Implementation of shared decision-making about rooming-in: A before and after an audit of breastfeeding in Taiwan.

BACKGROUND: The 24-h rooming-in policy is crucial to the Baby-Friendly Hospital Initiative (BFHI) for promoting breastfeeding. However, this policy may restrict maternal autonomy. In 2018, to integrate women's preferences into care decisions, Taiwan's Baby-Friendly certification included prenatal shared decision-making (SDM) for rooming-in. Prior to 2018, maternal knowledge, considerations, and intentions regarding rooming-in and the impact of prenatal SDM were unknown. METHODS: A retrospective electronic medical record cohort study was conducted in southern Taiwan. Data on healthy postpartum women eligible for rooming-in and breastfeeding for the years 2017 and 2019, reflecting the periods before and after prenatal SDM was introduced, were gathered. Maternal and newborn characteristics, maternal knowledge, considerations, and prenatal intentions for postpartum rooming-in and breastfeeding during hospitalization were collected. Additionally, data on actual postpartum rooming-in practices during hospitalization and exclusive breastfeeding (EBF) practices from birth to hospital discharge, to 1 month, and to 2 months postpartum were collected. Descriptive and non-parametric statistics were applied to analyze the data. RESULTS: A total of 621 women in 2017 and 311 women in 2019 were included. After prenatal SDM was introduced, the rooming-in rate during hospitalization fell from 42.2% in 2017 to 25.6% in 2019 (p < 0.001), and the EBF rate declined from 45.9% to 35.7% (p = 0.01). Additionally, the 1-month postpartum EBF rate decreased from 46.4% in 2017 (n = 571) to 44.3% in 2019 (n = 264), and the 2-month postpartum EBF rate dropped from 45.5% in 2017 (n = 591) to 40.2% (n = 308). According to the 2019 Patient Decision Aids responses (n = 236), women demonstrated limited understanding of rooming-in, with only 40.7% expressing an intention toward 24-h rooming-in. Women of older maternal age (p < 0.001), with a graduate degree (p = 0.02), full-time employment (p = 0.04), and concerns about rest disruption (p < 0.001), were more likely to prefer non-24-h rooming-in. CONCLUSIONS: Initiatives must promote prenatal SDM to enable healthcare providers to address misconceptions and tailor education, thereby increasing women's intention toward 24-h rooming-in and EBF. Future research should explore women's experiences and unmet needs at BFHI facilities to inform the construction of a baby- and mother-friendly environment.

Cross-cultural adaptation and validation of the medical outcome study social support survey among mothers of children aged 6-23 months in Indonesia.

BACKGROUND: Social support significantly influences a mother's adherence to complementary feeding guidelines, with family support fostering a positive attitude towards this practice. The Medical Outcome Study Social Support Survey (MOS-SSS) is a multidimensional scale designed to evaluate functional aspects of social support, but no instrument has been validated for Indonesia. PURPOSE: The study aims to validate the MOS-SSS instrument for measuring mothers' social support in providing complementary food to infants and young children aged 6-23 months in Indonesia. METHODS: A cross-sectional survey was conducted on 196 mothers with children aged 6-23 months in West Sumatera, Indonesia. The MOS-SSS's internal consistency was assessed using Cronbach alpha, composite reliability, and split-half analysis, while its construct validity was evaluated using convergent and discriminant validity. RESULTS: The Indonesian version of the MOS-SSS among mothers with children aged 6-23 months has been found to be satisfactory in content validity through translation and expert review. The questionnaire exhibits strong convergent and discriminant validity, reliable construct reliability, and internal consistency. CONCLUSIONS AND IMPLICATIONS: The MOS-SSS questionnaire was found to be reliable and valid in measuring the social support mothers perceive in providing complementary feeding to their infants and young children. Future research should explore the psychometric properties of the Indonesian version of the MOS-SSS in various populations, including pregnant women, lactating mothers, and women with special conditions.

Caregivers' experiences of having a child with cerebral palsy. A meta-synthesis.

