[Changes in Patient Safety Culture Attitudes Among Emergency, Intensive Care, and General Ward Nurses During the COVID-19 Pandemic].

BACKGROUND: Patient safety culture is an indicator of healthcare quality and a topic of global importance in medical care. PURPOSE: In this study, the attitudes towards patient safety culture of nursing staff working in the emergency, intensive care, and general wards are compared before and during the COVID-19 pandemic. METHODS: A retrospective research design was utilized and an anonymous questionnaire survey conducted on the Taiwan Patient Safety Culture Survey web-based platform system was used to collect the data. The survey was administered in a regional hospital in northern Taiwan between 2018 and 2020. The 1,540 nursing personnel who participated in this study worked in the emergency, intensive care units, or general adult ward. The analysis focused on assessing participant attitudes towards patient safety culture in terms of both the overall score and sub-dimensions. RESULTS: The participants were mostly female and between 21 and 30 years old. A majority had completed a diploma or university education. The two analyses revealed the highest and lowest average scores were earned, respectively, in the "teamwork" and "resilience" dimensions of patient safety culture. In 2020, the average scores for all dimensions were lower than in 2018, and the average scores for the emergency and critical care group were lower than those for the general adult ward group. Sub-dimension analysis showed that the general adult ward group earned significantly higher scores in "teamwork" across all three sub-dimensions compared to the emergency and critical care groups. The general ward group exhibited the most significant score decline between the two surveys. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: Overall scores were found to have decreased during the COVID-19 pandemic period (2020). Notably, emergency and intensive care nurses earned consistently lower scores, likely due to the severity of patient conditions and increased pandemic-related workloads and stress. "Resilience" scores were the lowest among all nursing staff, with the most significant drop seen in general ward nurses. Enhancing nursing staff education and training as well as addressing their psychological well-being will be crucial to improving patient safety culture attitudes. Managers should provide infection control, resilience training, and psychological counseling to help nurses manage the challenges posed by infectious diseases effectively and enhance patient safety culture.

Systematic review: Effect of mobile applications on college students with depressive symptoms.

AIM: To evaluate the effects of mobile applications (apps) on college students with depressive symptoms. DESIGN: Depression among college students is a school health issue, although little is known regarding effective app-based interventions for managing depressive symptoms. This review follows the concept of (1) theoretical guidance framework on app design, (2) app-based intervention study design and (3) effect of app-based interventions. DATA SOURCES: Cochrane Library, CINAHL Plus with Full Text and PubMed were searched in October 2022. METHODS: English-language reports of app-based interventions for college students with depressive symptoms. Quality appraisal and data extraction of selected articles was conducted by two independent reviewers using the mixed methods appraisal tool. Data synthesis using core outcome and findings of intervention. RESULTS: Five studies have shown that depressive symptoms significantly decreased after app use, specifically indicating the effects that occur in 4 weeks. Although four studies have applied the theoretical framework to the app design, the findings showed the low implementation of the intervention activities as originally designed and at the specified dosage and difficulty in understanding the processes through which the intervention resolves the depressive symptoms. CONCLUSION: App-based intervention can decrease depressive symptoms; furthermore, 4 weeks was the time point at which the changes were expected to occur. However, the theory-based app design for the depression population was rarely related, and studies clearly explaining the intervention measures, intervention dosage and duration required to achieve effectiveness are needed. IMPACT: This study provides the synthesis of evidence-based app interventions to manage depressive symptoms to zoom in on different views and we suggest using the applications for at least 4 weeks before changes are expected to occur. PATIENT OR PUBLIC CONTRIBUTION: No patient or public involvement in this study.

Physical function mediates the effects of sensory impairment on quality of life in older adults: Cross-sectional study using propensity-score weighting.

