Factors associated with work-related musculoskeletal disorders in commercial motorcyclists.

This study aimed to explore the prevalence of work-related musculoskeletal disorders (WMSDs) and to investigate factors associated with WMSDs in commercial motorcyclists in Indonesia. This cross-sectional study involved commercial motorcyclists operating in Indonesia. Data were collected using an anonymous questionnaire, including the Indonesian Version of the Nordic Musculoskeletal Questionnaire, occupational driving posture questionnaire, and occupational factor-related questions. The questionnaire was distributed at four rest stops located in Central Jakarta, Indonesia. The result showed that 40% of participants (129/322) were having WMSDs. Older age, overweight body mass index (BMI), obese body mass index, nonregular physical activity, driving duration (> 8 h/day), seniority (≥5 years), and poor driving posture were significant risk factors for WMSDs in commercial motorcyclists. Based on the risk factors identified in this study, the development of preventive strategies among commercial motorcyclists is warranted.

Effectiveness of diabetes shared care program on metabolic indicators of people with type 2 diabetes: A systematic review and meta-analysis.

AIMS: To explore the effectiveness of the Taiwanese Diabetes Shared Care Program (DSCP) on improving the metabolic indicators of people with type 2 diabetes. METHODS: Relevant studies published between January 2002 and August 2021 were retrieved from Chinese- and English-language electronic databases, including PubMed, MEDLINE, CINAHL, ProQuest, Cochrane Library, Airiti Library, and Taiwan Periodical Literature System. After screening, studies that met inclusion criteria were included in the literature review. RevMan 5.4 was employed for a meta-analysis. RESULTS: Ten studies published between 2007 and 2021 were included in the systematic review, with nine of them contributing to the meta-analysis. In total, 1506 and 1388 participants were classified into DSCP and non-DSCP groups, respectively, for the meta-analysis. The results revealed that the DSCP significantly improved glycated hemoglobin levels (mean difference [MD]: -0.50, 95% Confidence Interval [CI]: -0.83 to -0.17) and body weights (MD: -0.83, 95% CI: -1.29 to -0.38) within 1-year follow-up. However, it did not show significant improvement in other metabolic indicators. CONCLUSIONS: Taiwanese DSCP led to improvements in glycated hemoglobin levels and body weights among people with type 2 diabetes. This study suggests that people with diabetes and health-care institutions should consider participating in the DSCP.

Delaminated MnPS3 with Multiple Layers Coupled with Si Featuring Ultrahigh Detectivity and Environmental Stability for UV Photodetection.

Silicon (Si), the dominant semiconductor in microelectronics yet lacking optoelectronic functionalities in UV regions, has been researched extensively to make revolutionary changes. In this study, the inherent drawback of Si on optoelectronic functionalities in UV regions is potentially overcome through heterostructure coupling of delaminated p-type MnPS3, having bulk, multiple-layer, and few-layer features, with n-type Si. By artificially mimicking the architectures of shrubs with unique UV shading phenomena, the revolutionary multiple-layer MnPS3 structures with staggered stacking configurations trigger outstanding UV photosensing performances, displaying an average EQE value of 1.1 × 103%, average photoresponsivity of 3.1 × 102 A/W, average detectivity of 1.9 × 1014 cm Hz1/2W1-, and average on/off ratio of 1.8 × 103 under 365 nm light. To the best of our knowledge, this is the first attempt toward realizing gate-free MnPS3-based UV photodetectors, while all of the photodetection outcomes are better than those of more sophisticated field-effect transistor (FET) designs, which have remarkable impacts on the practicality and functionality of next-generation UV optoelectronics.

The effects of treatment via telemedicine interventions for patients with depression on depressive symptoms and quality of life: a systematic review and meta-ranalysis.

