The effect of oral massage intervention on oral hygiene at home care.

INTRODUCTION: Oral hygiene for individuals with disabilities living at home heavily relies on caregiver assistance. This study investigates differences in mouth opening, dental plaque index and halitosis grade among home-dwelling individuals with and without oral massage intervention. It is important to consider that extended bedridden periods, the presence of nasogastric tubes and difficulties in mouth opening can affect caregivers' oral cleaning effectiveness. METHOD: This single-blind controlled experiment spanned 12 weeks. Primary caregivers underwent a 15- to 20-min demonstration. The experimental group received guidance on the Bass brushing method, instructions for using oral cleaning tools and training in oral massage. The control group received guidance on the Bass brushing method and instructions for oral cleaning tools. Measurement tools included basic participant information, oral examination records, mouth opening assessments, dental plaque index evaluations and halitosis ratings. RESULTS: The study included 38 subjects, all over 80 years old with disabilities. Dental plaque index significantly improved after massage (p = 0.001). Compared to their pre-massage conditions, the experimental group showed significant improvements in maximum mouth opening (11.65-20.71 mm, p = 0.001), dental plaque index (98.04%-59.74%, p < 0.0001) and halitosis rating (4.12-3.76, p = 0.034). CONCLUSIONS: Oral massage effectively improved mouth opening, reduced the dental plaque index and lowered halitosis ratings in the experimental group, underscoring its positive impact on oral hygiene. The study's insights can significantly benefit oral care for individuals with disabilities living at home.

An Acute Kidney Injury Prediction Model for 24-hour Ultramarathon Runners.

Acute kidney injury (AKI) is frequently seen in ultrarunners, and in this study, an AKI prediction model for 24-hour ultrarunners was built based on the runner's prerace blood, urine, and body composition data. Twenty-two ultrarunners participated in the study. The risk of acquiring AKI was evaluated by a support vector machine (SVM) model, which is a statistical model commonly used for classification tasks. The inputs of the SVM model were the data collected 1 hour before the race, and the output of the SVM model was the decision of acquiring AKI. Our best AKI prediction model achieved accuracy of 96% in training and 90% in cross-validation tests. In addition, the sensitivity and specificity of the model were 90% and 100%, respectively. In accordance with the AKI prediction model components, ultra-runners are suggested to have high muscle mass and undergo regular ultra-endurance sports training to reduce the risk of acquiring AKI after participating in a 24-hour ultramarathon.

Effective licorice gargle juice for aphthous ulcer pain relief: A randomized double-blind placebo-controlled trial.

The aim of this study was to determine the effects of licorice gargle juice on aphthous ulcers, which is a common and painful disease that causes loss of normal mucous tissues and results in inflammatory ulcers in the oral mucosa. A randomized double-blind placebo-controlled trial involving primary care patients suffering from aphthous ulcer was performed. The intervention group received licorice gargle juice for 1 and 2 days. Of the 54 patients that participated in the study, 30 were included in the intervention group and 24 in the placebo group. A 10-point visual analog scale (VAS) was used to assess the patients' self-assessed pain levels before and after treatment. Statistical analyses were performed by using the nonparametric Mann-Whitney test. The licorice gargle juice group had a significantly reduced pain level rate compared with the placebo group at day 1 (mean VAS, 2.47 [95% CI, 1.95-2.98] vs. 4.75 [3.96-5.54]; P<0.001) and day 2 (mean VAS, 1.07 [95% CI, 0.81-1.32] vs. 4.08 [3.23-4.94]; P<0.001).The current study indicates that licorice gargle juice rapidly reduce pain and healing time and thus can improve the quality of life of a patient with aphthous ulcer.

Motion Artifact Resilient SCG-based Biometric Authentication Using Machine Learning.

