[The Effect of Dry Care on the Time of Umbilical Cord Separation in Newborns: A Systematic Review and Meta-Analysis].

BACKGROUND: There are many different approaches to umbilical cord care in clinical practice. Dry care is recommended by the WHO based on its ease of implementation and relatively low cost. However, the effect of dry care on the time of umbilical cord separation and related complications require further study. PURPOSE: The aim of this study was to conduct a systematic review and meta-analysis of randomized controlled trials to evaluate the effect of dry care on the time of umbilical cord separation and related adverse events in newborns. METHODS: A literature search was conducted of articles published before December 2021 in the Cochrane Library, PubMed, Medline, CINAHL, Embase, Airiti Library, and National Digital Library of Theses in Taiwan databases. The research quality of the identified articles was assessed using the Modified Jadad Scale. Statistical analyses were performed using Review Manager, version 5.3, with statistics reported as mean differences with 95% confidence intervals. RESULTS: Seven randomized controlled trials covering a total of 27,037 newborns were identified for analysis. Umbilical cord care in these studies included the following approaches: dry care, alcohol, chlorhexidine (CHX), mother's milk, and salicylic sugar powder (SSP). The results of the meta-analysis showed that umbilical cord separation time was significantly lower for the dry care approach compared to the alcohol approach (MD: -1.78 days, 95% CI: -2.4 to -1.16, three studies, n = 2,102) but not significantly different than the CHX approach (MD: -0.15 days, 95% CI [-1.99, 1.69], two studies, n = 10,519). Notably, the umbilical cord separation time for both mother's milk (MD: 1.19 days, 95% CI [0.82, 1.56], three studies, n = 730) and SSP (MD: 4.9 days, 95% CI [3.71, 6.09], one study, n = 92) approaches were reported as significantly less than the dry care approach. In addition, the CHX approach was associated with significantly fewer cord-related adverse events, while the alcohol, mother's milk, and SSP approaches were associated with rates of cord-related adverse advents similar to dry care. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: Because using dry care for umbilical cord care shortens the cord separation time compared to the alcohol approach and does not increase the incidence of omphalitis, this approach should be the first choice for cord care. Both mother's milk and SSP approaches are also associated with shorter umbilical cord separation times without adverse effects, and may be used as alternatives to dry care in umbilical cord care.

Efficacy of medium-chain triglyceride oil massage on growth in preterm infants: a randomized controlled trial: A CONSORT-compliant article.

BACKGROUND: Medium-chain triglyceride (MCT) oil consists of 8-12 carbons with higher absorption and provides better calories than long-chain triglyceride oil. This study was to explore the effect of MCT oil massage on growth in preterm infants. METHODS: A prospective, single-blind, randomized (two treatments and one control) study was conducted. Preterm infants weighing between 1500 and 2000 g were recruited and randomly assigned to three groups: the MCT oil massage, massage alone and no massage groups. The standardized massage intervention consisted of two 5-min phases, including tactile and kinesthetic stimulation, which were given three times a day for 7 consecutive days. Premature infants in the oil massage group received massage with 10 mL/kg/day of MCT oil divided equally into three applications. Weight, length and head circumference were measured in the three groups at birth and on study days 1 to 7. RESULTS: Forty-eight neonates were evaluated with 16 in each of three groups. The linear mixed effect model was adjusted for other factors, and results showed that weight gain on the 4th day in the oil massage group was greater than that in the no massage group (P < .05). From the 5th to 7th day, weight gain in the oil massage group was greater than that in the other two groups (P < .05). Regarding head circumference and height, this study found that the MCT oil massage group did not have better results than the other two groups. No adverse events were noted in the massage groups. CONCLUSION: The results indicate that preterm infant daily massage with MCT oil is an effective intervention for weight gain that should be recognized as part of low-birth-weight infant developmental care. TRIAL REGISTRATION: clinicaltrials.gov identifier NCT04281563, Registered on 24 February 2020.

Effectiveness of green tea mouthwash for improving oral health status in oral cancer patients: A single-blind randomized controlled trial.

