Poor personal protective equipment practices were associated with heat-related symptoms among Asian healthcare workers: a large-scale multi-national questionnaire survey.

BACKGROUND: It is pertinent to understand the perceptions of healthcare workers (HCWs) with their associated personal protective equipment (PPE) usage and heat strain symptoms experienced to effectively combat the negative effects of heat stress during treatment and care activities. METHODS: We evaluated the associated heat stress perceived by HCWs across Asia and validated a questionnaire on perceptions of heat stress, associated PPE usage, and heat strain symptoms experienced. The questionnaire was administered to 3,082 HCWs in six Asian regions. Factor analyses, including Cronbach's alpha, assessed the questionnaire's validity and reliability. Structural equation modelling analysed the effects of knowledge, attitudes and practices, and heat strain symptoms. RESULTS: The questionnaire was found to be reliable in assessing HCWs' knowledge, and attitudes and practices towards heat stress and PPE usage (both Cronbach's alpha = 0.9), but not heat strain symptoms (Cronbach's alpha = 0.6). Despite knowledge of heat stress, HCWs had negative attitudes and practices regarding PPE usage (ß1 = 0.6, p < 0.001). Knowledge (path coefficient = 0.2, p < 0.001), and negative attitudes and practices (path coefficient = 0.2, p < 0.001) of HCWs towards heat stress and PPE usage adversely affected symptoms experienced. CONCLUSIONS: The questionnaire was not reliable in assessing symptoms. HCWs should, nevertheless, still self-assess their symptoms for early detection of heat strain. To effectively attenuate heat strain, understanding HCWs' attitudes and practices towards PPE usage should guide policymakers in implementing targeted heat management strategies.

The role of workplace bullying in the relationship between occupational burnout and turnover intentions of clinical nurses.

AIM: To identify the effect of workplace bullying on the relationship between occupational burnout and turnover intentions among clinical nurses. BACKGROUND: Recent evidence showed that a sense of burnout may cause workplace bullying; nevertheless; few studies have explored the effects of occupational burnout on workplace bullying. Furthermore, whether the experience of workplace bullying can aggregate the effect of occupational burnout on turnover intentions remains unclear. METHODS: A cross-sectional study was conducted to recruit nursing staff from two general hospitals in Taiwan. Data measurements comprised demographic characteristics, workplace bullying (Negative Acts Questionnaire-Revised), occupational burnout (occupational burnout inventory), and turnover intentions (employee turnover intentions and job destination choice). A hierarchical linear regression model and indirect effect test were conducted to examine the effect of workplace bullying on the relationship between occupational burnout and turnover intentions. RESULTS: An indirect effect test confirmed that workplace bullying can exacerbate the effect of occupational burnout on turnover intentions. Nearly one in ten nurses with occupational burnout may have experienced bullying at work, which increased their turnover intentions. CONCLUSIONS: Reducing workplace bullying should be considered an important strategy for lowering turnover rates in nursing environments. Nursing mangers should develop appropriate strategies and establish mandatory regulations to create a respectful work environment. Moreover, continuous education and training to empower nursing staff to confront and eliminate workplace bullying are required in healthcare institutions.

Effects of work conditions and organisational strategies on nurses' mental health during the COVID-19 pandemic.

AIMS: This study aims to examine coronavirus disease 2019 (COVID-19) pandemic-related work factors for adverse effects on the mental health and whether organisational strategies attenuate these effects. BACKGROUND: COVID-19 pandemic has led to increased work burden and mental health risks for nurses. METHODS: A total of 1499 Taiwanese full-time nurses completed a web-based questionnaire between July and December 2020. Pandemic-related work conditions, namely, increased working hours, caring for COVID-19 patients, occupational stigma and redeployment, were assessed. Organisational strategies to combat pandemic-related work stressors including compensation to workers and adequate protection equipment were surveyed. Outcome measures were intention to leave, burnout and depression assessed using validated questionnaires. RESULTS: Redeployment, increased working hours and occupational stigma were associated with adverse mental health and intention to leave in logistic regression analysis. Caring for COVID-19 patients was negatively associated with depression. Adequate compensation for workers modified the association between redeployment and burnout. CONCLUSIONS: Pandemic-related work conditions were associated with adverse mental health and intention to leave. Organisational strategies attenuated the adverse impact of the pandemic. IMPLICATIONS FOR NURSING MANAGEMENT: Efforts to decrease stigma and organisational strategies including compensation for workers and adequate protection equipment provision should be adopted to improve nurses' health during a pandemic.