On account of privacy preserving issue and health-care monitoring, physiological signal biometric authentication system has gained popularity in recent years. Seismocardiogram (SCG) is now easily accessible owing to the advance of wearable sensor technology. However, SCG biometric has not been widely explored due to the challenging motion artifact removal. In this paper, we design placing the sensors at different body parts under different activities to determine the best sensor location. In addition, we develop SCG noise removal algorithm and utilize machine learning approach to perform biometric authentication tasks. We validate the proposed methods on 20 healthy young adults. The dataset contains acceleration data of sitting, standing, walking, and sitting post-exercise activities with the sensor placed at the wrists, neck, heart and sternum. We demonstrate that vertical and dorsal-ventral SCG near the heart and the sternum produce reliable SCG biometric evidenced by achieving the state-of-the-art performance. Moreover, we present the efficacy of the devised noise removal procedure in the authentication during walking motion.Clinical relevance- A seismocardiography-based biometric authentication system can help serve privacy preserving and reveal cardiovascular functioning information in clinics.

Star-ECG: Visualization of Electrocardiograms for Arrhythmia and Heart Rate Variability.

Conventional electrocardiograms (ECG) are displayed in one dimension. Reading one-dimensional ECG waveform becomes challenging when one wants to visualize the heart rate variability with naked eye. Some ECG visualization techniques have been proposed. However, they rely on domain knowledge to comprehend the heart rate variability. To improve the readability for patients and non-experts, we introduce Star-ECG, a novel ECG visualization approach. Such approach projects ECG waveforms onto a two-dimensional plane in a circular form. We demonstrate that Star-ECG offers not only easily deciphered visualization of cardiac abnormalities and heart rate variability, but also the application of state-of-the-art arrhythmia classification with integrated deep neural networks. We also report positive user feedback from both experts and non-experts that Star-ECG can provide readable and helpful information to monitor cardiac activities.

Motion Artifact Resilient Cuff-Less Blood Pressure Monitoring Using a Fusion of Multi-Dimensional Seismocardiograms.

Blood pressure (BP) monitoring is critical to raise awareness of hypertension and hypotension, yet the commonly used techniques require the person staying still along with a cuff around the arm. Some cuff-less approaches have been researched, but all hinder the person from moving around. To address the challenge, we propose using a fusion of accelerometers to achieve motion artifact resilient blood pressure monitoring. Such technique is accomplished with the motion artifact removal process and feature extraction from multi-dimensional seismocardiograms. The efficacy of our BP monitoring models is validated in 19 young healthy adults. Both the diastolic and systolic BP monitoring models fulfill the AAMI standard and British Hypertension Society protocol. For sitting still BP monitoring, the mean and standard deviation of diastolic and systolic difference errors (DE) are 0.09 ± 4.10 and -0.25 ± 5.45 mmHg; moreover, the mean absolute difference errors (MADE) are 3.62 and 4.73 mmHg. In walking motions, the DE are 1.15 ±4.47 mmHg for diastolic BP and -0.38 ± 6.67 for systolic BP; furthermore, the MADE are 3.36 and 5.07 mmHg, respectively. The motion artifact resilient cuff-less BP monitoring reveals the potential of portable BP monitoring in healthcare environments.

Heart Rate and Respiratory Rate Monitoring Using Seismocardiography.

Vital signs monitoring is critical for healthcare. Currently, at-home vital signs monitoring is obstructed by the complicated device, unaffordable cost, and inconvenience. In this study, we develop a simultaneous heart rate and respiratory rate monitoring technique that requires only one tri-axial accelerometer placing on the sternum. We devise a signal processing technique to generate seismocardiography and respiratory vibration from the raw acceleration data; furthermore, we formulate the algorithms to compute the heart rate and respiratory rate from the processed signals. We tested the methodology on 20 young healthy adults during pre-exercise and post-exercise sitting. The accuracy of 98.3% and 97.3% are achieved in heart rate monitoring during pre-exercise and post-exercise sitting. For respiratory rate, an accuracy of 96.8% is accomplished. Given the accuracy, affordable cost and convenience, the acceleration-based technique shows great promise for at-home vital signs monitoring.Clinical relevance- Portable heart rate and respiratory rate monitoring is substantial in elevating the quality of healthcare environment.