AIMS: To investigate the effect of sensory impairment on quality of life in older adults and to assess the role of physical function as a mediator of the effect of the sensory impairment on quality of life. DESIGN: A cross-sectional study. METHODS: Older adults aged ≥65 years (N = 600) were recruited from January 2019 to May 2020. Hearing and visual function were measured with pure-tone audiometry and Snellen visual acuity tests, respectively. Quality of life (World Health Organization Quality of Life Scale Brief Version), physical function (Multidimensional Functional Assessment Questionnaire) and sociodemographic characteristics were reported by participants using interviewer-administered questionnaires. Propensity score weighting analysis was conducted based on generalized propensity scores via multinominal logistic regression for age, gender, education, income, and comorbidities. The difference in the quality of life was tested by applying a one-way analysis of variance. Multiple mediation analysis was conducted to explore the direct, indirect, and total effects of sensory impairment on quality of life through physical function. RESULTS: After propensity score weighting adjustment, when compared with participants with no sensory impairment, participants with dual sensory impairment had the worst quality of life, followed by visual impairment and then hearing impairment. Physical function statistically significantly mediated the effect of hearing impairment, visual impairment and dual sensory impairment on quality of life in older adults. CONCLUSION: Our findings demonstrated that the negative effect of the sensory impairment on quality of life in older adults was mediated through physical function. IMPACT: The convergence of an increasing ageing population and the prevalence of sensory impairment presents a significant global health burden. This study demonstrated that physical function was a mediator of quality of life in older adults. Designing appropriate physical activity interventions for older adults with sensory impairment could serve to enhance physio-psychological health and improve quality of life.

Development and psychometric testing of the safety climate instrument suitable for nurses handling chemotherapy drugs.

AIM: To develop and test the psychometric properties of the Taiwanese safety climate instrument suitable for nurses handling chemotherapy drugs. DESIGN: This is an instrument development study. METHOD: All four stages, including questionnaire design, expert consultation, cognitive testing and psychometric validation, were used in this study. The data were collected between August and December 2018. Nurses with experience in handling chemotherapy drugs (N = 484) at one medical centre and two regional hospitals in Taiwan completed this instrument. Data were randomly split into two groups: one group (N = 237) for exploratory factor analysis and the other (N = 247) for confirmatory factor analysis. RESULTS: The instruments' items were based on qualitative research, and the content validity index levels exceeded the acceptable value. An exploratory factor analysis revealed 43 items remaining in six factors, which accounted for 74.4% of variance. The result of the confirmatory factor analysis verified the acceptability of a 43-item model. The composite reliability values, Cronbach's alpha values, convergent validity and discriminant validity for each factor exceeded the acceptable value. CONCLUSION: Most climate safety instruments used in the health care sector focus mainly on patient safety outcomes. Furthermore, there is no safety climate instrument for handling chemotherapy drugs, and there is a cultural difference. Through the development and validation process, we have developed a new instrument suitable for nurses handling chemotherapy drugs, which has good psychometric properties. IMPACT: This instrument is valuable as its development was based on the concept of a safety climate for health care perceptions and qualitative survey findings. Hospital managers can use this instrument regularly to evaluate nurses' perceptions of the safety climate to determine the strengths and weaknesses of their workplace, thereby assisting organizational managers in proposing concrete actions.

Community-based multiple screening for metabolic syndrome by innovative theory: A longitudinal study.

The purpose of this research is to elucidate whether metabolic syndrome affects the rate of adoption of a new multiple cancer screening programme, based on the Diffusion of Innovation theory. The time to attend the screening programme, conducted in Keelung, Taiwan, within 10 years was assessed by innovativeness (innovators, early adaptors, early majority, late majority and laggard) using data from 79,303 residents, with the information on metabolic syndrome accrued from routine adult health check-ups. The median time of adopting the programme and the relative rates of early adoption by metabolic syndrome and its severity score were estimated. The results show that the estimated times to adopt the programme ranged from 3 months for innovators to 10 years for the laggard. The rate of early adoption was 34% higher for participants without metabolic syndrome than for those with the disease, and the gradient relationship of disease severity was noted. The adjusted median time to adopt innovativeness was 0.82 years earlier for participants who were disease-free than those with the disease. Meanwhile, the adjusted median time was wider by up to 2.25 years for those with severe disease. The study suggests that innovation should prioritise the potential risk of the metabolic syndrome population.