BACKGROUND: Painful oral mucositis or trismus, caused by cancer therapy, reduces patients' willingness to maintain basic oral hygiene and eventually results in a poor oral health status. Using mouth rinses and cleaning the tongue are popular ways to improve the oral health status. OBJECTIVES: To evaluate the effectiveness of green tea mouthwash for improving the oral health status in oral cancer patients undergoing cancer treatment. DESIGN: This was a prospective, single-blind, randomized, controlled trial. SETTINGS: Patients were recruited from a major regional teaching hospital that provides specialist cancer care services in Chia-Yi, Taiwan, from July 2018 to June 2020. PARTICIPANTS: A total of 63 patients met the following criteria: > 20 years old; newly diagnosed with oral cancer by a physician; treated with oral surgery within one month prior; and completion of follow-up, with or without chemotherapy or radiation therapy. The exclusion criteria were mental illness; an acute and severe illness; complete edentulism; and inability to open the mouth more than 1 cm. METHODS: Patients were randomly assigned to 2 groups: the mouthwash with green tea (intervention) group or the tap water (control) group. After each teeth-brushing procedure, those in the intervention group rinsed the mouth with 100 ml of a green tea solution for 60 seconds, and those in the control group rinsed the mouth with 100 ml of tap water for 60 seconds. The primary outcome was the oral health status, which was evaluated according to the Oral Assessment Guide and measured at baseline and at every monthly outpatient follow-up until six months by the same nurse. RESULTS: There were 31 subjects in the intervention group and 30 subjects in the control group in the final analysis. The results of t-test showed that compared with baseline, the improvement in the oral health status in the intervention group was significantly better than that in the control group at 4 months after the intervention began. At 4 to 6 months after the intervention began, the oral health status score in the intervention group significantly decreased, by 1.71, 2.97 and 2.93 points, respectively, compared with that in the control group. CONCLUSIONS: The oral health status can be improved and maintained for a long time with the continuous use of green tea mouthwash. Green tea mouthwash is a simple, natural, effective and safe intervention that should be recognized as a nonpharmacological treatment option for protecting the oral mucosa. TRIAL REGISTRATION: clinicaltrials.gov identifier NCT04615780.

[Effects of the Otago Exercise Program on Lower Extremity Strength in Residents of a Long-Term Care Institution].

BACKGROUND: Falls are a very common problem in older adults. Improving lower extremity muscle strength is the primary objective of fall-prevention programs. PURPOSE: The aim of the study was to evaluate the effects of the Otago Exercise Program (OEP) on the lower extremity muscle strength of residents living in a long-term care institution. METHODS: In this repeated measurement study, participants were allocated into either the experimental group (EG) or the control group (CG). All of the participants maintained normal activities, and EG participants were additionally enrolled in a 6-month group OEP led by a physiotherapist. The OEP, comprising warm-up exercises, strength training, balance training, and walking training, requires about 45 minutes per session, 3 times a week. A total of 78 OEP sessions were performed during the 6-month intervention. A 30-Second Sit-to-Stand Test and lower extremity muscle strength measurements were performed at baseline, after 3 months, and after 6 months. RESULTS: The twenty participants in this study had a mean age over 80 years and were recruited from a long-term care institution in southern Taiwan. There were ten participants in each group, and the mean total OEP session attendance for EG participants was 92.8%. Although the EG had lower extremity muscle strength than the CG at baseline, the EG had achieved significant improvements in the muscle strength values for the knee extensor, knee flexor, ankle plantar flexors, and dorsiflexors after 6 months (group x time interaction, p < .05). In addition, the results of the 30-second sit-to-stand test for the EG were poor at baseline and significantly better after 6 months, while the results for the CG worsened between baseline and 6 months. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The results of this study support that participating in a group-based OEP three times per week over 6 months effectively improves lower extremity muscle strength in older adults. Therefore, OEP should be incorporated into fall-prevention programs organized in long-term care institutions.

The Effectiveness of Preoperative Preparation for Improving Perioperative Outcomes in Children and Caregivers.

