Development and Validation of the Interprofessional Collaboration Practice Competency Scale (IPCPCS) for Clinical Nurses.

Interprofessional collaborative practice is a core competency and is the key to strengthening health practice systems in order to deliver safe and high-quality nursing practice. However, there is no Interprofessional Collaboration Practice Competency Scale (IPCPCS) for clinical nurses in Taiwan. Therefore, the purposes of this study were to develop an IPCPCS and to verify its reliability and validity. This was a psychometric study with a cross-sectional survey using convenience sampling to recruit nurses from the seven hospitals of a medical foundation. A self-designed structured IPCPCS was rolled out via a Google survey. The data were analyzed using descriptive statistics, principal-axis factoring (PAF) with Promax rotation, Pearson correlation, reliability analysis, and one-way ANOVA. PAF analysis found that three factors could explain 77.76% of cumulative variance. These were collaborative leadership and interprofessional conflict resolution, interprofessional communication and team functioning, and role clarification and client-centered care. The internal consistency of the three factors (Cronbach's α) was between 0.970 to 0.978, and the Pearson correlation coefficients were between 0.814 to 0.883. Significant differences were presented in the IPCPCS score by age, education level, total years of work experience, position on the nursing clinical ladder, and participation in interprofessional education. In conclusion, the three factors used in the IPCPCS have good reliability and construct validity. This scale can be used as an evaluation tool of in-service interprofessional education courses for clinical nurses.

Are we of one mind about core competencies of nurse preceptors? A nominal group technique study.

AIM: This paper explored the differences in perspectives on the core competencies of nurse preceptors among postgraduate-year nurses, clinical nursing preceptors and head nurses. DESIGN: Cross-sectional design with nominal group technique (NGT). METHOD: The sample consisted of 32 postgraduate-year nurses, 42 preceptors and 27 head nurses. Two rounds of NGT were used to collect the group opinions. RESULTS: While the rank/level of importance varied, three groups all agreed that teaching traits, clinical nursing profession, communication and collaboration, teaching pedagogy, reaction of contingency and consultation of academic writing were important core competencies for nurse preceptors. The three groups disagreed on critical thinking and reflection, as well as lifelong learning. This study clarifies cognitive differences and expectations among three groups and can assist medical institutes in designing preceptor training courses.

Exploring core competencies of clinical nurse preceptors: A nominal group technique study.

AIM: The aim of this study was to explore core competencies of nurse preceptors based on the perspectives of postgraduate-year nurses, nurse preceptors and head nurses. BACKGROUND: Perspectives of core competencies of nurse preceptors are varied among postgraduate-year nurses, nurse preceptors and head nurses, which makes it difficult to establish preceptor training programs and develop evaluation instruments. DESIGN: A nominal group technique study. METHODS: A nominal group technique procedure was applied to small-group and large-group discussion. The participants were recruited from the inpatient units at five nonprofit hospitals, each having over 1000 patient beds, in Taiwan. A total of 101 participants were involved in this study: 32 postgraduate-year nurses, 42 nurse preceptors and 27 head nurses, who were respectively sorted into five, six and four small groups with six to eight members in each group. After applying nominal group technique procedure, the core competencies were scored and ranked. Based on the final scores and ranking, the core competencies that the participants felt to be most important for nurse preceptors were identified. The expert panel then integrated these core competencies and derived a consensus. RESULTS: Seven core competencies of nurse preceptors were derived, in order of declining importance: teaching traits, clinical nursing profession, communication and collaboration, teaching pedagogy, reaction of contingency, critical thinking and reflection and consultation on academic writing. All participants perceived that teaching traits (198 points) and clinical nursing profession (161 points) were the most important. Consultation of academic writing is unique, which may be due to the clinical ladder system still being implemented in Taiwan. CONCLUSIONS: The nominal group technique is an efficient and proper method to conduct a consensus for specific issues or values among individuals and groups. The results of this study can facilitate the development of evaluation indicators or instruments as well as provide a direction of continuing education program for preceptor training.

The objective structured clinical examination as an assessment strategy for clinical competence in novice nursing practitioners in Taiwan.

