Predictive factors of in-hospital mortality in ventilated intensive care unit: A prospective cohort study.

Although it is clear that ventilated intensive care unit (ICU) patients have worse outcomes than those who are not, information about the risk factors of in-hospital mortality remains important for medical groups to target interventions for these patients.The purpose of this study was to identify predictive factors of in-hospital mortality in ventilated ICU patients with an admission diagnosis of acute respiratory failure.We conducted a prospective cohort study in 3 medical ICUs in a 3600-bed university hospital. Consecutive patients with acute respiratory failure who received mechanical ventilation (MV) for at least 96 hours without evidence of pre-existing neuromuscular diseases were followed until discharge. Upon inclusion, the following parameters were collected or evaluated: demographics, clinical history (admission body mass index [BMI], etiology of acute respiratory failure, comorbidity, Charlson comorbidity index, laboratory data), Acute Physiology and Chronic Health Evaluation (APACHE) II, and right and left quadriceps femoris muscle force. The days of MV before extubation, ICU length of stay, survival status at discharge, and hospital length of stay were recorded from the hospital discharge summary. The primary endpoint was in-hospital mortality.In all, 113 patients (65.49% males) were recruited with a mean age of 69.78 years and mean APACHE II score of 22.63. The mean ICU length of stay was 14.88 ±â€Š9.79 days. Overall in-hospital mortality was 25.66% (29 out of 113 patients). Multivariate analysis showed that the essential factors associated with increased in-hospital mortality were lower BMI (P = .013), and lower scores on the right or left quadriceps femoris muscle force (P = .002 and .010, respectively).Our study suggests that lower BMI and lower scores on lower limb muscle force may be associated with increased in-hospital mortality in ventilated ICU patients.

[Application of the 6-Minute Walking Test and Shuttle Walking Test in the Exercise Tests of Patients With COPD].

Exercise training improves the management of stable chronic obstructive pulmonary disease (COPD). COPD patients benefit from exercise training programs in terms of improved VO2 peak values and decreased dyspnea, fatigue, hospital admissions, and rates of mortality, increasing exercise capacity and health-related quality of life (HRQOL). COPD is often associated with impairment in exercise tolerance. About 51% of patients have a limited capacity for normal activity, which often further degrades exercise capacity, creating a vicious circle. Exercise testing is highly recommended to assess a patient's individualized functions and limitations in order to determine the optimal level of training intensity prior to initiating an exercise-training regimen. The outcomes of exercise testing provide a powerful indicator of prognosis in COPD patients. The six-minute walking test (6MWT) and the incremental shuttle-walking test (ISWT) are widely used in exercise testing to measure a patient's exercise ability by walking distances. While nursing-related articles published in Taiwan frequently cite and use the 6MWT to assess exercise capacity in COPD patients, the ISWT is rarely used. This paper introduces the testing method, strengths and weaknesses, and application of the two tests in order to provide clinical guidelines for assessing the current exercise capacity of COPD patients.

[A pilot study of the professional autonomy, job satisfaction, and related factors of nurses at a regional hospital].

BACKGROUND: Professional autonomy often causes confusion in nursing staffs that limit their ability to perform to the best of their professional capabilities. Moreover, heavy and busy workloads reduce the energy available for work resulting in lower working efficiency and lower job satisfaction. PURPOSE: This study explores the status and factors related to professional autonomy and job satisfaction in nurses. METHODS: A cross-sectional design was used to target the nurses employed at a regional hospital in southern Taiwan. Data on locus of control, professional autonomy, and job satisfaction were collected for analysis. RESULTS: Data were collected from 207 nurses, with 196 valid responses (response rate: 94.69%). One hundred and forty-six subjects (74.5%) were found to have an internal locus of control personality type. Scores for both professional autonomy and job satisfaction were above the "moderate" level (averages: 3.37 and 3.32, respectively, on a maximum scale of 5). Social demographic differences contributed to the variance in professional autonomy and job satisfaction among participants. Professional autonomy was found to be positively associated with job satisfaction. CONCLUSIONS: The findings of this study indicate that nurses with an internal locus of control personality exhibit higher professional autonomy and job satisfaction and that higher professional autonomy is associated with higher job satisfaction.

