[Factors Related to Musculoskeletal Disorders Among Hospital Nurses].

BACKGROUND: Nurses are a high-risk group for musculoskeletal disorders. Few studies conducted in Taiwan have been published regarding the relationships among work characteristics, psychological well-being, and musculoskeletal discomfort in nursing personnel. PURPOSE: This study was designed to investigate musculoskeletal discomfort among hospital nursing staff, as well as its associated factors. METHODS: A secondary data analysis design was used to examine hospital staff health survey data for 2018 from two regional hospitals in southern Taiwan. Data from 328 full-time nurses who had passed their probationary period and been employed for more than 6 months were included in the analysis, which was conducted using a logistic regression model. RESULTS: The prevalence of musculoskeletal disorders was found to be highest in the shoulders (73.8%), lower back (72.9%), and neck (64.0%), respectively. Number of sleep hours, work stress, confidence in dealing with work stress, workload, supervisor support, workplace justice, and depression level differed significantly between the groups with and without full-body musculoskeletal disorders (p < .05). The results of the logistic regression model analysis showed individuals with severe depression have 4.27 times higher odds of experiencing musculoskeletal discomfort compared to those without depression (odds ratio 4.27, 95% confidence interval [1.27, 14.41]). Severe depression was found to be a significant predictor of musculoskeletal disorders. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: Nurses are at high risk for musculoskeletal disorders. The results of this study indicate that level of risk is influenced significantly by psychological well-being, work environment, and workload. Efforts should be made to improve the relevant risk factors in the workplace to reduce the incidence of musculoskeletal disorders among nurses.

Rates of susceptibility of carbapenems, ceftobiprole, and colistin against clinically important bacteria collected from intensive care units in 2007: Results from the Surveillance of Multicenter Antimicrobial Resistance in Taiwan (SMART).

BACKGROUND: Data on susceptibility to ceftobiprole and colistin, and the complete evolutionary trends of minimum inhibitory concentrations (MICs) of important carbapenem agents among important pathogens collected in intensive care units (ICUs) in Taiwan are lacking. METHODS: We surveyed the MIC distribution patterns of ceftobiprole and colistin and susceptibility profiles of some important pathogens collected from patients hospitalized in intensive care units (ICUs) of major teaching hospitals throughout Taiwan in 2007. We also investigated the rates of nonsusceptibility to powerful carbapenems (imipenem, meropenem) among four important species of Enterobacteriaceae (Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae, and Proteus mirabilis) collected during the same period. MIC breakpoints recommended by the Clinical and Laboratory Standards Institute in 2014 were applied. RESULTS: Colistin showed excellent in vitro activity (susceptibility rate, 96%) against Acinetobacter baumannii isolates but moderate (73-77% susceptibility rate) activity against isolates of Pseudomonas aeruginosa and E. cloacae. The ceftobiprole MIC90 value was 4 µg/mL for methicillin-resistant Staphylococcus aureus and 16 µg/mL for P. aeruginosa. The phenotype of methicillin resistance did not markedly increase the MIC value of ceftobiprole among S. aureus isolates. Interestingly, the proportion of isolates that displayed nonsusceptibility to imipenem was significantly higher among P. mirabilis isolates than among isolates of the other three Enterobacteriaceae species, regardless of the production of extended-spectrum ß-lactamase. CONCLUSION: Continuous monitoring of susceptibility profiles of ICU pathogens to important antibiotics is warranted to provide appropriate antimicrobial regimens against infections in the ICU.

Carbapenem susceptibility among Escherichia coli, Klebsiella pneumoniae, and Enterobacter cloacae isolates obtained from patients in intensive care units in Taiwan in 2005, 2007, and 2009.

To investigate the evolutionary trends in non-susceptibility of carbapenems against the isolates of Escherichia coli, Klebsiella pneumoniae, and Enterobacter cloacae from patients hospitalized in intensive care units (ICUs) of major teaching hospitals throughout Taiwan during 2005-2009, we applied the breakpoints of MICs recommended by Clinical and Laboratory Standards Institute and European Committee on Antimicrobial Susceptibility Testing in 2013. Escalations in imipenem MIC levels for overall E. coli and E. cloacae isolates and extended-spectrum ß-lactamase (ESBL)-producing K. pneumoniae isolates were noted during this period. The overall MIC levels against imipenem and meropenem for subgroups of ESBL producers of 3 Enterobacteriaceae species were significantly higher than those of respective overall groups in 2007 and 2009. Compared with meropenem, we found that significant evidence of imipenem MIC creep and evidence of extraordinarily high rates of non-susceptibility to ertapenem among isolates of 3 species in 2009 existed. The prominent rises in rates of ertapenem non-susceptibility for ESBL-producing E. coli and K. pneumoniae during 2005-2009 and rate of ESBL positivity for E. cloacae between 4 years were notably found. Based on our findings, ertapenem should be used cautiously in management of the ICU infections caused by these potentially ESBL-producing Enterobacteriaceae isolates in Taiwan.