Machine-Based Hand Massage Ameliorates Preoperative Anxiety in Patients Awaiting Ambulatory Surgery.

BACKGROUND: Hand massage therapies have been used to relieve anxiety and pain in various clinical situations. The effects of machine-based hand massage on preoperative anxiety in ambulatory surgery settings have not been evaluated. PURPOSE: This prospective study was designed to investigate the effect of machine-based hand massage on preoperative anxiety and vital signs in ambulatory surgery patients. METHODS: One hundred ninety-nine patients aged 18 years and older who were scheduled to receive ambulatory surgery were recruited from the Taipei Municipal Wanfang Hospital in Taipei City, Taiwan. The patients were assigned randomly to the experimental group (n = 101), which received presurgical machine-based hand massage therapy, and the control group (n = 98), which received no intervention. The patients in both groups completed the Spielberger State-Trait Anxiety Inventory short form at preintervention (baseline) and postintervention. RESULTS: Within-group comparisons of Spielberger State-Trait Anxiety Inventory short form scores showed significant decreases between preintervention and postintervention scores in the experimental group (44.3 ± 11.2 to 37.9 ± 8.7) and no significant change in the control group. Within-group comparisons of vital signs revealed a significant increase in mean respiration rate between baseline and postintervention in both groups (both ps < .05). Blood pressure was found to have decreased significantly only in the control group at postintervention (p < .05). No significant preintervention to postintervention change in pulse was observed in either group. CONCLUSIONS: The findings of this study indicate that machine-based hand massage reduces anxiety significantly in patients awaiting ambulatory surgery while not significantly affecting their vital signs.

A Large-Scale Survey on Trauma, Burnout, and Posttraumatic Growth among Nurses during the COVID-19 Pandemic.

A large-scale survey study was conducted to assess trauma, burnout, posttraumatic growth, and associated factors for nurses in the COVID-19 pandemic. The Trauma Screening Questionnaire, Maslach Burnout Inventory, and Posttraumatic Growth Inventory-Short Form were utilized. Factors associated with trauma, burnout, and posttraumatic growth were analysed using logistic and multiple regressions. In total, 12 596 completed the survey, and 52.3% worked in COVID-19 designated hospitals. At the survey's conclusion in April, 13.3% reported trauma (Trauma ≥ 6), there were moderate degrees of emotional exhaustion, and 4,949 (39.3%) experienced posttraumatic growth. Traumatic response and emotional exhaustion were greater among (i) women (odds ratio [OR]: 1.48, 95% CI 1.12-1.97 P = 0.006; emotional exhaustion OR: 1.30, 95% CI 1.09-1.54, P = 0.003), (ii) critical care units (OR: 1.20, 95% CI 1.06-1.35, P = 0.004; emotional exhaustion OR: 1.23, 95% CI 1.12-1.33, P < 0.001) (iii) COVID-19 designated hospital (OR: 1.24, 95% CI 1.11-1.38; P < 0.001; emotional exhaustion OR: 1.26, 95% CI 1.17-1.36; P < 0.001) and (iv) COVID-19-related departments (OR: 1.16, 95% CI 1.04-1.29, P = 0.006, emotional exhaustion only). To date, this is the first large-scale study to report the rates of trauma and burnout for nurses during the COVID-19 pandemic. The study indicates that nurses who identified as women, working in ICUs, COVID-19 designated hospitals, and departments involved with treating COVID-19 patients had higher scores in mental health outcomes. Future research can focus on the factors the study has identified that could lead to more effective prevention and treatment strategies for adverse health outcomes and better use of resources to promote positive outcomes.

Swallowing exercises for head and neck cancer patients: A systematic review and meta-analysis of randomized control trials.