Acupressure improves the weaning indices of tidal volumes and rapid shallow breathing index in stable coma patients receiving mechanical ventilation: randomized controlled trial.

Background. Acupressure has been shown to improve respiratory parameters. We investigated the effects of acupressure on weaning indices in stable coma patients receiving mechanical ventilation. Methods. Patients were randomly allocated to one of three treatments: standard care with adjunctive acupressure on one (n = 32) or two days (n = 31) and standard care (n = 31). Acupressure in the form of 10 minutes of bilateral stimulation at five acupoints was administered per treatment session. Weaning indices were collected on two days before, right after, and at 0.5 hrs, 1 hr, 1.5 hrs, 2 hrs, 2.5 hrs, 3 hrs, 3.5 hrs, and 4 hrs after the start of treatment. Results. There were statistically significant improvements in tidal volumes and index of rapid shallow breathing in the one-day and two-day adjunctive acupressure study arms compared to the standard care arm immediately after acupressure and persisting until 0.5, 1 hr, and 2 hrs after adjustment for covariates. Conclusions. In the stable ventilated coma patient, adjunctive acupressure contributes to improvements in tidal volumes and the index of rapid shallow breathing, the two indices most critical for weaning patients from mechanical ventilation. These effects tend to be immediate and likely to be sustained for 1 to 2 hours.

[A preliminary study of the work values of male nurses in Taiwan and related factors].

BACKGROUND: Male nurses account for 1.08% of Taiwan's total professional nursing workforce. While work values are known to impact the practice of female nurses, the work values of male nurses have never been fully evaluated. PURPOSE: The aim of this study was to explore the work values of male nurses in Taiwan and related factors. METHODS: We applied a cross-sectional design that targeted all male nurses nationwide and used a structured questionnaire distributed by mail to collect data. RESULTS: Data were collected from 1,087 Taiwan-based male nurses with 745 valid responses. Mean score for overall work value was 2.78 (on a maximum scale of 4). Socio-demographic differences contributed to work value variance among respondents. Major factors of influence on work value included education, work unit, work position, work rank, salary, hospital classification, and reason for choosing a nursing career. CONCLUSION: This study found personal characteristics, occupational roles, job performance, and reason for choosing a career in nursing to all correlate strongly with work value.

Effectiveness of paced walking to music at home for patients with COPD.

The use of rhythmic music is beneficial in assisting with the exercise intensity at home. This paper investigated the effects of paced walking to music at home with an 80% VO(2) peak for patients with COPD. A prospective randomized clinical trial consisting of a treatment group (n = 20) assigned to a 12-week period of paced walking to music at home, while the patients in the control group (n = 21) were only given educational information. The treatment response was measured based on the patient's score in the maximal exercise capacity test using the incremental shuttle walking test (ISWT), lung function, health- related quality of life (HRQOL) using the Saint George Respiratory Questionnaire (SGRQ) and their health care utilization during baseline, 4, 8, 12 and 16 weeks. The treatment group increased their distance in the ISWT from 243.5 ± 135.4 at baseline to 16 weeks (306.0 ± 107.3, p < 0.001), Borg RPE-D decreased from 2.2 ± 1.3 at baseline to 0.8 ± 1.1 (p < 0.001) at 16 weeks, and Borg RPE-L decreased from 1.2 ± 1.4 at baseline to 0.3 ± 0.7 (p < 0.05) at 16 weeks, and improved all of the domains of the SGRQ, compared to the control group. The paced walking to music at home program helps patients to achieve a higher-intensity exercise. It is easily incorporated into the care of COPD patients, providing them with a convenient, safe and enjoyable exercise.

Brushing teeth with purified water to reduce ventilator-associated pneumonia.