Effects of a health education technology program on long-term glycemic control and self-management ability of adults with type 2 diabetes: A randomized controlled trial.

AIMS: This study aimed to explore the effects of a health technology education program on long-term glycemic control and the self-management ability of adults with type 2 diabetes (T2D). METHODS: The study was a randomized controlled trial with repeated measures design. The experimental group (n = 53) received a novel health technologies education program plus focus groups and routine shared care, the control group (n = 55) received routine shared care. Glycosylated hemoglobin (HbA1c) level and self-management ability were the primary and secondary outcomes. Subject self-management ability was evaluated using the Chinese version of Perceived Diabetes Self-Management Scale (PDSMS). A linear mixed-effect model for repeated measures was used to analyze changes in HbA1c level and self-management ability after controlling for pretest effects. RESULTS: The mean HbA1c levels in the experimental group decreased by 0.692% (7.564 mmol/mol) and 0.671% (7.332 mmol/mol) at 3 and 6 months after the intervention (p < 0.05) while the mean increase in the PDSMS scores at 3 and 6 months after the intervention were significantly higher than those in the control group (p < 0.05). CONCLUSION: The health technology education program was more effective than routine shared care alone in lowering HbA1c and increasing self-management ability in T2D patients.

Cuff-Less Blood Pressure Monitoring with a 3-Axis Accelerometer.

OBJECTIVE: The aim was to propose a cuff-less, cost-efficient, and ultra-convenient blood pressure monitoring technique with a 3-axis accelerometer. METHODS: The efficacy of the proposed approach was examined in 8 young healthy volunteers undergoing different activities with a 3-axis accelerometer leveled on their upper chest. The 3-dimensional accelerations were exploited to select features for the calculation of systolic pressure (SP) and diastolic pressure (DP); the whole process involved signal processing, feature extraction, linear multivariate regression, and leave-one-out cross validations (LOOCV). RESULTS: DP and SP could be approximated with the linear combination of the extracted features: the L2 norm of lateral acceleration for both DP and SP, state variation (defined in the proposed algorithm) of vertical acceleration for SP, and I-J interval (defined in ballistocardiogram) of vertical acceleration for DP. The correlation coefficient (r) of the estimated and the measured DP was 0.97, and for SP, r = 0.96. In LOOCV, our best validated results in difference errors were -0.02±3.82 mmHg for DP and -0.59 ± 7.46 mmHg for SP. CONCLUSION: Compared to AAMI criteria, the proposed acceleration-based technique fulfilled the requirement. The accelerometer-based technique showed the potential to monitor blood pressure cuff-lessly, cost-efficiently, ultra-conveniently, and to be embedded in a long-term wearable device for clinical usage.

Comorbidity profiles among women with postcoital bleeding: a nationwide health insurance database.

PURPOSE: Most of the existing studies on postcoital bleeding (PCB) in Western countries. To date, no study has focused on the various PCB-related comorbidities in Taiwan women. This work aims to analyze and compare the presence or absence of PCB among Taiwanese women with gynecological comorbidity. METHODS: This study is a population-based retrospective cohort investigation. Outpatients with PCB after the index date were considered. A total of 2377 female patients with PCB (ICD-9 626.7) were identified using a nationwide outpatient sample from 2001 to 2010. For comparison, 7131 cases were randomly matched with the study group in terms of gender and age. RESULTS: The PCB incidence rate was 39-59 cases/100,000 Taiwanese women, with mean age (±SD) of 36.74 ± 10.79 years, median age of 36 years, and mode age of 29 years. Women with PCB exhibited 1.47-fold risk of cervical dysplasia and 1.59-fold risk for malignant neoplasm of cervix. Young women with PCB showed high risk of cervical cancer. The most common benign diseases among PCB- related comorbidities were cervical erosion and ectropion (20.66%), followed by vaginitis and vulvovaginitis (19.18%). Comparison between PCB and non-PCB groups indicated several significant high-risk comorbidities including cervical polyps, cervical erosion, leukoplakia of cervix, intrauterine contraceptive device, cervicitis, vaginitis, menopause, dyspareunia, and vulvodynia. CONCLUSIONS: This study provides evidence that PCB-related comorbidities manifested benign diseases (51.58%), lower genital tract infection (46.11%), and cervical cancer (2.31%). Thus, healthcare providers must ensure that appropriate routine screening tests and counseling are given to women with PCB.