Most children experience significant anxiety during the preoperative period. Greater preoperative anxiety may be related to a higher incidence of negative behaviors. This study aimed to develop a family-centered preoperative preparation program and to evaluate the effects of this program on children's preoperative emotional behaviors, postoperative behavior, and posthospital behavior, and on caregiver anxiety. A prospective, randomized controlled study was conducted. The population consisted of children who underwent minor surgery and their caregivers. The control group received standard care, and the experimental group received standard care plus preoperative preparation, which included a tour, a cartoon video depicting a boy's surgical journey, and familiarization with medical equipment. Children's emotional behaviors and caregiver anxiety were measured at the preoperative visit, in the preoperative holding area, and at induction of anesthesia. Postoperative behavior was measured when children were in the recovery room, and the researcher also contacted caregivers 2 weeks after the surgery to assess the children's behavior at home. A linear mixed-effects model results showed that as the surgery approached, the experimental group had fewer and more stable preoperative emotional behaviors (least squares means of preoperative emotional behaviors from preoperative visit to induction of anesthesia = 10.01-10.95). However, the control group exhibited significantly increased preoperative emotional behaviors as the surgery approached (least squares means of preoperative emotional behaviors from the preoperative visit to induction of anesthesia = 7.87-12.23). Family-centered preoperative preparation can effectively improve children's negative emotional behaviors from their time in the preoperative holding area to the induction of anesthesia.

Information needs of patients with lung cancer from diagnosis until first treatment follow-up.

The aim of this study was to analyze the information needs of lung cancer patients from diagnosis until first treatment follow-up. Sixty-nine participants with lung cancer were recruited from Ditmanson Medical Foundation Chia-Yi Christian Hospital in Midwest Taiwan. The Modified Toronto Informational Needs Questionnaire (TINQ) was used to assess information needs during visits to the outpatient oncology department. Generalized estimating equations were applied to compare changes in information needs over time and to examine correlates of information needs of lung cancer patients. The greatest concern of lung cancer patients was the cancer itself and access to recovery information. The need for information regarding food selection and social welfare resources was also high. However, the means of information needs for each domain significantly decreased over time. Demographic information (age, gender, disease stage, current treatment, education, work status, and having children) was significantly associated with information needs over time. The need for "disease-related information" remained high regardless of disease stage. Oncology nurses can use the results of this study to better address the information needs of patients in an effort to fill knowledge gaps between patients and healthcare providers. Further studies are needed to explore the use of an appropriate instrument, like that used in this study, to identify newly-diagnosed lung cancer patients' difficulties, concerns, and target interventions to improve their quality of life.

Efficacy of cold application on pain during chest tube removal: a randomized controlled trial: A CONSORT-compliant article.

BACKGROUND: Use of analgesics is the most common method to alleviate the pain induced by chest tube removal (CTR), but patient response to medication can vary and may not be achieved complete relaxation. This study was to determine the effectiveness of cold application in combination with standard analgesic administration before CTR on CTR-induced pain. METHODS: A prospective, randomized, single-blind, sham-controlled study was conducted. In addition to the same routine care, subjects in the experimental group (n = 30) received cold application of 600-g ice packs 15 minutes before CTR, whereas subjects in the sham group (n = 30) received tap water packs. Numerical rating scale was used to measure pain intensity before, immediately after, and 10 minutes after CTR. RESULTS: The generalized linear estimating equation (GEE) model, adjusted for other factors, both the groups demonstrated a trend toward decreased pain during CTR over time (P < .001), but no significant differences between the 2 groups (P = .65), even stratifying by gender. If we fixed experimental group, women significant reduced pain score of 2.7 on immediately after CTR compared with before CTR (P < .0001) and reduced pain score of 2.05 on 10 minutes after CTR compared with before CTR (P < .0001). The sham group had no similar performance as the experimental group. In the male subgroup, both experimental and sham groups, men significantly reduced pain score on immediately after CTR and 10 minutes after CTR compared with before CTR (P < .0001). CONCLUSION: The results indicate that cold application is not more effective than sham treatment in decreasing pain during CTR, even among gender. Although statistically non-significant, clinically important differences of decreased pain score were observed with cold application among women (Clinical Trial Registration: clinicaltrials.gov identifier NCT03307239).