BACKGROUND: Oral care may decrease the development of ventilator-associated pneumonia (VAP) and improve oral hygiene. However, little evidence is available to guide the development of oral care protocols. The practical effect of toothbrushing on VAP development and oral health and hygiene improvement is inconclusive. PURPOSE: This study evaluated the effects in postneurosurgical, intensive care unit patients of brushing teeth twice daily with purified water on VAP rates and oral health or hygiene. METHODS: This study conducted a randomized controlled pilot trial. Patients consecutively admitted to the surgical intensive care unit at a suburban hospital in 2007 were invited to participate if they met two inclusion criteria: (a) under ventilator support for at least 48 to 72 hours and (b) no current pneumonia. Upon obtaining informed consent, subjects were randomized into experimental and control groups. Both groups received usual hospital care, that is, daily oral care using cotton swabs. The experimental group additionally received a twice-daily oral care protocol of toothbrushing with purified water, elevating the head of the bed, and before-and-after hypopharyngeal suctioning. The control group also received twice-daily mock oral care (elevating the head of the bed, moisturizing the lips, and before-and-after hypopharyngeal suctioning). VAP was defined by a clinical pulmonary infection score of > 6. Oral hygiene and health was assessed after conclusion of the intervention. RESULTS: Patients (N = 53) were predominantly male (64.2%), mean age was 60.6 years old, and most had received emergency surgery (75.5%). After 7 days of toothbrushing with purified water, cumulative VAP rates were significantly lower in the experimental (17%) than in the control (71%; p <.05) group. The experimental group also had significantly better scores for oral health (p <.05) and plaque index (p <.01). CONCLUSION/IMPLICATION FOR PRACTICE: Findings suggest that, as an inexpensive alternative to existing protocols, toothbrushing twice daily with purified water reduces VAP and improves oral health and hygiene.

Evaluation of the feasibility of a school-based asthma management programme in Taiwan.

AIMS AND OBJECTIVES: To investigate the feasibility of a school-based asthma management programme for middle school children. BACKGROUND: Asthma rates are increasing among school-aged children. Successful asthma treatment in children depends in part on clear communication and effective education. DESIGN: This feasibility study employed a one-group only longitudinal design with four time points over 18 months. METHODS: Nineteen female and twelve male (n = 31) seventh-grade children with asthma (13 SD 0·71 years) were identified using a six-stage asthma case-finding approach. Teachers and school staff were trained in the principles and methods of the proposed school-based asthma management programme. An individualised guided asthma self-management programme was developed for each child by a clinical team at a major academic medical centre. We assisted teachers in implementing the school programme; building a support network and monitoring children's activities. Outcome measures included lung function tests (at 0, six, 12 and 18 months), disease-related symptoms, psychosocial status and impact of asthma on learning (at 0 and 18 months). School provided data on academic achievement and school absences at 0, six, 12 and 18 months. RESULTS: Significant improvements were noted at six, 12 and 18 months on forced vital capacity (FVC)% of predicted (p = 0·001, 0·015, 0·015, respectively), forced expiratory volume in one second (FEV(1) )% of predicted (p = 0·001, 0·006, 0·088, respectively) and FEV(1) /FVC% of predicted (p = 0·001, 0·015, 0·099, respectively). There was a trend towards improved asthma symptoms (p = 0·050) and a significant decrease in positive perception of curriculum (p = 0·017) at 18 months after adjustment for covariates. CONCLUSIONS: This programme was associated with respiratory benefits on physiological asthma markers commonly, with a trend for symptom control. Academic and psychosocial outcomes are subject of further inquiry. RELEVANCE TO CLINICAL PRACTICE: School-based asthma management holds promise as a feasible clinical option for middle school children with asthma in the Taiwanese school system.

[A brief introduction to life energy cultivation strategies in traditional Chinese medicine].

The knowledge embraced within the broad field of Traditional Chinese Medicine (TCM) represents an important part of our common human heritage, as it incorporates time-tested and viable health promotion approaches applicable to everyone, regardless of ethnicity and geographic location. TCM emphasizes the importance of increased self-consciousness, which, once achieved, becomes regular aspect of daily life. Cultivating life energies in order to prevent and treat disease lies at the heart of TCM. This paper provides a brief introduction to TCM life energy cultivation strategies for nurse reference.

[Total knee replacement pain management: enhancing nursing instructions to patients].

The purpose of this project was to improve the comprehensiveness of nursing instructions given to patients on managing pain following total knee replacement surgery. The project began on 3 January 2007 and concluded on 30 June of the same year. The four methods used included 1) promoting the knowledge of nurses with regard to postoperative pain management; 2) establishing nursing instruction sheets for postoperative pain management; 3) adapting a visual pain analog scale to accept information expressed verbally; and 4) developing standard nursing care procedures for post-operative pain management. Results showed the score for patient pain management effectiveness following total knee replacement rose from an initial 1.7 to 3.6 at discharge. Nursing instruction performance also rose from 28.6% to 95.0% and the correctness of nurse knowledge with regard to postoperative pain management rose from an initial 62.1% to 93.1%. In conclusion, this project to improve the appropriateness and comprehensiveness of nurse instructions to patients with the objective of managing pain following total knee replacement surgery effectively achieved significantly positive results.

