Effectiveness of a computerised system of patient education in clinical practice: a longitudinal nested cohort study.

INTRODUCTION: Developing electronic health record information systems is an international trend for promoting the integration of health information and enhancing the quality of medical services. Patient education is a frequent intervention in nursing care, and recording the amount and quality of patient education have become essential in the nursing record. The aims of this study are (1): to develop a high-quality Patient Education Assessment and Description Record System (PEADRS) in the electronic medical record (2); to examine the effectiveness of the PEADRS on documentation and nurses' satisfaction (3); to facilitate communication and cooperation between professionals. METHODS AND ANALYSIS: A quasi-experimental design and random sampling will be used. The participants are nurses who are involved in patient education by using traditional record or the PEADRS at a medical centre. A prospective longitudinal nested cohort study will be conducted to compare the effectiveness of the PEADRS, including (1): the length of nursing documentation (2); satisfaction with using the PEADRS; and (3) the benefit to professional cooperation. ETHICS AND DISSEMINATION: Patient privacy will be protected according to Electronic Medical Record Management Practices of the hospital. This study develops a patient education digital record system, which would profit the quality of clinical practice in health education. The results will be published in peer-reviewed journals and will be presented at scientific conferences.

The Effects of an Exercise Program on Anxiety Levels and Metabolic Functions in Patients With Anxiety Disorders.

The purpose of this study was to evaluate the effects of a home-based (HB) exercise program on anxiety levels and metabolic functions in patients with anxiety disorders in Taiwan. Purposive sampling was used to recruit 86 participants for this randomized, experimental study. Participants were asked to complete a pretest before the 3-month exercise program, a posttest at 1 week, and a follow-up test at 3 months after the exercise program. Study measures included four Self-Report Scales and biophysical assessments to collect and assess personal data, lifestyle behaviors, anxiety levels, and metabolic control functions. Of the 86 study participants, 83 completed the posttest and the 3-month follow-up test, including 41 in the experimental group and 42 in the control group. Participants in the experimental group showed significant improvements in body mass index, high-density lipoprotein cholesterol levels, and the level of moderate exercise after the program relative to the control group, as analyzed by generalized estimating equations mixed-model repeated measures. State and trait anxiety levels were also significantly improved from pretest to follow-up test in the experimental group. Finally, the prevalence of metabolic syndrome declined for participants in the experimental group. The HB exercise program produced positive effects on the metabolic indicators and anxiety levels of Taiwanese adults with anxiety disorders. Health providers should consider using similar HB exercise programs to help improve the mental and physical health of patients with anxiety disorders in their communities.

Increased low back pain risk in nurses with high workload for patient care: A questionnaire survey.

OBJECTIVE: To examine whether the prevalence of low back pain (LBP) increased in hospital nurses with high patient care workload. MATERIALS AND METHODS: A structured, self-administered questionnaire was used to collect information on the prevalence of LBP and its associated factors from 788 registered nurses from a medical center in Taiwan. RESULTS: Among all nurses with eligible questionnaires, 567 (72.0%) had LBP. Mean daily hours of working, standing, and walking were persistently longer in the LBP group. Results from multivariate logistic regression analysis showed that daily working for 1 hour longer is linked to a 35% (95% confidence interval (CI)=2-78%) greater risk of LBP. Compared with <2 years of service as nurse, nurses with 2-5 years of service had the highest risk (odds ratio (OR)=2.11, 95% CI=1.07-4.18). LBP risk was also higher for nurses with chore duty responsibilities (OR=1.99, 95% CI=1.12-3.53) and other back related disorders (OR=4.43, 95% CI=1.99-9.86). CONCLUSION: Our results suggest that longer daily working hours and a large number of cared patients per shift should be discouraged in order to prevent musculoskeletal problems such as LBP in registered nurses.

Increased Risk of Coronary Heart Disease in Patients with Primary Fibromyalgia and Those with Concomitant Comorbidity-A Taiwanese Population-Based Cohort Study.

OBJECTIVES: Fibromyalgia has seldom been associated with coronary heart disease (CHD). The aim of this study was to evaluate the risk of CHD in patients with fibromyalgia. METHODS: We used a dataset of one million participants, systemically scrambled from the Taiwanese national insurance beneficiaries, to identify 61,612 patients with incident fibromyalgia (ICD-9-CM 729.0-729.1) and 184,834 reference subjects matched by sex, age and index date of diagnosis in a 1:3 ratio from 2000 to 2005, with a mean 8.86 ± 2.68 years of follow-up until 2011. Risk of CHD was analyzed by Cox proportional hazard modeling. RESULTS: Patients with fibromyalgia had a mean age of 44.1 ± 16.5 years. CHD events developed in fibromyalgia patients (n = 8,280; 15.2 per 103 person-years) and reference subjects (n = 15,162; 9.26 per 103 person-years) with a significant incidence rate ratio of 1.64 (95% confidence interval: 1.61-1.68). The adjusted hazard ratio for CHD in fibromyalgia patients relative to reference subjects was 1.47 (1.43-1.51), after adjusting for age, gender, occupation, monthly income, traditional cardiovascular comorbidities, depression and anxiety. We noted that fibromyalgia and cardiovascular comorbidities had a significant interaction effect on CHD risk (p for interaction <0.01), which was markedly enhanced in fibromyalgia patients with concomitant comorbidities relative to patients with primary fibromyalgia and reference subjects (no fibromyalgia, no comorbidity). CONCLUSIONS: Our report shows that fibromyalgia patients have an independent risk for CHD development. Fibromyalgia patients with concomitant comorbidities have markedly increased CHD risk relative to those with primary fibromyalgia.

Acupressure and meridian massage: combined effects on increasing body weight in premature infants.

AIMS AND OBJECTIVES: The purpose of this study was to assess the body weight gain of combined acupressure and meridian massage in premature infants. BACKGROUND: Each year in Taiwan, 8-10% of newborns are delivered prematurely. Effective postnatal care is essential to ensure the healthy development of premature infants. Massage therapy has been administered to facilitate weight gain in the neonatal unit. The evidence-based findings in previous studies did not include acupressure or meridian massage. DESIGN: A double-blind clinical trial was conducted in a medical centre in central Taiwan. METHODS: Forty subjects were randomised into two groups. The 20 subjects in the experimental group were given a standard procedure of acupressure at Zhongwan, Zusanli, Yongquan, abdominal rubbing, spleen and stomach meridian massage, and kneading the points along the spine of the bladder meridian. These treatments were administered for 15 minutes per session, one hour before meals, three times daily over 10 days. The control group, also consisting of 20 subjects, underwent routine care and was observed. The infants' body weights and the volume of milk ingested were measured and recorded daily. RESULTS: The daily average weight gain of the infants in the experimental group was 32.7 g (SD = 8.1) compared with 27.3 g (SD = 7.7) in the control group. While in the first week there was no significant difference in weight gain between the two groups; in the second week, the weight gain observed in the experimental group was significantly higher than that observed in the control group. CONCLUSIONS: An experimental trial established the effects of using acupressure and meridian massage on increasing body weight in premature infants. Acupressure and meridian massage have a significant effect on weight gain in premature infants. RELEVANCE TO CLINICAL PRACTICE: Nurses could be trained in acupressure and meridian massage techniques to provide more effective level of clinical care for premature infants.