Aim: The aim of this systematic review and meta-analysis was to identify, evaluate, and synthesize the evidence from studies that have investigated the treatment effect via telemedicine interventions on depressive symptoms, quality of life, and work and social functioning in patients with depression.Methods: Six electronic databases (MEDLINE [1916-2021], PubMED [1950-2021], PsycINFO [1971-2021], Scopus [2004-2021], Embase [1972-2021], and CINAHL [1937-2021]) were systematically searched in March 2021. Reference lists of identified articles were hand searched. Randomized controlled trials were included if they investigated the treatment effects via telemedicine interventions in patients who had a depression diagnosis. Quality assessment was evaluated using the critical appraisal checklists developed by the Joanna Briggs Institute.Results: Seventeen (17) trials (n = 2,394) met eligibility criteria and were included in the analysis. Eleven (11) randomized controlled trials shared common outcome measures, allowing meta-analysis. The results provided evidence that treatment via telemedicine interventions were beneficial for depressive symptoms (standardized mean difference= -0.44; 95% CI= -0.64 to -0.25; p < .001) and quality of life (standardized mean difference= 0.25, 95% CI -0.01 to 0.49, p = .04) in patients of depression. There were insufficient data for meta-analysis of work and social functioning.Conclusion: This study showed the positive effects of treatment via telemedicine interventions on depressive symptoms and quality of life in patients with depression and supported the idea for clinical practice to establish a well-organized telepsychiatry system.KEY MESSAGESTelemedicine is effective at reducing symptoms of depression.Telemedicine can improve quality of life in persons with depression.

The impact of adverse drug reactions on medication adherence and outpatient treatment outcomes in female breast cancer: A review protocol.

AIM: Discover the impact of adverse drug reactions of hormonal and chemotherapy on medication adherence and outpatient treatment outcomes in the breast cancer patient population. DESIGN: A systematic review following the reporting guidance from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) guided by the Joanna Briggs Institute methodology will be conducted. DATA SOURCES: A literature search will be conducted using the following databases: PubMed, CINAHL, Web of Science, Medline and Scopus. REVIEW METHODS: Studies published in English before 2022 that report adverse drug reactions with medication adherence and outpatient treatment outcomes as primary outcome measures, following the initiation of one or more oral hormonal, endocrine and chemotherapy agents in female patients with diagnoses of breast cancer will be identified. Observational studies will be included for review, and two reviewers will independently screen study titles, abstracts and full text for inclusion. The quality assessment will be conducted using the Joanna Briggs Institute tools. A meta-analysis will be conducted where sufficient data are available. RESULTS: This is a systematic review study protocol, and results are not available at the time of the submission. All results will be reported on the completion of this study. DISCUSSION: This systematic review will highlight the impact of medication non-adherence on the breast cancer patient population, support determining strategies to address this issue and identify areas for further research. PATIENT OR PUBLIC CONTRIBUTION: This protocol article will identify the impact of adverse drug reactions on medication non-adherence and treatment outcomes in the female breast cancer patient population. A unique contribution of our study is to support determining strategies to address this ongoing public health issue and identify areas for further research. TRIAL REGISTRATION: This protocol has been registered with the International Prospective Register of Systematic Reviews (PROSPERO) database (registration number CRD 42021291364).

Effects of the Government Response and Community Mobility on the COVID-19 Pandemic in Southeast Asia.

Preventive policies and mobility restrictions are believed to work for inhibiting the growth rate of COVID-19 cases; however, their effects have rarely been assessed and quantified in Southeast Asia. We aimed to examine the effects of the government responses and community mobility on the COVID-19 pandemic in Southeast Asian countries. The study extracted data from Coronavirus Government Response Tracker, COVID-19 Community Mobility Report, and Our World in Data between 1 March and 31 December 2020. The government responses were measured by containment, health, and economic support index. The community mobility took data on movement trends at six locations. Partial least square structural equation modeling was used for bi-monthly analyses in each country. Results show that the community mobility generally followed government responses, especially the containment index. The path coefficients of government responses to community mobility ranged from -0.785 to -0.976 in March to April and -0.670 to -0.932 in May to June. The path coefficients of community mobility to the COVID-19 cases ranged from -0.058 to -0.937 in March to April and from -0.059 to -0.640 in September to October. It suggests that the first few months since the mobility restriction implemented is the optimal time to control the pandemic.

The Effect of Physician Communication on Inpatient Satisfaction.