Quality of life among older stroke patients in Taiwan during the first year after discharge.

AIM AND OBJECTIVE: To explore the one-year poststroke trajectories in health-related quality of life and physical function in a sample of older stroke patients in Taiwan. BACKGROUND: Health-related quality of life has repeatedly been reported as decreased in poststroke patients. The vast majority of information on the health-related quality of life of older patients after stroke is based on data collected in Western developed countries. In contrast, little is known about older stroke patients in Asian countries. DESIGN: A descriptive, prospective and correlational design was used. METHODS: Older stroke survivors (n = 98) were assessed at the end of one, three, six and 12 months after hospital discharge for health-related quality of life (measured by the Medical Outcomes Study Short Form 36) and physical functioning (measured by the Chinese Barthel Index and Instrumental Activities of Daily Living Scale). RESULTS: The subjects, who were 65-88 years old, performed considerably worse at 12 months after hospital discharge in social and physical functioning (means = 61.1, 54.8, respectively) than the age-matched community-dwelling norm (means = 78.7, 69.7, respectively). During the first year after discharge, subjects improved significantly on the Medical Outcomes Study Short Form 36 physical component summary scale and role limitations due to physical problems; during the first three months after discharge, they improved significantly on performance of activities of daily living and instrumental activities of daily living; and from the third to sixth month after discharge, they improved significantly in physical functioning. CONCLUSIONS: The first year, especially the first three months after hospital discharge, is critical for improvements in health-related quality of life and physical functioning for older stroke survivors in Taiwan. RELEVANCE TO CLINICAL PRACTICE: Older Taiwanese/Chinese people who suffer a stroke will likely benefit from interventions during the first 12 months after discharge and the most effective interventions may be earlier, during the first three months after discharge.

Mortality Factor Survey of Severe Acute Respiratory Syndrome in Taiwan.

BACKGROUND: Severe acute respiratory syndrome (SARS) is a new respiratory tract infectious disease caused by the highly contagious coronavirus (SARS-CoV). Its propagation and symptom progress are very rapid. This study evaluated the clinical characteristics, laboratory results and mortality factors of probable SARS cases. METHODS: This study was adopted with a retrospective research design to study probable SARS cases from the Chang Gung Memorial Hospital in Linkou and Kaoshiung from August 2003 to February 2004, with a total of 78 cases (average age, 44 years; standard deviation, 18 years; age range, 13-84 years) including 24 males (30.8%) and 54 females (69.2%). RESULTS: Most of the 78 cases involved nosocomial infection (56.4%). A total of 24 patients died, and the mortality rate was as high as 30.8%. Logistic regression analysis found that intubation (odds ratio, 115; p < 0.001) was the mortality forecast factor. CONCLUSION: The mortality rate of intubation patients was 115 times higher than that of those who did not require intubation. Therefore, special care must be taken with SARS disease with severe infiltration chest X-ray images and respiratory distress. Positive medical treatment should be performed to lower the mortality rate.

Incidence density and relative risk of nosocomial infection in Taiwan's Only Children's Hospital, 1999-2003.

We report on 2,688 nosocomial infection episodes involving 3,238 pathogens in Taiwan's only children's hospital. The mean annual incidence density was 4.06 cases per 1,000 patient-days. The relative risk was highest in intensive care units, oncology wards, and neonatal observation wards. Very young, low-birth-weight, critically ill, and oncology patients were most at risk.

The effectiveness of acupuncture on pain and mobility in patients with osteoarthritis of the knee: a pilot study.

