Search

Purpose: To examine the trajectory of decisional conflict and anxiety experienced by adolescents after the cancer diagnosis, and explore their perceptions on participation in shared decision‐making (SDM). Design: This longitudinal study used incorporated data from questionnaires and interviews. Methods: Participants recruited from an academic hospital in southern Taiwan ranged in age from 13 to 20 years with a cancer diagnosis within 1 month and received cancer treatment. Each participant completed questionnaires on decisional conflict and anxiety at diagnosis, 1, 3, and 6 months later. Individual interviews were to gain an in‐depth understanding of SDM. Findings: Total scores on decisional conflict changed significantly over time (F = 2.98, p = 0.039); the scores at 1 month were higher than 3 months (t = 2.18, p = 0.04) and 6 months (t = 2.97, p = 0.008). Participants perceived significantly different levels of values clarify (F = 9.49, p < 0.01) and support (F = 8.46, p < 0.01) over time. Only 27.3% of participants were anxiety‐free. No significant differences were found in anxiety over time. The perception of SDM was a situational involvement. Conclusions: Decisional conflict changed over time. Participants experienced greater decisional conflict at 4–8 weeks after diagnosis and their anxiety did not decrease over time. The different levels of participation in SDM during their treatment trajectory were found. Clinical Relevance: Participants experienced the highest decisional conflict during diagnosis, and highlighted how their roles in healthcare discussions varied from direct participation to indirect involvement. Further research is needed to develop an SDM model which accommodates different levels of needs and implements timely support. [ABSTRACT FROM AUTHOR]

Acute lymphoblastic leukemia (ALL) is the most common childhood cancer. While ALL therapies are highly effective, western studies have shown excesses late life effects of therapies in survivors. In this survey, we recruited subjects being diagnosed as ALL before the age of 18‐year‐old and had been in complete continuous remission for at least 3 years. Subjects were arranged to receive three cognitive tests (Wechsler intelligence test, Conners' continuous performance test, and Wisconsin card sorting test). Standardized questionnaires were used to inquiry about attention problem in real life context. Treatment outcome were compared between the standard risk and high/very high risk groups. Final survivors were 42 subjects (26 males, 16 females) with median current age of 17.8 years. Subjects were diagnosed to be with ALL at a median age of 4.8 years. The median survival time (from discontinuation of ALL treatment to the study date) was 8.4 years. Results indicated that 17 subjects (40.5%) had chronic physical conditions in need of clinical management and six subjects (14.3%) had mental condition. For the performance‐based cognitive outcome, the average full scale intelligence quotient was 91.7 ± 13.8. Ten percent of the subjects had problem in test of attention, 20% had problem in test of impulsivity and 42.8% of the subject had problems in executive function. When judged from real life contexts, 19 subjects (42%) were with obvious attention problems. Group comparison between standard risk vs high/very high risk patients revealed no difference in neurocognitive outcomes. We hope that this information may benefit the implementation of follow‐up program for Taiwanese pediatric leukemia survivors. [ABSTRACT FROM AUTHOR]

Background The genetic background of patients with hemoglobin (Hb) H disease in Taiwan has been investigated; however, the clinical features and treatment outcomes were not reported. Objective To analyze the clinical features and genotypes of patients with HbH who reside in Taiwan. Methods We conducted a retrospective analysis of the clinical and molecular characteristics of 38 patients with HbH disease who were undergoing treatment at Kaohsiung Medical University Hospital, Taiwan. Results Initial Hb levels were lower and the numbers of patients requiring iron-chelation therapy were higher in the nondeletional HbH group than in the deletional HbH group (P <.05). Compared with the healthy population, the patients with HbH disease exhibited short body length, low body weight, and low body mass index (BMI). Conclusions Patients with nondeletional HbH disease had lower Hb levels and a higher requirement for splenectomy and iron-chelation therapy than did those with deletional HbH disease. Also, growth status was compromised in patients with HbH disease. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims and objectives To determine the effectiveness of an oral health care program for preventing ventilator-associated pneumonia ( VAP). Background Research has shown a significant correlation between oral bacteria and VAP, indicating that an oral health care program plays a very important role in VAP prevention. Design and methods A quasi-experimental study was used and conducted in the intensive care unit in a medical centre. A total of 199 mechanically ventilated patients were enrolled and divided into two groups: the experimental group ( n = 99) and control group ( n = 100). The experimental group was cared for using an evidence-based oral health care program, and the control group was cared for using routine nursing care procedures. Each group received the assigned treatment for four consecutive days. Results The incidence of VAP in the experimental group (4%, 4/95) was significantly lower than that in the control group (21%, 18/82). The oral assessment guide ( OAG) mean score (9.16 ± 2·07) of the experimental group was significantly different ( P < 0·05) from that of the control group (10·07 ± 1·79). The general estimated equation further showed that there was a significant difference between groups ( P < 0·01) for the third post-test data and no significant difference for the pre-test or the first and second post-test data between groups, indicating that an increased duration of intervention resulted in significant decreases in the OAG scores in the experimental group compared with the control group. Conclusions The evidence-based oral health care program effectively improved oral mucosal health and statistically reduced the incidence of VAP in this study. Relevance to clinical practice The study findings may be useful as an empirical reference for health care professionals performing an oral health care program in the future. Additionally, it may serve as a reference for long-term care policies aimed at reducing the ventilation duration, days of hospitalization and mortality rate to enhance patient safety and the quality of medical care. [ABSTRACT FROM AUTHOR]

