Kaohsiung, Taiwan
| | - Hsin-Tien Hsu
- Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,School of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Che-Yu Su
- Department of Emergency Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chun-Hsien Chen
- Department of Emergency Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - I-Jeng Yeh
- Department of Emergency Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Yen-Hung Wu
- Department of Emergency Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Li-Chin Chen
- Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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33
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Tsai KH, Wang WC, Cheng CH, Tsai CY, Wang JK, Lin TH, Fang SH, Chen LC, Tsao Y. Blind Monaural Source Separation on Heart and Lung Sounds Based on Periodic-Coded Deep Autoencoder. IEEE J Biomed Health Inform 2020; 24:3203-3214. [PMID: 32795973 DOI: 10.1109/jbhi.2020.3016831] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Auscultation is the most efficient way to diagnose cardiovascular and respiratory diseases. To reach accurate diagnoses, a device must be able to recognize heart and lung sounds from various clinical situations. However, the recorded chest sounds are mixed by heart and lung sounds. Thus, effectively separating these two sounds is critical in the pre-processing stage. Recent advances in machine learning have progressed on monaural source separations, but most of the well-known techniques require paired mixed sounds and individual pure sounds for model training. As the preparation of pure heart and lung sounds is difficult, special designs must be considered to derive effective heart and lung sound separation techniques. In this study, we proposed a novel periodicity-coded deep auto-encoder (PC-DAE) approach to separate mixed heart-lung sounds in an unsupervised manner via the assumption of different periodicities between heart rate and respiration rate. The PC-DAE benefits from deep-learning-based models by extracting representative features and considers the periodicity of heart and lung sounds to carry out the separation. We evaluated PC-DAE on two datasets. The first one includes sounds from the Student Auscultation Manikin (SAM), and the second is prepared by recording chest sounds in real-world conditions. Experimental results indicate that PC-DAE outperforms several well-known separation works in terms of standardized evaluation metrics. Moreover, waveforms and spectrograms demonstrate the effectiveness of PC-DAE compared to existing approaches. It is also confirmed that by using the proposed PC-DAE as a pre-processing stage, the heart sound recognition accuracies can be notably boosted. The experimental results confirmed the effectiveness of PC-DAE and its potential to be used in clinical applications.
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34
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Quon JL, Bala W, Chen LC, Wright J, Kim LH, Han M, Shpanskaya K, Lee EH, Tong E, Iv M, Seekins J, Lungren MP, Braun KRM, Poussaint TY, Laughlin S, Taylor MD, Lober RM, Vogel H, Fisher PG, Grant GA, Ramaswamy V, Vitanza NA, Ho CY, Edwards MSB, Cheshier SH, Yeom KW. Deep Learning for Pediatric Posterior Fossa Tumor Detection and Classification: A Multi-Institutional Study. AJNR Am J Neuroradiol 2020; 41:1718-1725. [PMID: 32816765 PMCID: PMC7583118 DOI: 10.3174/ajnr.a6704] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 05/27/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND PURPOSE Posterior fossa tumors are the most common pediatric brain tumors. MR imaging is key to tumor detection, diagnosis, and therapy guidance. We sought to develop an MR imaging-based deep learning model for posterior fossa tumor detection and tumor pathology classification. MATERIALS AND METHODS The study cohort comprised 617 children (median age, 92 months; 56% males) from 5 pediatric institutions with posterior fossa tumors: diffuse midline glioma of the pons (n = 122), medulloblastoma (n = 272), pilocytic astrocytoma (n = 135), and ependymoma (n = 88). There were 199 controls. Tumor histology served as ground truth except for diffuse midline glioma of the pons, which was primarily diagnosed by MR imaging. A modified ResNeXt-50-32x4d architecture served as the backbone for a multitask classifier model, using T2-weighted MRIs as input to detect the presence of tumor and predict tumor class. Deep learning model performance was compared against that of 4 radiologists. RESULTS Model tumor detection accuracy exceeded an AUROC of 0.99 and was similar to that of 4 radiologists. Model tumor classification accuracy was 92% with an F1 score of 0.80. The model was most accurate at predicting diffuse midline glioma of the pons, followed by pilocytic astrocytoma and medulloblastoma. Ependymoma prediction was the least accurate. Tumor type classification accuracy and F1 score were higher than those of 2 of the 4 radiologists. CONCLUSIONS We present a multi-institutional deep learning model for pediatric posterior fossa tumor detection and classification with the potential to augment and improve the accuracy of radiologic diagnosis.