[Safe Working Environments: The Foundation of Patient Safety].

Patient safety is a primary concern in the medical and healthcare industry. The safety climate (or culture) of a hospital is determined by the overall perception of its safety policies and the safety-related behaviors of medical staff that affect the quality of care provided by the organization and risk of occupational injury. The perceptions of nurses related to the hospital safety climate relate positively to their behavior in the workplace. An organization's safety culture determines the risk of patient care. Patankar and Sabin (2010) identified safety values, safety leadership, safety climate, and safety performance as important factors affecting the development and improvement of an organization's safety climate. Several papers in the literature have examined the characteristics (Lin et al., 2017), influencing factors (Wagner et al., 2020), outcomes (Arzahan et al., 2022), and improvement strategies (Lee et al., 2019) related to hospital safety climates. The occupational safety of medical staff and their compliance with safety regulations relate closely to patient safety and care outcomes (Hessels & Larson, 2016). The most frequently used outcome indicators of hospital safety culture are mortality rate, length of stay, infection rates, and patient satisfaction. However, unsafe medical environments and work stress may hinder the compliance of medical staff with safety behaviors and affect the value they place on these behaviors. Furthermore, perceiving a working environment as "unsafe" induces physical and mental health problems and dissatisfaction, leading to work stress and causing occupational injuries, physical and mental health issues, increased turnover, and decreased work satisfaction (Arzahan et al., 2022; Kalteh et al., 2021). The working environment of nurses is highly complex and uncertain, and considered to be one of the most hazardous occupational settings. However, guaranteeing a safe and friendly working environment is the responsibility of every organization and also a basic employee right. The International Council of Nurses (International Council of Nurses, 2017) advocates that every nurse has the right to work in a healthy and safe environment that minimizes the risks of injury and illness. Therefore, patient health outcomes should not be the only focus when discussing hospital safety culture, and more attention should be paid to promoting a safe working environment for medical staff as well. In their study conducted in Taiwan, Lin et al. (2022) proposed that the safety climate of hospitals covers six dimensions. Three of these, including "experience of clinical jobs hindering the use of personal protective equipment," "perception of comfort using personal protective equipment," and "easy usage of personal protective equipment", have not been addressed in studies conducted elsewhere. These three dimensions, which all relate directly to work environment safety, earned relatively low mean scores from the nurses surveyed, with "comfort in using personal protective equipment" earning the lowest mean score of all. Although the safety of working environments in medical organizations includes many dimensions (International Council of Nurses, 2017), including biological (infection risk), chemical (chemotherapy drugs), ergonomic (improper design, lifting), physical (radiation, needle stick injuries), and psychological (workload, workplace violence), the accumulated evidence provides insights that administrators may use to further improve hospital safety environments. Lin et al. (2022)'s investigation of nursing management practices related to hazardous antineoplastic drugs found the availability of adequate and appropriate personal protective equipment to be essential to promoting a safe working environment. During the current coronavirus disease pandemic, the three Taiwan-specific dimensions related to personal protective equipment have great value in helping nurse administrators foster and assess the safety climate in their hospitals. In addition to showing that nurses use personal protective equipment for self-protection and the protection of clients, these dimensions also provide to nurse administrators specific directions for creating a safe working environment by providing to nurses adequate, comfortable, and easy-to-use personal protection equipment.

[Hospital Safety Climate: Concept and Measurement Tools].

Work environments at healthcare organizations involve biological, chemical, and physical risks. Healthcare providers adhere to safe work practices and promote organizational activities proactively to improve practice safety and patient safety, both of which are closely linked to quality of care. In light of the limited research on safety culture and employee safety performance in the healthcare industry, this paper was developed to introduce the concept of hospital safety climate; the factors known to influence the safety climate in hospitals and safety performance and outcomes; and related safety climate measurement tools from the perspective of promoting safe performance among hospital healthcare providers. We recommend management create a safe work environment to reinforce employees' positive perceptions about the commitment of management to safety and subsequently promote shared beliefs regarding workplace safety and motivate employees to create a safer work environment. In addition, healthcare providers' perceptions of the safety climate should be assessed to identify strengths and weaknesses in the safety climate, guide the development of related improvement measures, and enhance the safety-climate perceptions of employees.