BACKGROUND: The conventional written tests and professional assessment have limitation in fair judgement of clinical competence. Because the examiners may not have total objectivity and may lack standardization throughout the assessment process. We sought to design a valid method of competence assessment in medical and nursing specialties. This work was aimed to develop an Objective Structured Clinical Exam (OSCE) to evaluate novice nursing practitioners' clinical competency, work stress, professional confidence, and career satisfaction. METHODS: A Quasi-experimental study (pre-post). Fifty-five novice nursing practitioners received the OSCE three-months following their graduation, which consisted of four stations: history taking, physical examination, problem-directed management, interpersonal communication, and the required techniques of related procedures. The examiners had to complete an assessment checklist, and the participants had to complete a pre-post questionnaire (modified from a Nursing Competency Questionnaire, a Stress scale, and Satisfaction with Learning scale). RESULTS: Among the novice nursing practitioners, 41 of them (74.5 %) passed the exam with a mean score of 61.38 ± 8.34. There was a significantly higher passing rate among nurses who were working in medical-surgical wards (85.7 %) and the intensive care unit-emergency department (77.8 %) compared to novice nursing practitioners working in other units. All the novice nursing practitioners at Station A had poor performance in assessing patients with a fever. OSCE performance was more associated with educational attainment and work unit, rather than the gender. Finally, the participants showed statistically significant increases in their clinical competency, confidence in their professional competence, satisfaction with the clinical practice, and decreased work stress after the OSCE. CONCLUSIONS: We found that the OSCE process had a positive educational effect, in providing a meaningful and accurate assessment of the competence of novice nursing practitioners. An appropriate OSCE program is vital for novice nursing practitioners, educators, and administrators. The effective application of OSCEs can help novice nursing practitioners gain confidence in their clinical skills.

Effectiveness of communication skill training on cancer truth-telling for advanced practice nurses in Taiwan: A pilot study.

OBJECTIVE: Advanced practice nurses (APNs) can best support physicians in improving the quality of truth-telling. However, the effectiveness of communication skill training (CST), based on the Japanese SHARE model exclusive to APNs, has not been tested from APNs' and recipients' viewpoints, motivating the author to conduct the present study. METHODS: A two-group before-after model design was adopted, and 61 APNs from two hospitals were randomly assigned to either an experimental group (EG; N = 28) or an control group (CG; N = 33). APNs in the EG received 6 h of CST under the guidance of qualified facilitators and simulated patients. This study used APNs' subjective assessment (N = 61) (self-confidence and perceptions on truth-telling) and recipients' opinions (N = 480) (cancer patients' and their caregivers' satisfaction with truth-telling and emotional status) to assess the effectiveness of the SHARE CST. Data were collected before CST (baseline, T0), immediately after (T1), and 2 weeks after (T2). RESULTS: APNs in the EG had more confidence (p < 0.05) and better perceptions of cancer truth-telling (p < 0.01) than APNs in the CG at both T1 and T2. No group differences were found in patients' or their caregivers' satisfaction with truth-telling, emotional distress, and anxiety (p > 0.05). In addition, patients in the EG had higher depression than patients in the CG (ß = 1.65, p = 0.01). CONCLUSIONS: SHARE CST can improve APNs' confidence and perceptions of cancer truth-telling. However, more rigorous studies are required to test the effectiveness of CST from recipients' viewpoint.

Effectiveness of an Evidence-Based Practice Educational Intervention among School Nurses.

The evidence-based practice (EBP) approach to high-quality care is designed to improve patient outcomes. However, little research has been conducted to determine how EBP is adopted and implemented among school nurses in Taiwan. This study evaluated an EBP training program implemented among school nurses in Taiwan to determine whether and how effectively it improved their knowledge levels, attitudes, skills, and self-efficacy. A pretest-posttest research design was employed. Participants were recruited via convenience sampling from among 193 primary schools throughout Tao-Yuan and New Taipei City in Taiwan. The EBP program implemented both mobile learning technology and the flipped classroom format. The learning outcomes were evaluated before, immediately after, and at a 3-month follow-up. In this regard, the data were collected using the School Nurse Evidence-Based Practice Questionnaire. The results showed that the participant scores for the items of knowledge and self-efficacy significantly increased over the study period. Somewhat differently, scores for the skill items significantly increased from the pre-test to the immediate post-test, but significantly decreased from the immediate post-test to the final follow-up. Overall, however, the EBP program led to marked improvements in knowledge, skills, and self-efficacy. These findings can help guide the development of a creative evidence-based school nursing curriculum.