BACKGROUND: Extensive surgery and chemo/radiation therapy (C/RT) to manage head and neck cancer (HNC) patients affects their ability to swallow food and liquids, risk of aspiration and greatly influences their quality of life (QOL). OBJECTIVES: Ascertain the effectiveness of swallowing exercises on improving swallowing function, performance status, mouth opening, risk of aspiration/penetration and QOL in HNC patients. DESIGN: Systematic review and meta-analysis of randomized controlled trials DATA SOURCES: PubMed, Ovid-Medline, Embase, Cochrane Library, CINAHL and Web of Science and included all available RCTs. REVIEW METHODS: We followed the PRISMA guidelines and standard methods for conducting a systematic review and meta-analysis. Comprehensive Meta-analysis 3.0 using the random effects model was used for data analysis. RESULTS: In total, 19 RCTs with 1100 participants were identified and included in the current review. Swallowing exercises had significant small effect on swallowing function 0.33 (95%CI = 0.00-0.65) and moderate effect on mouth opening 0.60 (95%CI = 0.21-0.99) immediately after intervention and small effect at 6-month follow-up 0.46 (95%CI = 0.11-0.81). However, non-significant effects were observed on risk of aspiration/penetration, performance status and all domains of QOL. CONCLUSION: Swallowing exercises demonstrated effectiveness in improving swallowing function and mouth opening in HNC patients undergoing multimodal treatment. This is the first comprehensive systematic review and meta-analysis of RCTs to assess the effect of swallowing exercises in HNC patients undergoing multimodal treatment. Nurses can play an important role in assisting the delivery of oropharyngeal swallowing exercises including jaw exercises, tongue exercises and swallowing maneuvers with assistance and guidance from speech pathologists to help improve HNC complications and QOL for HNC survivors.

The effectiveness of eye movement desensitization and reprocessing toward anxiety disorder: A meta-analysis of randomized controlled trials.

BACKGROUND: Eye Movement Desensitization and Reprocessing (EMDR) has been well established as an effective treatment for post-traumatic stress disorder (PTSD). However, PTSD has been re-categorized as part of trauma and stressor-related disorders instead of anxiety disorders. We conducted the first meta-analysis on Randomized Controlled Trials to evaluate the effectiveness of EMDR on reducing symptoms of anxiety disorders. METHODS: A manual and systematic search using various databases and reference lists of systematic review articles published up to December 2018 was conducted. The symptoms of anxiety, phobia, panic, traumatic feelings and behaviors/somatic symptoms were examined. Hedges' g effect sizes were computed, and random effect models were used for all analyses. RESULTS: A total of 17 trials with 647 participants were included in this meta-analysis. EMDR was associated with a significant reduction of anxiety (g = -0.71; 95% CI: -0.96 to -0.47), panic (g = -0.62; 95% CI: -1.10 to -0.14), phobia (g = -0.45; 95% CI: -0.81 to -0.08), behavioural/somatic symptoms (g = -0.40; 95% CI: -0.63 to -0.12), but not traumatic feelings (g = -0.48; 95% CI: -1.14 to -0.18). Subgroup analysis revealed greater effects of EMDR if compared to passive control. However, the effects were not significantly different based on the duration, number of therapy sessions, or the number of weekly sessions. CONCLUSIONS: Our meta-analysis indicates that EMDR is efficacious for reducing symptoms of anxiety, panic, phobia, and behavioural/somatic symptoms. Further research is needed to explore EMDR's long term efficacy on anxiety disorders.

Construction and evaluation of multidomain attention training to improve alertness attention, sustained attention, and visual-spatial attention in older adults with mild cognitive impairment: A randomized controlled trial.