Effects of mHealth-based interventions on health literacy and related factors: A systematic review.

AIMS: To evaluate the effects of mobile health (mHealth)-based interventions on health literacy and related factors. BACKGROUND: Few reviews exist on the effects of mHealth-based interventions on the improvement and changes in health literacy and related factors. EVALUATION: A systematic review was conducted using the Mixed Methods Appraisal Tool to evaluate the quality of articles. RESULTS: Outcome variables included eHealth literacy, mHealth literacy and health literacy. Two studies showed that health literacy was significantly enhanced after mHealth application use, particularly among those with low education and health literacy levels. Two articles reported that health information seeking and health information appraisal improved after mHealth-based interventions, thereby increasing health literacy levels. In one article, no significant relationship was found between health literacy levels and mHealth literacy. CONCLUSION: mHealth can enhance health literacy; furthermore, mobile applications effectively improve patient health literacy. However, measurement tools used for evaluating health literacy indicators are inconsistent, with the concept and components of these tools being not specifically designed for evaluating health literacy indicators. IMPLICATIONS FOR NURSING MANAGEMENT: To successfully and effectively overcome health problems in diverse clinical settings, the theory-based mHealth services should be adopted while considering their intensity, frequency, duration and credibility.

Validation of the Chinese version of the Life-Space Assessment in community-dwelling older adults.

The Life-Space Assessment (LSA) is a comprehensive tool for assessing mobility in older adults, but the evidence of its psychometric properties in Chinese older adults is lacking. The aim was to adapt and validate the psychometric properties of the Chinese version of the Life-Space Assessment (LSA-C) in community-dwelling older adults. A cross-sectional study was designed with 225 community-dwelling older adults. The content validity of the LSA-C was satisfactory. The criterion validity was supported by significant correlation between the LSA-C and the Multidimensional Functional Assessment Questionnaire (MFAQ). Additionally, the LSA-C was negatively correlated with the 10-item Center for Epidemiological Studies Depression Scale (CESD-10) and positively correlated with the General Health subscale of the Short-Form-36 Health Survey (GH of the SF-36), implying good construct validity. Finally, the LSA-C showed excellent stability (intraclass correlation coefficient = 0.88). The LSA-C demonstrates adequate psychometric properties, supporting its use in future research in the Chinese context.

Patient willingness to undergo a two-week free trial of a telemedicine service for coronary artery disease after coronary intervention: A mixed-methods study.

AIM: To understand the factors affecting willingness to use telemedicine in patients with coronary artery disease after coronary intervention. BACKGROUND: Telemedicine is a relatively new service provided to discharged patients in Taiwan, therefore, public acceptance is low. METHOD: This mixed-methods study conducted between January and June 2014 used convenience sampling. In total, 140 patients were offered a two-week free trial of telemedicine services before hospital discharge. Participants completed structured questionnaires and answered semi-structured qualitative questions related to willingness to use telemedicine services. RESULTS: Patients' willingness to use telemedicine was not significantly correlated with experience using technology, perceived ease of use or computer self-efficacy; instead, it was based on trust in the hospital staff, opinions of the staff and ongoing support from the case manager. Reasons for their lack of willingness to use the service were mainly related to diseases, technology/equipment and environmental factors. CONCLUSION: Staff support through telephonic tracking and real-time feedback can increase willingness to use telemedicine. IMPLICATIONS FOR NURSING MANAGEMENT: Case managers can collect necessary personal information and offer the patients 24-hr services as a monitor, an instructor and a companion, thereby accommodating more patients, building value and strengthening telemedicine services.

[Current State of Appropriate Medication Use in Older Adults and Future Prospects].