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Affiliation(s)
- J L Quon
- From the Departments of Neurosurgery (J.L.Q., G.A.G., M.S.B.E.)
| | - W Bala
- Department of Radiology (W.B., J.S., M.P.L., K.W.Y.)
| | | | - J Wright
- Department of Radiology (J.W.), Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington
| | - L H Kim
- Stanford University School of Medicine (L.H.K., M.H., K.S.), Stanford, California
| | - M Han
- Stanford University School of Medicine (L.H.K., M.H., K.S.), Stanford, California
| | - K Shpanskaya
- Stanford University School of Medicine (L.H.K., M.H., K.S.), Stanford, California
| | - E H Lee
- Electrical Engineering (E.H.L.)
| | | | | | - J Seekins
- Department of Radiology (W.B., J.S., M.P.L., K.W.Y.)
| | - M P Lungren
- Department of Radiology (W.B., J.S., M.P.L., K.W.Y.)
| | - K R M Braun
- Departments of Clinical Radiology & Imaging Sciences (K.R.M.B., C.Y.H.), Riley Children's Hospital, Indiana University, Indianapolis, Indiana
| | - T Y Poussaint
- Departments of Radiology (T.Y.P.), Boston Children's Hospital, Boston, Massachusetts
| | - S Laughlin
- Departments of diagnostic Imaging (S.L.)
| | | | - R M Lober
- Department of Neurosurgery (R.M.L.), Dayton Children's Hospital, Wright State University Boonshoft School of Medicine, Dayton, Ohio
| | - H Vogel
- and Pathology (H.V.), Stanford University, Stanford, California
| | - P G Fisher
- Division of Child Neurology (P.G.F.), Lucile Packard Children's Hospital, Stanford University, Palo Alto, California
| | - G A Grant
- From the Departments of Neurosurgery (J.L.Q., G.A.G., M.S.B.E.)
| | - V Ramaswamy
- and Haematology/Oncology (V.R.), The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - N A Vitanza
- Division of Pediatric Hematology/Oncology (N.A.V.), Department of Pediatrics, University of Washington, Seattle Children's Hospital, Seattle Washington.,Fred Hutchinson Cancer Research Center (N.A.V.), Seattle, Washington
| | - C Y Ho
- Departments of Clinical Radiology & Imaging Sciences (K.R.M.B., C.Y.H.), Riley Children's Hospital, Indiana University, Indianapolis, Indiana
| | - M S B Edwards
- From the Departments of Neurosurgery (J.L.Q., G.A.G., M.S.B.E.)
| | - S H Cheshier
- Departments of Neurosurgery (S.H.C.), University of Utah School of Medicine, Salt Lake City, Utah
| | - K W Yeom
- Department of Radiology (W.B., J.S., M.P.L., K.W.Y.)
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35
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Chen LC, Alexanderson KA. Sick leave and disability pension before and after breast cancer diagnosis: a Swedish cohort study. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz187.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Most working-aged women are, after diagnosed with breast cancer (BC), on some sickness absence and/or disability pension (SADP). We aimed to explore possible trajectories of their previous and subsequent SADP days and risk factors for consistently high levels of future SADP.
Methods
In a longitudinal cohort study of all 3536 women in Sweden aged 19-64 with a first BC diagnosis in 2010, we calculated their annual SADP net days from two years before to three years after BC diagnosis date. A group-based trajectory model was applied to depict SADP patterns. Logistic regressions were used to calculate odds ratios (OR) with 95% confidence intervals (CI) for having >90 or > 180 SADP days/year in the three postdiagnostic years.
Results
Three trajectories of SADP days/month over the five years were identified: “high” (30% of all)”, “increase only around diagnosis” (61%), and ’constant very high’ (9%). Across the study period, the risk factors associated with constantly high levels of SADP days (>90 or > 180 days/year) were similar. Particularly, factors significantly associated with having annual SADP >90 days during all the three postdiagnostic years were: stage II cancer (OR = 4.59; 95% CI 2.98-7.07), stage III+IV (OR = 26.57; 13.52-52.22), prediagnosis SA 1-30 days (OR = 2.73; 1.30-5.70), prediagnosis SA > 90 days (OR = 24.52; 12.25-49.08), and prediagnosis DP (OR = 659.97; 292.52->999.99).
Conclusions
When diagnosed with BC, SADP increased significantly postdiagnosis, however, decreased with time and the absolute majority had no SADP the third year after BC diagnosis. Advanced cancer stage and previous high SADP were the highest risk factors for later SADP.
Key messages
Most breast cancer survivors’ work capacity (sickness absence (SA) and disability pension (DP) is only affected shortly post-diagnosis. Prior SADP and high cancer stage were strongest risk factors. Register-based information on breast cancer patients and their sickness absence and disability pension before and after diagnosis are useful to identify different types of return-to-work patterns.
