Developing an International Classification of Functioning, Disability and Health Core Set for Pediatric Brain Tumor Survivors in Chinese Clinical Settings.

BACKGROUND: The International Classification of Functioning, Disability and Health (ICF) core set (CS) facilitates the standardization of functioning and impairment assessment for integration of holistic care. OBJECTIVE: This study developed an ICF CS for interviewing pediatric brain tumor survivors in Taiwan to help healthcare professionals in implementing disability assessment and management measures. METHODS: A group of 29 experts in 10 relevant fields with at least 5 years of experience working with children with brain tumors participated in this study. The first questionnaire contained 247 second-level ICF categories. The experts rated the significance of each category by using a 5-point Likert scale. Correlations between individual and group scores were calculated to determine consensus. Categories with an average rating of higher than 4 and for which greater than or equal to 80% (23) of the participants provided a rating of 4 or higher were included in the final CS. RESULTS: The final CS contained a total of 57 ICF categories: 20 from the Body Functions and Structures component, 36 from the Activities and Participation component, and 1 from the Environmental Factors component. CONCLUSION: The ICF CS for pediatric brain tumor survivors provides a framework for relevant healthcare professionals to deliver patient-centered care, ensuring that services focus on all areas of development. IMPLICATIONS FOR PRACTICE: Patient ratings for this ICF CS may serve as a new practical and effective patient-reported information tool for acquiring patient input and for the systematic monitoring of pediatric brain tumor survivors in clinical practice. Further research should be conducted on this CS to verify our findings.

Prevalence of sleep disorders among first responders for medical emergencies: A meta-analysis.

Background: Shift work and irregular work schedules among first responders have been associated with physical and psychological problems such as sleep disorders. We conducted the first meta-analysis to explore and estimate the prevalence of sleep disorders among first responders for medical emergencies. Methods: We searched four databases: Web of Science, Psych Info, CINAHL, and PubMed. The Generalized Linear Mixed model (GLMM) was used to estimate the prevalence estimates of sleep disorders in R software and the DerSimonian-Lard random-effects model in Comprehensive Meta-Analysis was used to explore associated comorbidities for OSA and insomnia, presented as odds ratios (ORs) and confidence intervals (CIs). The Cochran's Q, τ2, and the statistics were used to assess heterogeneity and the moderator analysis was conducted to identify moderator variables. Results: Twenty-eight studies with 100 080 first responders were included from the total of 1119 studies retrieved from the databases. The prevalence rates for sleep disorders were 31% (95% CI = 15%-53%) for shift work disorder (SWD), 30% (95% CI = 18%-46%) for obstructive sleep apnea (OSA), 28% (95% CI = 19%-39%) for insomnia, 28% (95% CI = 24%-33%) for excessive daytime sleepiness (EDS), 2% (95% CI = 1%-4%) for restless leg syndrome, and 1% (95% CI = 0%-5%) for narcolepsy. Anxiety (OR = 2.46; 95% CI = 1.99%-3.03%), cardiovascular disease (CVD) (OR = 2.03; 95% CI = 1.43-2.88), diabetes mellitus (DM) (OR = 1.93; 95% CI = 1.41-2.65), depression (OR = 1.89; 95% CI = 1.01-3.56), gastroesophageal reflux disease (GERD) (OR = 1.83; 95% CI = 150-2.22), and post-traumatic stress disorder (PTSD) (OR = 1.78; 95% CI = 1.33-2.39) were associated with OSA. Depression (OR = 9.74; 95% CI = 4.67-20.3), anxiety (OR = 9.22; 95% CI = 3.81-22.3), and PTSD (OR = 7.13; 95% CI = 6.27-8.10) were associated with insomnia. Age, gender, first responders, continent, study quality, study design, and assessment tool were significant moderator variables for OSA, insomnia, and EDS. Conclusions: This meta-analysis found a substantially high prevalence of sleep disorders including SWD, OSA, insomnia, and EDS among first responders for medical emergencies. Early assessment and management of sleep disorders among first responders is necessary to promote good, quality sleep to help prevent anxiety, depression, CVD, DM, GERD, and PTSD.

[Metamorphosis of Nurses: The Development and Breakthroughs of Advanced Practice Registered Nurses].

BACKGROUND: The introduction and development of the advanced practice registered nurse (APRN) is a global trend in nursing. However, the development of APRNs in Taiwan remains uncertain and lacks necessary consensus. PURPOSE: This research study aimed to explore the views and suggestions of nursing experts in industry, government, and academia regarding the development of APRNs (clinical nurse specialists, case managers, certified clinical registered nurse anesthetists, and certified nurse-midwives) in Taiwan. METHODS: Data were collected from March to August 2017. Sixty-four experts participated in one of six focus group discussions held in northern, central, and southern Taiwan. These group discussions were recorded and transcribed verbatim with the consent of the participants. Content analysis was used to analyze the transcribed data. RESULTS: The comments and suggestions raised during the discussions were categorized into four major themes: professional development of necessity, core competencies, accreditation, and future promotion-related issues. Each theme was further divided into several subthemes. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The opinions of relevant experts regarding the current status of development of the roles, practical scope, and management and suggestions for APRNs were summarized to facilitate the future development of APRNs in Taiwan in terms of education, core competencies, certification, and practical scope. Furthermore, the results may be referenced in the establishment of a nursing consensus model and as a basis for promoting APRNs.

Effectiveness of prone position in acute respiratory distress syndrome and moderating factors of obesity class and treatment durations for COVID-19 patients: A meta-analysis.