AIM: To synthesize qualitative research findings of caregiver experiences and challenges in caring for and raising a child with cerebral palsy. DESIGN: A systematic review and meta-synthesis. METHODS: Four electronic databases: CINAHL, Embase, OVID Medline, and Cochrane, were systematically searched for qualitative research papers published before December 2022. Two independent reviewers assessed eligibility and further appraised the quality of methodology using the Critical Appraisal Skills Program (CASP) tool for qualitative research. A content thematic analysis approach was used to synthesize the qualitative research findings, construct core subthemes, and synthesize themes. RESULTS: Sixty-seven findings were extracted from the 12 included studies. The findings were grouped into eleven sub-themes and then into five synthesized themes. The synthesized themes are 1. Need for convenient healthcare facilities, therapeutic services, and accessible public places, 2. Need for healthcare information and financial aid, 3. Psychological, and physical constraints, 4. Societal rejection and stigma, and 5. Overwhelming caring burden. CONCLUSION: Caregivers face many challenges in adjusting their lifestyles to meet the needs of the child with cerebral palsy. Some adjustments reported included giving up full-time jobs and businesses to be full-time caregivers, giving up leisure activities, and confinement to one place.

Gasification of biomass for syngas production: Research update and stoichiometry diagram presentation.

Gasification is a thermal process that converts organic materials into syngas, bio-oil, and solid residues. This mini-review provides an update on current research on producing high-quality syngas from biomass via gasification. Specifically, the review highlights the effective valorization of feedstocks, the development of novel catalysts for reforming reactions, the configuration of novel integrated gasification processes with an assisted field, and the proposal of advanced modeling tools, including the use of machine learning strategies for process design and optimization. The review also includes examples of using a stoichiometry diagram to describe biomass gasification. The research efforts in this area are constantly evolving, and this review provides an up-to-date overview of the most recent advances and prospects for future research. The proposed advancements in gasification technology have the potential to significantly contribute to sustainable energy production and reduce greenhouse gas emissions.

Factors associated with appropriate complementary feeding: A scoping review.

PROBLEM: Childhood stunting becomes a vital point of an underlying problem in early life. Appropriate and adequate complementary feeding is necessary for children to prevent malnutrition and introduce healthy eating habits. Knowledge of factors related to complementary feeding practices is needed to design strategies that improve optimal complementary feeding and avoid malnutrition in children. However, factors related to appropriate complementary feeding practices have not been systematically examined; hence, the present study aims to synthesize the available evidence on factors associated with proper complementary feeding practices. METHODS: A scoping review was conducted. Five databases were searched for relevant studies, including Medline, Embase, Cochrane, CINAHL, and Web of Science. The studies selected for review were those published in English from 2009 to 2022 on complementary feeding practices and related factors, measuring at least three complementary feeding indicators, and available in full text. The criteria resulted in 30 eligible articles that were selected, extracted, and then analyzed using descriptive and content analysis. FINDING: Factors associated with complementary feeding practice include maternal factors (knowledge, attitude, self-efficacy, parity, antenatal care visit, place of delivery, and postnatal check-up), socio-environmental factors (age, educational level, income, employment status, residence, household size, mother's ethnicity, and support) and informational factors (exposure to media, source of information and intervention). CONCLUSION AND IMPLICATION: Maternal, socio-environmental, and informational factors are associated with appropriate complementary feeding in infants and young children. Further research is necessary to identify causal relationships between the three groups of factors and complementary feeding practices.

Type-wide biochars loaded with Mg/Al layered double hydroxide as adsorbent for phosphate and mixed heavy metal ions in water.

This study discussed the adsorption of mixed heavy metal ions (Cu2+, Co2+, Pb2+) and phosphate ions by ten pristine biochars and those with precipitated Mg/Al layered double hydroxide (LDH). The pristine biochars have adsorption capacities of 6.9-13.4 mg/g for Cu2+, 1.1-9.7 mg/g for Co2+, 7.8-20.7 mg/g for Pb2+, and 0.8-4.9 mg/g for PO43-. The LDH-biochars have markedly increased adsorption capacities of 20.4-25.8 mg/g for Cu2+, 8.6-15.0 mg/g for Co2+, 26.5-40.4 mg/g for Pb2+ with mixed metal ions, and 13.0-21.8 mg/g for PO43-. Part of the Mg ions but Al ions are released from the LDH-biochars during adsorption, counting less than 7.2% of the adsorbed ions. The pristine biochars have specific adsorption sites for Cu2+ and Co2+, separate Pb2+ sites related to ether groups on biochar, and areal-dependent sites for PO43-. There is no universal adsorption mechanism corresponding to mixed metal ion adsorption for individual pristine biochar involving different contributions of C-O-C, C-O-H, and CO groups and graphitic-N, pyrrolic-N, and pyridine-N groups. The LDH complexes with hydroxyl and carbonyl groups of biochar, and the LDH interacts with biochar's ether groups, which contributes to metal adsorption, against the conception that the biochar is merely a carrier of LDH as adsorbents.