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Affiliation(s)
- L C Chen
- Division of Insurance Medicine, Karolinska Institutet, Sweden, Sweden
| | - K A Alexanderson
- Division of Insurance Medicine, Karolinska Institutet, Sweden, Sweden
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36
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Lin CC, Liang HF, Han CY, Chen LC, Hsieh CL. Professional resilience among nurses working in an overcrowded emergency department in Taiwan. Int Emerg Nurs 2018; 42:44-50. [PMID: 29954706 DOI: 10.1016/j.ienj.2018.05.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 05/28/2018] [Accepted: 05/31/2018] [Indexed: 11/18/2022]
Abstract
PURPOSE Professional resilience has become increasingly important for nurses in adverse work environments to reduce the negative results and increase the positive outcomes of stress. This study aimed to explore and understand the experiences of resilience among nurses in an overcrowded emergency department (ED) and increase knowledge about what nurses identified as protective factors, which may be useful for future planning. METHODS A construction-grounded theory (CGT) approach was adopted. Purposive sampling and snowball technique were employed to recruit 13 participants, which proved sufficient to achieve theoretical saturation. In-depth interviews were conducted and audiotaped. RESULTS Doubting work value and maintaining optimism were the 2 main themes in the core category of seeing and taking work difficulty and responsibility. Nurses described how their passion for their profession gradually diminished, but they assessed the situation and took responsibility for their jobs. CONCLUSION This study found that nurses retain their compassion, which sustains them in their work. The issue of ED overcrowding led to pessimism among nurses. However, work rewards encouraged nurses to adopt a more proactive attitude toward work-related adversity.
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Affiliation(s)
- Chun-Chih Lin
- Department of Nursing, Chang Gung University of Science and Technology, Taiwan; Chang Gung Memorial Hospital at ChiaYi, Taiwan.
| | - Hwey-Fang Liang
- Department of Nursing, Chang Gung University of Science and Technology, Taiwan; Chang Gung Memorial Hospital at ChiaYi, Taiwan.
| | - Chin-Yen Han
- Department of Nursing, Chang Gung University of Science and Technology, Taiwan; Chang Gung Memorial Hospital at Linkou, Taiwan.
| | - Li-Chin Chen
- Department of Nursing, Linkou Chang Gung Memorial Hospital, Taiwan; Taiwan Association Critical Care Nurses (TACCN), Taiwan.
| | - Chun-Lan Hsieh
- Department of Nursing, Linkou Chang Gung Memorial Hospital, Taiwan.
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37
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Chen LC, Lin CC, Han CY, Hsieh CL, Wu CJJ, Liang HF. An Interpretative Study on Nurses' Perspectives of Working in an Overcrowded Emergency Department in Taiwan. Asian Nurs Res (Korean Soc Nurs Sci) 2018; 12:62-68. [PMID: 29496585 DOI: 10.1016/j.anr.2018.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 02/13/2018] [Accepted: 02/21/2018] [Indexed: 10/17/2022] Open
Abstract
PURPOSE This study aims to gain in-depth understanding of nurses' perspectives of working in an overcrowded emergency. METHODS Symbolic interactionism and Charmaz's construction of grounded theory were used. Purposive sampling at the start of the study and a further theoretical sampling by snowball technique were used to recruit 40 registered nurses (RN) to participate in in-depth, semi-structured interviews between May and November, 2014. Data analysis included analytic techniques of initial, focused and theoretical coding. RESULTS Study findings showed searching for work role is derived by the themes of Finding the role of positioning in Emergency Department (ED), Recognizing causes of ED overcrowding, and Confined working environment. Nurses' work experience which represents the RNs not gained control over their work, as care actions influenced by the problematic overcrowded circumstance of the ED environment. CONCLUSION The findings fill a gap in knowledge about how RNs experience their work role in the context of an overcrowded Emergency Department in Taiwan. Arising from the study result include taking account of nurses' perspectives when planning staff/patient ratios, strategies to reduce waiting time and ensure that clients receive appropriate care.
