Factors associated with postoperative efficacy evaluation in patients with morbid obesity.

The global obesity problem is becoming increasingly serious, with eight of the top ten causes of death in Taiwan in 2020 being related to obesity. Morbid obesity poses a significant threat to one's health and well-being. In recent years, bariatric surgery has emerged as a more effective treatment option for patients with morbid obesity. However, the procedure is not without risks. This study aims to examine the factors that impact the postoperative efficacy evaluation of patients with morbid obesity. This study uses a retrospective cross-sectional design, with medical records being collected retrospectively. The data was collected from patients who underwent bariatric surgery between July 1, 2017 and June 30, 2020 at a hospital in southern Taiwan. A total of 663 patients were included in the study and were observed for 1 year after the surgery. The independent variables included demographic variables, perceived symptoms variables, perceived lifestyle variables, and surgery-related variables, while the dependent variables included weight loss outcomes and complications. The prognostic factors affecting the postoperative efficacy evaluation of patients with pathological obesity were determined using multiple regression analysis and binary regression analysis. The study found that 65.6% of the participants were female, with an average age of 36.8 years. The results of the multiple regression and binary logistic regression showed that gender, age, BMI, diabetes, and smoking habit were the predictors of postoperative weight loss. Hypertension, diabetes, liver disease, kidney disease, smoking habit, drinking habit, and operation time were the predictors of postoperative complications. The study found that the presence of the aforementioned 12 significant factors can affect the success of weight loss after surgery and the incidence of postoperative complications. This information can serve as a reference for clinical care institutions and patients to improve the postoperative efficacy evaluation.

Factors Associated with Postoperative Rehospitalization in Patients with Cervical Disc Herniation.

Cervical disc herniation (CDH) is a prevalent disease because of the poor living habits of and great pressure in modern society. Patients experience hand numbness, neck stiffness, soreness, and weakness due to neck nerve root compression, which leads to a gradual increase of neurosurgery outpatients. Although poor posture by the overuse of computers is possibly the origin of CDH, analysis of related factors causing the rehospitalization for CDH patients after surgery in Taiwan is not commonly reported. Thus, the present study focused on the demographics and surgery-related treatment on the relevance of rehospitalization for CDH patients after surgery. The design of the study was retrospective, and we collected data by medical record review, which was derived from the inpatient surgery data of patients at a medical center in southern Taiwan. The study lasted two years from 1 January 2017 to 31 December 2018, and a total of 248 patients underwent surgery for intervertebral disc protrusion in the neck. The retrospective study adopted narrative statistics, the chi-squared test, and binary logistic regression analysis to identify factors affecting postoperative rehospitalization. Among 248 postoperative patients with intervertebral disc protrusion, 178 underwent cervical fusion surgery, and 32 were rehospitalized after surgery for one-year follow up, accounting for an overall prevalence rate of 12.9%. There were no significant differences in sex, age, occupation, hypertension, anterior cervical discectomy and fusion, artificial disc replacement, hybrid surgery, and postoperative cervical coil use (p > 0.05). The results of binary logistic regression analysis showed statistically significant differences in abnormal body mass index (p = 0.0187, 95% CI = 1.238-10.499), diabetes (p = 0.0137, 95% CI = 1.288-9.224) and cervical vertebral surgery hospital days (p = 0.0004, 95% CI = 1.028-1.102), predicting the outcome of rehospitalization for CDH patients after surgery. The above results showed that abnormal body mass index, diabetes, and cervical vertebral surgery hospitalization days impacted rehospitalization in CDH patients after surgery. Thus, to prevent diabetes, weight control must be monitored, and maintaining correct posture can reduce CDH and decrease the rate of rehospitalization after surgery, which provides a critical reference for hospital managers and clinical staff.

Impact of a Banning Indoor Dining Policy on Restaurant Avoidance Behavior during the COVID-19 Outbreak.

