Search

Liver transplant recipients have an increased risk of osteoporosis and fractures. The aim of this study was to identify risk factors for fractures after liver transplant in a Taiwanese population. We identified newly diagnosed liver transplant recipients from the National Health Insurance Research Database in Taiwan between 2003 and 2015. Risk factors of post-transplant fractures were analyzed using a Cox proportional hazards model. A total of 4821 patients underwent liver transplantation, of whom 419 (8.7%) had post-transplant fractures. Independent predictors of post-transplant fractures were age ≥65 years at transplantation (hazard ratio (HR): 1.566; 95% confidence interval (CI) 1.122–2.186), female sex (HR: 1.648; 95% CI 1.319–2.057), fractures within 1 year prior to transplant (HR: 3.664; 95% CI 2.503–5.364), hepatitis C carriers (HR: 1.594; 95% CI 1.289–1.970), alcoholism (HR: 1.557; 95% CI 1.087–2.230) and daily prednisolone dose >1.61–3.78 mg/day (HR: 1.354; 95% CI 1.005–1.824), >3.78–9.18 mg (HR: 4.182; 95% CI 3.155–5.544) and >9.18 mg (HR: 13.334; 95% CI 9.506–18.703). Post-transplant fractures were inversely correlated with tacrolimus (HR: 0.617; 95% CI 0.417–0.913) and sirolimus/everolimus (HR: 0.504; 95% CI 0.391–0.650) treatment. The liver transplant recipients, and especially those who were aged ≥65 years, female, hepatitis C carriers, had a history of fractures within 1 year prior to transplant, alcoholism, and higher daily prednisolone dose were associated with an increased risk of post-transplant fractures. Conversely, the use of tacrolimus and sirolimus/everolimus was associated with a decreased risk of fractures. This study identified risk factors for fractures after liver transplant in a population-based study in an area with high prevalence of hepatitis B and hepatitis C. Recipients who were aged ≥65 years, female, hepatitis C carriers, had a history of fractures within 1 year prior to transplant, alcoholism, and higher daily prednisolone dose were independent risk factors for post-transplant fractures. Our findings highlight the importance of identifying individuals at high risk of fractures and concomitant tacrolimus and sirolimus/everolimus treatment to avoid the use of high-dose steroids and prevent post-transplant fractures. [ABSTRACT FROM AUTHOR]

Ratings are the basis for the survival of programmes and the key to commercial television (TV) stations’ operations in Taiwan. Therefore, in the decisionmaking process of drama purchasing, TV stations need an objective and comprehensive selection model owing to the complex criteria and because the drama purchasing decision is crucial to their ratings and operations. From the viewpoint of commercial TV station managers, we proposed a decisionmaking model to select overseas dramas. We first established the criteria for purchasing overseas dramas based on past literature and fuzzy Delphi method (FDM), including American, Korean, Japanese, and Chinese dramas. The case commercial TV station then selected the most suitable Chinese dramas for purchase by conducting empirical research with decision making trial and evaluation laboratory (DEMATEL), analytic network process (ANP), and technique for order preference by similarity to ideal solution (TOPSIS). This model provides an objective, quantitative, and effective way for commercial TV stations to purchase the optimal overseas dramas with academic and practical value and contribution. [ABSTRACT FROM AUTHOR]

Background: The professional knowledge and personal attitudes of pediatric clinicians regarding pediatric pain are the most important factors impacting pediatric pain relief care. Few studies have investigated the knowledge and attitudes regarding pediatric pain management of clinicians in Taiwan. Purpose: Research purposes were to evaluate the knowledge and attitudes of pediatric clinicians regarding pain management and to describe the barriers of applying pain management across pediatric and neonatal settings. Design and Methods: A cross‐sectional descriptive comparative design was used. Pediatric clinicians from two medical centers and three general hospitals in Taiwan were recruited to complete a questionnaire. Results: A total of 264 clinicians participated. On 33 questions measuring knowledge of pain management, the average correct response rate was 23.67. A significantly positive relationship was identified between clinicians' knowledge and prior training experience. Professional degree attainment significantly impacted clinicians' attitudes about pediatric pain management. Clinicians at pediatric wards showed more positive attitudes than did clinicians at either pediatric intensive care units or neonatal intensive care units. Five barriers to pediatric pain management were found. Conclusion: The findings of this study suggest that pediatric clinicians in Taiwan need further education regarding pediatric pain management. This study will also helpful in implementing multidisciplinary pediatric pain management programs to improve the quality of pediatric practice in pediatric care settings of hospitals. [ABSTRACT FROM AUTHOR]

Aim To explore the energy expenditure ( EE) in a group of preterm infants during the periods of environmental stress, and to explore the relationship between EE and physiological stress signals of preterm infants. Methods Research design was an explorative secondary analysis of 4164 research data from 37 preterm infants which included physiological signals and environmental stressors in neonatal intensive care units. The current study investigated the data of EE calculated using heart-rate-based EE estimate. Results A significantly positive relationship between EE and different levels of nursing intervention was found ( P < 0.005). In addition, there was a significantly negative relationship between EE and oxygen saturation ( P < 0.001). Conclusion These research results confirmed that environmental stressors may impact the growth and developmental outcomes in preterm infants by increasing their EE. Neonatal clinicians should minimize excessive stimulations in order to conserve energy for the growth and developmental needs of preterm infants. Research found a significant relationship between an increase in EE and a decrease in oxygen saturation in preterm infants. The authors further hypothesized that EE of preterm infants may be predicted by estimating the oxygen saturation. Further study using different research methods and an enlarged sample size is needed. [ABSTRACT FROM AUTHOR]