Acupuncture has been repeatedly reported to relieve pain associated with osteoarthritis of the knee. As the vast majority of information on the effectiveness of acupuncture on this condition is based on data collected in Western countries, little is known about patients with osteoarthritis of the knee in Asian countries. In this pilot clinical study, acupuncture was incorporated into the standard care for adult patients with osteoarthritis of the knee to determine its contribution to pain relief and improved mobility. In a prospective, non-randomized controlled study, patients with osteoarthritis of the knee were separated into two groups. The first (the experimental group; n = 12) was scheduled for up to 8 sessions of acupuncture in addition to standard care, while the second (the control group; n = 12) received standard care only. Measurements using the six-minute walking distance test, pain visual analogue scale, and osteoarthritis of the knee outcome measurement were taken at baseline and after 4 weeks. Both study and control groups showed significant improvement with respect to time effects in terms of six-minute walking distance, pain visual analogue scale, pain domain and mobility domain scores determined by the osteoarthritis of the knee outcome measurement (p < .01), after adjusting for covariables. However, improvements measured in the study group did not differ significantly from those in the control group. Patients with osteoarthritis of the knee seemed to experience clinical improvements in six-minute walking distance, pain relief and mobility when their standard care was supplemented with acupuncture.

[Northern Taiwan nurse practitioners' perceptions of their roles].

The purpose of this qualitative research was to explore northern Taiwan nurse practitioners' perceptions of their roles. Eight nurse practitioners participated in this research, which used purposive sampling. Data were collected by in-depth audio-taped interviews, and analysed by qualitative content analysis. For qualitative research, data analysis and data collection go hand in hand. Four themes were evolved from data analysis, which were roles dilemma, roles daybreak, roles function and roles requirement. According to findings, nurse practitioners confront roles dilemma in both intra-professional and inter-professional conflicts and risk of illegal practice. However, nurse practitioners find daybreak from clinical effectiveness, positive role recognition and the progress of related regulations. They conceive their role capability as that of medical subordinate, coach, counselor, and coordinator. They emphasize important requirements for being a nurse practitioner, such as a Bachelor's degree, 5 years medical-surgical practice experience, achieving level 3 on the nursing clinical ladder and possessing an ACLS license. The above research findings might be used to support decision making for NP policy in the future.

[Development of an add-on module for the WHOQOL-BREF on patients with allergic rhinitis].

The purpose of this study was to develop an add-on module for the Taiwan-version WHOQOL-BREF for assessing the quality of life of people with allergic rhinitis. A cross-sectional survey design was used. In accordance with the seven steps for the development of population-specific modules of the WHOQOL, the instrument added new items on the basis of opinions of expert groups, including patients, families and physicians, to the Taiwan-version WHOQOL-BREF measure. The new questionnaire, comprising 52 items, was tested on 252 patients with allergic rhinitis. For content validity, each item was significantly correlated with the domain to which it belonged (r= .157-.715, p< .05); and each domain was significantly correlated with each other domain (r= .211-.535, p< .01). The construct validity was examined by means of the multitrait-multimethod method. The total score and the scores on the physiological and environmental subscales showed convergent validity with the score for IgE (r= -.317 - -.380, p< .01) and with the total score and the scores on the subscale of the allergic rhinitis symptom questionnaire (r= -.202 - -.360, p< .01). The scores on the body constitution subscale also showed convergent validity with the score for IgE (r= .329, p< .01) and with the total score and the scores on the subscale of the allergic rhinitis symptom questionnaire (r= .187-.261, p< .01). This result supports the appropriateness of this new questionnaire specifically for assessing the quality of life of people with allergic rhinitis. As regards concurrent validity, the total score was significantly correlated with the score of all subscales in the Medical Outcomes Study Short Form Taiwan-version (SF-36) (r= .256-.542, p< .01). The internal consistency reliability established by Cronbach's alpha ranged for each domain from .73-.81. The test-retest reliability correlated for each domain of the instrument was .719-.794 (p< .01). In conclusion, the add-on module developed in this paper for the Taiwan-version WHOQOL-BREF for patients with allergic rhinitis is reliable, valid and specific.

[A conceptual framework of the effectiveness of acupuncture].

The term, "Acupuncture," is used in its broadest senses to refer to needling, moxibustion, acupressure, laser acupuncture, electric acupuncture, and microsystem acupuncture, such as ear, face, hand and scalp acupuncture. Numerous surveys show that, of all the complementary medical systems, acupuncture enjoys the most credibility in the medical community. This article introduces a conceptual framework of the effectiveness of acupuncture from the perspective of responses to acupuncture shown in extensive, basic scientific evidence. The researchers hope, through this review of literature, to enable medical personnel to gain something of an understanding of acupuncture.