Effects of the experience of breastfeeding-friendly practices and breastfeeding intention and self-efficacy on breastfeeding behavior: a cohort study in Taiwan.

BACKGROUND: Approximately 80% of births in Taiwan occurred in Baby-Friendly accredited facilities, although the trend of exclusively breastfeeding infants until 6 months of age has stagnated in the last ten years. To guide breastfeeding promotion interventions during postnatal stays and encourage mothers to continue breastfeeding for the first 6 months, factors associated with breastfeeding behaviors to 6 months post-delivery must be investigated. This study explored the relationships among breastfeeding intention, experience of breastfeeding-friendly practices, breastfeeding self-efficacy, and breastfeeding behavior at four and 6 months after childbirth. METHODS: In this longitudinal cohort study, women who gave birth to healthy newborns at two Baby-Friendly hospitals in Taiwan and who had initiated breastfeeding were recruited two to 4 days after giving birth. Data were collected three to 5 days after childbirth during hospitalization and at one, two, four, and 6 months after childbirth using a self-developed questionnaire to measure breastfeeding intention and the experience of breastfeeding-friendly practices, and the traditional Chinese version of the Breastfeeding Self-Efficacy Scale-Short Form to measure self-efficacy. RESULTS: A total of 155 women completed the questionnaires five times within 6 months. The determinants of exclusive breastfeeding at 4 months and any breastfeeding at 6 months were the intention to breastfeed for over 6 months; a higher score for the experience of breastfeeding-friendly practices; and a higher level of breastfeeding self-efficacy during that period. The experience of breastfeeding-friendly practices during hospitalization did not predict breastfeeding behavior at 4 and 6 months. Intending to breastfeed for less than 4 months and lower breastfeeding self-efficacy during the hospital stay were both associated with shorter breastfeeding durations of less than 6 months after childbirth. CONCLUSIONS: Longer intended duration of breastfeeding, sustaining breastfeeding-friendly practices after discharge, and maintenance of a higher level of breastfeeding self-efficacy were the determinants of breastfeeding at 4 and 6 months. Healthcare professionals in Taiwan must support breastfeeding-friendly practices and consider interactive interventions to promote continued breastfeeding at different stages during the first 6 months after childbirth on the basis of the mother's breastfeeding plan and breastfeeding self-efficacy during their postnatal hospitalization.

[Establishment of Administrative Core Competencies and Evaluation Indicators for Head Nurses].

BACKGROUND: The increasing complexity of the healthcare environment in recent years highlights the importance of cultivating in head nurses the leadership and management competencies necessary to effectively handle complicated administrative tasks and lead nurses in facing various challenges. Identifying the core administrative management competencies required of head nurses and evaluating competency level using behavioral indicators are fundamental to evaluating related training outcomes. PURPOSE: This study was designed to identify the core administrative management competencies required of head nurses as well as the associated job responsibilities, tasks, behavioral evaluation indicators, work outputs, and requisite knowledge and skills. METHODS: This study was conducted in two phases using a qualitative method. The first phase identified the core administrative management competencies and their behavioral definitions. The second phase established competency-related job responsibilities, tasks, behavioral evaluation indicators, work outputs, and requisite knowledge and skills. Each phase consisted of (1) a qualitative interview (first stage) or focus group discussion (second stage) to establish the prototype content; (2) a head nurse workshop to obtain multiple perspectives to modify the prototype content; and (3) a focus group discussion to achieve consensus regarding the content. RESULTS: Nine core competencies related to head nurse administration were identified, including: strategic planning, care supervision, quality improvement, communication, crisis management, responsible leadership, evidence-based practice, digital technology application, and presentation persuasion. Corresponding to these competencies, four responsibilities and associated work tasks were identified. Finally, the related behavioral evaluation indicators, work outputs, and requisite knowledge and skills were confirmed. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The results of this study may be used as the basis for head nurse administrative management training programs, while the identified behavioral evaluation indicators may be used to evaluate head nurse work performance and training outcomes. We recommend other institutions apply the results of this study and develop their own administrative core competencies and evaluation indicators for head nurses.

