Experience with a step-down respiratory care center at a tertiary referral medical center in Taiwan

OBJECTIVE: The aim of the study was to describe the outcome of patients after 1 year's implementation of an integrated delivery system for respiratory care mandated by the National Health Insurance Bureau in Taiwan. DESIGN: A retrospective observational study was conducted in a step-down respiratory care center (RCC). PATIENTS: Patients included adults receiving prolonged mechanical ventilation (> or =21 days). MEASUREMENTS AND MAIN RESULTS: A total of 224 cases were available for review; 108 (48.2%) patients were successfully weaned. Those who failed weaning had a longer stay in the intensive care unit and RCC (25.1 vs 20.9 and 31.4 vs 18.6 days, P < .05), but there were no differences in the patients' ages (74.3 vs 70.4 years, P = .17) or the Simplified Acute Physiology Score II (52 vs 46.9, P = .18) before admission to the RCC. After discharge from the RCC, only 4.9% of the patients still on a ventilator were weaned within 1 year. Patients who failed weaning in the RCC had a shorter overall survival (5.2 vs 10.4 months, P < .05) and a lower 1-year survival (23.6% vs 44.6%, P < .05). CONCLUSION: Patients admitted to the RCC were still critically ill. Patients who failed weaning in the RCC had had a longer intensive care unit and RCC stay and a worse outcome after leaving the RCC.     

Nurses' attitudes toward nursing research at a metropolitan medical center.

To support the implementation of a nursing research initiative in a large medical center, we collected baseline data on nurses' attitudes toward nursing research, perception of the institution as a research environment, and personal involvement in research activities. This study replicates that conducted by Rizzuto, Bostrom, Suter, and Chenitz [Predictors of nurses' involvement in research activities. Western Journal of Nursing Research, 16(2), 193-204] in 1994. To better understand the findings, we traced the historical evolution of nursing research through successive American Nurses Association codes of ethics. Our review of the literature presents (in table format) factors that encourage and those that impede nursing research. The study results validate the work of other researchers: nurses' positive attitudes toward research are discordant with their actual involvement in research activities. The data suggest that positive attitudes and perceived institutional support are not enough to increase involvement in nursing research; as such, we describe additional institutional infrastructure and forms of educational support.     

Distribution and drug susceptibilities of Candida species causing candidemia from a medical center in central Taiwan

Invasive fungal infections have increased significantly in the past few decades because of the increase in high-risk populations. To investigate the distribution and drug susceptibilities of such infections, we analyzed all 152 Candida isolates causing candidemia from 2004 to 2006 at the China Medical University Hospital, a medical center in central Taiwan. Candida albicans was the most common species, accounting for 52.6 % of the isolates, followed by C. tropicalis (19.7 %), C. parapsilosis (14.5 %), C. glabrata (8.6 %), C. guilliermondii (3.9 %), and C. pelliculosa (0.7 %). All isolates were susceptible to amphotericin B, anidulafungin, micafungin, and voriconazole according to minimum inhibitory concentrations (MICs) after a 24-h incubation; 0.7 %, 6.6 %, and 7.9 % of isolates were resistant to amphotericin B, fluconazole, and voriconazole, respectively, after 48-h incubation. Both C. albicans and C. parapsilosis had high degrees of agreement for azoles between 24- and 48-h incubation periods, whereas C. glabrata (38.5–46.2 %) and C. tropicalis (56.7–63.3 %) did not. The majority of the isolates with high azole MICs displayed a trailing growth phenotype. Hence, the MICs of different drugs after 24-h incubation may be considered for prognosis of candidemia.     

社区医疗中心护理组织与管理

随着城市医疗保险制度改革的不断深入，社区医疗中心的护理组织与管理就变得更为重要。笔介绍了北京大学医院社区医疗服务中心的设施组成以及人员组织结构，然后就中心护理管理中的护士培训、护理规则、护理内容、护理组织进行了详细的讨论，这些措施为保证北京大学医院社区医疗服务中心取得良好的社会效益提供了保障。     

Journal club intervention in promoting evidence-based nursing: Perceptions of nursing students