Medication is the most common strategy for addressing the healthcare needs of older adults. In order to treat disease, maintain health, prevent further declines in health, prolong survival, and improve quality of life, the proper use of medicine is of great importance in the care of older patients (de Oliveira Alves, Schuelter-Trevisol, & Trevisol, 2014). Since the physician Dr. Beers put forward the concept of potentially inappropriate medication (PIM) almost thirty years ago in 1991 (Beers et al., 1991), scholars around the world have issued explicit criteria related to PIM for clinical and research purposes. It is necessary for the first-line medical personnel who are involved in caring for older patients to increase their knowledge and understanding of the medication status of their older patients, clarify the indications of medicines taken by these patients, and become familiar with the tools used to assess the appropriateness of medications in order to assist the medical team to identify PIM and to serve as a channel between older patients and the medical team. A systematic literature review found prevalences of PIM among older individuals ranging from 3.6% to 92.0% (Nothelle, Sharma, Oakes, Jackson, & Segal, 2017; Redston, Hilmer, McLachlan, Clough, & Gnjidic, 2018; Storms, Marquet, Aertgeerts, & Claes, 2017), subject to different research samples, study sites, and assessment tools. The prevalence of PIM among older patients in Taiwan has been estimated at 9.8%-91.2% (Chang et al., 2011; Huang, Yeh, Hung, Hsieh, & Tsai, 2011; Lin, Peng, Chen, Lin, & Hwang, 2011; Shen, 2008), which indicates that the problem of PIM among older patients in Taiwan is no less serious than in Europe or the United States. A survey of medication used by older adult inpatients at a medical center in northern Taiwan found the incidences of PIM in the sample to be 76.3%, 80.9%, 70.0%, 69.1%, and 75.2%, respectively, at hospital admission, during hospitalization, at discharge, at the first return visit, and 3 months after discharge (Ho, 2017). This not only revealed a high prevalence of PIM among older people in Taiwan but also suggests that PIM may initially decrease and subsequently increase over time after hospital discharge. This possible trend deserves further assessment and attention. Nurses, especially homecare nurses, are frontline personnel in medical care who play an important role in reviewing medication safety. Lou (2016) used focus group research to explore the challenges of medication safety faced by older patients under the care of homecare nurses. The study found that homecare nurses lack the self-confidence necessary to review of the appropriateness of medication due to several factors, including medication complexity, lack of clinical experience, the regular introduction of new drugs, and the fact that homecare nurses are not medical experts. Lou further used PIM-Taiwan criteria (version 1) to design and develop an application software program (app) that reviews automatically the appropriateness of medications given to older patients. This app is a supplemental assistance device for non-drug experts and facilitates the timely reporting of medication review results to prescribing physicians. The app was further shown to have a positive and significant impact in a demonstration trial. The administration of medication is a key part of the routine work of nurses. In addition to administering correct dosages, nurses should have a better understanding of the appropriateness of medications. Nurses should not only be familiar with the medicines that they give to their older patients but should also be able to identify their appropriateness. They should make good use of explicit criteria to identify the appropriateness of medications and apply related technological products in clinical situations in order to improve quality of care in terms of medication safety for older patients.

[Introduction to Tools for Assessing Medication Use Appropriateness in Older Adults].

The prevalence of potentially inappropriate medication (PIM) use is high, presenting a serious public health problem. In older adults, PIM increases the risks of adverse drug events, falls, hospitalizations, and emergency treatments as well as related medical expenses. The currently popular criteria for determining medication appropriateness and several common medication appropriateness assessment tools are introduced in this paper, including the Medication Appropriateness Index, the Beers criteria series, the Screening Tool of Older Person's Prescriptions (STOPP) and the Screening Tool to Alert doctors to Right Treatment (START) series, Thailand criteria, and the PIM-Taiwan criteria, with the goal of facilitating their application by medical professionals in clinical practice.

Mediating effects of burden on quality of life for caregivers of first-time stroke patients discharged from the hospital within one year.