Abdominal obesity and hypertension are correlated with health-related quality of life in Taiwanese adults with metabolic syndrome.

OBJECTIVE: Metabolic syndrome (MetS) gains more attention due to high prevalence of obesity, diabetes and hypertension among adults. Although obesity, diabetes and hypertension can certainly compromise health-related quality of life (HRQoL), the correlations of sociodemographic factors, quality of life and MetS remains unclear. This study aims to investigate the association between HRQoL and MetS in an Asian community of the sociodemographic characteristics. RESEARCH DESIGN AND METHODS: We performed a cross-sectional study by recruiting 2588 Taiwanese patients aged ≥30 years between August 2015 and August 2017. Sociodemographic data and anthropometric variables were obtained from medical records and physical examination. Meanwhile, HRQoL was assessed by 36-Item Short-Form Health Survey questionnaires. RESULTS: The overall prevalence of MetS was 32.8%. Multivariate analysis revealed that age ≥65 years (OR=1.987, p<0.001), body mass index (BMI) ≥24 kg/m2 (OR=7.958, p<0.001), low educational level (OR=1.429, p=0.014), bad self-perceived health status (OR=1.315, p=0.01), and betel nut usage (OR=1.457, p=0.048) were associated with the development of MetS. For patients with MetS, the physical and mental health domains of HRQoL are negatively correlated with abdominal obesity and hypertension, respectively. CONCLUSIONS: Adult MetS in Taiwan was associated with certain sociodemographic factors including older age, high BMI, low educational level, bad self-perceived health status, and betel nut use. Abdominal obesity and hypertension was correlated with HRQoL in patients with MetS.

Correlates Between Health Beliefs and Health-Promoting Lifestyle Profiles in the Development of Metabolic Syndrome in Taiwan.

Differences in sociodemographic variables, health beliefs, and a healthy lifestyle all contribute to the varied prevalence of metabolic syndrome (MetS). We investigated the associations among MetS-related risk factors and performed a cross-sectional study, recruiting 1741 Taiwanese residents aged ≥30 years, between August 2014 and August 2015. Data were obtained on sociodemographic factors, health beliefs, and health-promoting lifestyle profiles using questionnaires. Multivariate analysis revealed that age ≥65 years (odds ratio [OR] = 2.17), low educational level (OR = 1.46), body mass index ≥24 kg/m2 (OR = 9.00), more health responsibility (OR = 1.08), and less exercise (OR = 0.924) were independent risk factors for MetS development. A correlation existed between health beliefs and health-promoting lifestyle profiles, suggesting that the establishment of an effective health-promoting program should consider participants' health beliefs.

[Effectiveness of an Interdisciplinary Health Education Intervention on Metabolic Syndrome in Community Residents: A Study of Four Towns in Northern Taiwan].

BACKGROUND: Metabolic syndrome, a widespread condition in Taiwan, increases the risks of cardiovascular diseases. Cardiovascular disease is the second leading cause of death in Taiwan after cancer. Thus, this health problem is a priority issue of concern. PURPOSE: To study the effects of active intervention of interdisciplinary health education on the prevalence of metabolic syndrome in community residents. METHODS: This longitudinal study was conducted from 2014 to 2015 on 661 participants who were all over 30 years old and living in four towns in northern Taiwan. The data were collected into two steps. In the first step, participants completed a blood study, body measurement, and pretest questionnaires and participated in the entire course of metabolic syndrome health education. The results of the blood test and body measurement were blinded to the experienced metabolic physicians before and after the education courses. In the second step, one year after administering the interdisciplinary health education course, the participants repeated the blood study, body measurement, and posttest questionnaires. RESULTS: 1. The participants had a higher incidence of metabolic syndrome. However, gender and marital status had no significant correlation with metabolic syndrome. Higher education levels were associated with a lower prevalence of metabolic syndrome. 2. The average scores for literacy rose from 2.30 pretest to 5.65 posttest. There were significant correlations (p < .05) between pretest and posttest health education. 3. The diagnosis of metabolic syndrome in this study changed from 215 participants (32.5%) to 170 participants (25.7%) between pretest and posttest (p < .05). 4. active health education had significant and positive effects on the cessation of smoking and chewing betel nut (p <.05). CONCLUSIONS: The active interdisciplinary health education intervention used in this study significantly decreased the smoking and betel-nut chewing habits and decreased the overall risk of metabolic syndrome in participants. Therefore, providing active health education on metabolic syndrome holds the potential to significantly decrease the prevalence of metabolic syndrome in at-risk populations. In addition, healthcare providers should make appropriately targeted health education more accessible to elderly patients who are prone to metabolic syndrome. Finally, the cessation of chewing betel nut should be seen as a major factor in the prevention and alleviation of metabolic syndrome.