This study focused on nursing journal clubs as an intervention in promoting evidence-based nursing. Nursing journal clubs refer to arranged meetings where nurses convene to discuss the use of research knowledge in nursing practice. Researchers and directors of a university hospital planned the intervention. The study aimed to assess learning and utilization of research knowledge after implementation of nursing journal clubs from the perspective of nursing students. In journal clubs, answers were sought from scientific nursing articles to solve nursing problems specified by each ward/outpatient unit. Nursing students paired up to make an oral presentation of a research article to staff nurses. After the presentation, they acted as chairpersons in the discussion. The students had a vocational nursing diploma and were aiming at bachelor's degree in nursing. After the final club meeting, the students (n = 53) responded to a questionnaire.The results indicated that the students were not able to utilize the studies to the same extent as they learnt from them. Age, work experience and participation in research and development activities were connected to learning. Despite limitations, the results may be used to develop nursing journal clubs as a learning and collaboration method between nurse education and health care.     

Economic benefits of sponsored clinical trials on pharmaceutical expenditures at a medical center in Taiwan

Concerns exist regarding the additional cost of patient care when patients are enrolled in clinical trials at hospitals. To assess the avoidance of drug costs by conducting sponsored clinical trials, a retrospective analysis evaluating drug cost avoidance in all sponsored clinical trials was conducted in 2008 at the most prominent medical center in Taiwan. The National Health Insurance (NHI) reimbursement prices of either the investigated drugs or the standardized drug therapy for each specific disease were used to calculate the cost avoidance. Drug cost avoidance from sponsored clinical trials per year, per trial, per patient, in different therapeutic areas, and in different phases was analyzed. Three quarters of the cost avoidance in drug expenditures from 194 sponsored clinical trials were estimated. All cost values are in US Dollars. Around $11.2 million was avoided at the center in 2008. The average value of cost avoidance was $58,000/trial-year or $3,900/participant-year. The early-phase trials and phase III trials accounted for 25% and 56% of all trials, respectively, while they constituted 32% and 49% of the total costs avoided, respectively. The most frequently conducted and highest cost-avoiding trials were those for antineoplastic agents, especially targeted therapy which accounted for 85% of the total cost avoidance of anti-cancer trials. This study demonstrates the profoundly positive economic impact on the healthcare system in Taiwan by sponsored clinical trials. To understand the trend of economic benefits of the trials on pharmaceutical expenditure, it would be important to analyze the cost avoidance of trials regularly in an institution.     

正确认识循证护理推动护理实践发展

循证护理即通过寻求最佳临床证据为临床护理实践中的决策提供可靠的科学依据.然而在开展循证护理过程中,也出现了一些概念认识上的误区,本文对循证护理的概念、方法的认识及应用方面存在的一些误区进行分析,认为循证护理既是一种工作方法,又是一种观念,但并非一种模式或工作形式,同时在实施循证护理的过程中存在一些方法论上的误区,应加以纠正,才能切实推进循证护理在我国护理实践中的应用.     

循证护理在内科护理学教学中的应用

目的 在内科护理学的教学中融入循证护理内容,验证教学改革对提高护理专业学生循证护理知识与技能的作用,为护理教育者完善临床课教学提供依据.方法 采用自制的循证护理知识、技能调查问卷及教学效果反馈问卷对73名大学四年级护理专业本科学生进行调查,前者采用前后对照法.结果 学生的循证护理相关知识和技能都有不同程度的提高.多数学生认为教学改革对于指导今后的护理实践和加深所学的理论知识有积极作用.结论 在内科护理学的教学中融入循证护理内容有助于学生相应知识、技能的完善,对于其今后的护理实践具有积极作用.     

全面提升军队疗养院护理质量的做法及体会

目的为了提升军队疗养院护理质量,强化护理人员质量意识,进一步推进疗养院护理管理的科学化、规范化和标准化建设。方法健全护理质量管理组织,规范护理质量监控程序,制定护理质量控制标准,规范服务流程,统一办公用品的配备及放置。结果有效地改进了护理质量,强化了质量管理意识,提升了护理人员的综合能力。结论疗养院护士由于服务性质的原因,大部分护士满足于宾馆服务员的工作模式,安于现状,知识及技术更新缓慢。因此,作为疗养院的护理管理者,应居安思危,增强护理风险防范意识,强化护理质量管理,全面提升护理质量,确保疗养护理安全。     