Effect of 0.12% Chlorhexidine Oral Rinse on Preventing Hospital-Acquired Pneumonia in Nonventilator Inpatients.

BACKGROUND: Nonventilator hospital-associated pneumonia (NV-HAP) is a nosocomial infection with a multifactorial etiology that is particularly prevalent in individuals with poor oral health. PURPOSE: This study was designed to determine the effect of a 0.12% chlorhexidine gluconate oral rinse intervention on oral health and on reducing NV-HAP in inpatients. METHODS: A randomized, double-blind, and triple-arm clinical trial was conducted on a sample of 103 patients aged ≥ 50 years. Using the blocking sample method, patients were randomly assigned into three groups. These included Group A, using an oral rinse solution of 0.12% chlorhexidine; Group B, using Listerine; and Group C, using a standard saline oral rinse. In addition to routine hospital-associated pneumonia preventative nursing care, the participants used the oral rinse solutions twice a day with a period of at least 9 hours between each use. Oral health, the degree of bacterial exposure, and the clinical pneumonia index scale were evaluated in each of the groups at baseline (first day), on Intervention Days 3 and 7, and at discharge. The clearance rate was calculated by dividing the number of bacteria cleared by the total frequency of oral bacteria in the collected culture × 100%. RESULTS: Each arm of the study was composed of 34-35 participants, with an average hospitalization duration of 7.5 days. There was no incidence of NV-HAP or any changes in clinical pulmonary infection score among the three groups. Group A achieved a more significant improvement in oral health assessment tool scores between baseline and discharge than either Group B or C ( p = .03), particularly in the tongue, gums, and tissues; saliva; and oral cleanliness subscales. In addition, Group A reported higher clearance rates for Staphylococcus (100.00% vs. 66.67% vs. 66.67%, respectively), Escherichia coli (100.00% vs. 60.00% vs. 66.67%, respectively), and Pseudomonas aeruginosa (75.00% vs. 46.30% vs. 25.00%, respectively) than Groups B and C. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Although the results do not provide evidence supporting the use of a 0.12% chlorhexidine oral rinse as better in terms of preventing NV-HAP in middle-aged and elderly inpatients, nursing supervision was found to have an overall positive effect on oral health. The use of oral rinse with 0.12% chlorhexidine for nonventilated patients with poor oral health may be recommended.

The Effects of Work Satisfaction and Work Flexibility on Burnout in Nurses.

BACKGROUND: The World Health Organization has encouraged improving working conditions for nurses to decrease turnover and increase nurse staffing and nursing capacity. The International Council of Nurses has pointed out that a positive work environment can improve satisfaction and decrease burnout in nurses. However, the effects of working conditions and work satisfaction on burnout in nurses remain unclear. PURPOSE: The purpose of this study was to explore the effects of working-condition-related flexibility and work satisfaction on burnout in nurses. METHODS: A cross-sectional design was employed, and 450 nurses from a single medical center participated in this study. In addition to demographic information, three survey instruments, including the Taiwanese Hospital Nurses' Job Satisfaction Scale, the Working Conditions and Flexible System Scale, and the Maslach Burnout Inventory-Chinese Version, were used to measure working condition flexibility, work satisfaction, and burnout. Descriptive statistics, the Pearson correlation coefficient, and hierarchical linear regression were used to analyze the data. RESULTS: Four hundred thirty-five nurses were enrolled as participants. Most were female, with a mean age of 29 years. Over four fifths (83.1%) were unmarried, and 65.5% had at least 2 years of prior experience working at other hospitals. Although the participants reported experiencing burnout several times per month, they reported feeling satisfied with their work. They noted flexibility related to working conditions, especially task-related flexibility, as important. Four variables (satisfaction/professional autonomy, interpersonal interaction, workload, and working condition flexibility/task flexibility) were found to be significant predictors of emotional exhaustion (adjusted R2 = 0.212). However, only professional autonomy was found to significantly predict a sense of low personal accomplishment (adjusted R2 = .077), whereas nursing competence significantly predicted depersonalization (adjusted R2 = .086). CONCLUSIONS: Work satisfaction and flexibility related to working conditions were shown to relate negatively to burnout. Nursing managers should improve the level of satisfaction related to professional autonomy, interpersonal interaction, and workload as well as task flexibility for nurses.

