Taiwan mini-frontier of primary aldosteronism: Updating detection and diagnosis.

BACKGROUND: To update information about the internationally accepted standards and clinical recommendations for the detection and diagnosis of primary aldosteronism (PA). METHODS: The Taiwan Society of Aldosteronism (TSA) Task Force reviewed the latest literature and reached a consensus after group meetings. The nine critical issues were recognized to provide updated information and internationally acceptable protocols. RESULTS: When screening for PA by using the plasma aldosterone concentration (PAC) to plasma renin activity (PRA) ratio (ARR), withdrawal or adjustment of antihypertensive medication is not always necessary on the first patient visit. Hypokalemia should be corrected before ARR screening. In spontaneous hypokalemia, plasma renin below detection levels, and PAC higher than 20 ng/dL (550 pmol/L), further confirmatory testing is unnecessary for PA diagnosis. Direct renin concentration (DRC) could be used for PA diagnosis if PRA is unavailable. Although additional confirmatory tests are suggested, the result of a single test is still reliable. For patient safety, discontinuation or adjustment of antihypertensive medications is indicated before adrenal venous sampling (AVS). ACTH could be beneficial for successful adrenal vein cannulation but is not necessary for determining lateralization in AVS. Simultaneous technique is preferred for AVS. Adrenal NP-59 scintigraphy integrated with SPECT/CT could guide PA management. CONCLUSION: With introduction of these new concepts to the clinicians, we expect better identification, management and treatment of PA patients.

A Study of Interpersonal Conflict Among Operating Room Nurses.

BACKGROUND: Team collaboration is an important factor that affects the performance of the operating room (OR). Therefore, the ability of OR nurses to adapt to and manage interpersonal conflict incidents properly is very important. PURPOSE: The aims of this study were to investigate the interpersonal conflict management capabilities of OR nursing staffs and to find the relationships among the demographics of OR nurses and the following: work-related variables, interpersonal conflict management style, and target of interpersonal conflict. METHODS: This study investigated 201 OR nurses who had worked for more than 6 months at the target hospitals, which were located in the three counties of Changhua, Yunlin, and Chiayi. The questionnaire that was used to collect data included three components: a demographic and work-related variables survey, interpersonal conflict management factor analysis scale, and interpersonal conflict parties and frequency scale. Data were analyzed using independent t test, analysis of variance, Scheffe's test, and Pearson's correlation coefficient. RESULTS: The main findings were as follows: (a) Integration and arbitration were the major interpersonal conflict management strategies adopted by the participants; (b) medical doctor, OR nurses, and anesthetists were the primary targets of conflict for the participants; (c) the factors of educational background, job position, experience in other departments, seniority, attending courses in conflict management, and level of hospital significantly affected the strategies that participants used to manage interpersonal conflict; and (d) license level, experience in other departments, seniority, and inclination toward serving in the OR were each found to relate significantly to the target of interpersonal conflict and the frequency of interpersonal conflict incidents. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The main implications of this study are as follows: (a) The environment for communication in the OR should be made more friendly to encourage junior OR nurses to adopt constructive interpersonal conflict management strategies; (b) prior experience in other departments should be one of the most important factors of consideration when recruiting new nurses for the OR; and

Non-traumatic out-of-hospital cardiac arrest in rural Taiwan: A retrospective study.

OBJECTIVE: Out-of-hospital cardiac arrest (OHCA) studies are usually conducted at metropolitan medical centres. Because rural studies are rare, our study aimed to assess non-traumatic OHCA prevalence and resuscitation outcomes in rural Taiwan. DESIGN: A retrospective observational study. SETTING: All seven designated community hospital emergency departments (ED) in Nantou County, Taiwan. PARTICIPANTS: All OHCA patients from May 2011 to March 2013. MAIN OUTCOME MEASURES: Any return of spontaneous circulation (ROSC) and survival for ED discharge. RESULTS: In the 23-month period, 850 OHCA cases were reported; 741 (87.2%) were non-traumatic. The overall ROSC achievement rate was 19.7%, with 16.4% case survival for ED discharge. Logistic regression identified that arrest in public (OR: 2.62, 95% CI: 1.19-5.78), witness when collapsed (OR: 2.14, 95% CI: 1.28-3.60), and cardiopulmonary resuscitation (CPR) by bystander (OR: 2.09, 95% CI: 1.02-4.26) might increase the likelihood of any ROSC; arrest in public (OR: 2.68, 95% CI: 1.10-6.50), witnessed collapse (OR: 2.26, 95% CI: 1.24-4.09) and CPR by bystander (OR: 2.79, 95% CI: 1.28-6.05) might also increase the likelihood of survival. For non-traumatic OHCA patients conveyed to EDs via emergency medical service system (EMS), a shorter response time (OR: 1.09, 95% CI: 1.01-1.18) and travelling time (OR: 1.04, 95% CI: 1.00-1.09) might also increase the chance of survival. CONCLUSION: Compared to previous data from metropolitan areas, ROSC achievement rate was lower in rural Taiwan. Witness presence, response and travelling times affect ROSC achievement in non-traumatic OHCA patients in rural Taiwan.