School Nurses' Perceptions, Knowledge, and Related Factors Associated with Evidence-Based Practice in Taiwan.

The implementation of evidence-based practice (EBP) in health care has been focused mainly on hospital settings and there is little research on EBP adoption and implementation among school nurses in Taiwan. This study aimed to determine primary school nurses' perceptions regarding EBP and to explore the factors that influence EBP in Taiwan. A cross-sectional design was used and the School Nurse Evidence-Based Practice Questionnaire was developed to collect data. A total of 2679 elementary school nurses in Taiwan were invited to participate in this study, and 1200 completed questionnaires were returned, with a 45% response rate. Participants' mean age was 37.5 (range: 31⁻62) years and the mean duration of employment as a school nurse was 8.4 (range: 1⁻20) years. The majority of participants had a Bachelor's degree (56%). The results revealed that participants had insufficient EBP knowledge and skills. However, they had a positive attitude toward and moderate self-efficacy in EBP. The demographic data positively correlated with knowledge, attitudes, skills, self-efficacy, and influencing factors. Certain influencing factors were highlighted. As school nurses play a crucial role in promoting children's health, they ought to embrace EBP so as to provide more effective services. School organization should play a supportive role with regard to EBP implementation.

Potential risk for bacterial contamination in conventional reused ventilator systems and disposable closed ventilator-suction systems.

BACKGROUND: Few studies have investigated the difference in bacterial contamination between conventional reused ventilator systems and disposable closed ventilator-suction systems. The aim of this study was to investigate the bacterial contamination rates of the reused and disposable ventilator systems, and the association between system disconnection and bacterial contamination of ventilator systems. METHODS: The enrolled intubated and mechanically ventilated patients used a conventional reused ventilator system and a disposable closed ventilator-suction system, respectively, for a week; specimens were then collected from the ventilator circuit systems to evaluate human and environmental bacterial contamination. The sputum specimens from patients were also analyzed in this study. RESULTS: The detection rate of bacteria in the conventional reused ventilator system was substantially higher than that in the disposable ventilator system. The inspiratory and expiratory limbs of the disposable closed ventilator-suction system had higher bacterial concentrations than the conventional reused ventilator system. The bacterial concentration in the heated humidifier of the reused ventilator system was significantly higher than that in the disposable ventilator system. Positive associations existed among the bacterial concentrations at different locations in the reused and disposable ventilator systems, respectively. The predominant bacteria identified in the reused and disposable ventilator systems included Acinetobacter spp., Bacillus cereus, Elizabethkingia spp., Pseudomonas spp., and Stenotrophomonas (Xan) maltophilia. CONCLUSIONS: Both the reused and disposable ventilator systems had high bacterial contamination rates after one week of use. Disconnection of the ventilator systems should be avoided during system operation to decrease the risks of environmental pollution and human exposure, especially for the disposable ventilator system. TRIAL REGISTRATION: ClinicalTrials.gov PRS / NCT03359148.

How Taiwanese parents of children with autism spectrum disorder experience the process of obtaining a diagnosis: A descriptive phenomenological analysis.

An autism spectrum disorder can result in considerable stress and confusion for parents as they attempt to understand their child's problems and obtain a diagnosis. Few studies have explored the parental experience in the context of Chinese culture. The purpose of this study was to understand the experiences of parents in Taiwan of children diagnosed with autism spectrum disorder. In total, 15 parents, 1 father and 14 mothers, were recruited by purposive sampling. This qualitative study used semi-structured interviews and descriptive phenomenological analysis. The findings indicated that parents of children diagnosed with autism spectrum disorder underwent five coping experiences during the diagnostic process: (1) uncertainty and difficulty understanding their child's behaviour, which occurred during the pre-diagnosis phase; (2) obligation to obtain professional services; (3) anxious searching for a second opinion, which occurred during the diagnosis phase; (4) acceptance and fortitude and (5) further adjustment during the post-diagnosis phase. Our findings add to our understanding of how parents experience the diagnostic process, which could improve medical professionals' counselling and support for parents at the stage of obtaining a diagnosis for their children.