(1) Background: The importance of physician-patient communication and its effect on patient satisfaction has become a hot topic and has been studied from various aspects in recent years. However, there is a lack of systematic reviews to integrate recent research findings into patient satisfaction studies with physician communication. Therefore, this study aims to systematically examine physician communication's effect on patient satisfaction in public hospitals. (2) Methods: Using a keywords search, data was collected from five databases for the papers published until October 2021. Original studies, observational studies, intervention studies, cross-sectional studies, cohort studies, experimental studies, and qualitative studies published in English, peer-reviewed research, and inpatients who communicated with the physician in a hospital met the inclusion criteria. (3) Results: Overall, 11 studies met the inclusion criteria from the 4810 articles found in the database. Physicians and organizations can influence two determinants of inpatient satisfaction in physician communication. Determinants of patient satisfaction that physicians influence consist of amounts of time spent with the patient, verbal and nonverbal indirect interpersonal communication, and understanding the demands of patients. The organization can improve patient satisfaction with physician communication by the organization's availability of interpreter service and physician workload. Physicians' communication with inpatients can affect patient satisfaction with hospital services. (4) Conclusions: To improve patient satisfaction with physician communication, physicians and organizational determinants must be considered.

Modeling the Enhanced Efficacy and Curing Depth of Photo-Thermal Dual Polymerization in Metal (Fe) Polymer Composites for 3D Printing.

This article presents, for the first time, the efficacy and curing depth analysis of photo-thermal dual polymerization in metal (Fe) polymer composites for 3D printing of a three-component (A/B/M) system based on the proposed mechanism of our group, in which the co initiators A and B are Irgacure-369 and charge-transfer complexes (CTC), respectively, and the monomer M is filled by Fe. Our formulas show the depth of curing (Zc) is an increasing function of the light intensity, but a decreasing function of the Fe and photoinitiator concentrations. Zc is enhanced by the additive [B], which produces extra thermal radical for polymerization under high temperature. The heat (or temperature) increase in the system has two components: (i) due to the light absorption of Fe filler and (ii) heat released from the exothermic photopolymerization of the monomer. The heat is transported to the additive (or co-initiator) [B] to produce extra radicals and enhance the monomer conversion function (CF). The Fe filler leads to a temperature increase but also limits the light penetration, leading to lower CF and Zc, which could be overcome by the additive initiator [B] in thick polymers. Optimal Fe for maximal CF and Zc are explored theoretically. Measured data are analyzed based on our derived formulas.

The Effectiveness of Health Services Delivered by Community Health Workers on Outcomes Related to Non-Communicable Diseases among Elderly People in Rural Areas: A Systematic Review.

BACKGROUND: The number of elderly and the burden of non-communicable diseases increase with time. Community involvement is expected to be an important prevention agent for their neighbors. This study aimed to determine the effectiveness of health services delivered by community health workers (CHWs) which focus on physiological indices related to non-communicable diseases among elderly people and to explain the health services or interventions carried out by CHWs. METHODS: This systematic review was conducted based on the PRISMA guidelines. PubMed, ProQuest Science Database, Scopus, EBSCOhost CINAHL, and Web of Science were taken as the source of databases. Manual search was also conducted for articles published before March 2019 without time restriction. The quality of each study was assessed using Critical Checklist by Joanna Briggs Institute. RESULTS: Of the 3,275 initial studies retrieved, 4 studies were included in qualitative synthesis analysis. Three studies arranged a face-to-face interview, while the other study was conducted over the phone. All the 4 studies were intervention studies. Three of them showed a significant improvement in mean systolic blood pressure for the intervention group compared to the control group. The other study showed a significant improvement in weight loss for the intervention group. CONCLUSION: Health services delivered by CHWs was beneficial to elderly people in rural areas on some physiological indices. It suggested that health services delivered CHWs could contribute toward secondary prevention programs.

Employer or Employee: Who is More Likely to Suffer From Burnout?