[Dysmenorrhea: a study of affected factors and approaches to relief among female students at a college in southern Taiwan].

BACKGROUND: Dysmenorrhea is a major problem in the general gynecology clinic. It causes discomfort among healthcare staffs and significant losses in terms of time and finances. PURPOSE: The purpose of this study was to determine the affected factors of dysmenorrhea and evaluate the self-perceived efficacy of relief methods. METHODS: A cross-sectional research design was used to collect data. Participants included 586 female students enrolled at a college in southern Taiwan. Data was analyzed using a t-test, one-way ANOVA, and Scheffe test. RESULTS: Traditional Chinese medicine pattern identifications related significantly to dysmenorrhea frequency perception. Lifestyle characteristics related significantly to dysmenorrhea level perception. Using shenghua decoction, siwu and pig blood decoction, Angelica drink, ginger, ziziphus jujube, brown sugar tea, and analgesics all related significantly to dysmenorrhea relief efficacy. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Strategies found to help relieve dysmenorrhea level perception include increasing the duration and regularity of sleep and avoiding the consumption of pungent foods. Seeking and adhering to physician recommendations can also increase dysmenorrhea self-care efficacy. Dysmenorrhea-relief courses should be improved in hospitals and schools to assist women to self-manage dysmenorrhea more effectively.

A study of operating room scheduling that integrates multiple quantitative and qualitative objectives.

BACKGROUND: Most operating room (OR) scheduling is done by scheduling personnel based on experience or heuristics. Such often results in excessive overtime for medical personnel and poor resource-use efficiencies. PURPOSE: This study was designed to employ an integrated OR scheduling performance evaluation model (IOSPEM), which integrates quantitative and qualitative multiple objectives, to the improvement of OR scheduling quality. METHODS: The fuzzy Delphi method was used to obtain the weight values of time factor, cost factor, and risk factor. The fuzzy set theory was applied to transform qualitative risk measures into quantitative values. The desirability function was utilized to integrate time, cost, and risk factors to develop the IOSPEM. The simulated annealing algorithm was used to develop the scheduling system and test proposed model performance. RESULTS: The proposed IOSPEM successfully integrated the quantitative and qualitative indices into a sole quantitative index. Experiment results show that the IOSPEM incorporating the simulated annealing algorithm is able to obtain the most efficient OR schedule and is helpful in reducing costs and fatigue risks. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Operating room scheduling will be made more objective and efficient if OR scheduling personnel can simultaneously consider the cost, fatigue risk, and other factors in scheduling. Cost of each OR room should be considered to set appropriate cost coefficients in practical application of the IOSPEM. It is also suggested that other indices (e.g., OR overtime costs and OR nurse fatigue risks) also be considered in the proposed model so as to better reflect the actual scheduling environment. The procedure and methods implemented in this study may be used as the basis for further developing more effective and efficient OR scheduling systems.

A study of job stress, stress coping strategies, and job satisfaction for nurses working in middle-level hospital operating rooms.

BACKGROUND: Understanding the interactive relationships between demographics and work-related variables, job stress, job stress coping strategies, and job satisfaction for operating room (OR) nurses is important. PURPOSE: The purpose of this study was to determine the stressors, the stress coping strategies, and the job satisfaction of nursing staff who worked in the OR and to evaluate influence of demographic characteristics on job stress, stress coping strategies, and job satisfaction. METHODS: A cross-sectional research design was used to collect data. Participants included 121 nurses with more than 6 months of work experience at seven hospitals in Yunlin and Chiayi Counties. Data were collected from March through May 2008. One hundred twelve questionnaires were returned, giving a response rate of 92.56%. The questionnaire included four parts designed to gather data on demographics and work-related information, job stress, stress coping strategies, and job satisfaction. RESULTS: Major findings of this study were as follows: (a) stress level and frequency perception of OR nurses were significantly related to the type of hospital; (b) the most intense stressor perceived by OR nurses was patient safety; (c) the stressor most frequently perceived by OR nurses was administrative feedback; (d) although all job stressors were positively related to destructive stress coping strategies, professional status, patient safety, and OR environment were also positively related to constructive stress coping strategies; (e) factors including work rewards, OR environment, and administrative management of job satisfaction were inversely related to destructive stress coping strategies; and (f) factors including work rewards, OR environment, and administrative management of job satisfaction were inversely related to all job stressors. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Major suggestions of this study include the following: (a) hospitals should ensure set standard operating procedures for the OR, strengthen the designed-in security of the OR working environment, and provide adequate safety protection equipment to safeguard OR staff and patients; (b) the OR department should increase the quantity and the quality of stress relief courses; (c) the OR department should improve the OR environment and the administrative management skills; and (d) the OR department should offer self-esteem-related training programs to assist OR nursing staff to adopt constructive stress coping strategies.