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Affiliation(s)
- Li-Chin Chen
- Department of Nursing, Chang Gung Memorial Hospital at Linkou, Linkou, Taiwan; Taiwan Association Critical Care Nurses (TACCN), Tauyuan, Taiwan
| | - Chun-Chih Lin
- Department of Nursing, Chang Gung University of Science and Technology, ChiaYi, Taiwan; Department of Nursing, Chang Gung Memorial Hospital at ChiaYi, ChiaYi, Taiwan.
| | - Chin-Yen Han
- Department of Nursing, Chang Gung Memorial Hospital at Linkou, Linkou, Taiwan; Department of Nursing, Chang Gung University of Science and Technology, Linkou, Taiwan
| | - Chun-Lan Hsieh
- Department of Nursing, Chang Gung Memorial Hospital at Linkou, Linkou, Taiwan
| | - Chiung-Jung Jo Wu
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Hervey Bay, Australia; Royal Brisbane and Women's Hospital (RBWH), Hervey Bay, Australia; Mater Research Institution-University of Queensland, Hervey Bay, Australia
| | - Hwey-Fang Liang
- Department of Nursing, Chang Gung University of Science and Technology, ChiaYi, Taiwan; Department of Nursing, Chang Gung Memorial Hospital at ChiaYi, ChiaYi, Taiwan
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Chen LC, Xie Q. [Clinical timing and benefit of antiviral treatment for hepatitis C]. Zhonghua Gan Zang Bing Za Zhi 2017; 25:164-169. [PMID: 28482401 DOI: 10.3760/cma.j.issn.1007-3418.2017.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Current treatments for hepatitis C include pegylated interferon-α (Peg-IFNα) and ribavirin (RBV) combination therapy and direct antiviral agents (DAAs). Antiviral treatment can be initiated after 4 to 6 months of clinical observations for patients with acute infections, but should be started as early as possible for those with chronic infections. However, for patients who are ineligible for Peg-IFN and RBV combination therapy and have no unrestricted access to DAAs, it is advised that they wait for the approval of DAAs in China if their medical condition is under control. Though, antiviral therapy should be started immediately if the disease progresses. It has been reported that there are numerous clinical benefits of antiviral treatment for hepatitis C. However, the long-term impact of DAAs treatment including efficacy and safety is limited and remains to be explored.
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Affiliation(s)
- L C Chen
- Department of Infectious Diseases, Rui Jin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
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Lu YCA, Chen LC. [Smart Medicine and Healthcare]. Hu Li Za Zhi 2017; 64:26-33. [PMID: 28762222 DOI: 10.6224/jn.000051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Innovation and rapid technological development in Smart Medicine or Smart Healthcare impact profoundly on many aspects of healthcare. It is believed that Health Information Technology (HIT) has the potential to improve integration between care providers, reduce administrative costs and burdens, reduce medical errors, and improve care quality and patient outcomes. However, issues such as interoperability, compatibility, and integration are critical to effectively integrating hardware and software in order to fully realize the benefits of HIT. High-end medical devices and equipment, including medical carts / mobile computer carts and wireless physiological and biomedical monitoring devices, should also be integrated into the hospital information system. Furthermore, the Data, Information, Knowledge, and Wisdom Hierarchy (DIKW) has been gaining popularity in the development of Nursing Information Systems (NIS) since 2013. To create a DIKW-based information system, data must first be defined and analyzed and then transformed into meaningful information. Eventually, this information is transformed into an intelligent system. For example, if evidence-based nursing research results / findings are integrated into the NIS to guide clinical practice, patient outcomes, patient safety, and healthcare quality will be greatly enhanced.
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Affiliation(s)
| | - Li-Chin Chen
- Department of Nursing, Chang Gung Memorial Hospital, Linkou Branch, Taiwan, ROC.
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Yang SH, Jerng JS, Chen LC, Li YT, Huang HF, Wu CL, Chan JY, Huang SF, Liang HW, Sun JS. Incidence of patient safety events and process-related human failures during intra-hospital transportation of patients: retrospective exploration from the institutional incident reporting system. BMJ Open 2017; 7:e017932. [PMID: 29101141 PMCID: PMC5695373 DOI: 10.1136/bmjopen-2017-017932] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Intra-hospital transportation (IHT) might compromise patient safety because of different care settings and higher demand on the human operation. Reports regarding the incidence of IHT-related patient safety events and human failures remain limited. OBJECTIVE To perform a retrospective analysis of IHT-related events, human failures and unsafe acts. SETTING A hospital-wide process for the IHT and database from the incident reporting system in a medical centre in Taiwan. PARTICIPANTS All eligible IHT-related patient safety events between January 2010 to December 2015 were included. MAIN OUTCOME MEASURES Incidence rate of IHT-related patient safety events, human failure modes, and types of unsafe acts. RESULTS There were 206 patient safety events in 2 009 013 IHT sessions (102.5 per 1 000 000 sessions). Most events (n=148, 71.8%) did not involve patient harm, and process events (n=146, 70.9%) were most common. Events at the location of arrival (n=101, 49.0%) were most frequent; this location accounted for 61.0% and 44.2% of events with patient harm and those without harm, respectively (p<0.001). Of the events with human failures (n=186), the most common related process step was the preparation of the transportation team (n=91, 48.9%). Contributing unsafe acts included perceptual errors (n=14, 7.5%), decision errors (n=56, 30.1%), skill-based errors (n=48, 25.8%), and non-compliance (n=68, 36.6%). Multivariate analysis showed that human failure found in the arrival and hand-off sub-process (OR 4.84, p<0.001) was associated with increased patient harm, whereas the presence of omission (OR 0.12, p<0.001) was associated with less patient harm. CONCLUSIONS This study shows a need to reduce human failures to prevent patient harm during intra-hospital transportation. We suggest that the transportation team pay specific attention to the sub-process at the location of arrival and prevent errors other than omissions. Long-term monitoring of IHT-related events is also warranted.
