The purpose of this project was to increase the executive rate of standard nursing care of centra... more The purpose of this project was to increase the executive rate of standard nursing care of central venous catheters. The average rating of the procedure used by our nurses in caring for central venous catheters in our unit was 58.5%. Reasons why our rating failed to reach 100% included: (1) there was no clear, detailed explanation of the aseptic technique of standard nursing care of central venous catheters; (2) nurses were too busy to complete the detailed steps necessary to the procedure; (3) nurses were unfamiliar with standard nursing care of central venous catheters. Observation, analysis, literature review and discussions with the Infection Control Team were the measures we adopted to improve the standard nursing care of central venous catheters in our unit. Through the application of what we learned we increased our average rating of standard nursing care of central venous catheters to 100%.
To evaluate wound infection rates, pain scores, satisfaction with wound care, and wound care cost... more To evaluate wound infection rates, pain scores, satisfaction with wound care, and wound care costs starting 48 hours after surgery. Showering after surgery is a controversial issue for wound care providers and patients. We investigated the benefits and detriments of showering for postoperative wound care. Patients undergoing thyroid, lung, inguinal hernia, and face and extremity surgeries with clean or clean-contaminated wounds were included. The patients were randomized to allow showering (shower group) or to keep the wound dry (nonshower group) for postoperative wound care starting 48 hours after surgery. The primary endpoint was the rate of surgical wound infection. The secondary endpoints included the wound pain score, satisfaction with wound care, and cost of wound care. Between May 2013 and March 2014, there were 222 patients randomized to the shower group and 222 to the nonshower group. Two patients in each group were lost to follow-up. There were 4 superficial surgical site infections in the shower group and 6 in the nonshower group (4/220, 1.8% vs 6/220, 2.7%, P = 0.751). Postoperative pain scores were comparable between the 2 groups. Patients in the shower group were more satisfied with their method of wound care, and their wound care costs were lower when compared with the nonshower group. Clean and clean-contaminated wounds can be safely showered 48 hours after surgery. Postoperative showering does not increase the risk of surgical site complications. It may increase patients' satisfaction and lower the cost of wound care.
Incontinence is a common problem faced by family caregivers that is recognized as a major burden ... more Incontinence is a common problem faced by family caregivers that is recognized as a major burden and predictor of institutionalization. However, few studies have evaluated the experiences of family caregivers caring for stroke survivors with incontinence. To describe experiences of caregivers managing incontinence in stroke survivors. This qualitative descriptive study employed a grounded-theory approach. Semi-structured in-depth interviews with ten family caregivers of stroke survivors with incontinence were conducted during 2011. Audiotaped interviews were transcribed and analyzed using content analysis. Data analysis identified four themes: chaos, hypervigilance, exhaustion, and creating a new life. There were nine related subcategories: fluster, dirtiness, urgency, fear of potential health-hazard, physically demanding and time-consuming, mentally draining, financial burden, learning by doing, and attitude adjustment. Together, these described a process of struggling to cope with...
International journal of nursing practice, Jan 13, 2014
Bacteraemia is a systemic infection associated with strong febrile immune reactions. Fever defini... more Bacteraemia is a systemic infection associated with strong febrile immune reactions. Fever definitions, fever intensity and other factors might affect the recognition, management and prognosis of patients with bacteraemia. A prospective observational design was used to study 412 consecutive Taiwanese patients with healthcare-associated bacteraemia. The study variables were fever intensity, factors related to fever intensity, the association of physical function to thermogenic capacity and the sensitivity of three definitions of fever for identifying patients with bacteraemia. Age, Charlson comorbidity index (CCI) score, chills and pathogen types were predictors of fever intensity. Barthel index score, CCI score and pathogen types were predictors of chills, an indicator of thermogenic capacity. The sensitivity of three fever definitions (basal body temperature plus 1°C, ≥ 38°C and ≥ 38.3°C) to identify patients with bacteraemia was 93.3%, 83.5% and 71.4%, respectively. Clinicians can...