A Nationwide Population-Based Study of Corrosive Ingestion in Taiwan: Incidence, Gender Differences, and Mortality.

Corrosive injury results from the intake of corrosive-acid-based chemicals. However, this phenomenon is limited to a small number of cases and cannot be extrapolated to the epidemiology of corrosive injuries in actual situations. This study focuses on the annual incidence of corrosive injury and its connection to gender, risk factors, and in-hospital mortality. All patients with corrosive injury (ICD-9 947.0-947.3) were identified using a nationwide inpatient sample from 1996 until 2010. Chi-squared tests and multivariate logistic regression were used to examine risk factors of gender differences and in-hospital mortality of corrosive injury. Young adults comprised the majority of patients (71.2%), and mean age was 44.6 ± 20.9 years. Women showed a higher incidence rate of corrosive injuries, age, suicide, psychiatric disorder, and systemic complications compared with men (p < 0.001). The present study demonstrated that age (OR = 10.93; 95% CI 5.37-22.27), systemic complications (OR = 5.43; 95% CI 4.61-6.41), malignant neoplasms (OR = 2.23; 95% CI 1.37-3.62), gastrointestinal complications (OR = 2.02; 95% CI 1.63-2.51), chronic disease (OR = 1.30; 95% CI 1.08-1.56), and suicide (OR = 1.23; 95% CI 1.05-1.44) were strongly associated with in-hospital mortality. Educational programs may be helpful for reducing the incidence of ingestion of corrosive chemicals.

Musculoskeletal pain in people with and without type 2 diabetes in Taiwan: a population-based, retrospective cohort study.

BACKGROUND: Musculoskeletal pain in people with type 2 diabetes is a common issue even to this day. The study aimed to explore the 10-year cumulative incidence of musculoskeletal pain, the mean number of doctor visits for musculoskeletal pain, and the mean number of doctor visits for musculoskeletal pain by location in people with type 2 diabetes, compared with respective values for people without diabetes. METHODS: The study utilized a population-based retrospective cohort study design. The subjects were randomly obtained from the Taiwan National Health Insurance Research Database. The diabetic group included 6586 people with type 2 diabetes aged 18-50 years, while the non-diabetic group consisted of 32,930 age- and sex-matched people. Based on the medical records of individuals with musculoskeletal pain in the two groups from 2001 to 2010, the 10-year cumulative incidence of musculoskeletal pain, the mean number of doctor visits for musculoskeletal pain, and the mean number of doctor visits for musculoskeletal pain by location were calculated and compared, with the aim of identifying differences between the two groups. RESULTS: Showed that people in the diabetic group had a higher 10-year cumulative incidence of and a higher mean number of doctor visits for musculoskeletal pain than the non-diabetic group (p < 0.05). The relative risk (RR) of the 10-year cumulative incidence of musculoskeletal pain in the two groups was the highest (RR = 1.39) for people between 30 and 39 years of age. The mean number of doctor visits for musculoskeletal pain by location was significantly different between the two groups. However, the mean number of doctor visits for limb pain registered the largest difference between the two groups. CONCLUSION: People with type 2 diabetes aged 18-50 years had a higher 10-year cumulative incidence of and a higher mean number of doctor visits for musculoskeletal pain than the non-diabetic group. Musculoskeletal pain might directly or indirectly interfere with or decrease the physical activity levels of people with diabetes. Therefore, it is important to detect and treat musculoskeletal pain early in order to promote physical activity and optimize blood sugar control.