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Affiliation(s)
- Shu-Hui Yang
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Jih-Shuin Jerng
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Center for Quality Management, National Taiwan University Hospital, Taipei, Taiwan
| | - Li-Chin Chen
- Center for Quality Management, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Tsu Li
- Center for Quality Management, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsiao-Fang Huang
- Center for Quality Management, National Taiwan University Hospital, Taipei, Taiwan
| | - Chao-Ling Wu
- Department of Integrated Diagnostics & Therapeutics, National Taiwan University Hospital, Taipei, Taiwan
| | - Jing-Yuan Chan
- Center for Quality Management, National Taiwan University Hospital, Taipei, Taiwan
| | - Szu-Fen Huang
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
- Center for Quality Management, National Taiwan University Hospital, Taipei, Taiwan
| | - Huey-Wen Liang
- Center for Quality Management, National Taiwan University Hospital, Taipei, Taiwan
- Department of Physical Medicine & Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Jui-Sheng Sun
- Center for Quality Management, National Taiwan University Hospital, Taipei, Taiwan
- Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan
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Chen IH, Chang SC, Feng JY, Lin SJ, Chen LC, Lee CL, Lai FC. Nurse Participation in Continuing Education in Disaster Nursing in Taiwan. J Emerg Nurs 2017; 43:197-201. [PMID: 28359709 PMCID: PMC7119321 DOI: 10.1016/j.jen.2016.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 10/20/2016] [Accepted: 10/23/2016] [Indexed: 12/02/2022]
Affiliation(s)
- I-Hui Chen
- Taichung, Hualien, Tainan, Taipei, and Kuei Shan, Taiwan
| | | | - Jui-Ying Feng
- Taichung, Hualien, Tainan, Taipei, and Kuei Shan, Taiwan
| | - Shou-Ju Lin
- Taichung, Hualien, Tainan, Taipei, and Kuei Shan, Taiwan
| | - Li-Chin Chen
- Taichung, Hualien, Tainan, Taipei, and Kuei Shan, Taiwan
| | - Chun-Lan Lee
- Taichung, Hualien, Tainan, Taipei, and Kuei Shan, Taiwan
| | - Fu-Chih Lai
- Taichung, Hualien, Tainan, Taipei, and Kuei Shan, Taiwan.
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Jerng JS, Huang SF, Liang HW, Chen LC, Lin CK, Huang HF, Hsieh MY, Sun JS. Workplace interpersonal conflicts among the healthcare workers: Retrospective exploration from the institutional incident reporting system of a university-affiliated medical center. PLoS One 2017; 12:e0171696. [PMID: 28166260 PMCID: PMC5293271 DOI: 10.1371/journal.pone.0171696] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 01/06/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE There have been concerns about the workplace interpersonal conflict (WIC) among healthcare workers. As healthcare organizations have applied the incident reporting system (IRS) widely for safety-related incidents, we proposed that this system might provide a channel to explore the WICs. METHODS We retrospectively reviewed the reports to the IRS from July 2010 to June 2013 in a medical center. We identified the WICs and typed these conflicts according to the two foci (task content/process and interpersonal relationship) and the three properties (disagreement, interference, and negative emotion), and analyzed relevant data. RESULTS Of the 147 incidents with WIC, the most common related processes were patient transfer (20%), laboratory tests (17%), surgery (16%) and medical imaging (16%). All of the 147 incidents with WIC focused on task content or task process, but 41 (27.9%) also focused on the interpersonal relationship. We found disagreement, interference, and negative emotion in 91.2%, 88.4%, and 55.8% of the cases, respectively. Nurses (57%) were most often the reporting workers, while the most common encounter was the nurse-doctor interaction (33%), and the majority (67%) of the conflicts were experienced concurrently with the incidents. There was a significant difference in the distribution of worker job types between cases focused on the interpersonal relationship and those without (p = 0.0064). The doctors were more frequently as the reporter when the conflicts focused on the interpersonal relationship (34.1%) than not on it (17.0%). The distributions of worker job types were similar between those with and without negative emotion (p = 0.125). CONCLUSIONS The institutional IRS is a useful place to report the workplace interpersonal conflicts actively. The healthcare systems need to improve the channels to communicate, manage and resolve these conflicts.