OBJECTIVES: We aimed to analyze the effects of multidomain attention training on alertness, sustained attention, and visual-spatial attention in older adults with mild cognitive impairment (MCI). DESIGN: The design used in this study was a two-arm, parallel group, double-blind randomized controlled trial. SETTING AND PARTICIPANTS: The participants of the study were seventy-eight older adults with MCI (mean age: 79.5 ± 7.9 years) from retirement centers and community housing for the elderly. INTERVENTION: The participants were randomly assigned to an experimental group (multidomain attention training, n = 39) or an active control group (n = 39). Both groups underwent training sessions for 45 minutes three times per week for 6 weeks (18 sessions in total). MEASURES: The main efficacy indicator was alertness (Trail Making Test Part B), sustained attention (Digit Vigilance Test), and visual-spatial attention (Trail Making Test Part A). The secondary outcome indicators were other cognitive functions (Mini-Mental State Examination [MMSE] and Montreal Cognitive Assessment [MoCA] subscales). Measurements were obtained at pretest, posttest, and 3 and 6 months after training. RESULTS: The results were analyzed by a generalized estimating equation (GEE), which indicated that attention outcomes (alertness, sustained attention, and visual-spatial attention) of the experimental group did not improve after training. However, the experimental group displayed a significant improvement in the attention, memory, and orientation of MMSE and MoCA subscales over a period of 6 months and also showed superior results compared with the control group. CONCLUSIONS: Multidomain attention training demonstrated improved alertness and visual-spatial attention for posttest after 6 months. We also outline potential future advances in attention training for improving attention in older adults with MCI.

Effect of home-based music intervention versus ambient music on breast cancer survivors in the community: A feasibility study in Taiwan.

To explore the effects of home-based music intervention (HBMI) on symptom severity, pain intensity and perceived fatigue among patients with breast cancer. In this randomised controlled trial, patients with breast cancer were randomly assigned into an HBMI or control group. The HBMI group was administered 24-week HBMI involving five 30-min sessions per week. The primary outcome was symptom severity; the secondary outcomes were pain and fatigue. A generalised estimating equation was employed to compare the effects after 6, 12 and 24 weeks of intervention between the two groups. A total of 60 patients were recruited. After 6, 12 and 24 weeks, HBMI significantly reduced symptom severity, pain intensity, overall fatigue, general fatigue, emotional fatigue and vigour (p < 0.05). Additionally, HBMI significantly reduced physical fatigue after 6 (p = 0.003) and 12 (p = 0.013) weeks and mental fatigue after 6 weeks (p = 0.001). After 6, 12 and 24 weeks, HBMI reduced symptom severity, pain intensity and overall fatigue. Furthermore, HBMI instantaneously reduced physical and mental fatigue. We recommend that HBMI be administered to patients with breast cancer to reduce their negative thoughts associated with cancer.

Development and effectiveness of virtual interactive working memory training for older people with mild cognitive impairment: a single-blind randomised controlled trial.

BACKGROUND: memory training is a potential intervention for retaining memory and reducing dementia risk in older adults with mild cognitive impairment (MCI). OBJECTIVE: this study examined the effect of virtual interactive working memory training (VIMT) in older adults with MCI. DESIGN: single-blind, two-arm parallel-group, randomised controlled design. SETTING: retirement homes, institutions, and communities. SUBJECTS: a total of 66 older adults with MCI were recruited (mean age: 78.5 ± 7.6 years). METHODS: participants were randomly assigned to the experimental group (VIMT, n = 33) or active control group (n = 33). The VIMT program used the CogniPlus (includes four training modules). Both groups attended 45 min sessions 3 times per week, a total of 36 sessions. The primary outcome was working memory; secondary outcomes were immediate memory, delayed memory, subjective memory complaints and global cognitive function. All variables were measured at pre-test, post-test, and 3-month follow-up. RESULTS: between group, the effect of working memory adjusted mean difference by 1.75 (95% CI: 0.56 to 2.94; P < 0.01) at post-test. The results were analysed by a generalised estimating equation, which indicated that VIMT group significantly improved working memory at post-test (P = 0.01) relative to the active control group. CONCLUSIONS: the applied VIMT program can enable older adults with MCI to maintain their working memory and reduce the rate of cognitive deterioration. TRIAL REGISTRATION: This trial was registered on ClinicalTrials.gov (no.: NCT02462135).

Effect of interactive cognitive-motor training on eye-hand coordination and cognitive function in older adults.