Impact of interactive situated and simulated teaching program on novice nursing practitioners' clinical competence, confidence, and stress.

BACKGROUND: Novice nursing practitioners (NNPs) often struggle to make the transition to fully competent professionals. We sought to determine the impact of an interactive, situated learning workshop on a participant's clinical competence. OBJECTIVES: This work aimed to improve the clinical competence, promote the self-confidence, and reduce the number of work-related stressors of NNPs. METHODS: We randomly allocated 31 newly graduated NNPs into interactive situated and simulated teaching (ISST) and non-ISST groups, which were perceived as the homogeneity of the 2 groups based upon no significant difference at age, education level and work units. The ISST program comprised six follow-up interactive face-to-face support sessions over a three-month period following the standard orientation training course. We assessed the participants' competency, stress, and confidence levels in professional competence before and at the end of the study. RESULTS: At the end of the three-month study period, the ISST group demonstrated superior nursing competency (p=0.001), as well as reported lower stress levels (p=0.011), and increased confidence in professional competence (p=0.026) as compared with those in the control group. A multiple regression analysis revealed that clinical nursing competence was positively correlated with the use of ISST (p=0.02) and negatively correlated with stress (p=0.03). CONCLUSIONS: The ISST program for NNPs significantly improved their clinical competence. It may be helpful to ensure that new trainees have access to training programs that can facilitate their acclimation to their new working environments at the beginning of their careers.

Coping strategies of Taiwanese children with autism spectrum disorders.

AIMS AND OBJECTIVES: To explore and describe the coping experiences of children with autism spectrum disorders in Taiwan. BACKGROUND: Children with autism spectrum disorders are faced with daily social and living challenges, which can cause stress. Chinese culture emphasises discipline and obedience, which may influence coping strategies of children with autism spectrum disorders in Taiwan. DESIGN: This qualitative study employed an exploratory descriptive design. METHOD: Data were collected from in-depth, face-to-face structured interviews. Interviews explored coping strategies of Taiwanese school-aged children (aged 6-19) with autism spectrum disorders. Children (N = 17) and their caregivers were recruited by purposive sampling. Transcribed interview data were thematically analysed using the procedure of Miles and Huberman. RESULT: Five themes emerged from the analysis of the data, which described the coping strategies of the children: (1) problem-solving, (2) acting-out, (3) avoidance, (4) seeking help and (5) self-regulation. These themes included multiple coping strategies, which employed the concepts of engagement and disengagement. CONCLUSIONS: The children with autism spectrum disorder used many strategies to cope with the stresses resulting from behaviours and symptoms associated with the disorder. Most of the Taiwanese children use both problem-solving and emotional-focused coping strategies. RELEVANCE TO CLINICAL PRACTICE: Understanding coping strategies of children with autism spectrum disorder could help caregivers (parents, teachers) and medical professionals develop interventions to reduce these challenges, which could alleviate stress and improve social functioning for these children.

The Stress of Caring for Children With Asthma: A Qualitative Study of Primary Caregivers.

BACKGROUND: Asthma is one of the most common chronic diseases in children. The unpredictability, frequency, and health risks associated with acute asthma attacks have a profound impact on the daily lives of affected children and their families. Understanding the experiences of primary caregivers may help nurses provide better care to children with asthma. PURPOSE: This study explores the experience of primary caregivers in providing care to children with asthma. METHODS: The study used exploratory and descriptive research methods and collected data using a qualitative research interview approach. Seventeen primary caregivers of children with asthma who visited the allergy clinics of two medical centers and one regional hospital in northern Taiwan participated in the study. An interview guide with a semistructured questionnaire was used, and verbatim transcripts of the audiotape-recorded interviews were analyzed using content analysis. RESULTS: The findings are described in three themes covering 10 categories. These themes and categories include feelings of uncertainty during illness (disease as perception related, lack of information), feelings of chaos and instability (worry, fear, frustration, helplessness, physical distress), and social tension and family conflict (disorientation of daily activity and burden of care, economic burden, family tensions and disagreements). CONCLUSIONS: Negative experiences with asthma care and the unpredictability of the disease outcomes impair the ability of caregivers to adapt successfully to their caregiving role and encourage perceptions that they cannot cope with this illness. Better understanding the caregiver experience may assist healthcare providers to better target support to these caregivers so that they are better able to care for children with asthma.