To investigate the common gastro-intestinal symptoms and quality of life in severely obese subjec... more To investigate the common gastro-intestinal symptoms and quality of life in severely obese subjects. We prospectively recruited 340 severely obese patients [mean age 30.5 ± 7.8 years; mean body mass index (BMI) 42.9 ± 6.1 kg/m(2)] and 340 healthy persons (mean BMI 23.1 ± 3.8 kg/m(2)) matched in sex, age, marriage and education. The quality of life was studied using a specific gastrointestinal quality of life index (GIQLI) questionnaire. The 36 items and four functional domains of the GIQLI were compared and analyzed between the groups. The possible correlation of GIQLI scores with specific clinical variables in severely obese patients was assessed by measuring Pearson's coefficient of correlation. The mean GIQLI score of severely obese patients was lower than the normal control group (108.5 ± 17.1 vs 123.2 ± 14.8, P < 0.01). Severely obese patients had decreased scores in the domains of general health, including physical (17.3 ± 6.0 vs 22.4 ± 3.1, P < 0.01), emotional (12.6 ± 4.3 vs 16.6 ± 3.1, P < 0.01) and social function (14.7 ± 3.9 vs 17.9 ± 2.5, P < 0.01), and in the domain of gastrointestinal symptoms (63.9 ± 6.7 vs 66.3 ± 7.2, P < 0.05). A significantly decreased score was found in nine items, and there was an increased score in one out of the 19 items in the domain of symptoms of the GIQLI questionnaire. The decreased score in the domain of symptoms was correlated with increasing glycosylated hemoglobin (HbA1c) levels. Severe obesity resulted in a significant impairment of the quality of life and caused specific gastrointestinal symptoms compared with normal controls. The development of gastrointestinal symptoms is correlated increasing HbA1c, suggesting that a poor control of hyperglycemia might be the etiology.
Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, Jan 16, 2015
The purpose of this study was to determine the relationships of communication dysfunction, body i... more The purpose of this study was to determine the relationships of communication dysfunction, body image, and amount of speaking in patients who were treated for head and neck cancers (HNCs). This was a cross-sectional study of postoperative HNC patients at the otolaryngology outpatient departments of two leading medical centers in northern Taiwan. Data were collected using questionnaires to assess perceived communication dysfunction, body image, symptom severity, and amount of speaking after treatment. A total of 130 HNC patients were included in the analysis, and 70.8 % of patients reported speaking less after surgery as compared to the period before having HNC surgery. Overall, patients perceived a moderate level of communication dysfunction. Those with higher distress over their body image, higher symptom severity, and with hypopharyngeal and laryngeal cancer reported speaking less. Patients with advanced stage cancer and a tumor in a facial area and those that received reconstruct...
Vertical banded gastroplasty (VBG) has been a popular bariatric operation for the past 2 decades,... more Vertical banded gastroplasty (VBG) has been a popular bariatric operation for the past 2 decades, and this operation has evolved into a laparoscopic procedure. However, reports of laparoscopic VBG (LVBG) from large series with longer results are limited. From October 1998 to May 2002, 612 consecutive patients underwent LVBG. Mean age was 30.1 years and mean BMI 43.0 kg/m2. Laparoscopic Mason gastroplasty was performed. The change of BMI, obesity-related co-morbidities, and GI quality-of-life index (GIQLI) were studied. The major and minor complication-rate was 1.14% and 4.58% respectively. The mortality-rate was 0.16%. Mean BMI fell from 43.1 kg/m2 to 31.2, 31.3, 31.4, 32.2, and 32.8 kg/m2 at 1, 2, 3, 4, and 5 years respectively, with 93% follow-up. Revision rate was 9.2%. GIQLI decreased from 113.0 to 106.6, 110.9, 111.9, 112.1, and 106.4 at 1, 2, 3, 4, and 5 years. LVBG is safe and effective in weight reduction. The GIQLI failed to improve postoperatively even with good resolution of obesity-related co-morbidities. In carefully selected patients with diligent postoperative follow-up, LVBG is a bariatric surgery option.