BACKGROUND: Poor eye-hand coordination is associated with the symptoms of the early stage of cognitive decline. However, previous research on the eye-hand coordination of older adults without cognitive impairment is scant. Therefore, this study examined the effects of interactive cognitive-motor training on the visual-motor integration, visual perception, and motor coordination sub-abilities of the eye-hand coordination and cognitive function in older adults. METHODS: A double-blind randomized controlled trial was conducted with older adults. Sixty-two older adults were randomly assigned to the experimental (interactive cognitive-motor training) or active control (passive information activity) group, and both groups received 30 min of training each week, three times a week for 8 weeks. The primary outcome was eye-hand coordination, which was further divided into the sub-abilities of visual-motor integration, visual perception, and motor coordination. The secondary outcome was cognitive function. The generalized estimating equation was used to examine differences in immediate posttest, 3-month posttest, and 6-month posttest results between the two groups. Additionally, the baseline effect sizes were compared with the effect sizes of the immediate posttest, 3-month posttest, and 6-month posttests for the experimental group. RESULTS: There were no statistically significant differences between the intervention and control groups. The only statistically significant difference between the groups was in the attention dimension of cognitive function (p = 0.04). The visual-motor integration results showed a small to moderate effect size for pre post comparisons. CONCLUSIONS: The 24 sessions of interactive cognitive-motor training showed no difference to an active control intervention. In the future, this intervention could be further investigated to establish whether it can be superior to an active control group in other populations. TRIAL REGISTRATION: The study protocol has been published on Chinese Clinical Trial Registry (ChiCTR) (registry no.: ChiCTR-IOR-14005490 ).

Prevalence of workplace violent episodes experienced by nurses in acute psychiatric settings.

Nurses who experience workplace violence exhibit compromised care quality and decreased work morale, which may increase their turnover rate. This study explored prevalence of workplace violence, the reaction of victims, and workplace strategies adopted to prevent violence among acute psychiatric settings in northern Taiwan. A cross-sectional study was conducted, which consisted of 429 nurses who completed the Chinese version of the Workplace Violence Survey Questionnaire developed by the International Labor Office, International Council of Nurses, World Health Organization, and Public Services International. The rates of physical and psychological violence were 55.7% and 82.1%, respectively. Most perpetrator of the workplace violence were patients. Most victims responded by instructing the perpetrator to stop, followed by narrating the incident to friends, family, and colleagues. Only 4.9%-12% of the victims completed an incident or accident form, and the main reason for not reporting these violent incidents was the belief that reporting such incidents was useless or unimportant. The major strategies adopted by workplaces to prevent violence were security measures, patient protocols, and training. Institutions should train staff to handle violence, provide a therapeutic environment, simplify the reporting process, and encourage reporting of all types of violence.

[Workplace Violence Against Nurses in Northern Taiwan: A Cross-Sectional Study].

BACKGROUND: Nurses comprise a group in the healthcare team that is exposed to the highest levels of workplace violence. This not only causes negative emotions in nurses and adversely impacts the institution and the body and spirit of the nurses but also affects the quality of nursing care. PURPOSE: The aim of this study was to determine the prevalence of physical and psychological workplace violence experienced by the nursing staff and to identify the perpetrators of violence, the reactions of the victims, and the policies developed by employers to prevent violence. METHODS: This cross-sectional study was conducted using a stratified sampling method across different levels of healthcare institutions on the nursing personnel registered with the Taipei Nurses Association. The number of subjects was allocated according to hospital level. A total of 2,931 subjects were recruited, of whom 2,627 participated in this study. RESULTS: Over two-thirds (70.6% ) of participants had experienced workplace violence, of whom 31.0% had experienced physical violence and 66.0% had experienced psychological violence. A multiple logistic regression analysis showed that nurses who were married, who had less than one year of work experience, or were over 50 years of age were at lower risk of physical and psychological violence. Those who had a university education or higher faced a higher risk of psychological violence. The most common perpetrators were identified as patients. The aftermath reactions from the victims were varied, with the most prevalent being "telling the perpetrator to stop the violence", "telling friends or family," and "reporting the incident to a senior staff member". The perpetrators were mostly dealt with using a verbal warning, while the second-most common strategy was taking no action. Only 2.3% ‡6.8% of the victims notified the authorities about the violence because of the following primary reasons: "useless," "not important," and "fear of negative consequences." The major strategies that were adopted by employers to prevent violence included "security measures," "improvement of surroundings," and "training." CONCLUSIONS: Prevention of violence must be improved comprehensively using the strategies of physical facilities, management, education, and policies.