Purpose This research evaluated the relationship between behaviors and energy expenditure in preterm infants receiving nursing interventions. Design and Methods This study was an explorative secondary data analysis from a previous study. The current study investigated energy expenditure calculated using heart rate-based energy expenditure-estimate across 500 repeated measures for 37 infants. Results Research results indicate that preterm infants expend more energy when they show the following seven behaviors: grimace, sucking, diffusion squirm, fist, gape face, salute, and sneezing. Practice Implications The interventions for preterm infants should be flexible, according to the infant's stress behaviors and conditions of energy expenditure. [ABSTRACT FROM AUTHOR]

(1) To explore attitudes and beliefs of neonatal nurses toward nursing care for dying neonates; (2) to estimate the influence of neonatal nurses’ personal and professional characteristics on their attitudes towards end-of life care for dying infants. A cross-sectional design was used. A questionnaire was used to collect data from 80 neonatal nurses. Research setting was four level III NICUs at four medical centers around the central region of Taiwan. Research participants were neonatal nurses who had worked for at least 1 year in one of level III NICUs and had been directly involved with the care of dying infants. Research participants were 80 neonatal nurses (response rate 100 %). Research findings identified eight barriers hindering neonatal palliative care practice. These barriers were insufficient communication due to the lack of an in-service educational program; the lack of available counseling help for neonatal clinicians; inability to express personal opinions, values and beliefs towards neonatal palliative care; insufficient staffing; the lack of unit policies/guidelines for supporting palliative care; the technological imperative; parental demands and personal beliefs about death and previous experience caring for dying infants. Further studies are needed to explore each barrier and to provide in-service neonatal palliative care educational programs that are needed to decrease these barriers. [ABSTRACT FROM AUTHOR]

The purposes of research were to describe the neonatal clinicians' personal views and attitudes on neonatal ethical decision-making, to identify factors that might affect these attitudes and to compare the attitudes between neonatal physicians and neonatal nurses in Taiwan. Research was a cross-sectional design and a questionnaire was used to reach different research purposes. A convenient sample was used to recruit 24 physicians and 80 neonatal nurses from four neonatal intensive care units in Taiwan. Most participants agreed with suggesting a do not resuscitate (DNR) order to parents for dying neonates (86.5%). However, the majority agreed with talking to patients about DNR orders is difficult (76.9%). Most participants agree that review by the clinical ethics committee is needed before the recommendation of 'DNR' to parents (94.23%) and nurses were significantly more likely than physicians to agree to this (p=0.043). During the end-of-life care, most clinicians accepted to continue current treatment without adding others (70%) and withholding of emergency treatments (75%); however, active euthanasia, the administration of drug to end-of-life, was not considered acceptable by both physicians and nurses in this research (96%). Based on our research results, providing continuing educational training and a formal consulting service in moral courage for neonatal clinicians are needed. In Taiwan, neonatal physicians and nurses hold similar values and attitudes towards end-of-life decisions for neonates. In order to improve the clinicians' communication skills with parents about DNR options and to change clinicians' attitudes for providing enough pain-relief medicine to dying neonates, providing continuing educational training and a formal consulting service in moral courage are needed. [ABSTRACT FROM AUTHOR]

Background: Liver transplantation is a challenging procedure that is associated with perioperative morbidity and mortality, so it is justifiable to perform such a procedure in high-volume procedure centers. Organ shortage remains a major issue in Taiwan. Due to the difficulty in establishing a high-volume procedure center, it is important to review the overall outcome of patients undergoing liver transplantation at a small-volume procedure center to determine if performing such a procedure is justified. Methods: Between April 2001 and May 2005, 26 adults underwent deceased donor liver transplantation at Taipei Veterans General Hospital. The overall outcomes were reviewed in terms of 90-day mortality, 1-year and 3-year survival rates. In addition, the patients were divided into a hepatocellular carcinoma (HCC) group (n =12) and a benign end-stage liver disease (ESLD) group (n =14). The clinical demographics, 90-day mortality, 1-year and 3-year survival rates were reviewed and compared between the 2 groups. Results: The 90-day mortality was 15.3% in the whole series, 8.3% in the HCC group and 18.7% in the ESLD group. The overall 1-year and 3-year survival rates were 76.9% and 63.5%, respectively, for the whole series. For the 2 groups, the respective 1-year and 3-year survival rates were 83.3% and 71.4% in the HCC group, and 71.4% and 57.1% in the ESLD group. The survival difference was not significant (p =0.319) between the 2 groups. In the HCC group, the 1-year and 3-year disease-free survival rates were 88.9% and 71.1%, respectively. Conclusion: The survival rates between ESLD and HCC patients undergoing liver transplantation at a small-volume procedure center were comparable. The results of the whole series were not satisfactory, but the results for the HCC group were acceptable. [J Chin Med Assoc 2008;71(4):186–190] [Copyright &y& Elsevier]

Abstract: Purposes: Research purposes were to document the symptoms characteristic of neonates during their last week of life and to describe the activities undertaken in nursing care of dying neonates in neonatal intensive care unit (NICU). Methods: A retrospective chart review was used in this research. All charts of neonatal inpatients who died in the NICU between 2002 and 2008 and who met entry criteria were included the research review. Results: Sixty-one charts were evaluated in this research. The major underlying disease was the complications of prematurity (33%). Major physiological distress signs in the last week of life included respiratory distress (67.2%), cyanosis (54.1%), bradycardia (36.1%), oliguria (31.1%), and generalized edema (37.7%). All infants were intubated and received artificial ventilation in the last week of life. Physicians prescribed an analgesic medicine for 7 infants, and 7 infants received comfort interventions to manage their distress signs. Forty-one infants had preexisting do-not-resuscitate order at the time of death. Conclusions: Research findings suggest that the application of palliative care paradigm and more aggressive comfort care to manage signs in NICU might be beneficial to dying infants. [Copyright &y& Elsevier]