Psychometric analysis of the Short-Form Chinese Health and Safety Executive's Management Standards Indicator Tool among nurses in Taiwan.

The purpose of the study was to develop a Short-Form Chinese version of the Health and Safety Executive's Management Standards Indicator Tool that can be used to measure work-related stress among nurses in Taiwan. Three subscales (supportive climate, role perception, and workload) were developed from an exploratory factor analysis. The three-factor confirmatory factor analysis indicated that the model fit the data well. The evidence based on convergent validity was supported by a significant correlation between the Short-Form Chinese version of the Health and Safety Executive's Management Standards Indicator Tool and the job satisfaction subscale of the Chinese Patient Safety Attitude Questionnaire. Cronbach's α values demonstrated internal item consistency for the Short-Form Chinese version of the Health and Safety Executive's Management Standards Indicator Tool.

Relationship between the distribution of cefepime minimum inhibitory concentrations and detection of extended-spectrum ß-lactamase production among clinically important Enterobacteriaceae isolates obtained from patients in intensive care units in Taiwan: results from the Surveillance of Multicenter Antimicrobial Resistance in Taiwan (SMART) in 2007.

BACKGROUND: The data on susceptibility of important cephalosporins against four Enterobacteriaceae members producing potential extended-spectrum ß-lactamase (ESBL) collected from Taiwanese intensive care units are lacking. METHODS: Minimum inhibitory concentrations (MICs) of cefotaxime, ceftazidime, and cefepime were determined using agar dilution method, against Escherichia coli (n = 344), Klebsiella pneumoniae (n = 359), Enterobacter cloacae (n = 103), and Proteus mirabilis (n = 78). Susceptibilities of these isolates to three cephalosporins were assessed according to MIC breakpoints recommended by the Clinical and Laboratory Standards Institute (CLSI) and the European Committee on Antimicrobial Susceptibility Testing (EUCAST) in 2013. The double-disk synergy test using disks containing cefepime (30 µg) with or without clavulanate (10 µg) was applied to confirm production of ESBL for isolates with cephalosporin MIC ≥ 2 µg/mL. RESULTS: A total of 175 isolates were verified as ESBL producers. The rates of cefepime susceptibility among the ESBL-producing isolates, according to CLSI (EUCAST) criteria, were 56.7% (22.4%) for E. coli, 61.3% (12.0%) for K. pneumoniae, 57.9% (31.6%) for E. cloacae, and 71.4% (7.1%) for P. mirabilis. Using different cefepime MIC breakpoints (MICs ≥ 16 µg/mL recommended by CLSI criteria and ≥ 2 µg/mL by EUCAST criteria) to define nonsusceptibility, we found that both criteria were poorer at predicting ESBL producers among K. pneumoniae and E. cloacae than among the other two species. In addition, we also found that the cefepime MIC level of 1.0 µg/mL best distinguished non-ESBL- from ESBL-producing K. pneumoniae and E. cloacae. CONCLUSION: To detect ESBLs, CLSI should revise the cefepime MIC breakpoint against Enterobacteriaceae.

Carbapenem susceptibilities and non-susceptibility concordance to different carbapenems amongst clinically important Gram-negative bacteria isolated from intensive care units in Taiwan: results from the Surveillance of Multicentre Antimicrobial Resistance in Taiwan (SMART) in 2009.

To investigate the in vitro susceptibilities to various carbapenems amongst clinical Gram-negative bacteria isolated from patients in intensive care units of ten major teaching hospitals in Taiwan in 2009, a survey was conducted to determine the minimum inhibitory concentrations (MICs) of ertapenem, imipenem, meropenem and doripenem against isolates of Enterobacteriaceae (n = 594), Pseudomonas aeruginosa (n = 185), Acinetobacter baumannii (n = 192) and Burkholderia cepacia (n = 23) using the agar dilution method. Susceptibilities were determined according to 2009, 2011 and 2012 MIC breakpoints recommended by the CLSI as well as 2012 MIC breakpoints recommended by EUCAST. Based on CLSI 2012 criteria, the ertapenem susceptible rate was 93%, 81%, 68% and 92% for Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae and Serratia marcescens, respectively. All Proteus mirabilis and Morganella morganii isolates were susceptible to ertapenem; however, 64% of P. mirabilis and all M. morganii isolates were non-susceptible to imipenem. Meropenem and doripenem had better activities than imipenem against ertapenem-non-susceptible Enterobacteriaceae isolates. E. coli, K. pneumoniae and E. cloacae with ertapenem MICs≥4 mg/L were synchronously not susceptible to imipenem, meropenem and doripenem. Imipenem susceptibility was 65% and 29% for P. aeruginosa and A. baumannii, respectively. Additionally, P. aeruginosa and A. baumannii isolates with imipenem MICs≥8 mg/L were also not susceptible to meropenem and doripenem. These data provide a better understanding of choosing appropriate carbapenem agents to treat infections caused by ertapenem-non-susceptible Enterobacteriaceae as well as P. aeruginosa and A. baumannii isolates with imipenem MICs≥4 mg/L.