The coronavirus disease 2019 (COVID-19) is spreading around the world, and Taiwan is no exception. Faced with the outbreak of the epidemic, the Taiwan government immediately ordered a policy banning indoor dining. The main purpose of the present research is to extend a Theory of Planned Behavior (TPB) theoretical framework to explore the public perception toward banning indoor dining policy on restaurant avoidance behavior during the COVID-19 outbreak. An online survey was administered in Taiwan during the COVID-19 pandemic from 25 May to 8 June 2021; a total of 326 responses were collected by a convenience sampling method, and partial least square (PLS) analysis was deployed to examine the hypothesized relationships. The results showed that perception toward banning indoor dining policy had independent significant associations with attitude, perceived behavioral control, and restaurant avoidance behavior. Moreover, attitude, perceived behavioral control, and subjective norm had independent significant associations with restaurant avoidance behavior. This study provides theoretical and practical insights into the psychological and behavioral processes involved in policy by the general public during the COVID-19 pandemic, thus helping policymakers to better understand public opinion and responses to policy issues.

Associations between Lifestyle Habits, Perceived Symptoms and Gastroesophageal Reflux Disease in Patients Seeking Health Check-Ups.

Gastroesophageal reflux disease (GERD) is one of the most common diseases. It mainly causes the stomach contents to flow back to the esophagus, thereby stimulating the esophagus and causing discomfort. From the results of our research, we intend to provide the general public with information related to preventing gastroesophageal reflux disease and medical personnel with information on the treatment and care of patients with gastroesophageal reflux disease. This study aimed to investigate the association of lifestyle habits and perceived symptoms on GERD in patients who underwent routine health check-ups. This study was conducted as a retrospective cross-sectional design to collect GERD cases from the medical records containing the health questionnaires and the report of endoscopic findings on the day of the health check-up. A total of 5653 patients were enrolled between 1 January 2016, and 31 December 2018. About 60.2% (n = 3404) of patients with GERD were diagnosed based on endoscopic findings. Descriptive and multivariate logistic regression analyses were performed to identify the risk factors of the development of GERD. The results of the multivariate logistic regression analysis showed that age, sex, waist circumference, Areca catechu chewing habit, sleep disorders, otolaryngology symptoms, and hepatobiliary and gastrointestinal symptoms were significantly associated with GERD. In this study, our results can be used as a reference for public health care and clinicians. Because most GERD cases can be controlled and prevented by lifestyle modifications, health professionals should always obtain a detailed history regarding symptoms and lifestyle habits associated with GERD.

Detection and clinical characteristics of serrated polyps and conventional adenomas between patients in the outpatient and physical checkup unit receiving colonoscopy.

PURPOSE: The sessile serrated adenoma/polyp detection rate (SSA/PDR) among different colonoscopy indications from daily practice has not been fully understood. This study aimed to evaluate the detection and clinical characteristics of serrated polyps and conventional adenomas between outpatient department (OPD) and physical checkup unit (PCU) patients receiving colonoscopy. METHODS: The data for this retrospective study were collected between 2016 and 2017 at Kaohsiung Veterans General Hospital in Taiwan. A total of 7047 individuals were included, and information on polyp and adenoma detection was extracted from the colonoscopy reports. RESULTS: The adenoma detection rate, the SSA/PDR, and the detection rate of traditional serrated adenoma (TSA) were 32.2%, 0.60%, and 0.50%, respectively. Risk analysis revealed no significant difference (p = 0.095) in SSA/PDR between individuals < 50 years and ≥ 50 years, and no trend of increased SSA/PDR as age increased was observed (p = 0.320). SSA/P and TSA had higher risks for synchronous advanced neoplasia than conventional adenoma, but with proximal hyperplastic polyps lower (p < 0.001, respectively). No significant difference of SSA/PDR between OPD and PCU patients was observed (p = 1.000); however, the age of SSA/P was significantly older in OPD than in PCU patients (p = 0.048). CONCLUSION: The detection rates of CA and TSA were associated with age groups; however, SSA/PDR was insignificantly higher among individuals aged < 50 years than those with other age groups. In addition, SSA/PDR between OPD and PCU patients was not significantly found in daily practice of colonoscopies.