OBJECTIVE: The aims of this study were to examine burnout among full-time workers and to investigate the effect of employment status on burnout. METHODS: The data of this cross-sectional study were derived from the 2015 Taiwan Social Change Survey. Burnout was measured by the Copenhagen Burnout Inventory's four core items. Employment status was categorized into employer and employee. Multivariate linear regression models were used to assess the associations between employment status and burnout. RESULTS: Among 1007 full-time workers, 21.65% were employers and 78.35% were employees. The multivariate linear regression model indicated that after adjusting for all possible risk factors, being an employer (b = 3.95, 95% CI: 0.40 to 7.50) was associated with an increased risk of burnout among full-time workers. CONCLUSIONS: Employment status was a significant factor of burnout among workers.

A convenient diagnostic tool for discriminating adult-onset glutamic acid decarboxylase antibody-positive autoimmune diabetes from type 2 diabetes: a retrospective study.

BACKGROUND: The glutamic acid decarboxylase antibody (GADA) test, commonly used to diagnose autoimmune diabetes, is not cost-effective in areas of low prevalence. The aim of this study was to develop a convenient tool to discriminate adult-onset GADA-positive autoimmune diabetes from type 2 diabetes (T2DM) in patients with newly diagnosed diabetes. METHODS: This retrospective cross-sectional study, conducted at Changhua Christian Hospital in Taiwan, collected electronic medical record data from January 2009 to December 2018. Patients were divided into a case group (GADA+, n = 152) and a reference group (T2DM, n = 358). Variables that differed significantly between the groups were subjected to receiver operator characteristic analysis to establish cutoff values. Discriminant function analysis was then employed to discriminate the two groups. RESULTS: At the onset of diabetes, the GADA+ group was younger, with lower body mass index (BMI), higher hemoglobin A1c (HbA1c), higher high-density lipoprotein cholesterol (HDL-C), and lower total cholesterol and triglycerides (TG). Five major factors were identified to form the linear discriminant functions: BMI, age at onset, TG, HDL-C, and HbA1c. BMI < 23 kg/m2 was the most important factor, followed by TG < 98 mg/dL, HDL-C ≥ 46 mg/dL, age at onset < 30 years, and HbA1c ≥ 8.6%. The overall accuracy of the linear discriminant functions was 87.1%, with 84.2% sensitivity and 88.3% specificity. CONCLUSIONS: Routine tests in diabetes care were used to establish a convenient, low-cost tool that may assist in the early identification of adult-onset GAD+ autoimmune diabetes in clinical practice.

Are physicians on the same page about do-not-resuscitate? To examine individual physicians' influence on do-not-resuscitate decision-making: a retrospective and observational study.

BACKGROUND: Individual physicians and physician-associated factors may influence patients'/surrogates' autonomous decision-making, thus influencing the practice of do-not-resuscitate (DNR) orders. The objective of this study was to examine the influence of individual attending physicians on signing a DNR order. METHODS: This study was conducted in closed model, surgical intensive care units in a university-affiliated teaching hospital located in Northern Taiwan. The medical records of patients, admitted to the surgical intensive care units for the first time between June 1, 2011 and December 31, 2013 were reviewed and data collected. We used Kaplan-Meier survival curves with log-rank test and multivariate Cox proportional hazards models to compare the time from surgical intensive care unit admission to do-not-resuscitate orders written for patients for each individual physician. The outcome variable was the time from surgical ICU admission to signing a DNR order. RESULTS: We found that each individual attending physician's likelihood of signing do-not-resuscitate orders for their patients was significantly different from each other. Some attending physicians were more likely to write do-not-resuscitate orders for their patients, and other attending physicians were less likely to do so. CONCLUSION: Our study reported that individual attending physicians had influence on patients'/surrogates' do-not-resuscitate decision-making. Future studies may be focused on examining the reasons associated with the difference of each individual physician in the likelihood of signing a do-not-resuscitate order.

To examine the associations between medical students' conceptions of learning, strategies to learning, and learning outcome in a medical humanities course.