[Establishment of Role and Core Competencies of Geriatric Case Managers in Taiwan].

BACKGROUND: Older adults have unique and complex care needs that are multifaceted, continuous, and integrated and that span prevention and treatment to long-term rehabilitation. Case managers are able to integrate healthcare and social resources to help older adults and their caregivers manage the needs of daily life. Therefore, identifying the role and core competencies of geriatric case managers in Taiwan is crucial. PURPOSE: To develop the role and core competencies of geriatric case managers in Taiwan. METHODS: Based on a review of the literature, a two-round modified Delphi technique was used to evaluate the framework of the geriatric case manager role and core competencies. Experts were invited to join a panel to review and rank the importance of each role and competency within the context of the Delphi technique. RESULTS: Four roles and 36 core competencies of geriatric case managers were identified, and 94.4% consensus was reached in round two. The roles and core competencies included care expert (18 competencies), coordinator (6 competencies), consultant (6 competencies), and evidence-based practitioner (6 competencies). CONCLUSIONS / IMPLICATIONS FOR PRACTICE: Training programs may be developed for geriatric case managers based on the results of this study to further promote the quality of provided geriatric care.

Exploring dementia care competence of nurses working in acute care settings.

AIMS AND OBJECTIVES: To examine the current status of dementia care competence of nurses working in acute care settings as well as the relationship between competence and demographic attributes. BACKGROUND: Most people with dementia are older individuals when they are admitted to unfamiliar acute care settings for treatment, and they are prone to displaying BPSD. If nurses working in acute care settings are not sufficiently competent in dementia care, providing proper patient care is difficult. DESIGN: The study used a one-sample descriptive-correlation design. METHODS: This study enrolled nurses at two medical centres in southern Taiwan as the research participants and performed a stratified random sampling according to the units where they served. The Dementia Care Competence Scale was used for data collection. An independent samples t test, ANOVA and Pearson's product-moment correlation were performed for data analysis (See STROBE). RESULTS: A total of 308 valid questionnaires were collected. The results showed that dementia care competence of nurses working in acute care settings was moderate. In particular, they had insufficient knowledge of the special needs related to dementia and lacked the skills and patience necessary for identifying, preventing and managing BPSD. Additionally, although the nurses tended to have a positive attitude, they seldom communicated with people with dementia. This study also found that dementia care competence was better in nurses who were older, who had more seniority, who had taken care of people with dementia for a longer period of time and who had received training in dementia care. CONCLUSIONS: Dementia care training topics for nurses working in acute care settings should include palliative care for dementia, skills for managing behavioural and psychological symptoms of dementia and communication techniques for improving person-centred care. Nurses should also be encouraged to maintain a warm, friendly attitude when providing patient care. RELEVANCE TO CLINICAL PRACTICE: Continuing education in managing behavioural and psychological symptoms of dementia is necessary for currently practicing acute care nursing staff and should be developed according to the staff's educational background and needs.

Correction: The Rho Guanine Nucleotide Exchange Factor DRhoGEF2 Is a Genetic Modifier of the PI3K Pathway in Drosophila.

[This corrects the article DOI: 10.1371/journal.pone.0152259.].

Is nurse-led case management effective in improving treatment outcomes for cancer patients? A systematic review and meta-analysis.