Spinal muscular atrophy genetic testing experience at an academic medical center

Approximately 94% of spinal muscular atrophy (SMA) patients lack both copies of SMN1 exon 7. We report our SMA genetic testing experience (total 1281 cases), using SMA linkage analysis (32 families), SMA diagnostic testing by PCR-RFLP (restriction fragment length polymorphism) to detect the homozygous absence of SMN1 exon 7 (and exon 8) (533 cases), and an assay to determine copy number of SMN1 exon 7 (SMN1 gene dosage analysis) (716 cases). SMN1 gene dosage analysis is used for SMA carrier testing as well as for the confirmation of a heterozygous SMN1 deletion in symptomatic individuals who do not lack both copies of SMN1. We conclude that comprehensive SMA testing, including SMN1 deletion analysis, SMN1 gene dosage analysis, and linkage analysis, offers the most complete evaluation of SMA patients and their families.     

An experience of transition from a medical model to a nursing model in nurse education

The major focus of the paper will be on the change from a curriculum content which was primarily medically dominated to one in which a nursing model is clearly identified. The implications of such changes for nurse teachers, clinical staff and student nurses are discussed.     

Noise reduction at an emergency intensive care unit of medical center in southern Taiwan

This project was the result of numerous complaints from patients and their families about high levels of human and mechanical noise inside the emergency intensive care unit (EICU) of a major medical center in southern Taiwan. Other complaints were made by members of the medical staff, who claimed that they could not hear the alarms built into medical equipment. The project entailed a data inventory, analysis, and the identification of noise sources. Maximum mechanical noise level was measured at 79.6 dBA. After classifying noise sources as non-mechanical or mechanical, we established a list of objectives and used 13 approaches to achieve them. As a result, average reduction in mechanical noise volume was 11.72 dBA (14.47%) and in non-mechanical noise volume 10.5 dBA (14.0%). Still, we were only successful in protecting 50% of all EICU patients from noise disturbance levels according to the guidelines established in the Noise Prevention Act that is used in the United States. We therefore recommend that noise monitoring systems be added in order to increase the percentage of EICU patients who are protected from unnecessary noise.     

Symptom management excellence initiative: promoting evidence-based oncology nursing practice

Accessing and using the best evidence for cancer symptom interventions are prerequisites for nursing excellence. To incorporate evidence into direct care practice, staff at the Dana-Farber Cancer Institute implemented the Symptom Management Excellence initiative to compare patients' and nurses' reports of their most frequent and highest priority cancer symptoms. Interdisciplinary teams then convened to design and test the feasibility of bringing symptom management evidence into clinical practice. This article describes how the initiative has successfully used patient-reported data, direct-care nurse input, research evidence, and expert opinion to systematically improve cancer symptom management.     

Older sarcoidosis patients: experience of a medical center in Turkey

OBJECTIVES: Although sarcoidosis is classically defined to be a disease of young adults, it might also be seen at older ages. There are very few clinical studies which focus on the features of patients diagnosed at older ages. In this study, we tried to determine the frequency of patients diagnosed at or above 50 years of age and to compare the clinical and demographic features of these subjects with other sarcoidosis patients. METHODS: We evaluated the general clinical features of sarcoidosis patients more than 50 years of age who were diagnosed at our center within a 36-year period. We also compared the clinical features of older sarcoidosis patients with the features of other patients. RESULTS: Of 579 sarcoidosis patients being followed up at our center, 102 (17.7%) were older than 50 years of age at the time of initial diagnosis. The female to male ratio in this group was higher than the ratio in other sarcoidosis patients (3.43 versus 1.85, P = 0.015). When the features of older patients were compared with other sarcoidosis patients, extrapulmonary involvement was observed to be more common in this group (P < 0.001). By contrast, arthritis or arthralgia (P < 0.001), clinical presentation in the form of L?fgren syndrome (P < 0.001), erythema nodosum (P < 0.001), and uveitis (P = 0.006) were less frequent. CONCLUSIONS: Although generally presenting as a disease of the young, in many subjects sarcoidosis is diagnosed at older ages, and this study indicates that the clinical features of sarcoidosis in older subjects differ from those found among younger patients.