The Effectiveness of Vitamin B12 for Relieving Pain in Aphthous Ulcers: A Randomized, Double-blind, Placebo-controlled Trial.

Aphthous ulcers, the most common oral mucosal lesions seen in primary care, occur in up to ∼2%-50% of the general population. Our objective was to confirm the analgesic benefit of treatment of mouth ulcers with vitamin B12 as adjunctive therapy. A randomized, double-blind, placebo-controlled trial was performed with primary care patients. The intervention group received vitamin B12 ointment for 2 days. In total, 42 patients suffering from aphthous ulcers participated in the study: 22 were included in the intervention group and 20 in the control group. All parameters of aphthous ulcers of patients in the intervention group were recorded and compared with those in the control group. We assessed the patients' pain levels before and after treatment using a visual analog scale. The statistical analyses were performed using a nonparametric Mann-Whitney test. Statistically significant differences in pain levels were found between the intervention group and the control group after 2 days of treatment (mean visual analog scale, 0.36 [95% CI, 0.01-0.71] vs. 1.80 [1.16-2.44]; p < .001). In conclusion, the results of this research study provide evidence that vitamin B12 is an effective analgesic treatment for aphthous ulcers. This study indicates that healthcare providers could use vitamin B12 as an adjunctive therapy for mouth ulcers, providing more effective pain management and improving the quality of life for patients with mouth ulcers.

Dyspareunia and its comorbidities among Taiwanese women: analysis of the 2004-2010 Nationwide Health Insurance Database.

INTRODUCTION: Most of the existing studies on dyspareunia only focus on qualitative observations. These measurement tools may not reflect the actual situation of dyspareunia in Taiwan. AIM: This study aimed to estimate the incidence of dyspareunia in Taiwan and investigate dyspareunia-associated comorbidities using the National Health Insurance Research Database (NHIRD). METHODS: This study is a population-based retrospective cohort investigation. MAIN OUTCOME MEASURES: We analyzed the 2004-2010 claims data on dyspareunia from the NHIRD. Dyspareunia was identified by outpatient visits using International Classification of Diseases, Ninth Revision, Clinical Modification (diagnosis code 6250). Patients who visited as outpatients with dyspareunia after the index date were considered to have comorbidities associated with dyspareunia medical conditions. The index events included vaginal disorders, vulvar disorders, uterine and ovarian factors, female genital organ and menstrual cycle disorders, menopause, and relative abdominopelvic organ disorders. The incidence of dyspareunia among different age groups was determined. The location and areas significantly related to the physical gynecology or relative pelvic organ causing the disease were also analyzed. RESULTS: A total of 978 females of different ages had experienced dyspareunia. The incidence of dyspareunia was higher among individuals aged 30-34 years. The findings of this study indicated that dyspareunia was comorbid with menopause, pelvic floor dysfunction, and most gynecological infections. In particular, the more common physical causes of dyspareunia were introitus and vaginal infections (19.95%), menopause (16.80%), female genital organ and menstrual cycle disorders (15.22%), and female pelvic organ infections (13.65%). CONCLUSIONS: This study posits that women of all ages (20-70 years) experience painful sexual intercourse. This large-scale nationwide claims-based study showed that menopause and pelvic infection disorder were dyspareunia-related comorbidities. Moreover, gynecological infections and pelvic floor dysfunctions were associated with dyspareunia.

The educational needs of neonatal nurses regarding neonatal palliative care.