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Affiliation(s)
- Jih-Shuin Jerng
- Center for Quality Management, National Taiwan University Hospital, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Szu-Fen Huang
- Center for Quality Management, National Taiwan University Hospital, Taipei, Taiwan
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Huey-Wen Liang
- Center for Quality Management, National Taiwan University Hospital, Taipei, Taiwan
- Department of Physical Medicine & Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Li-Chin Chen
- Center for Quality Management, National Taiwan University Hospital, Taipei, Taiwan
| | - Chia-Kuei Lin
- Center for Quality Management, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsiao-Fang Huang
- Center for Quality Management, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Yuan Hsieh
- Center for Quality Management, National Taiwan University Hospital, Taipei, Taiwan
| | - Jui-Sheng Sun
- Center for Quality Management, National Taiwan University Hospital, Taipei, Taiwan
- Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan
- * E-mail:
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Abstract
Medical incidents threaten patients’ lives and health, increase medical costs, and can lead to medical disputes. A high proportion of medical incidents are not reported. The aim of this study was to explore the factors influencing nurses’ reporting of medical incidents. The cross-sectional survey design used a self-administered 47-item questionnaire to survey 835 nurses in three hospitals in Taiwan between January and December 2014. The intention among nurses to report medical incidents was high (3.86/5); nurses’ intention to report medical incidents was positively correlated ( r = .34, p < .0001) with their attitude about reporting, awareness of reporting ( r = .37, p < .0001), and support from interested parties ( r = .12, p = .001), and was negatively correlated with positive incentives ( r = -.14, p < .0001) and negative incentives ( r = .29, p < .0001). Nurses’ awareness and a supportive work environment affect nurses’ willingness to voluntarily report medical incidents; hence, they are critical considerations as Taiwan moves toward systems of mandatory reporting.
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Affiliation(s)
- Li-Chin Chen
- Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan
- Chang Gung University of Science and Technology, Taoyuan City, Taiwan
| | - Li-Hsiang Wang
- Chang Gung University of Science and Technology, Taoyuan City, Taiwan
- Chang Gung University, Taoyuan City, Taiwan
| | | | | | - Tsung-Lan Chu
- Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan
- Chang Gung University of Science and Technology, Taoyuan City, Taiwan
| | - Chin-Yen Han
- Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan
- Chang Gung University of Science and Technology, Taoyuan City, Taiwan
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Chen LC, Ninomiya S, Hiraoka K. Super-atmospheric pressure ionization mass spectrometry and its application to ultrafast online protein digestion analysis. J Mass Spectrom 2016; 51:ii. [PMID: 27270871 DOI: 10.1002/jms.3668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Pressure is a key parameter for an ionization source. In this Special Feature article, Lee Chuin Chen and colleagues review super-atmospheric pressure ionization MS with electrospray, corona-discharge-based chemical ionization, and field desorption. They routinely run their mass spectrometer with ion source pressures ranging from several to several tens of atmospheres. A number of strategies have been used to preserve the high vacuum of the instrument while working with a high-pressure (HP) ion source. A recent prototype uses a booster pump with variable pumping speed added to the first pumping stage of the mass spectrometer to regulate a constant vacuum pressure. Further, a new HP-ESI source allowing rapid (a few seconds) online protein digestion MS is also reported. Dr. Lee Chuin Chen is Associate Professor in the Department of Interdisciplinary Research at the University of Yamanashi (Yamanashi, Japan). His main research interest is the development of novel mass spectrometric methods for in-situ medical diagnosis.
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Chang W, Liu HE, Goopy S, Chen LC, Chen HJ, Han CY. Using the Five-Level Taiwan Triage and Acuity Scale Computerized System: Factors in Decision Making by Emergency Department Triage Nurses. Clin Nurs Res 2016; 26:651-666. [PMID: 26935346 DOI: 10.1177/1054773816636360] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
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.