Physiological analysis of silver nanoparticles and AgNO3 toxicity to Spirodela polyrhiza.

Silver nanoparticles (AgNPs) are commonly used in consumer products for their antibacterial activity. Silver nanoparticles may adversely influence organisms when released into the environment. The present study investigated the effect of AgNPs on the growth, morphology, and physiology of the aquatic plant duckweed (Spirodela polyrhiza). The toxicity of AgNPs and AgNO(3) was also compared. The results showed that silver content in plant tissue increased significantly with higher concentrations of AgNPs and AgNO(3) . Silver nanoparticles and AgNO(3) significantly decreased plant biomass, caused colonies of S. polyrhiza to disintegrate, and also resulted in root abscission. Physiological analysis showed that AgNPs and AgNO(3) significantly decreased plant tissue nitrate-nitrogen content, chlorophyll a (Chl a) content, chlorophyll a/b (Chl a/b), and chlorophyll fluorescence (Fv/Fm). Changes in soluble carbohydrate and proline content were also detected after both AgNO(3) and AgNPs treatment. However, after 192 h of recovery, total chlorophyll content increased, and Fv/Fm returned to control level. Median effective concentration (EC50) values for Chl a and phosphate content showed that AgNO(3) was more toxic than AgNPs (EC50 values: 16.10 ± 0.75 vs 7.96 ± 0.81 and 17.33 ± 4.47 vs 9.14 ± 2.89 mg Ag L(-1) , respectively), whereas dry-weight EC50 values showed that AgNPs were more toxic than AgNO(3) (13.39 ± 1.06 vs 17.67 ± 1.16 mg Ag L(-1) ).

Characterization of a new phage, termed ϕA318, which is specific for Vibrio alginolyticus.

Vibrio alginolyticus is an opportunistic pathogen of animals and humans; its related strains can also produce tetrodotoxin and hemolysins. A new phage, ϕA318, which lysed its host V. alginolyticus with high efficiency, was characterized. The burst size of ϕA318 in V. alginolyticus was 72 PFU/bacterium at an MOI of 1 at room temperature; the plaque size was as large as 5 mm in diameter. Electron microscopy (EM) of the phage particles revealed a 50- to 55-nm isomorphous icosahedral head with a 12-nm non-contractile tail, similar to the T7-like phages of the family Podoviridae. Phylogenetic analysis based on complete sequences of the DNA-directed RNA polymerase gene revealed that ϕA318 had 28-47% amino acid identity to enterobacteria phages T7 and SP6, and other Vibrio phages, and the phylogenetic distance suggested that ϕA318 could be classified as a new T7-like bacteriophage. Nevertheless, several motifs in the ϕA318 phage RNA polymerase were highly conserved, including DFRGR (T7-421 motif), DG (T7-537 motif), PSEKPQDIYGAVS (T7-563 motif), RSMTKKPVMTL PYGS (T7-627 motif), and HDS (T7-811 motif). Genetic analysis indicated that phage ϕA318 is not a thermostable direct hemolysin producer. The results suggest that the MOI should be higher than 0.1 to prevent the chance of hemolysin production by the bacteria before they are lysed by the phage.

Effect of acupressure on nausea, vomiting, anxiety and pain among post-cesarean section women in Taiwan.

The purpose of this study was to examine the effectiveness of acupressure for controlling post-cesarean section (CS) symptoms, such as nausea and vomiting, anxiety perception and pain perception. A total of 104 eligible participants were recruited by convenience sampling of operating schedules at two hospitals. Participants assigned to the experimental group received acupressure, and those assigned to the control group received only postoperative nursing instruction. The experimental group received three acupressure treatments before CS and within the first 24 hours after CS. The first treatment was performed the night before CS, the second was performed 2-4 hours after CS, and the third was performed 8-10 hours after CS. The measures included the Rhodes Index of Nausea and Vomiting, Visual Analog Scale for Anxiety, State-Trait Anxiety Inventory, Visual Analog Scale for Pain, and physiologic indices. Statistical methods included percentages, mean value with standard deviation, t test and repeated measure ANOVA. The use of acupressure reduced the incidence of nausea, vomiting or retching from 69.3% to 53.9%, compared with control group (95% confidence interval = 1.65-0.11; p = 0.040) 2-4 hours after CS and from 36.2% to 15.4% compared with control group (95% confidence interval = 0.59-0.02; p = 0.024) 8-10 hours after CS. Results indicated that the experimental group had significantly lower anxiety and pain perception of cesarean experiences than the control group. Significant differences were found in all physiologic indices between the two groups. In conclusion, the utilization of acupressure treatment to promote the comfort of women during cesarean delivery is strongly recommended.