Coping Card Usage can Further Reduce Suicide Reattempt in Suicide Attempter Case Management Within 3-Month Intervention.

This randomized controlled trial was designed to evaluate the effectiveness of using crisis coping cards (n = 32) in the case management of suicide prevention compared with case management without the use of coping cards (n = 32) over a 3-month intervention period. The generalized estimating equation was used to examine the interaction effect between treatments and time on suicide risk, depression, anxiety, and hopelessness. Results indicated that subsequent suicidal behaviors, severity of suicide risk, depression, anxiety, and hopelessness were reduced more in the coping card intervention group compared to the case management only group. Moreover, for the survival curves of time to suicide reattempt, the coping card group showed a significantly longer time to reattempt than the case management only group at 2-month and 3-month intervention periods.

[The effectiveness of a cold application for pain associated with chest tube removal: a systematic review].

BACKGROUND: Several previous studies have investigated the effectiveness of cold applications for pain associated with chest tube removal (CTR). However, the results of these studies are mutually contradictory. PURPOSE: The aim of this study was to determine the evidence related to the effectiveness of using a cold application to reduce the pain associated with CTR. METHODS: This review focused on studies published before June 2014 that were indexed in the following databases: Cochrane Library, PubMed, MEDLINE, CINAHL, ProQuest, Airiti Library, and National Digital Library of Theses and Dissertations in Taiwan. Keywords that were searched included: chest tube removal, cold application, and pain within a search design based on the PICO (patient, intervention, comparion, outcome) structure. Only randomized controlled trials (RCTs) that evaluated the efficacy of cold application in patients before CTR were included in analysis. Study quality was assessed using the Modified Jadad scale. RESULTS: Five RCTs that enrolled a total of 426 patients were included in the analysis. The mean age of participants ranged from 48.7 (SD = 16.5) to 60.2 (SD = 6.2) years. Ice packs were most widely used and applied to an area approximately 5-15 cm in diameter, with the chest tube entry point at the center. The findings of the effectiveness of the cold application were inconsistent among the studies. The researchers terminated the cold application when patients' skin temperature reached 13°C or after 20 min, which showed that the cold application immediately reduced the pain associated with CTR. It was also observed that the cold application prolonged the duration of time between the CTR and the administration of analgesics. Additionally, two studies in which analgesics were administered to participants 60 min before CTR showed that cold application in combination with analgesics administration reduced patient pain due to the enhancement affects of CTR, which obtained results that were better than analgesics administration alone. CONCLUSIONS: The results of this study may be used as a reference for reducing pain associated with CTR in clinical practice. However, further studies with larger sample sizes are required to support these results.

Effects of gerotranscendence support group on gerotranscendence perspective, depression, and life satisfaction of institutionalized elders.

OBJECTIVE: The purpose of this research was to test the clinical use of the gerotranscendence (GT) theory and its influence on GT perspective, depression, and life satisfaction among a group of institutionalized elders. METHODS: An experimental study utilizing pre-post group design and random assignment of elders into intervention and control group was conducted. The intervention support group was implemented in the experimental group once a week for eight weeks for 60 min. Over the eight-week period, 35 subjects in the experimental group and 41 in the control group completed the study. Data were collected one week before and one week after the intervention for both groups. Instruments include the GT Scale, Geriatric Depression Scale short form, and Life Satisfaction scale. Data were analyzed by paired t-test, Wilcoxon, McNemar, and analysis of co-variance. RESULTS: Pre- and post-test scores on the GT perspective and life satisfaction were significantly increased (p = 0.0000) in the experimental group. The mean depression score of the experimental group showed a slight but not significant decrease (p = 0.06). However, significant post-test differences were noted between groups in GT perspective, depression, and life satisfaction (p = 0.000, 0.01, and 0.000). CONCLUSION: The findings of this study suggest that after participating in a GT support group, institutionalized elders' GT perspective and life satisfaction were enhanced, and depression reduced. The positive effects demonstrated by this study can be extended and applied to the clinical health promotion of institutionalized elders. Ongoing GT intervention is encouraged to promote mental and spiritual health among institutionalized elders.