The purpose of the study was to describe variations in cognitive/behavioural changes during the c... more The purpose of the study was to describe variations in cognitive/behavioural changes during the course of delirium among older Taiwanese patients after elective surgery. A total of 106 patients assessed four times (admission, onset of delirium, delirium day 3 and delirium day 5) by the Mini Mental State Examination (MMSE) were included in the analysis to understand the neurocognitive/behaviour change during the course of delirium. Repeated measures anova was used to analyse within-subject differences across these four time points for those who became delirious and those who did not. The findings showed that patients who experienced delirium had significantly (P < 0.01) lower MMSE scores than non-delirious patients. Scores for the delirious group were also significantly different across the four assessments (P < 0.01) within the group. The subscales of orientation to time, orientation to place, registration and recall were the major changes from time 1 (admission assessment) to time 2 (onset of delirium) for delirious patients. When scores for time 4 (delirium day 5) and time 1 (admission assessment) were compared, the subscales of orientation to time, orientation to place and visual construction showed the least improvement among the subscales at time 4. The findings of the study suggest that mental status assessments are important during the patient's admission and hospital stay. The repeated assessments can be incorporated into routine nursing care so that problems can be detected and appropriate nursing care implemented.
Emerging evidence has shown that bariatric/metabolic surgery ameliorates type 2 diabetes (T2DM) i... more Emerging evidence has shown that bariatric/metabolic surgery ameliorates type 2 diabetes (T2DM) in mildly obese patients (BMI < 35 kg/m(2)) but long-term data is inadequate. We investigated the change of the quality of life after metabolic surgery in not well-controlled T2DM patients with BMI < 35 kg/m(2). The quality of life was measured by the gastrointestinal quality of life index (GIQLI), a 36-item questionnaire divided into three domains of general health and one domain of specific gastro-intestinal symptoms, administered before operation, at 3, 6, and 12 months after surgery. A control group matched in age, gender, and BMI was recruited for comparison. A total of 86 patients were enrolled, and the preoperative BMI and HbA1C (mean ± SD) were 30.7 ± 2.8 kg/m(2) and 9.3 ± 2.1 %, respectively. At 1 year after surgery, the BMI and HbA1C were 24.3 ± 2.3 kg/m(2) and 6.2 ± 1.1 %, respectively. There was a significantly improvement in all of the measures of glucose metabolism. Co...
The purpose of this project was to increase the executive rate of standard nursing care of centra... more The purpose of this project was to increase the executive rate of standard nursing care of central venous catheters. The average rating of the procedure used by our nurses in caring for central venous catheters in our unit was 58.5%. Reasons why our rating failed to reach 100% included: (1) there was no clear, detailed explanation of the aseptic technique of standard nursing care of central venous catheters; (2) nurses were too busy to complete the detailed steps necessary to the procedure; (3) nurses were unfamiliar with standard nursing care of central venous catheters. Observation, analysis, literature review and discussions with the Infection Control Team were the measures we adopted to improve the standard nursing care of central venous catheters in our unit. Through the application of what we learned we increased our average rating of standard nursing care of central venous catheters to 100%.
To evaluate wound infection rates, pain scores, satisfaction with wound care, and wound care cost... more To evaluate wound infection rates, pain scores, satisfaction with wound care, and wound care costs starting 48 hours after surgery. Showering after surgery is a controversial issue for wound care providers and patients. We investigated the benefits and detriments of showering for postoperative wound care. Patients undergoing thyroid, lung, inguinal hernia, and face and extremity surgeries with clean or clean-contaminated wounds were included. The patients were randomized to allow showering (shower group) or to keep the wound dry (nonshower group) for postoperative wound care starting 48 hours after surgery. The primary endpoint was the rate of surgical wound infection. The secondary endpoints included the wound pain score, satisfaction with wound care, and cost of wound care. Between May 2013 and March 2014, there were 222 patients randomized to the shower group and 222 to the nonshower group. Two patients in each group were lost to follow-up. There were 4 superficial surgical site infections in the shower group and 6 in the nonshower group (4/220, 1.8% vs 6/220, 2.7%, P = 0.751). Postoperative pain scores were comparable between the 2 groups. Patients in the shower group were more satisfied with their method of wound care, and their wound care costs were lower when compared with the nonshower group. Clean and clean-contaminated wounds can be safely showered 48 hours after surgery. Postoperative showering does not increase the risk of surgical site complications. It may increase patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; satisfaction and lower the cost of wound care.