Aims To evaluate the acceptability and efficacy of a psycho-educational intervention designed to improve effective coping and reduce symptom severity in children with cancer. Background Cancer treatments increase survival rates and also cause physical and psychological effects on children with cancer. A psycho-educational intervention is used to assist children and adolescents with these effects and its efficacy has been described in several studies. Design A randomized controlled trial. Methods Participants being treated were recruited and randomly assigned to two groups from September 2011-February 2013 in Taiwan. The intervention group received a psycho-educational intervention in addition to standard care, while the control group received only standard care. Each participant was assessed using a paediatric cancer coping scale and perceived symptom severity was evaluated at three time points (baseline, 1 month and 3 months). A repeated-measures analysis of variance was used to estimate the effects of intervention. Qualitative findings were analysed using content analysis. Results No significant difference in coping scores was found between groups, but the experimental group reported significantly lower scores in gastrointestinal problems and pain. Most symptoms decreased significantly over time in both groups, except for gastrointestinal problems. The scores in pain, bone marrow suppression and body image showed significant interaction effects between groups on changes over time. Qualitative results reported that participants evaluated the intervention positively, especially about receipt of psychological support and learnt coping skills. Conclusions The psycho-educational intervention administered was acceptable for children with cancer and was found to reduce gastrointestinal problems and pain. [ABSTRACT FROM AUTHOR]

Background: Workplace bullying is commonly experienced by nurses worldwide. Purpose: This study was conducted to examine the determinants of different types of workplace bullying and their relationship to depression in female nurses. Methods: A cross-sectional correlational study was employed, and 484 female nurses from a large medical center in southern Taiwan completed the questionnaire. Data were analyzed using logistic regression analysis. Results: Being unmarried and working in medical/surgical units were found to be the major determinants of work-related bullying, whereas being unmarried was found to be the single determinant of person-related and physical-intimidation bullying. Moreover, work-related and person-related bullying were both found to be significant determinants of depression. Conclusions/Implications for Practice: Nursing administrators should establish workplace-bullying prevention and management strategies by setting reasonable and equal workloads for nurses, assigning tasks equitably, and building depression-related support and consultation groups. [ABSTRACT FROM AUTHOR]