[A pilot study on the perspectives of hemodialysis room nurses on promoting advance directives].

BACKGROUND: Previous studies have shown that patients with end-stage renal disease experience a lower than optimal quality of dying and achieve a lower rate of advance directives (ADs) completion. Patients are frequently unaware of their option to withdraw from dialysis and also believe their physicians would oppose such a decision. Where there are inherent difficulties for medical staff in discussing end-of-life (EOL) issues with patients, patients on dialysis often develop a trusting, almost familial relationship with their nurses, who play a vital role in assisting patient and family to make EOL care decisions. PURPOSE: The purpose of this study was to explore the perspectives on advance directive discussion strategies of nurses working in hemodialysis rooms. METHODS: This was a descriptive-correlational research study that targeted 55 nurses working in a hemodialysis room at a regional hospital in southern Taiwan. Structured questionnaires were developed for this study that collected basic demographic information and assessed participant perspectives on discussing ADs. Data were analysed using descriptive statistics and deductive statistics, including independent t test, one-way ANOVA and Pearson correlation. RESULTS: Over 80% participants agreed that discussing ADs with patients could accurately identify patient preferences, improve EOL quality, and decrease family conflicts. However, 78.2% expressed that they did not have sufficient training to talk with patients about death and dying. Also, two-thirds (65.5%) worried about upsetting their patients, as they perceived their professional role as sustaining life (rather than helping prepare for death). Significant differences in discussing ADs with patients were found in respect to age and personal experience as well as with regard to whether the participant had discussed EOL care decisions with others. CONCLUSION: Discussing ADs with patients may improve EOL quality. Lack of training and negative perspectives represent major barriers. Therefore, teaching nurses how to engage in EOL care dialogue with patients and paying attention to patient EOL needs represent crucial tasks ahead.

[Exploring factors affecting meaning of life perceptions among ESRD elders].

BACKGROUND: The number of patient with end stage renal disease (ESRD) has been growing in Taiwan. Nearly 50% of ESRD sufferers are 65 years of age or older. The disease as well as issues related to patient physiology, psychology, and spiritual well-being are worth taking seriously. While research into this topic area has been conducted, most studies addressed issues in the physiological and psychological dimensions. Studies addressing the domain of spiritual well-being remain inadequate. The purpose of this study was to explore factors affecting meaning of life perceptions in ESRD elders. METHODS: Using a descriptive-correlation research approach, we employed purposive sampling to collect data from 80 ESRD elders currently under the care of a hemodialysis center in southern Taiwan. Research instruments used included a demographic questionnaire and Meaning in Life Scale. Data were analysed using SPSS 12.0 software. RESULTS: Findings showed that ESRD elders had relatively low meaning in life scores compared to the overall ESRD population in Taiwan. Influencing factors included education level, socio-economic status, and level of participation in leisure activities. CONCLUSION: Study findings may provide health professionals a better understanding of meaning of life perceptions amongst elders with ESRD, and, as a result, help them target better spiritual care and supportive interventions.

[The relationship between gerotranscendence and demographics in institutionalized elders].

Gerotranscendence is a shift of meta-perspective in later life that enables elders to experience successful aging and late-life growth. However, poor self esteem, illness or undergoing a major life event can hinder elders from achieving gerotranscendence status. The purpose of this study was to investigate the relationship between gerotranscendence and demographic factors. This was a descriptive-correlational research that used cluster sampling to collect data from 150 elderly residents of five long-term care facilities located in southern Taiwan. All were older than 65 and cognitively intact. Research instruments included the Basic Demographic Sheet and Gerotranscendence Scale. Data were analysed using SPSS 14.0 software. Findings showed that elders in Taiwan had a relatively lower level of gerotranscendence than other developed country peers. Influencing factors in gerotranscendence included gender, education, social economic status, religious beliefs, previous living conditions and particular events occurring within the previous two-year period. Study findings help health professionals better understand the development of the psychosocial perception of elders as well as assist clinical caregivers to plan relevant activities and nursing interventions.