Incontinence is a common problem faced by family caregivers that is recognized as a major burden ... more Incontinence is a common problem faced by family caregivers that is recognized as a major burden and predictor of institutionalization. However, few studies have evaluated the experiences of family caregivers caring for stroke survivors with incontinence. To describe experiences of caregivers managing incontinence in stroke survivors. This qualitative descriptive study employed a grounded-theory approach. Semi-structured in-depth interviews with ten family caregivers of stroke survivors with incontinence were conducted during 2011. Audiotaped interviews were transcribed and analyzed using content analysis. Data analysis identified four themes: chaos, hypervigilance, exhaustion, and creating a new life. There were nine related subcategories: fluster, dirtiness, urgency, fear of potential health-hazard, physically demanding and time-consuming, mentally draining, financial burden, learning by doing, and attitude adjustment. Together, these described a process of struggling to cope with...
International journal of nursing practice, Jan 13, 2014
Bacteraemia is a systemic infection associated with strong febrile immune reactions. Fever defini... more Bacteraemia is a systemic infection associated with strong febrile immune reactions. Fever definitions, fever intensity and other factors might affect the recognition, management and prognosis of patients with bacteraemia. A prospective observational design was used to study 412 consecutive Taiwanese patients with healthcare-associated bacteraemia. The study variables were fever intensity, factors related to fever intensity, the association of physical function to thermogenic capacity and the sensitivity of three definitions of fever for identifying patients with bacteraemia. Age, Charlson comorbidity index (CCI) score, chills and pathogen types were predictors of fever intensity. Barthel index score, CCI score and pathogen types were predictors of chills, an indicator of thermogenic capacity. The sensitivity of three fever definitions (basal body temperature plus 1°C, ≥ 38°C and ≥ 38.3°C) to identify patients with bacteraemia was 93.3%, 83.5% and 71.4%, respectively. Clinicians can...
To investigate the common gastro-intestinal symptoms and quality of life in severely obese subjec... more To investigate the common gastro-intestinal symptoms and quality of life in severely obese subjects. We prospectively recruited 340 severely obese patients [mean age 30.5 ± 7.8 years; mean body mass index (BMI) 42.9 ± 6.1 kg/m(2)] and 340 healthy persons (mean BMI 23.1 ± 3.8 kg/m(2)) matched in sex, age, marriage and education. The quality of life was studied using a specific gastrointestinal quality of life index (GIQLI) questionnaire. The 36 items and four functional domains of the GIQLI were compared and analyzed between the groups. The possible correlation of GIQLI scores with specific clinical variables in severely obese patients was assessed by measuring Pearson&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s coefficient of correlation. The mean GIQLI score of severely obese patients was lower than the normal control group (108.5 ± 17.1 vs 123.2 ± 14.8, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01). Severely obese patients had decreased scores in the domains of general health, including physical (17.3 ± 6.0 vs 22.4 ± 3.1, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01), emotional (12.6 ± 4.3 vs 16.6 ± 3.1, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01) and social function (14.7 ± 3.9 vs 17.9 ± 2.5, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01), and in the domain of gastrointestinal symptoms (63.9 ± 6.7 vs 66.3 ± 7.2, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). A significantly decreased score was found in nine items, and there was an increased score in one out of the 19 items in the domain of symptoms of the GIQLI questionnaire. The decreased score in the domain of symptoms was correlated with increasing glycosylated hemoglobin (HbA1c) levels. Severe obesity resulted in a significant impairment of the quality of life and caused specific gastrointestinal symptoms compared with normal controls. The development of gastrointestinal symptoms is correlated increasing HbA1c, suggesting that a poor control of hyperglycemia might be the etiology.
Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, Jan 16, 2015
The purpose of this study was to determine the relationships of communication dysfunction, body i... more The purpose of this study was to determine the relationships of communication dysfunction, body image, and amount of speaking in patients who were treated for head and neck cancers (HNCs). This was a cross-sectional study of postoperative HNC patients at the otolaryngology outpatient departments of two leading medical centers in northern Taiwan. Data were collected using questionnaires to assess perceived communication dysfunction, body image, symptom severity, and amount of speaking after treatment. A total of 130 HNC patients were included in the analysis, and 70.8 % of patients reported speaking less after surgery as compared to the period before having HNC surgery. Overall, patients perceived a moderate level of communication dysfunction. Those with higher distress over their body image, higher symptom severity, and with hypopharyngeal and laryngeal cancer reported speaking less. Patients with advanced stage cancer and a tumor in a facial area and those that received reconstruct...
Vertical banded gastroplasty (VBG) has been a popular bariatric operation for the past 2 decades,... more Vertical banded gastroplasty (VBG) has been a popular bariatric operation for the past 2 decades, and this operation has evolved into a laparoscopic procedure. However, reports of laparoscopic VBG (LVBG) from large series with longer results are limited. From October 1998 to May 2002, 612 consecutive patients underwent LVBG. Mean age was 30.1 years and mean BMI 43.0 kg/m2. Laparoscopic Mason gastroplasty was performed. The change of BMI, obesity-related co-morbidities, and GI quality-of-life index (GIQLI) were studied. The major and minor complication-rate was 1.14% and 4.58% respectively. The mortality-rate was 0.16%. Mean BMI fell from 43.1 kg/m2 to 31.2, 31.3, 31.4, 32.2, and 32.8 kg/m2 at 1, 2, 3, 4, and 5 years respectively, with 93% follow-up. Revision rate was 9.2%. GIQLI decreased from 113.0 to 106.6, 110.9, 111.9, 112.1, and 106.4 at 1, 2, 3, 4, and 5 years. LVBG is safe and effective in weight reduction. The GIQLI failed to improve postoperatively even with good resolution of obesity-related co-morbidities. In carefully selected patients with diligent postoperative follow-up, LVBG is a bariatric surgery option.
The purpose of the study was to describe variations in cognitive/behavioural changes during the c... more The purpose of the study was to describe variations in cognitive/behavioural changes during the course of delirium among older Taiwanese patients after elective surgery. A total of 106 patients assessed four times (admission, onset of delirium, delirium day 3 and delirium day 5) by the Mini Mental State Examination (MMSE) were included in the analysis to understand the neurocognitive/behaviour change during the course of delirium. Repeated measures anova was used to analyse within-subject differences across these four time points for those who became delirious and those who did not. The findings showed that patients who experienced delirium had significantly (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01) lower MMSE scores than non-delirious patients. Scores for the delirious group were also significantly different across the four assessments (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01) within the group. The subscales of orientation to time, orientation to place, registration and recall were the major changes from time 1 (admission assessment) to time 2 (onset of delirium) for delirious patients. When scores for time 4 (delirium day 5) and time 1 (admission assessment) were compared, the subscales of orientation to time, orientation to place and visual construction showed the least improvement among the subscales at time 4. The findings of the study suggest that mental status assessments are important during the patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s admission and hospital stay. The repeated assessments can be incorporated into routine nursing care so that problems can be detected and appropriate nursing care implemented.
Emerging evidence has shown that bariatric/metabolic surgery ameliorates type 2 diabetes (T2DM) i... more Emerging evidence has shown that bariatric/metabolic surgery ameliorates type 2 diabetes (T2DM) in mildly obese patients (BMI < 35 kg/m(2)) but long-term data is inadequate. We investigated the change of the quality of life after metabolic surgery in not well-controlled T2DM patients with BMI < 35 kg/m(2). The quality of life was measured by the gastrointestinal quality of life index (GIQLI), a 36-item questionnaire divided into three domains of general health and one domain of specific gastro-intestinal symptoms, administered before operation, at 3, 6, and 12 months after surgery. A control group matched in age, gender, and BMI was recruited for comparison. A total of 86 patients were enrolled, and the preoperative BMI and HbA1C (mean ± SD) were 30.7 ± 2.8 kg/m(2) and 9.3 ± 2.1 %, respectively. At 1 year after surgery, the BMI and HbA1C were 24.3 ± 2.3 kg/m(2) and 6.2 ± 1.1 %, respectively. There was a significantly improvement in all of the measures of glucose metabolism. Co...
Uploads