BACKGROUND: By learning medical humanities, medical students are expected to shift from handling the diseases only to seeing a whole sick person. Therefore, understanding medical students' learning process and outcomes of medical humanities becomes an essential issue of medical education. Few studies have been conducted to explore factors surrounding medical students' learning process and outcomes of medical humanities. The objectives were: (1) to investigate the relationships between medical students' conceptions of learning and strategies to learning; and (2) to examine the relationships between students' strategies to learning and learning outcomes for medical humanities. METHODS: We used the modified Approaches to Learning Medicine (mALM) questionnaire and Conceptions of Learning Medicine (COLM) questionnaire to measure the medical students' strategies to learning and conceptions of learning respectively. The learning outcome of medical humanities was measured using students' weighted grade in a medical humanities course. The confirmatory factor analysis (CFA) was used to validate the COLM and mALM questionnaires, in which construct validity and reliability were assessed. Pearson's correlation was used to examine the relationships among the factors of COLM, mALM, and the weighted grade. Path analysis using structural equation modeling technique (SEM) was employed to estimate the structural relationships among the COLM, mALM, and the weighted grade. RESULTS: Two hundred and seventy-five first-year medical students consented to participate in this study. The participants adopting surface strategies to learning were more likely to have unsatisfactory learning outcome (ß = - 0.14, p = .04). The basic-level conception of "Preparing for Testing" was negatively (ß = - 0.19, p < .01) associated with deep strategies of learning, and positively (ß = 0.48, p < .01) associated with surface strategies of learning (ß = 0.50, p < .01). The basic-level conception of "Skills Acquisition" was positively associated with deep strategies of learning (ß = 0.23, p < .01). CONCLUSION: Medical educators should wisely employ teaching strategies to increase students' engagement with deep and self-directed learning strategies, and to avoid using surface learning strategies in the medical humanities course in order to achieve better learning outcomes.

Physician workload associated with do-not-resuscitate decision-making in intensive care units: an observational study using Cox proportional hazards analysis.

BACKGROUND: Physicians play a substantial role in facilitating communication regarding life-supporting treatment decision-making including do-not-resuscitate (DNR) in the intensive care units (ICU). Physician-related factors including gender, personal preferences to life-supporting treatment, and specialty have been found to affect the timing and selection of life-supporting treatment decision-making. This study aimed to examine the influence of physician workload on signing a DNR order in the ICUs. METHODS: This is retrospective observational study. The medical records of patients, admitted to the surgical ICUs for the first time between June 1, 2011 and December 31, 2013, were reviewed. We used a multivariate Cox proportional hazards model to examine the influence of the physician's workload on his/her writing a DNR order by adjusting for multiple factors. We then used Kaplan-Meier survival curves with log-rank test to compare the time from ICU admission to DNR orders written for patients for two groups of physicians based on the average number of patients each physician cared for per day during data collection period. RESULTS: The hazard of writing a DNR order by the attending physicians who cared for more than one patient per day significantly decreased by 41% as compared to the hazard of writing a DNR order by those caring for fewer than one patient (hazard ratio = 0.59, 95% CI 0.39-0.89, P = .01). In addition, the factors associated with writing a DNR order as determined by the Cox model were non-operative, cardiac failure/insufficiency diagnosis (hazard ratio = 1.71, 95% CI 1.00-2.91, P = .05) and the Therapeutic Intervention Scoring System score (hazard ratio = 1.02, 95% CI 1.00-1.03, P = .03). Physicians who cared for more than one patient per day were less likely to write a DNR order for their patients than those who cared for in average fewer than one patient per day (log-rank chi-square = 5.72, P = .02). CONCLUSIONS: Our findings highlight the need to take multidisciplinary actions for physicians with heavy workloads. Changes in the work environmental factors along with stress management programs to improve physicians' psychological well-being as well as the quality.

The Effects of Lighting Problems on Eye Symptoms among Cleanroom Microscope Workers.

The visual health of microscope workers is an important occupational health concern, and a previous study suggested an association between lighting problems (e.g., flashing light, insufficient lighting) and eye symptoms among cleanroom workers in the electronics industry. This study aimed to explore the association between eye symptoms and lighting problems, as well as light-related counteracting behaviors among microscope workers in the cleanroom environment. Ninety-one cleanroom workers aged 20 years or older were recruited from an electronics factory. The socio-demographic factors, work-related factors, eye symptoms, and lighting problems were assessed using a self-administered questionnaire. There were 92.3% female participants in this study. Among all participants, 41.8% and 63.7% had symptoms of dry eye and eye fatigue, respectively. The counteracting behaviors of needing to move closer (adjusted odds ratio (aOR) = 3.47, 95% CI = 1.11 to 10.88) was significantly associated with dry eye symptoms. Workers who were more experienced at the job (aOR = 1.03, 95% CI = 1.01 to 1.06) and had shorter break times (aOR = 0.94, 95% CI = 0.91 to 0.98) were more likely to have eye fatigue. As a result of these findings, this study suggests that good lighting and adequate break times are crucial to improve the visual health of cleanroom microscope workers.