Analysis of the risk and risk factors for injury in people with and without dementia: a 14-year, retrospective, matched cohort study.

BACKGROUND: Most previous studies on dementia and injuries have focused on a particular type of injury, and few studies have investigated overall injury in people with dementia. In this study, we investigated the risk factors and risk of overall injury, including the diagnosis, cause, and intentionality of injury, in people with and without dementia in Taiwan. METHODS: We collected relevant data between 2000 and 2013 from the National Health Insurance Research Database (NHIRD). Overall, 455,630 cases, consisting of 91,126 people with dementia and 364,504 people without dementia, were included in this study and we performed subgroup analysis. A multivariate Cox proportional hazards regression analysis was used to determine the risk of injuries. RESULTS: The 14-year follow-up data showed that people with dementia had a higher risk of injury-related hospitalization than did people without dementia (19.92% vs 18.86%, hazard ratio (HR) = 1.070, p < 0.001). Regarding the cause of injury, people with dementia were more likely to be hospitalized due to suffocation (HR = 2.301, p < 0.001), accidental drug poisoning (HR = 1.485, p < 0.001), or falls (HR = 1.076, p < 0.001), and were less likely to be hospitalized due to suicide or self-inflicted injury (HR = 0.670, p < 0.001) or a traffic accident (HR = 0.510, p < 0.001) than were people without dementia. Subgroup analysis showed that people with dementia with any of the three subtypes of dementia were at a higher risk of homicide or abuse than were people without dementia (vascular dementia, HR = 2.079, p < 0.001; Alzheimer's disease, HR = 1.156, p < 0.001; other dementia, HR = 1.421, p < 0.001). The risk factors for overall injury included dementia diagnosis, female gender, age 65-74 years, and seeking medical attention for an injury within the past year. CONCLUSION: People with dementia are at a higher risk of injury-related hospitalization than people without dementia. The results of this study provide a reference for preventing suffocation, drug poisoning, and falls in people with dementia. In addition, government agencies should pay attention to and intervene in cases of abuse suffered by people with dementia.

Effect of interactive cognitive motor training on gait and balance among older adults: A randomized controlled trial.

BACKGROUND: Aging is a normal degenerative process that results in a decline in the gait and balance performance of older adults. Interactive cognitive motor training is an intervention that integrates cognitive and motor tasks to promote individuals' physical and cognitive fall risk factors. However, the additive effects of the interactive cognitive motor training on objective quantitative data and comprehensive descriptions of gait and balance warrants further investigation. OBJECTIVES: To investigate the effect of interactive cognitive motor training on older adults' gait and balance from immediate to long-term time points. DESIGN: A double-blind randomized control trial. SETTINGS: Four senior service centers and community service centers in Taiwan. PARTICIPANTS: 62 older adults who met the inclusion criteria. METHODS: The study participants were older adults without cognitive impairment, and they were randomly allocated to the experimental group or active control group. In both groups, older adults participated in three sessions of 30-min training per week for a total of 8 weeks, with the total number of training sessions being 24. The primary outcome was gait performance, which was measured using objective and subjective indicators. iWALK was used as an objective indicator to measure pace and dynamic stability; the Functional Gait Assessment was employed as a subjective indicator. The secondary outcome was balance performance, which was measured using iSWAY. A generalized estimating equation was used to identify whether the results of the two groups differ after receiving different intervention measures; the results were obtained from immediate to long-term posttests. RESULTS: Stride length in the pace category of the experimental group improved significantly in immediate posttest (p = 0.01), 3-month follow-up (p = 0.01), and 6-month follow-up (p = 0.04). The range of motion of the leg exhibited significant improvement in immediate posttest (p = 0.04) and 3-month follow-up (p = 0.04). The Functional Gait Assessment result indicated that statistically significant improvement was observed in immediate posttest (p = 0.02) and 12-month follow-up (p = 0.01). The results of balance performance showed that the experimental group attained statistically significant improvement in centroid frequency in the immediate posttest (p = 0.02). CONCLUSIONS: The research results validated that the 24 sessions of the interactive cognitive motor training intervention significantly improved gait and balance performance. Future studies should extend the sample to communities to promote the gait and balance performance of community-dwelling older adults without cognitive impairment and reduce their risk of falling and developing gait-related diseases.