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Affiliation(s)
- Wen Chang
- 1 Chang Gung University of Science and Technology, Taiwan, ROC.,2 Chang Gung University, Taiwan, ROC
| | | | | | | | - Hsiao-Jung Chen
- 1 Chang Gung University of Science and Technology, Taiwan, ROC
| | - Chin-Yen Han
- 1 Chang Gung University of Science and Technology, Taiwan, ROC
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Usmanov DT, Chen LC, Yu Z, Yamabe S, Sakaki S, Hiraoka K. Atmospheric pressure chemical ionization of explosives using alternating current corona discharge ion source. J Mass Spectrom 2015; 50:651-661. [PMID: 26149109 DOI: 10.1002/jms.3552] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 10/28/2014] [Accepted: 11/19/2014] [Indexed: 06/04/2023]
Abstract
The high-sensitive detection of explosives is of great importance for social security and safety. In this work, the ion source for atmospheric pressure chemical ionization/mass spectrometry using alternating current corona discharge was newly designed for the analysis of explosives. An electromolded fine capillary with 115 µm inner diameter and 12 mm long was used for the inlet of the mass spectrometer. The flow rate of air through this capillary was 41 ml/min. Stable corona discharge could be maintained with the position of the discharge needle tip as close as 1 mm to the inlet capillary without causing the arc discharge. Explosives dissolved in 0.5 µl methanol were injected to the ion source. The limits of detection for five explosives with 50 pg or lower were achieved. In the ion/molecule reactions of trinitrotoluene (TNT), the discharge products of NOx (-) (x = 2,3), O3 and HNO3 originating from plasma-excited air were suggested to contribute to the formation of [TNT - H](-) (m/z 226), [TNT - NO](-) (m/z 197) and [TNT - NO + HNO3 ](-) (m/z 260), respectively. Formation processes of these ions were traced by density functional theory calculations. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- D T Usmanov
- Clean Energy Research Center, University of Yamanashi, 4-3-11 Takeda, Kofu, Yamanashi, 400-8511, Japan
- Institute of Ion-Plasma and Laser Technologies, Dormon Yoli Street 33, Akademgorodok, Tashkent, 100125, Uzbekistan
| | - L C Chen
- Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, 4-3-11 Takeda, Kofu, Yamanashi, 400-8511, Japan
| | - Z Yu
- Clean Energy Research Center, University of Yamanashi, 4-3-11 Takeda, Kofu, Yamanashi, 400-8511, Japan
- School of Chemical and Life Sciences, Shenyang Normal University, Shenyang, 110034, China
| | - S Yamabe
- Fukui Institute of Fundamental Chemistry, Kyoto University, Takano, Sakyoku, Kyoto, 606-8103, Japan
| | - S Sakaki
- Fukui Institute of Fundamental Chemistry, Kyoto University, Takano, Sakyoku, Kyoto, 606-8103, Japan
| | - K Hiraoka
- Clean Energy Research Center, University of Yamanashi, 4-3-11 Takeda, Kofu, Yamanashi, 400-8511, Japan
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Amloy S, Karlsson KF, Eriksson MO, Palisaitis J, Persson POÅ, Chen YT, Chen KH, Hsu HC, Hsiao CL, Chen LC, Holtz PO. Excitons and biexcitons in InGaN quantum dot like localization centers. Nanotechnology 2014; 25:495702. [PMID: 25410551 DOI: 10.1088/0957-4484/25/49/495702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Indium segregation in a narrow InGaN single quantum well creates quantum dot (QD) like exciton localization centers. Cross-section transmission electron microscopy reveals varying shapes and lateral sizes in the range ∼1-5 nm of the QD-like features, while scanning near field optical microscopy demonstrates a highly inhomogeneous spatial distribution of optically active individual localization centers. Microphotoluminescence spectroscopy confirms the spectrally inhomogeneous distribution of localization centers, in which the exciton and the biexciton related emissions from single centers of varying geometry could be identified by means of excitation power dependencies. Interestingly, the biexciton binding energy (E(b)xx) was found to vary from center to center, between 3 to -22 meV, in correlation with the exciton emission energy. Negative binding energies are only justified by a three-dimensional quantum confinement, which confirms QD-like properties of the localization centers. The observed energy correlation is proposed to be understood as variations of the lateral extension of the confinement potential, which would yield smaller values of E(b)xx for reduced lateral extension and higher exciton emission energy. The proposed relation between lateral extension and E(b)xx is further supported by the exciton and the biexciton recombination lifetimes of a single QD, which suggest a lateral extension of merely ∼3 nm for a QD with strongly negative E(b)xx = -15.5 meV.
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Affiliation(s)
- S Amloy
- Department of Physics, Chemistry, and Biology (IFM), Linköping University, SE-58183 Linköping, Sweden. Department of Physics, Faculty of Science, Thaksin University, Phattalung 93110, Thailand.