AIMS: To identify and synthesize the outcomes of nurse-led case management interventions for improving cancer treatment. DESIGN: Systematic review with meta-analysis. DATA SOURCES: PubMed, MEDLINE, CINAHL, EMBASE, Cochrane Library and CEPS were searched for articles published from inception till June 2019, and search was finalized in January 2020. REVIEW METHODS: The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines. The quality of evidence was assessed using Joanna Briggs Institute Critical Appraisal Tools. Outcomes were analysed by using a pool of data of 95% confidence intervals (CIs), p value and fitting model based on heterogeneity of test results. RESULTS: Eleven articles were included in the meta-analysis. When compared with the regular care group, the nurse-led case management group had: 1) shorter time from diagnosis to treatment by 9.07 days, 2) an improved treatment completion rates (OR = 2.45) and 3) more number of patients received hormone therapy. CONCLUSION: The synthesized results presented that nurse-led case management is more effective than regular care in improving treatment timeliness, treatment completion rates and hormone therapy rates.

Effect of music therapy on improving sleep quality in older adults: A systematic review and meta-analysis.

OBJECTIVES: Poor sleep quality is a common issue among older adults; it can lead to a poor quality of life and impairments in cognitive function and physical health. This study aimed to conduct a systematic review and meta-analysis of the effect of listening to music on sleep quality in older adults. DESIGN: Systematic review and meta-analyses. SETTING: Five databases, including Embase, Ovid Medline, Cochrane Library, Scopus, and the Index to Taiwan Periodical Literature System, were searched to identify studies assessing the efficacy of music therapy in older adults aged 60 years and older published through February 20, 2021. PARTICIPANTS: Adults aged 60 years and older. MEASUREMENTS: We searched English- and Chinese-language studies of randomized control trials. All studies were reviewed by two independent investigators. The primary sleep outcome was the Pittsburgh sleep quality index. The Cochrane Collaboration tool was used to assess the risk of bias, and Review Manager 5.3 software was used to conduct the meta-analysis. RESULTS: Five randomized control trials were included in the meta-analysis. Older adults who listened to music experienced significantly better sleep quality than those who did not listen to music [mean difference (MD): -1.96, 95% CI -2.23 to -1.73, P = 0.003]. The subgroup analysis revealed that older adults who listened to sedative music obtained a more effective improvement in sleep quality than those who listened to rhythm-centered music (MD: -2.35, 95% CI -3.59 to -1.10, P = 0.0002). Furthermore, listening to music for longer than 4 weeks (MD: -2.61, 95% CI -4.72 to -0.50, P = 0.02) was to be effective at improving sleep quality. CONCLUSIONS: Music therapy is safe and easy to administer and can effectively improve sleep quality among older adults, particularly those listening to more sedative music for at least a four-week duration.

Amorphous mesoporous matrix from metal-organic framework UiO-66 template with strong nucleophile substitution.

The metal-organic framework (MOF) UiO-66 is made of zirconium clusters coordinated with 1,4-benzenedicarboxylate linkers that is stable in water and is highly tolerant to extremely acidic or basic environments. Conversely, the zirconium clusters are affine to nucleophiles so the crystalline structures of UiO-66 can be converted into amorphous derivatives. In a mineral acid solution both protons and coordinating nucleophile are present. This study for the first time revealed that it is the strong nucleophile instead of proton deteriorate the crystalline structures of UiO-66. Also, the so-produced amorphous mesoporous matrix, if not totally dissolved, can be applied as an efficient adsorbent. The noted adsorption capabilities of Cu(II) and nucleophiles by these amorphous mesoporous matrix did not correlate with the structural crystallinity or the internal surface area; conversely, the doped nucleophiles were noted to contribute to the adsorption tendencies towards Cu(II) and phosphate species via electrostatic interactions and hydrogen bonding, respectively. Conversion of sacrificing UiO-66 template to amorphous matrix can be applied as an effective way to fabricate specific adsorbent with resistance to extreme pH and strong nucleophile challenges.

Effect of Head-of-Bed Elevation on Nocturnal Reflux Symptoms of Esophageal Cancer Patients With Esophagectomy and Reconstruction.