Suicidality 6 Years After Occupational Injury.

OBJECTIVE: Suicide attempts can result from traumatic events, including those caused by occupational injury. However, literature on the long-term prevalence rates of suicidality after occupational injury is relatively lacking. This study investigated the long-term prevalence of suicidality after occupational injury. METHODS: Between February 1 and August 31, 2009, 4,403 workers in Taiwan sustained occupational injuries and were hospitalized for 3 days or longer. Surveys were conducted at 3 and 12 months after occupational injury, and 2,308 workers responded to either survey. They were invited to join the follow-up at 6 years after occupational injury, using the Brief Symptom Rating Scale (BSRS-5), Posttraumatic Symptom Checklist (PTSC), and 1 question on suicidal ideation. Workers with a high score on the BSRS-5 or PTSC were invited to participate in an in-depth psychiatric evaluation using the Chinese version of the Mini-International Neuropsychiatric Interview (MINI). RESULTS: The estimated MINI-diagnosed suicidality rates at 3 months, 12 months, and 6 years after occupational injury were 5.4%, 4.8%, and 9.5%, respectively. Injured workers who reported that the injury majorly affected their physical appearance, experienced additional occupational injury requiring hospitalization for > 3 days, had unstable employment, and had lower income in the past 1 year than that before occupational injury had a higher risk of suicidal ideation. Injury majorly affecting the physical appearance, unstable employment, and lower income than that before occupational injury were the most crucial factors. These factors accounted for 12.7%, 13.2%, and 19.0% of suicidal ideation among the injured workers. CONCLUSIONS: The suicidality rate increased at 6 years after occupational injury. The relevant factors for suicidal ideation were injury severity and work instability. Periodic monitoring of psychological and physical health and economic stability are warranted.

Impact of lower urinary tract symptoms on work productivity in female workers: A systematic review and meta-analysis.

AIMS: The aim of this systematic review and meta-analysis was to determine the impact of lower urinary tract symptoms (LUTS) on work productivity in female workers. METHODS: A comprehensive literature search was conducted using eight electronic databases (MEDLINE, PEDro, CINAHL, Cochrane library, EMBASE, PubMed, Scopus, and PsycINFO) to identify articles published before July 2017 that studied the work productivity in female workers with LUTS. Two reviewers independently assessed the quality of studies using the Joanna Briggs Institute. Meta-analyses were performed on studies having measured work productivity between females with and without LUTS, and odds ratios (ORs) or the mean differences were used. RESULTS: Fourteen articles (n = 48 223 females) were included in the review, and meta-analyses were performed with six of those articles. Lower urinary tract symptoms were significantly associated with work productivity loss (OR = 1.11, 95%CI = 1.06-1.15), presenteeism (OR = 1.10, 95%CI = 1.05-1.14), and activity impairment (OR = 1.11, 95%CI = 1.09-1.14). However, there was no significant difference in the probability of absenteeism between females with and without LUTS (OR = 1.03, 95%CI = 0.94-1.13). CONCLUSIONS: Evidence suggests that female workers with LUTS had significantly greater work productivity impairment compared to those without LUTS.

Burnout in the intensive care unit professionals: A systematic review.

