A nonparametric method for classification trees using grouped covariates.

A group of variables are commonly seen in diagnostic medicine when multiple prognostic factors are aggregated into a composite score to represent the risk profile. A model selection method considers these covariates as all-in or all-out types. Model selection procedures for grouped covariates and their applications have thrived in recent years, in part because of the development of genetic research in which gene-gene or gene-environment interactions and regulatory network pathways are considered groups of individual variables. However, little has been discussed on how to utilize grouped covariates to grow a classification tree. In this paper, we propose a nonparametric method to address the selection of split variables for grouped covariates and their following selection of split points. Comprehensive simulations were implemented to show the superiority of our procedures compared to a commonly used recursive partition algorithm. The practical use of our method is demonstrated through a real data analysis that uses a group of prognostic factors to classify the successful mobilization of peripheral blood stem cells.

Critical Care Nurses' Perceptions of Clinical Alarm Management on Nursing Practice.

The alarm management of physiological monitoring systems is a key responsibility of critical care nurses. However, the high numbers of false and nonactionable (true but clinically irrelevant) alarms cause distractions to healthcare professionals, interruptions to nursing workflow, and ignoring of crucial tasks. Therefore, understanding how nurses manage large amounts of alarms in their daily work could provide a direction to design interventions to prevent adverse patient care effects. A qualitative design with focus group interviews was conducted with 37 nurses in Taiwan. Content analysis was performed to analyze the interview data, and four main themes were derived: (1) the foundation stone of critical care nursing practice; (2) a trajectory adaptation of alarms management; (3) adverse impacts on the quality of care and patient safety; and (4) a hope for multimodal learning alternatives and wireless technology. Nurses manage alarm parameter settings influenced not only by their knowledge and skills of patient care, but also in accordance with the three dimensions of technology, human, and organization evaluation framework. Customized alarm management training alternatives, patient-centered care values, and application of wireless technology are the suggested approaches to enhance nursing care and minimize the risk of adverse events.

Critical Care Nurses' Perceptions of Clinical Alarm Management on Nursing Practice.

The management of alarms is a key responsibility of critical care nurses. A qualitative study with focus group interviews were conducted with 37 nurses in Taiwan. Four main themes were derived: the foundation of critical care practice, a trajectory of adjust alarms management, negative impacts on care quality and patient safety, hope for remote control and multimodal learning. Results revealed that diverse training methods may facilitate nursing competency and devices usability to promote critical care.

Pneumopericardium secondary to oesophageal cancer presenting as myocardial infarction: a case report.

The diagnosis of pneumopericardium can be challenging, as the symptoms are sometimes non-specific and can mimic those of other diseases. Especially, focal pneumopericardium presenting with regional ST-segment elevation on the electrocardiogram can be difficult to diagnose. Here, we present the case of a patient with pneumopericardium secondary to oesophageal cancer that was first diagnosed with community-acquired pneumonia and subsequently classified with acute coronary syndrome after an episode of cardiac arrest. The most prominent indication initially observed in this case was the history of oesophageal cancer and the presence of radiolucent areas in the heart under pleural effusion. When an unknown origin collapse develops in patients with oesophageal cancer, pneumopericardium should always be excluded, especially in cases where the cardiogenic shock is strongly suspected.

Unexpected cardio-circulatory arrest during a brain-dead donor organ retrieval.

According to the Maastricht classification category of donation after circulatory death (DCD), type IV DCD refers to brain-dead donors who are re-categorized after unexpected circulatory arrest before donor organ retrieval. Clinical management is challenging, even in intensive care units, where most of this type of organ donation occurs. We report a case of the first successful lung transplantation (LTx) using type IV DCD organ in Taiwan. The recipient's recovery was satisfactory, without acute or chronic organ dysfunction. When unexpected events made the brain-dead donors suffer from sudden onset of cardiac arrest before or during organ donation surgery, immediately switching the retrieval protocol from donation after brain death (DBD) to DCD could expand the donor pool and increase organ supply. The well-prepared and experienced transplant team and prompt protocol switch made this transplant surgery possible.

Evaluation of an online orientation program for new healthcare employees.

Online learning is one of the newest efforts of mainstream healthcare education. It has been cited as providing both an efficient and effective alternative learning medium. This study explored the acceptance of an online orientation program by new healthcare employees and identified several critical factors affecting online learning outcomes. The study applied triangulation methods including surveys, interviews, and test scores. Data were captured from 154 questionnaires (with a response rate of 78.2%) with related test scores and 13 participant interviews. The results showed that new healthcare employees were positive toward the computer-based learning program. "Perceived ease of use" and "perceived usefulness" were the major variables predicting technology acceptance, whereas "learner satisfaction" and "continued intention to use" were the major indices for the learning outcomes. Test scores, however, did not reveal any statistical impact. Additionally, human-computer interaction, instant feedback, and program content were commented on as factors affecting learning outcomes. Therefore, online learning is suitable for new healthcare employees, both in the orientation stage and as a follow-up learning method. The results of this study can help support the development of educational technology online programs.

[Using innovation diffusion theory to improve implementation of nursing information systems].

The application of health information technology (IT) to improve healthcare efficiency and quality is an increasingly critical task for all healthcare organizations due to rapid improvements in IT and growing concerns with regard to patient safety. While a growing field of evidence supports that nurses frequently play key roles in steering the healthcare industry to achieve such goals, adoption and diffusion of technology remain complex processes. The application of IT still makes many nurses uneasy, while a main question remains whether nursing staff are willing to use state-of-the-art IT in their routine work. Addressing the application of IT in healthcare, this paper reviews the essential concepts of Rogers' innovation-diffusion theory regarding strategies for applying the characteristics of innovation and adoption processes. An example of applying the theory at one hospital is presented at the end to illustrate nursing information system implementation principles and propose suggestions for increasing general nurse application of IT in their regular work. Results may serve as references for future nursing informatics and theory development.