A survey-based study of factors that motivate nurses to protect the privacy of electronic medical records.

BACKGROUND: The purpose of this study is to investigate factors that motivate nurses to protect privacy in electronic medical records, based on the Decomposed Theory of Planned Behavior. METHODS: This cross-sectional study used questionnaires to collect data from nurses in a large tertiary care military hospital in Taiwan. RESULTS: The three hundred two (302) valid questionnaires returned resulted in a response rate of 63.7 %. Structural equation modeling identified that the factors of attitude, subjective norm, and perceived behavioral control of the nurses significantly predicted the nurses' intention to protect the privacy of electronic medical records. Further, perceived usefulness and compatibility, peer and superior influence, self-efficacy and facilitating conditions, respectively predicted these three factors. CONCLUSIONS: The results of our study may provide valuable information for education and practice in predicting nurses' intention to protect privacy of electronic medical records.

An Extended Expectation-Confirmation Model for Mobile Nursing Information System Continuance.

Nursing is critical in health care systems and comprises the planning, execution, and documentation of nursing care. To better manage health care information during patient care, the use of a mobile nursing information system (MNIS) provides more time to care for inpatients by reducing time-consuming and redundant paperwork. The purpose of this study was to extend the expectation-confirmation model and explore the roles of nursing professional competency (skill in use), habit (customary use), satisfaction (with use), and frequency of prior use in the context of MNIS continuance usage. We randomly chose 3 hospitals from among 14 hospitals in Taiwan that had indicated they used an MNIS. We conducted a field survey of nurses who had experience using the MNIS. We used a valid sample of 90 nurses to test the research model, using structural equation modeling with the partial least squares method. The results show that habit and frequency of prior use had a significant impact on MNIS continuance usage. Satisfaction and frequency of prior use had a significant impact on habit. Nurses' professional competence is crucial to perceived usefulness and, thus, is relevant in the context of MNIS continuance usage. When habit weakens over time, the continuance intention predicts continuance usage. This study showed that the extended expectation-confirmation model effectively predicts nurses' MNIS continuance usage and provides implications. Academics and practitioners should understand how nurses' habits form and how they affect continued MNIS use. Understanding the antecedents of habits can help nursing managers identify and manipulate habit formation.

Pharmacoepidemiology of chronic noncancer pain patients requiring chronic opioid therapy: A nationwide population-based study.

OBJECTIVE: This study was aimed to explore the pharmacoepidemiology of chronic noncancer pain (CNCP) patients who required chronic opioid therapy (COT) in the Taiwanese population. METHODS: Using the Taiwan National Health Insurance Research Database during 2008-2009, COT-requiring CNCP patients were identified by the inclusion criteria of both chronic analgesic requirement for >3 months per year and long-term use of controlled opioids for >28 therapeutic days during any 3-month period in ambulatory visits with malignancy-related pain excluded. Their demographic data and pharmacoepidemiological characteristics of opioid consumption and opioid prescriptions issued in ambulatory visits were analyzed. RESULTS: In total, 159 patients were enrolled as COT-requiring CNCP patients, and the prevalence was calculated at 0.016% in a 2-year period. Females were outnumbered by males (45.3% vs. 54.7%). Almost 60% of them were of working age and 93.7% belonged to low-income households, as in the health insurance claims, probably implying socioeconomic disadvantages associated with CNCP. The leading three diagnoses were unspecified myalgia and myositis, lumbago, and abdominal pain of unspecified site. The most common department from where these 159 CNCP patients obtained their opioid prescriptions was the emergency department (27.6%), ensued by a pain clinic (25.3%), but they could acquire only a few opioid therapeutic days through emergency department visits. Moreover, pain clinic satisfied the majority of opioid therapeutic days. Among all opioids, morphine was the most frequently prescribed in opioid-obtaining ambulatory visits, accounting for most of the opioid therapeutic days as well as opioid consumption. CONCLUSION: COT-requiring CNCP patients were easily associated with adverse socioeconomic liabilities and often visited emergency department as well as pain clinics. Morphine was the main opioid used for their chronic pain. Transfer of COT-requiring CNCP patients to appropriate departments is strongly recommended for efficient long-term pharmacotherapy for their chronic pain.