BACKGROUND: Studies revealed the symptom of gastroesophageal reflux (GE reflux) disturb patients following esophageal reconstruction. OBJECTIVE: To examine the effect of head-of-bed elevation by using the wedge-shaped pillow (WSP) on the reflux symptoms of patients with esophageal cancer following esophagectomy and reconstruction. METHODS: Fourteen patients with nocturnal reflux symptoms following esophagectomy and gastric tube reconstruction were enrolled and randomized into 2 groups. A 2-week crossover trial was performed using 2 sequences (drug only and drug plus WSP). The WSP was designed with a height of 20 cm, a length of 62 cm, and an elevation angle of 20 degrees and used with fabricated from memory foam. After 2 weeks, all of the patients received combined drug and WSP intervention for 3 months. Reflux symptoms were measured by Dysfunction After Upper Gastrointestinal Surgery for Cancer and examined by endoscopic observations prior to intervention and follow-up for 3 months. RESULT: The average reflux symptom score for the combined drug and WSP treatment in the beginning 2 weeks was lower than that for the drug-only sequence. The severity of esophagitis was improved in 46.1%, and 38.5% showed a stabilization after 3 months. CONCLUSIONS: Combined drug and WSP treatment may be beneficial in improving GE reflux symptoms. IMPLICATIONS FOR PRACTICE: Nursing care professionals would suggest patients find a similar WSP to elevate the head of the bed to reduce the severity of nocturnal reflux symptoms after esophagectomy and gastric tube reconstruction.

Status and related factors of depression, perceived stress, and distress of women at home rest with threatened preterm labor and women with healthy pregnancy in Taiwan.

BACKGROUND: Women with threatened preterm labor (TPTL) resting at home face several life challenges, but their psychological well-being has been ignored. This study aimed to explore the status and related factors of the psychological status of women with TPTL resting at home, and to compare the psychological status differences between TPTL and healthy pregnant women. METHODS: A cross-sectional, multiple time-point study was conducted to repeatedly assess depression, perceived stress, and distress in 49 TPTL women and 62 healthy pregnant women during pregnancy in Taiwan. Mann-Whitney U tests were used to compare the psychological status differences between these women and the generalized estimating equation was used to identify the factors related to their psychological status. RESULTS: The TPTL women's perceived stress at 24-27 weeks (p=0.047) and 32-35 weeks (p=0.04) and distress at each time point was significantly greater than that of healthy pregnant women (p<0.001). The common distress experienced by TPTL women was the inability to provide self-care and family care, the baby's health and safety, and to request leave from work for bed rest. Positive personalities, gestational age, preterm birth history, follow-up status and employment have been shown to be related to the psychological status of TPTL women. LIMITATIONS: The major limitation of this study is the small sample size. CONCLUSION: This study contributed to a better understanding of the emotional burdens of women with TPTL resting at home. Such findings highlight the need for constructing effective interventions to alleviate the psychological burden of these women.

Development and validation of the prenatal activity restriction stress questionnaire: a Rasch rating scale analysis.

BACKGROUND: Antepartum activity restriction (AAR) is a common recommendation given to women at risk for preterm delivery. However, such treatment has been shown to cause heavy emotional burdens on the women receiving it since it requires them to face many challenges derived from the intervention. Nevertheless, current existing scales lack effective items that can reflect the distress of these women. The aim of this study was to develop a reliable instrument to assess the distress of women experiencing AAR. METHOD: The Prenatal Activity Restriction Stress Questionnaire (PARSQ) was developed according to comprehensive literature review, women's interviews, and existing pregnancy-special stress scales from August 2016 to July 2017 in southern Taiwan. Six experts evaluated its content validity; the Rasch rating scale model (RSM) was used to examine its item-fit, dimensionality, and reliability with 200 women with AAR experience. Furthermore, the concurrent validity was assessed through computing the correlation of AAR women's scores on the PARSQ and Perceived Stress Scale (PSS), and discriminant validity of the PARSQ was assessed to compare the scores' differences between the AAR women and the healthy pregnant women. RESULTS: The PARSQ was constructed with 23 items in the 4-dimensional scale: Role function changes (8 items), Fetal safety and health (5 items), Physical and psychological care issues (5 items), and Socioeconomic and medical issues (5 items). It was confirmed to have satisfactory content vitality (CVI = 0.78 to 1.0), reasonable item-fit (0.77 to 1.51), and good reliability in RSM model, as well as adequate concurrent validity (p = 0.005) and discriminant validity (p < 0.001). CONCLUSIONS: Understanding the distress of women undergoing AAR is necessary for developing appropriate prenatal care to assist women in coping with their situation to alleviate their emotional burdens. The developed PARSQ with satisfied psychometric properties can be an informative instrument for clinicians/researchers to assess the specific stress of pregnant women with AAR.