Effectiveness of executive function training on mental set shifting, working memory and inhibition in healthy older adults: A double-blind randomized controlled trials.

AIMS: The aim of this study was to evaluate the effectiveness of executive function training on mental set shifting, working memory and inhibition for healthy older adults. BACKGROUND: Executive functions control and guide individuals' behaviours through a top-down cognitive model and have been regarded as the exhibition and integration of various high-level cognitive functions. However, prior studies have rarely focused on the subcomponent indicators of executive function, such as mental set shifting, working memory and inhibition in healthy older adults. DESIGN: Randomized controlled trial. METHODS: A total of 62 participants were recruited between January 2015 - March 2017, with both groups attending a 30-min training session three times per week for 8 weeks. Executive function training group received the training content that focused on the mental set shifting, working memory and inhibition. Active control group engaged in passive information activities. The primary outcome was mental set shifting, measured by the Wisconsin card sort test. The secondary outcomes were working memory measured by digit span and inhibition measured by the Stroop color word test. RESULTS: The executive function training group had statistically significant higher scores of mental set shifting and working memory at immediate follow-up and that its effect on mental set shifting could be maintained for 3-6 months. However, this training did not have any statistically significant results on inhibition. CONCLUSION: The executive function training may be an effective preventive intervention for healthy older adults. Future studies are recommended to include a broader range of participants with different levels of cognitive function.

[Evidence-Based Knowledge Translation: From Scientific Evidence to Clinical Nursing Practice].

In 1992, Gordon Guyatt coined the term "evidence-based medicine", which has since attracted worldwide attention. In 2007, the Institute of Medicine's Roundtable on Evidence-Based Medicine set the goal that 90% of clinical decisions would be supported by accurate, timely, and up-to-date clinical information and would reflect the best available evidence by 2020. However, the chasm between knowing and doing remains palpable. In 2000, the Canadian Institute of Health Research applied the term "knowledge translation" to describe the bridge that is necessary to cross the gap between research knowledge and clinical practice. The present paper outlines the conceptual framework, barriers, and promotion strategies for evidence-based knowledge translation and shares clinical experience related to overcoming the seven layers of leakage (aware, accepted, applicable, able, acted on, agreed, and adhered to). We hope that this paper can enhance the public well-being and strengthen the future health care system.

The EPCOR model: a model for promoting the successful implementation of evidence-based nursing in hospital-based settings.

BACKGROUND: An effective organizational infrastructure is essential to successfully implement and sustain an evidence-based nursing (EBN) practice. Although EBN has been promoted in Taiwan for more than 10 years, variations in the organizational policies and strategies necessary to support EBN among healthcare organizations have prevented effective implementation. Barriers to the implementation of EBN located at the organizational level have also been reported. The need for a model that focuses on the organizational infrastructure to promote EBN in Taiwan has therefore become increasingly apparent. PURPOSE: This study aims to develop a model that contains the key contextual elements of organizational infrastructure necessary to effectively promote EBN, especially in hospital settings. METHODS: A steering committee drafted the components and related strategies of the proposed model. Delphi technique was used to obtain consensus on the proposed model among a group of experts with expertise in EBN. Thirty experts participated in all three rounds of the Delphi survey. To confirm the appropriateness of the proposed model for clinical settings, the model was further reviewed by a focus group composed of experts with experience in implementing EBN or evidence-based medicine in hospitals. The strategies were then further modified based on the suggestions of this focus group, and only those strategies that best fit hospital settings were retained. RESULTS: Five key contextual elements and related strategic processes were identified, including equipment, policy, training courses, outcome indicators, and reward plans. The resultant model was named EPCOR, an acronym composed of the names of each identified element. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: EPCOR is a comprehensive model of organizational infrastructure and strategic procedures for implementing EBN in hospital-based settings in Taiwan. Organizations may use the EPCOR model to initiate and implement EBN practices and then to evaluate their effectiveness.