BACKGROUND: Studies have shown that education can improve the knowledge, attitudes, and beliefs of neonatal nurses regarding neonatal palliative care. However, no study has investigated the need for neonatal nurse education in neonatal palliative care in Taiwan. OBJECTIVE: The purpose of this study was to explore neonatal nurses' experiences in caring for dying neonates and their educational backgrounds regarding palliative care, as well as to assess their educational needs. METHODS: A cross-sectional survey was used for this research. A research structural questionnaire was used to investigate the research goals. RESULTS: One hundred fifteen nurses participated in this survey. Few participants indicated having received neonatal palliative care education (13%), but most responded that palliative care is necessary in neonatal nursing education (97.4%). Participants also responded that they were often or always exposed to death in NICU (62.6%), but few reported providing pain management to dying neonates (8.7%) and few had experience providing symptomatic care for dying neonates (19.1%). Fifty percent ranked "pain control" as the area in which they most required training. Another high-ranked need was in discussing with parents and families the outcomes of CPR and their neonate's progress. CONCLUSION: Research indicates that the education currently provided to neonatal nurses does not meet their distinctive needs. Neonatal nurses in Taiwan expressed an urgent desire for training in pain control and communication. Research suggests that the most important topics to trainees are pain management and end-of-life communication. Additionally, non-pharmacological pain control interventions are valuable and should be included in an educational program.

The attitudes of neonatal professionals towards end-of-life decision-making for dying infants in Taiwan.

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.

To explore the neonatal nurses' beliefs and attitudes towards caring for dying neonates in Taiwan.

(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.

Sexual Activity during Pregnancy in Taiwan: A Qualitative Study.

BACKGROUND: Pregnancy is a special period in a woman's life that involves physical and mental changes. These changes are influenced by cultural, social, religious, and emotional factors among others. AIM: The aims of this article were to gather information, to describe the changes and behavior of sexual experiences in pregnancy, and to identify the reasons why pregnant women from central Taiwan decrease coital frequency during pregnancy. METHODS: This phenomenological qualitative research was intended to respond to open-ended questions that allowed the respondents to elaborate on the individuals' experiences. We collected data from in-depth, tape-recorded, and semi-structured interviews conducted in a cross-sectional study of 62 healthy pregnant women. The investigation ended when three consecutive interviewed subjects could not offer any new activities, which indicated that the study had reached its saturation point. MAIN OUTCOME MEASURES: We performed data collection and content analysis to ensure standards of rigor and reliability. Credibility was enhanced by prolonged engagement, triangulation, referential adequacy, member checking, and expert review; we categorized meaningful unit-codes in a mutually exclusive and exhaustive manner into perceptions, experiences, and practices such that common themes were grouped into categories. RESULTS: THREE THEMES EMERGED: negative aspects of sexual experiences; stress and emotional responses; and changes in sexual practices. The majority of the women stopped engaging in coital activities during pregnancy. We determined that in most cases, the 62 participants obtained information regarding sexual activity during pregnancy from postpartum women and the Internet. CONCLUSIONS: The current evidence-based findings encourage the provision of sexuality education to newlyweds and the discussion of sex-related issues during pregnancy. We propose developing strategies for increasing sexual knowledge and focusing on emotional support to decrease pregnant women's anxiety regarding sexuality in Taiwan. Liu HL, Hsu P, and Chen KH. Sexual activity during pregnancy in Taiwan: A qualitative study. Sex Med 2013;1:54-61.

Cultural practices and end-of-life decision making in the neonatal intensive care unit in Taiwan.

The purpose of this research was to describe conditions of decision making for dying infants and cultural effects on the process of infant death in the neonatal intensive care unit. A retrospective chart review was used in this research. Fifty charts were reviewed; the major cause of death for the research subjects was complications of prematurity (52%). Eighty-two percent of the charts documented a do not resuscitate order, and 16% of parents allowed discontinuation of ventilator support when they realized the futility of continued care. In 30 nursing records, parents and their dying infants were offered a quiet place in which to grieve. In 10 cases, nurses accompanied these parents and allowed them to express their emotions. Research findings showed great outward expression of religion at the time of death. Various cultural issues affected both the grieving process of the families and the dying process of their infants.

To explore the conditions of dying infants in NICU in Taiwan.

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.