How do patients respond to violation of their information privacy?

The introduction of electronic medical records (EMRs) can expose patients to the risk of infringement of their privacy. The purpose of this study was to explore the relationship between patients' concerns about information privacy and their protective responses. A questionnaire survey conducted in a Taiwanese hospital revealed that, regarding information privacy, patients' concerns about the collection of information about themselves, the secondary use of this information and the possibility of errors in the recorded information were associated with their information privacy-protective responses, while concern for unauthorised access to their information by other staff in the medical facility was not. Medical facilities should devote every effort to alleviate patients' concerns about the invasion of their information privacy to avoid eroding the reputation of medical facilities and impeding the promotion of EMRs.

An investigation of the effect of nurses' technology readiness on the acceptance of mobile electronic medical record systems.

BACKGROUND: Adopting mobile electronic medical record (MEMR) systems is expected to be one of the superior approaches for improving nurses' bedside and point of care services. However, nurses may use the functions for far fewer tasks than the MEMR supports. This may depend on their technological personality associated to MEMR acceptance. The purpose of this study is to investigate nurses' personality traits in regard to technology readiness toward MEMR acceptance. METHODS: The study used a self-administered questionnaire to collect 665 valid responses from a large hospital in Taiwan. Structural Equation modeling was utilized to analyze the collected data. RESULTS: Of the four personality traits of the technology readiness, the results posit that nurses are optimistic, innovative, secure but uncomfortable about technology. Furthermore, these four personality traits were all proven to have a significant impact on the perceived ease of use of MEMR while the perceived usefulness of MEMR was significantly influenced by the optimism trait only. The results also confirmed the relationships between the perceived components of ease of use, usefulness, and behavioral intention in the Technology Acceptance Model toward MEMR usage. CONCLUSIONS: Continuous educational programs can be provided for nurses to enhance their information technology literacy, minimizing their stress and discomfort about information technology. Further, hospital should recruit, either internally or externally, more optimistic nurses as champions of MEMR by leveraging the instrument proposed in this study. Besides, nurses' requirements must be fully understood during the development of MEMR to ensure that MEMR can meet the real needs of nurses. The friendliness of user interfaces of MEMR and the compatibility of nurses' work practices as these will also greatly enhance nurses' willingness to use MEMR. Finally, the effects of technology personality should not be ignored, indicating that hospitals should also include more employees' characteristics beyond socio-demographic profiles in their personnel databases.

Factors that influence nurses' job satisfaction.

OBJECTIVE: To examine factors affecting the job satisfaction of registered nurses (RNs). BACKGROUND: A growing recognition of job dissatisfaction among RNs in South Carolina hospitals has contributed to current problems with recruitment and retention. If administrators identify factors influencing RNs' job satisfaction in hospitals and implement strategies to address these factors, RN turnover rates will decrease and recruiting and retention rates will increase. METHODS: A cross-sectional study of secondary data was designed to identify the individual, work, and geographic factors that impact nursing job satisfaction at the state level. A 27-question self-administered survey was sent to 17,500 RNs in South Carolina with postage-paid envelopes for their responses. Surveys from 3472 nurses were completed anonymously. Univariate statistics were used to describe the study sample. One-way and multivariable Analysis of Variance were used to determine which variables contributed the most to job satisfaction. RESULTS: For about two thirds of the RNs, job satisfaction remained the same or had lessened over the past 2 years. In addition, statistically significant differences were found between job satisfaction and years of service, job position, hospital retirement plan, and geographic area. CONCLUSIONS: The findings have implications for nurse managers and hospital administrators for planning and implementing effective health policies that will meet the unique needs of their staffs and organizations. Such research is particularly relevant in this difficult time of nursing shortages throughout the healthcare industry.