OBJECTIVES: To examine the effectiveness of prone positioning on COVID-19 patients with acute respiratory distress syndrome with moderating factors in both traditional prone positioning (invasive mechanical ventilation) and awake self-prone positioning patients (non-invasive ventilation). RESEARCH METHODOLOGY: A comprehensive search was conducted in CINAHL, Cochrane library, Embase, Medline-OVID, NCBI SARS-CoV-2 Resources, ProQuest, Scopus, and Web of Science without language restrictions. All studies with prospective and experimental designs evaluating the effect of prone position patients with COVID-19 related to acute respiratory distress syndrome were included. Pooled standardised mean differences were calculated after prone position for primary (PaO2/FiO2) and secondary outcomes (SpO2 and PaO2) RESULTS: A total of 15 articles were eligible and included in the final analysis. Prone position had a statistically significant effect in improving PaO2/FiO2 with standardised mean difference of 1.10 (95%CI 0.60-1.59), SpO2 with standardised mean difference of 3.39 (95% CI 1.30-5.48), and PaO2 with standardised mean difference of 0.77 (95% CI 0.19-1.35). Patients with higher body mass index and longer duration/day are associated with larger standardised mean difference effect sizes for prone positioning. CONCLUSIONS: Our findings demonstrate that prone position significantly improved oxygen saturation in COVID-19 patients with acute respiratory distress syndrome in both traditional prone positioning and awake self-prone positioning patients. Prone position should be recommended for patients with higher body mass index and longer durations to obtain the maximum effect.

Prevalence of dysphagia and risk of pneumonia and mortality in acute stroke patients: a meta-analysis.

BACKGROUND: Post-stroke dysphagia (PSD) has been associated with high risk of aspiration pneumonia and mortality. However, limited evidence on pooled prevalence of post-stroke dysphagia and influence of individual, disease and methodological factors reveals knowledge gap. Therefore, to extend previous evidence from systematic reviews, we performed the first meta-analysis to examine the pooled prevalence, risk of pneumonia and mortality and influence of prognostic factors for PSD in acute stroke. METHODS: Our search was conducted in CINAHL, Cochrane Library, EMBASE, Ovid-Medline, PubMed, and Web of Science an initial search in October 2020 and a follow-up search in May 2021. Data synthesis was conducted using the Freeman-Tukey double-arcsine transformation model for the pooled prevalence rate and the DerSimonian-Lard random-effects model for prognostic factors and outcomes of PSD. RESULTS: The pooled prevalence of PSD was 42% in 42 studies with 26,366 participants. PSD was associated with higher pooled odds ratio (OR) for risk of pneumonia 4.08 (95% CI, 2.13-7.79) and mortality 4.07 (95% CI, 2.17-7.63). Haemorrhagic stroke 1.52 (95% CI, 1.13-2.07), previous stroke 1.40 (95% CI, 1.18-1.67), severe stroke 1.38 (95% CI, 1.17-1.61), females 1.25 (95% CI, 1.09-1.43), and diabetes mellitus 1.24 (95% CI, 1.02-1.51) were associated with higher risk of PSD. Males 0.82 (95% CI, 0.70-0.95) and ischaemic stroke 0.54 (95% CI, 0.46-0.65) were associated with lower risk of PSD. Haemorrhagic stroke, use of instrumental assessment method, and high quality studies demonstrated to have higher prevalence of PSD in the moderator analysis. CONCLUSIONS: Assessment of PSD in acute stroke with standardized valid and reliable instruments should take into account stroke type, previous stroke, severe stroke, diabetes mellitus and gender to aid in prevention and management of pneumonia and thereby, reduce the mortality rate. TRIAL REGISTRATION: https://osf.io/58bjk/?view_only=26c7c8df8b55418d9a414f6d6df68bdb .

Humoral Immunogenicity and Reactogenicity of the Standard ChAdOx1 nCoV-19 Vaccination in Taiwan.

BACKGROUND: The ChAdOx1 nCoV-19 vaccine has been widely administered against SARS-CoV-2 infection; however, data regarding its immunogenicity, reactogenicity, and potential differences in responses among Asian populations remain scarce. METHODS: 270 participants without prior COVID-19 were enrolled to receive ChAdOx1 nCoV-19 vaccination with a prime-boost interval of 8-9 weeks. Their specific SARS-CoV-2 antibodies, neutralizing antibody titers (NT50), platelet counts, and D-dimer levels were analyzed before and after vaccination. RESULTS: The seroconversion rates of anti-RBD and anti-spike IgG at day 28 after a boost vaccination (BD28) were 100% and 95.19%, respectively. Anti-RBD and anti-spike IgG levels were highly correlated (r = 0.7891), which were 172.9 ± 170.4 and 179.3 ± 76.88 BAU/mL at BD28, respectively. The geometric mean concentrations (GMCs) of NT50 for all participants increased to 132.9 IU/mL (95% CI 120.0-147.1) at BD28 and were highly correlated with anti-RBD and anti-spike IgG levels (r = 0.8248 and 0.7474, respectively). Body weight index was statistically significantly associated with anti-RBD IgG levels (p = 0.035), while female recipients had higher anti-spike IgG levels (p = 0.038). The GMCs of NT50 declined with age (p = 0.0163) and were significantly different across age groups (159.7 IU/mL for 20-29 years, 99.4 IU/mL for ≥50 years, p = 0.0026). Injection-site pain, fever, and fatigue were the major reactogenicity, which were more pronounced after prime vaccination and in younger participants (<50 years). Platelet counts decreased and D-dimer levels increased after vaccination but were not clinically relevant. No serious adverse events or deaths were observed. CONCLUSION: The vaccine is well-tolerated and elicited robust humoral immunity against SARS-CoV-2 after standard prime-boost vaccination in Taiwanese recipients.