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Mousa R, Chen LC, Cheung KL. An Evidence-Based Model Design to Inform the Cost-Effectiveness Evaluation of Primary Endocrine Therapy And Surgery for Older Women with Primary Breast Cancer. Value Health 2014; 17:A638. [PMID: 27202281 DOI: 10.1016/j.jval.2014.08.2295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- R Mousa
- University of Nottingham, Nottingham, UK
| | - L C Chen
- University of Nottingham, Nottingham, UK
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Hsu YC, Jerng JS, Chang CW, Chen LC, Hsieh MY, Huang SF, Liu YP, Hung KY. Integrating team resource management program into staff training improves staff's perception and patient safety in organ procurement and transplantation: the experience in a university-affiliated medical center in Taiwan. BMC Surg 2014; 14:51. [PMID: 25115403 PMCID: PMC4136399 DOI: 10.1186/1471-2482-14-51] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 08/05/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The process involved in organ procurement and transplantation is very complex that requires multidisciplinary coordination and teamwork. To prevent error during the processes, teamwork education and training might play an important role. We wished to evaluate the efficacy of implementing a Team Resource Management (TRM) program on patient safety and the behaviors of the team members involving in the process. METHODS We implemented a TRM training program for the organ procurement and transplantation team members of the National Taiwan University Hospital (NTUH), a teaching medical center in Taiwan. This 15-month intervention included TRM education and training courses for the healthcare workers, focused group skill training for the procurement and transplantation team members, video demonstration and training, and case reviews with feedbacks. Teamwork culture was evaluated and all procurement and transplantation cases were reviewed to evaluate the application of TRM skills during the actual processes. RESULTS During the intervention period, a total of 34 staff members participated the program, and 67 cases of transplantations were performed. Teamwork framework concept was the most prominent dimension that showed improvement from the participants for training. The team members showed a variety of teamwork behaviors during the process of procurement and transplantation during the intervention period. Of note, there were two potential donors with a positive HIV result, for which the procurement processed was timely and successfully terminated by the team. None of the recipients was transplanted with an infected organ. No error in communication or patient identification was noted during review of the case records. CONCLUSION Implementation of a Team Resource Management program improves the teamwork culture as well as patient safety in organ procurement and transplantation.
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Affiliation(s)
- Ya-Chi Hsu
- Center for Quality Management, National Taiwan University, Taipei, Taiwan
| | - Jih-Shuin Jerng
- Center for Quality Management, National Taiwan University, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ching-Wen Chang
- Center for Quality Management, National Taiwan University, Taipei, Taiwan
| | - Li-Chin Chen
- Center for Quality Management, National Taiwan University, Taipei, Taiwan
| | - Ming-Yuan Hsieh
- Center for Quality Management, National Taiwan University, Taipei, Taiwan
| | - Szu-Fen Huang
- Center for Quality Management, National Taiwan University, Taipei, Taiwan
- Department of Nursing, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yueh-Ping Liu
- Department of Emergency Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Kuan-Yu Hung
- Center for Quality Management, National Taiwan University, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, No. 7, Zhongshan South Road, Taipei 100, Taiwan
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Lin CC, Han CY, Pan IJ, Chen LC. The teaching-learning approach and critical thinking development: a qualitative exploration of Taiwanese nursing students. J Prof Nurs 2014; 31:149-57. [PMID: 25839955 DOI: 10.1016/j.profnurs.2014.07.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Indexed: 11/19/2022]
Abstract
Health care professionals are challenged by the complexities of the health care environment. This study uses a qualitative approach to explore how teaching strategy affects the development of critical thinking (CT) among Taiwanese baccalaureate-level nursing students. Data collected from 109 students' reflection reports were analyzed using content analysis. Three categories generated by the analysis were the teaching-learning strategy, enhancing CT, and transiting into a different learning style. The teaching-learning strategy consisted of concept mapping, question and answer, and real-life case studies. CT was enhanced alternately by self-directed learning, the realization of the gap between known and unknown, and connecting the gap between theoretical nursing knowledge and clinical practice. The study results emphasize participants' perceptions of becoming a critical thinker, turning into an active learner, and eventually achieving self-confidence. These learning effects invest the wisdom of teaching-learning with a far-reaching significance.
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Affiliation(s)
- Chun-Chih Lin
- Assistant Professor, ChiaYi Campus, Chang Gung University of Science and Technology, ChiaYi, Taiwan, ROC..
| | - Chin-Yen Han
- Assistant Professor, Chang Gung University of Science and Technology, Taoyuan, Taiwan, ROC..
| | - I-Ju Pan
- Assistant Professor, I-Shou University, Kaohsiung City, Taiwan, ROC..
| | - Li-Chin Chen
- Deputy Director, Linkou Chang Gung Memorial Hospital, Taoyuan County, Taiwan, ROC..
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