Self-administered acupressure reduces the symptoms that limit daily activities in bronchiectasis patients: pilot study findings.

AIMS AND OBJECTIVES: To examine and compare the effects of acupressure on the perceived health-related quality of life of the participants with bronchiectasis. BACKGROUND: In an attempt to offer comfort, pain control and symptom management, nursing is becoming increasingly involved in offering complementary-alternative medicine as part of its caring-healing focus in comprehensive patient care. Acupressure is one such modality that is being increasingly used by both medical and nursing professionals. While acupressure has been reported to have beneficial effects in patients with respiratory disease, the benefits to bronchiectasis patients have remained uncertain. DESIGN: A randomized, partially blinded study consisting of three groups. METHODS: Thirty-five out-patients of both genders, aged 59.46 SD 11.52 years, who were suffering from bronchiectasis, were randomly split into one of three groups: standard care with supplemental acupressure for eight weeks (11 participants); standard care with supplemental sham acupressure for eight weeks (11 participants); and standard care alone (13 participants). Outcomes were determined by changes in daily sputum amounts, sputum self-assessment, six-minute walking distance, breathing difficulty (measured on the dyspnea visual analogue scale) and health-related quality of life (measured by the Saint George Respiratory Questionnaire). RESULTS: The sputum self-assessment score improved over time for the sham acupressure participants (P = 0.03), when compared with the controls. For acupressure participants, the Saint George respiratory questionnaire activity component scores also improved over time, compared with controls (P = 0.01) after adjustment for covariates (treatment, time, age, sex and baseline values). Other variables did not differ between the standard care alone group and the other two groups. CONCLUSIONS: Eight weeks of self-administered acupressure could be useful in reducing the effects of bronchiectasis on a patient's daily activities. RELEVANCE TO CLINICAL PRACTICE: Acupressure may be regarded as a viable nursing intervention.

Manual hyperinflation improves alveolar recruitment in difficult-to-wean patients.

STUDY OBJECTIVES: To investigate the effect of manual hyperinflation (MH) in patients with atelectasis associated with ventilation support. DESIGN: Patients were randomized to either an experimental group or a control group. SETTING: Pulmonary ICUs from two hospitals. PATIENTS: Twenty-three patients with atelectasis associated with ventilation support. INTERVENTIONS: The MH technique was at a rate of 8 to 13 breaths/min for a period of 20 min each session, three times per day for 5 days. The control group received their standard prescribed mechanical ventilation without supplemental MH. Sputum contents (wet/dry weight ratio, viscosity), respiratory system capacity (spontaneous tidal volume [Vt], maximal inspiratory pressure, rapid shallow breathing index [f/Vt], chest radiograph signs, and Pa(O2)/fraction of inspired oxygen [Fi(O2)]) were measured just prior to the MH at day 0 as baseline, and at day 3 and day 6 of the study. MEASUREMENTS AND RESULTS: There were significant improvements in scores over the 6-day study in the experimental group compared to the control group in spontaneous Vt (p = 0.035) and chest radiograph signs (p = 0.040), and a trend toward improvement of f/Vt (p = 0.066) and Pa(O2)/Fi(O2) (p = 0.061) after adjustment for covariates. Other outcome variables did not differ significantly between the experimental and control groups. CONCLUSIONS: MH performed on patients with atelectasis from ventilation support significantly improved alveolar recruitment.

[Application of acupressure in nursing practice].

In an attempt to offer comfort, pain control and symptom management, nurses are increasingly offering acupressure as part of their focus on comprehensive patient care. According to many research reports, acupressure may be regarded as a viable nursing intervention. From a practical perspective, acupressure has several distinct advantages; it is non-invasive, free, and relatively easy to learn. Most importantly, since acupressure depends on neither tools nor products, it is more accessible than medical techniques, and easily taught to patients to enable them to engage in holistic self-treatment. Once patients learn the techniques involved, acupressure can be self-administered at home as required, thus reducing the dependence of patients on clinic visits. This paper provides a brief introduction to acupressure and its aims, and explains how it may be applied in nursing practice.