BACKGROUND: Caregiver burden may be either a predictor or an outcome of caregiver quality of life (QoL). Patient or caregiver factors that directly affect caregiver QoL, predictors that are simultaneously shared with caregiver burden and QoL, and factors that affect caregiver QoL through caregiver burden are not well understood. This study explored predictors of caregiver QoL and identified whether caregiver burden is a mediator for caregivers of first-time stroke patients. METHODS: This is a cross-sectional study. We recruited first-time stroke patients who had been discharged from the hospital within 1 year. We screened caregivers with two major inclusion criteria: age > 20 years old and being the family member who provides the most patient-care hours out of all family caregivers. Caregiver burden (Caregiver Strain Index, CSI), QoL (Caregiver Quality of Life Index, CQLI), and patient and caregiver characteristics were assessed with structured questionnaires. Multiple-regression and bootstrap analysis were conducted for data analysis. RESULTS: A total of 126 caregivers completed the questionnaires. Higher caregiver burdens, lower caregiver education level, lower self-rated health, lower monthly family income, and spouses who were responsible for medical fees were significant predictors of lower caregiver QoL. Poor self-rated health and monthly family income of $ 666 USD or below were the strongest predictors of caregiver QoL. Spouses who were responsible for medical fees and lower monthly family income had direct negative effects on caregiver QoL, but these factors exhibited no indirect mediating effect between caregiver characteristics and QoL through caregiver burden as a mediator. Caregiver education level at or below elementary school and poor or fair self-rated-health had direct negative effects on caregiver QoL, which were mediated by caregiver burden. CONCLUSIONS: Our study indicated predictors of caregiver QoL and the relationships with caregiver burden among first-time stroke survivors in the early stage. Caregivers' financial factors affected caregiver QoL directly. Caregivers' poor self-rated health and lower education level negatively affected caregiver QoL indirectly through caregiver burden as a mediator. Interventions to make appropriate policies for financial subsidies, to enhance caregivers' health and to provide tailored stroke-related education through multidisciplinary cooperation may effectively promote caregiver QoL.

Quality of life in older adults with sensory impairments: a systematic review.

PURPOSE: Sensory impairments are common in older adults. Hearing and visual impairments affect their physical and mental health and quality of life adversely. However, systematic reviews of the relationship between hearing impairment, visual impairment, dual sensory impairment, and quality of life are scarce. The purpose of this systematic review was to determine the relationship between hearing impairment, visual impairment, dual sensory impairment, and quality of life. METHODS: Searches of EMBASE, PubMed, CINAHL, MEDLINE, Cochrane Library, and Airiti Library were conducted between January 2006 and December 2017 using the keywords "quality of life," "life satisfaction," "well-being," "hearing impairment," and "visual impairment." Two authors independently assessed methodologic quality using a modified Downs and Black tool. Data were extracted by the first author and then cross-checked by the second author. RESULTS: Twenty-three studies consisting mostly of community-dwelling older adults were included in our review. Sensory impairment was found to be in significant association with quality of life, with an increase in hearing impairment or visual impairment severity resulting in a lower quality of life. Quality of life for dual sensory impairment was worse than for hearing impairment or visual impairment individually. CONCLUSIONS: A significant association was confirmed between hearing impairment, visual impairment, dual sensory impairment, and quality of life. Our review can be used to enhance health care personnel's understanding of sensory impairment in older adults and enable health care personnel to actively assess older adults' sensory functions, so that they can help alleviate the negative impact of sensory impairments on QOL in older adults.

Concept analysis of safety climate in healthcare providers.