Low cord blood vitamin D levels are associated with increased milk sensitization in early childhood.

BACKGROUND: The association between vitamin D status at birth and allergen sensitizations is uncertain. The aim of this study was to investigate the relationship between cord blood vitamin D status with allergen sensitizations and the development of atopic diseases in early childhood. METHODS: Children aged 0 through 4 yr from a birth cohort in the Prediction of Allergies in Taiwanese Children (PATCH) study were enrolled. Serum levels of 25-hydroxyvitamin D (25(OH)D) in cord blood were measured by a new automated electrochemiluminescence-based assay. Specific IgE antibodies against food and inhalant allergens were measured at 6 months, and 1, 1.5, 2, 3, and 4 yr of age. RESULTS: A total of 186 children were regular followed up at clinics for a 4-yr follow-up period. The mean level of cord blood 25(OH)D was 23.8 ± 9.5 ng/ml with a high prevalence of low vitamin D status (<20 ng/ml) at birth (42%). There was a tendency of low cord blood 25(OH)D levels being associated with higher risk of food sensitization throughout childhood. Cord blood 25(OH)D levels were inversely associated with the risk of milk sensitization at age 2, at which age a higher prevalence of milk sensitization was significantly associated with the risk of allergic rhinitis, and asthma development at age 4. CONCLUSIONS: Low cord blood vitamin D levels appear to be associated with increased milk sensitization but not with asthma, eczema, or allergic rhinitis in early childhood.

Interactive support interventions for caregivers of asthmatic children.

OBJECTIVES: Asthmatic children and their parents constantly need to adjust their lifestyles due to asthma attacks. We evaluated the effectiveness of a self-management interactive support (SMIS) program for caregivers of asthmatic children. METHODS: Children with persistent asthma were randomized into two groups, one receiving SMIS and the other receiving usual care (the control group). The SMIS program involved a three-month multifaceted behavioral intervention. Changes in the caregivers' knowledge and attitude regarding self-management, children's lung function, and number of emergency department visits and hospital admissions were examined at 12 months post-enrollment. RESULTS: Sixty-five asthmatic children and caregivers (78% follow-up) completed the study. Primary caregivers in the SMIS group had significant improvements in knowledge and attitude regarding asthma compared to those in the control group (p < .05). Most importantly, knowledge about asthma medications and exacerbations significantly improved and attitudes toward medication adherence and dealing with asthma care became more positive in the SMIS group. The forced expiratory volume in one second was significantly improved in the SMIS group after 12 months (p < .05), and performance in the methacholine challenge test at the end of the study was significantly better in the SMIS group (p < .05). Participants in the SMIS group also had a lower rate of emergency room use (p < .05). CONCLUSION: The SMIS program for the self-management of asthma in children by their caregivers improved lung function and reduced the number of visits to the emergency departments. Interactive support interventions reinforce learning incentives and encourage self-care and maintenance of therapeutic regimens.

The impact of self-management support on the progression of chronic kidney disease--a prospective randomized controlled trial.