Background and Objectives: In response to the COVID-19 pandemic outbreak and to ensure the safety of epidemic prevention in the hospital, the hospital has established mitigation strategies in advance including risk assessment and effect analysis to control hospital visitors and accompanying persons. The study aims to assess the effectiveness of mitigation strategies implemented to effectively prevent the invasion and spread of the virus., Method: Conduct a status analysis in accordance with the Healthcare Failure Mode and Effect Analysis (HFMEA) 4-step model, construct a response workflow, confirm the failure mode and potential causes, perform hazard matrix analysis and decision tree analysis, and formulate risk control management measures., Results: For the 4 main processes and 9 subprocesses of the accompanying carers and contract caregivers entering the hospital, 26 potential failure modes and 42 potential causes of failure were analyzed. Following implementing improvement measures including strategies targeting the accompanying person, mitigation workflow failure rates decreased from 42 to 13 items, the pass rate for the maximum body temperature cutoff increased from 53.1% to 90.8%, and the compliance rate of hand washing increased from 89.5% to 100%., Conclusion: The HFMEA model can effectively implement preventive risk assessment and workflow management of high-risk medical procedures. The model can adjudicate the health of hospital visitors during the epidemic/pandemic, provide epidemic/pandemic education training and preventive measure health education guidance for hospital visits, and improve their epidemic prevention cognition. When combined, these strategies can prevent nosocomial infection to achieve the best anti-epidemic effect., Competing Interests: The authors have declared no conflict of interest for this article., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: Congenital hemolytic anemia caused by red blood cell (RBC) membrane defects is a heterogeneous group of disorders. The present study aimed to search the causative gene mutations in patients with RBC membrane disorders in Taiwan., Materials and Methods: Next-generation sequencing approach using whole-exome sequencing (WES) was performed. Sanger sequencing was performed for confirmation of variants detected in WES in patients and their family members., Results: Five causative variants, including two ANK1, two SPTA and one SPTB variants, were detected in four patients. All these variants, except one SPTA1 variant c.83G > A (p.R28H), are novel variants. Their pedigree analysis showed one de novo SPTA1 mutation c.83G > A (p.R28H) combined with α LELY , one de novo ANK1 mutation c.1034C > A (p.A345E), one autosomal dominant combined SPTA1 c.4604A > C (p.Q1535P) and SPTB c.6203 T > C (p.L2068P) mutations and one autosomal dominant ANK1 c.4462C > T (p.R1488X) mutation., Conclusions: Our data demonstrated that WES is an efficient tool for determining genetic etiologies of RBC membrane disorders and can facilitate accurate diagnosis and genetic counseling. Additional studies should be conducted on larger cohorts to investigate the distribution of gene mutations in patients with RBC membrane disorders in Taiwan., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Purpose: To examine the effects of walking exercise on exercise tolerance, fatigue, sleep quality, and quality of life (QOL) for children and adolescents with cancer., Methods: A 6-week walking exercise regimen was implemented in pediatric hematological and oncological wards and in clinics of a medical center in Taiwan. A 6-min walk test (6MWT), fatigue, sleep quality, and QOL were measured at baseline and for six subsequent weeks., Results: Adherence to the walking exercise regimen was achieved by 72-89% of the participants in this study. Significant improvements in exercise tolerance were observed after two weeks and they continued through week 6 (F = 17.07, p < 0.001). Both cognitive fatigue and general fatigue were significantly improved after six weeks of walking exercise (t = 2.41, p = 0.02; t = 2.76, p = 0.01), while sub-scores for sleep/rest fatigue did not improve. No significant impact on sleep quality or QOL was observed., Conclusions: Walking exercise is a feasible and tolerable intervention that should be considered for children and adolescents with cancer. Here, a 6-week walking exercise regimen increased exercise tolerance and improved fatigue. We recommend that walking exercise should be promoted during hospitalization and at home to alleviate fatigue., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Hemophilia B (HB) is an X-linked recessive disorder characterized by mutations in the clotting factor IX (FIX) gene that result in FIX deficiency. Previous studies have shown a wide variation of FIX gene mutations in HB. Although the quality of life in HB has greatly improved mainly because of prophylactic replacement therapy with FIX concentrates, there exists a significant burden on affected families and the medical care system. Accurate detection of FIX gene mutations is critical for genetic counseling and disease prevention in HB. In this study, we used denaturing high-performance liquid chromatography (DHPLC), which has proved to be a highly informative and practical means of detecting mutations, for the molecular diagnosis of our patients with HB. Ten Taiwanese families affected by HB were enrolled. We used the DHPLC technique followed by direct sequencing of suspected segments to detect FIX gene mutations. In all, 11 FIX gene mutations (8 point mutations, 2 small deletions/insertions, and 1 large deletion), including two novel mutations (exon6 c.687-695, del 9 mer and c.460-461, ins T) were found. According to the HB pedigrees, 25% and 75% of our patients were defined as familial and sporadic HB cases, respectively. We show that DHPLC is a highly sensitive and cost-effective method for FIX gene analysis and can be used as a convenient system for disease prevention., (Copyright © 2013. Published by Elsevier B.V.)

Purpose: Long-term survival of childhood leukemia has become a reality with treatment advancement; hence, the need to assess the survivors' health-related quality of life (HRQL) is essential. Although a growing number of Western studies have documented the considerable impact of diagnosis and treatment on HRQL in pediatric leukemia survivors, little finding has been reported in non-Western developing countries., Methods: We used a previously validated 14-dimensional questionnaire, Child Health Questionnaire 50-item Parent Form (CHQ-PF 50), to examine the perceived HRQL of 32 child/adolescent survivors, currently aged 13.17 ± 2.49 years, who had experienced first complete continuous remission from leukemia for at least 3 years. The HRQL status was compared with that obtained from community subjects (N = 154) and survivors' nonadult siblings (N = 30). Intelligence quotients (IQ) and computerized neuropsychological assessments were performed for subjects., Results: The HRQL of leukemia survivors was noted to be worse than that of community children and nonadult siblings as reflected by significantly lower scores in both the physical summary and the psychosocial summary score of CHQ-PF 50. 15.6% of the survivors had impaired intelligence (estimated IQ below 70). 27.8% of the adolescents were impaired in the cognitive domains as assessed by neuropsychological tests., Conclusions: In this Taiwanese single institution experience, pediatric leukemia survivors carried a morbidity burden into their teen years as reflected by worse HRQL than controls. These findings may guide the support required by this population.