AIM AND OBJECTIVE: To report an analysis of the concept of safety climate in healthcare providers. BACKGROUND: Compliance with safe work practices is essential to patient safety and care outcomes. Analysing the concept of safety climate from the perspective of healthcare providers could improve understanding of the correlations between safety climate and healthcare provider compliance with safe work practices, thus enhancing quality of patient care. DESIGN: Concept analysis. DATA SOURCES: The electronic databases of CINAHL, MEDLINE, PubMed and Web of Science were searched for literature published between 1995-2015. Searches used the keywords 'safety climate' or 'safety culture' with 'hospital' or 'healthcare'. METHOD: The concept analysis method of Walker and Avant analysed safety climate from the perspective of healthcare providers. RESULTS: Three attributes defined how healthcare providers define safety climate: (1) creation of safe working environment by senior management in healthcare organisations; (2) shared perception of healthcare providers about safety of their work environment; and (3) the effective dissemination of safety information. Antecedents included the characteristics of healthcare providers and healthcare organisations as a whole, and the types of work in which they are engaged. Consequences consisted of safety performance and safety outcomes. Most studies developed and assessed the survey tools of safety climate or safety culture, with a minority consisting of interventional measures for improving safety climate. CONCLUSION: More prospective studies are needed to create interventional measures for improving safety climate of healthcare providers. This study is provided as a reference for use in developing multidimensional safety climate assessment tools and interventional measures. RELEVANCE TO CLINICAL PRACTICE: The values healthcare teams emphasise with regard to safety can serve to improve safety performance. Having an understanding of the concept of and interventional measures for safety climate allows healthcare providers to ensure the safety of their operations and their patients.

Health status and quality of life of survivors of extra corporeal membrane oxygenation: a cross-sectional study.

AIMS: To understand the influential factors related to quality of life for adult patients who have undergone extra corporeal membrane oxygenation. BACKGROUND: Extracorporeal membrane oxygenation is an invasive treatment for critically ill patients requiring temporary cardiac or respiratory support. Most studies have focused on survival outcomes for patients; few have evaluated health-related quality of life. DESIGN: A cross-sectional design. METHODS: Data were collected in 2013 from a convenience sample of adult patients who had survived treatment with extracorporeal membrane oxygenation between 2009-2011. Structured questionnaires collected data about health status. The Short Form 36-item questionnaire measured quality of life. RESULTS: The 100 participants averaged 48·95 years of age. Pearson's correlation showed two measures of health status had significant correlations with quality of life: the Barthel Index and the Instrumental Activities of Daily Living; two measures had significant negative correlations: Charlson's Comorbidity Index and the Nottingham Health Profile-part II. Mean scores for the physical and mental component summaries of the Short Form-36 questionnaire were 49·25 and 48·13 respectively. These component scores had significant negative correlations with the Nottingham health profile-part II. Stepwise multiple linear regression analysis indicated the number of life areas affected on the Nottingham health profile-part II was a common factor influencing both the mental and physical component summaries scores for quality of life. CONCLUSIONS: Social participation was a common factor influencing quality of life. Examining health status and quality of life of extracorporeal membrane oxygenation survivors can help nurses determine interventions for effectively improving health-related quality of life.

Parental Body Mass Index Is Associated With Adolescent Obesity in Taiwan.

Adolescent obesity is a crucial public health concern, and understanding its risk factors can facilitate the establishment of prevention policies. In this study we investigated the prevalence of adolescent obesity in Taiwan, determined the influential factors, and compared the prevalence of obesity in our study population with international indices. The cross-sectional study was an analysis of data from the 2010-2011 Nutrition and Health Survey in Taiwan, an anthropometric measurement and questionnaire survey of adolescents aged 11-18 years. Our sample was 1,826 adolescents (910 males and 916 females). Data were analyzed using logistic regression modeling. Based on body mass index standards specific to Taiwan norms, the prevalence of overweight and obesity in Taiwan adolescents was 12.4% and 16.8%, respectively. The prevalence was lower when international indices of overweight and obesity were applied. In logistic regression, obesity was linked to male gender, an obese father, overweight or obese mother, poor dietary attitudes, and perceived low dietary benefits. Monitoring and preventing adolescent obesity should focus on both adolescents and their parents. When planning behavioral change and education for adolescent obesity, health professionals and policy-makers should view the family as a unit. © 2016 Wiley Periodicals, Inc.

Access site complications following transfemoral coronary procedures: comparison between traditional compression and angioseal vascular closure devices for haemostasis.