BACKGROUND: Burnout has been described as a prolonged response to chronic emotional and interpersonal stress on the job that is often the result of a period of expending excessive effort at work while having too little recovery time. Healthcare workers who work in a stressful medical environment, especially in an intensive care unit (ICU), may be particularly susceptible to burnout. In healthcare workers, burnout may affect their well-being and the quality of professional care they provide and can, therefore, be detrimental to patient safety. The objectives of this study were: to determine the prevalence of burnout in the ICU setting; and to identify factors associated with burnout in ICU professionals. METHODS: The original articles for observational studies were retrieved from PubMed, MEDLINE, and Web of Science in June 2016 using the following MeSH terms: "burnout" and "intensive care unit". Articles that were published in English between January 1996 and June 2016 were eligible for inclusion. Two reviewers evaluated the abstracts identified using our search criteria prior to full text review. To be included in the final analysis, studies were required to have employed an observational study design and examined the associations between any risk factors and burnout in the ICU setting. RESULTS: Overall, 203 full text articles were identified in the electronic databases after the exclusion of duplicate articles. After the initial review, 25 studies fulfilled the inclusion criteria. The prevalence of burnout in ICU professionals in the included studies ranged from 6% to 47%. The following factors were reported to be associated with burnout: age, sex, marital status, personality traits, work experience in an ICU, work environment, workload and shift work, ethical issues, and end-of-life decision-making. CONCLUSIONS: The impact of the identified factors on burnout remains poorly understood. Nevertheless, this review presents important information, suggesting that ICU professionals may suffer from a high level of burnout, potentially threatening patient care. Future work should address the effective management of the factors negatively affecting ICU professionals.

Further deliberating the relationship between do-not-resuscitate and the increased risk of death.

Few studies have examined the outcome of do-not-resuscitate (DNR) patients in surgical intensive care units (SICUs). This study deliberated the association between a DNR decision and the increased risk of death methodologically and ethically. This study was conducted in three SICUs. We collected patients' demographic characteristics, clinical characteristics, and the status of death/survival at SICU and hospital discharge. We used Kaplan-Meier survival curves to compare the time from SICU admission to the end of SICU stay for the DNR and non-DNR patients. Differences in the Kaplan-Meier curves were tested using log-rank tests. We also conducted a Cox proportional hazards model to account for the effect of a DNR decision on mortality. We found that having a DNR order was associated with an increased risk of death during the SICU stay (aRR = 2.39, p < 0.01) after adjusting for severity of illness upon SICU admission and other confounding variables. To make the conclusion that a DNR order is causally related to an increased risk of death, or that a DNR order increases the risk of death is absolutely questionable. By clarifying this key point, we expect that the discussion of DNR between healthcare professionals and patients/surrogate decision-makers will not be hampered or delayed.

The Associations Between the Religious Background, Social Supports, and Do-Not-Resuscitate Orders in Taiwan: An Observational Study.

Prior studies have demonstrated important implications related to religiosity and a do-not-resuscitate (DNR) decision. However, the association between patients' religious background and DNR decisions is vague. In particular, the association between the religious background of Buddhism/Daoism and DNR decisions has never been examined. The objective of this study was to examine the association between patients' religious background and their DNR decisions, with a particular focus on Buddhism/Daoism.The medical records of the patients who were admitted to the 3 surgical intensive care units (SICU) in a university-affiliated medical center located at Northern Taiwan from June 1, 2011 to December 31, 2013 were retrospectively collected. We compared the clinical/demographic variables of DNR patients with those of non-DNR patients using the Student t test or χ test depending on the scale of the variables. We used multivariate logistic regression analysis to examine the association between the religious backgrounds and DNR decisions.A sample of 1909 patients was collected: 122 patients had a DNR order; and 1787 patients did not have a DNR order. Old age (P = 0.02), unemployment (P = 0.02), admission diagnosis of "nonoperative, cardiac failure/insufficiency" (P = 0.03), and severe acute illness at SICU admission (P < 0.01) were significantly associated with signing of DNR orders. Patients' religious background of Buddhism/Daoism (P = 0.04), married marital status (P = 0.02), and admission diagnosis of "postoperative, major surgery" (P = 0.02) were less likely to have a DNR order written during their SICU stay. Furthermore, patients with poor social support, as indicated by marital and working status, were more likely to consent to a DNR order during SICU stay.This study showed that the religious background of Buddhism/Daoism was significantly associated with a lower likelihood of consenting to a DNR, and poor social support was significantly associated with a higher likelihood of having a DNR order written during SICU stay.