BACKGROUND: Chronic kidney disease (CKD) is a public health problem worldwide. Multidisciplinary intervention helps improve outcomes for CKD patients. We conducted an open-label, randomized controlled trial to examine the impact of self-management support (SMS) in the outcome of late-stage CKD patients. METHODS: Incidental CKD (Stages III-V) patients were randomized into self-management support (SMS) and non-SMS groups and followed up for 12 months. SMS comprised health information, patient education, telephone-based support and the aid of a support group. The primary end points were absolute estimated glomerular filtration rate (eGFR) alteration and number of hospitalization events. The secondary end points were an eGFR decrease of up to 50%, end-stage renal disease (ESRD) demanding renal replacement therapy (RRT), all-cause mortality or a composite secondary end point. RESULTS: The study included 54 patients; 27 patients were randomized into an SMS group and the same number into a non-SMS group. The absolute eGFR at the end of the study was significantly higher in SMS patients than in the non-SMS group (29.11 ± 20.61 versus 15.72 ± 10.67 mL/min; P < 0.05). There were fewer hospitalization events for SMS patients than for non-SMS patients [5 (18.50%) versus 12 (44.47%); P < 0.05]. One patient (3.7%) in the SMS group and nine (33.3%) in the non-SMS group had an eGFR reduction of >50% (P < 0.05). However, survival analysis of the composite secondary end points of ESRD that required RRT and all-cause mortality revealed no differences between the two groups. CONCLUSIONS: Our randomized study suggests that a standardized SMS program may play a significant role in reducing CKD progression and morbidity of late-stage CKD patients.

Patient education: an efficient adjuvant therapy for hyperphosphatemia in hemodialysis patients.

BACKGROUND: Hemodialysis and phosphate (P) binder therapy are the major methods to reduce the phosphate level in dialysis patients. However, dietary P restriction is necessary for adequate control. The successful dietary control is based on patient compliance. Patient education is the best method to assure the knowledge and drive of dietary control, which are the key features for patient compliance. The aim of the study is to investigate quantitatively the effect of patient education on serum P levels in hyperphosphatemic hemodialysis patients. METHODS: We conducted a prospective self-control study. Fifty hemodialysis patients with a pre-dialysis serum P level greater than 6.0 mg/dL were studied. Intensified patient education was given. Serum P, calcium (Ca), and intact parathyroid hormone (iPTH) were evaluated before and one month after patient education. RESULTS: Thirty-six (72%) patients had improved pre-dialysis P level (pre-education: 7.50 +/- 1.33; post-education: 5.85 +/- 1.20 mg/dL, p < 0.001) and Ca x P product (pre-education: 68.17 +/- 12.70; post-education: 54.70 +/- 11.87 mg(2)/dL(2), p < 0.001). The effect lasted for at least three months. There is no significant change on calcium levels. The only predictor of a successful patient education is the iPTH level (improved: 348.8 +/- 277.6; non-improved: 668.0 +/- 674.1 ng/mL, p = 0.021). CONCLUSIONS: Patient education could be helpful and efficient in hyperphosphatemic control in dialysis patients. The patient education should be given before the serum iPTH level getting high.

Survey of the clinical practice of physicians in the management of asthma in Taiwan.

Asthma is a common problem with a prevalence rate increasing every year. However, not all asthmatic patients receive appropriate treatment, partly due to the disease entity or patients' compliance, and partly due to physicians' knowledge and disposition in terms of treatment. This study was designed to investigate the current status of asthma treatment among clinicians in different practice settings, particularly regarding the acceptance of and adherence to asthma treatment guidelines and asthma patient education. Questionnaires were distributed by randomized sampling to doctors throughout the entire country. The questionnaire had six parts, measuring the following: 1) the use of different kinds of medication in the treatment of asthma; 2) adherence to asthma treatment guidelines; 3) the use of inhaled corticosteroids as part of management; 4) the use of peak flow meters in monitoring asthma; 5) relative efficiency in treating asthma; and 6) the use of a referral system, from general practitioners to specialists. There were 531 respondents out of 1,000 questionnaires distributed. The results revealed the following: 1) 20.2% of physicians use oral corticosteroids for maintenance therapy; 2) 31.8% of physicians do not follow asthma treatment guidelines; 3) 77.2% of physicians use inhaled corticosteroids for maintenance therapy (physicians in medical centers and regional hospitals use inhaled corticosteroids more frequently than private practitioners); 4) 51% of doctors do not use peak flow meters to monitor asthma symptoms because of prohibitive costs; 5) approximately 80% of clinicians have confidence in dealing with asthma problems; and 6) 29.2% of general practitioners do not refer patients to asthma specialists unless there is poor control or a need for further evaluation. Adherence to asthma treatment guidelines is poor, and such guidelines need to be popularized or simplified. There are still many discrepancies among doctors at different levels of hospitals. Re-education and review of asthma knowledge is necessary to keep clinical practitioners at the forefront of standard practice.