BACKGROUND: Vascular closure devices such as angioseal are used as alternatives to traditional compression haemostasis. Although the safety and efficacy of angioseal are confirmed, their use remains controversial because of the potential complications of these devices compared with those of traditional compression haemostasis. The aim of this study was to compare the access site complication rate, the predictive factors for these complications, and patient comfort levels after coronary procedures with traditional compression or angioseal haemostasis. METHODS: Data were collected from a cardiac unit in a medical center in northern Taiwan. A total of 130 adult patients were recruited and equally divided into two groups according to the method of haemostasis used after the coronary procedure: a traditional compression group and an angioseal group. We observed the incidence of access site complications, including bleeding, oozing, haematoma formation, and arteriovenous fistula formation. In addition, we used a 0-10 numeric rating scale to assess soreness, numbness, and back and groin access site pain after 1 h of catheter removal and immediately before getting out of bed. RESULTS: The overall incidence of complications was 3.8 % (n = 5), which was not significantly different between the two groups (p = .06). The propensity score--adjusted multivariate analyses revealed that the only independent predictor for access site complications was an age of >70 years (OR, 10.44; 95 % CI, 1.81-60.06; p = .009). Comfort levels were higher in the angioseal group than in the traditional compression group. CONCLUSIONS: Angioseal used after coronary procedures did not increase the incidence of complications relative to that associated with traditional compression haemostasis; however, it increased patient comfort levels. Health personnel should pay special attention to the predictive factor for access site complications after coronary procedures, such as age >70 years.

Biofeedback relaxation for pain associated with continuous passive motion in Taiwanese patients after total knee arthroplasty.

Effective pain management is crucial for patient recovery after total knee arthroplasty (TKA). Biofeedback therapy, which encourages relaxation and helps alleviate various conditions associated with stress, may help to decrease postoperative pain in patients undergoing TKA. A quasi- experimental design was used to investigate the efficacy of a biofeedback relaxation intervention in reducing pain associated with postoperative continuous passive motion (CPM) therapy. Sixty-six patients admitted to a general hospital in Taiwan for TKA were recruited and randomly assigned to the intervention or control group. The intervention group received biofeedback training twice daily for 5 days, concurrent with CPM therapy, whereas the control group did not receive the biofeedback intervention. Pain was measured using a numeric rating scale before and after each CPM therapy session on postoperative days 1 through 5. The CPM-elicited pain score was calculated by subtracting the pre-CPM pain score from the post-CPM pain score. Results of repeated-measures analysis of variance showed intervention group reported significantly less pain caused by CPM than did the control group (f = 29.70, p < 0.001). The study results provide preliminary support for biofeedback relaxation, a non-invasive and non-pharmacological intervention, as a complementary treatment option for pain management in this population.

Prevalence of impaired fasting glucose and analysis of related factors in Taiwanese adolescents.

OBJECTIVE: To determine the prevalence of impaired fasting glucose (IFG) in Taiwanese adolescents and important related variables. SUBJECTS AND METHODS: This analysis was based on the Nutrition and Health Survey in Taiwan (NAHSIT) data during 2010 and 2011. The original study was a cross-sectional and national representative survey. A total of 1949 subjects (965 males and 984 females) aged 11-20 years participated. Research tools consisted of questionnaires, anthropometry parameters, and blood biochemical indicators. The acquired data were analyzed using descriptive and inferential statistics. RESULTS: The prevalence of IFG in Taiwanese adolescents was 22% (a fasting glucose level between 100 and 125 mg/dL is considered abnormal). Factors that significantly affected IFG levels included sex, age, quality of family dietary environment, overweight, obesity, and the number of cardio-metabolic risk factors. CONCLUSION: The prevalence of IFG in Taiwanese adolescents is a public health issue that should not be ignored. The prevalence may be reduced by adjusting lifestyles. Healthy family environments should be encouraged and appropriate healthy lifestyle counseling plans offered specifically to male adolescents with overweight, obesity, and cardio-metabolic risk factors.