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Effects Of Steno Diabetes Dialogue Cards (Steno Balance Cards) As A Teaching Aid On Blood Glucose Management In Adolescents With Type 1 Diabetes
No full textA Project to Improve Nasal Ice Packs
No full text[[abstract]]鼻部疾病是耳鼻喉科常見疾病，多尋求中西醫治療，當各項治療無效即選擇外科手術治療。2006年統計該病房接受手術治療的病人數255人，術後鼻部疼痛腫脹是常見的，因此減輕腫脹疼痛就成為最重要的護理工作之一。筆者於臨床照護中發現病人常抱怨術後鼻部腫脹疼痛不適，資料收集發現病人使用冰敷意願低，調查該單位鼻部手術後使用廠商製作鼻型局部冰敷物品之30位病人，結果因其不服貼(100%)、不易固定(100%)、不實用及不方便性(83.3%)等原因，故整體使用率僅達16.7%。透過本專案改善於臨床中找尋替代物品，以橡皮手套裝置50公克碎冰與水，將其集中於其中兩指併緊束，以棉質白色帶子固定於約束處作耳部固定。以自製鼻型冰敷物提昇冰敷使用率，改善其不服貼、不易固定、增加實用及方便性，達減輕疼痛及局部腫脹之效果。專案實施後改善結果顯示：病人使用冰敷意願提昇至96.7%，冰敷物品服貼度提昇至96.7%，容易固定達100%，實用及使用方便達96.7%。專案改善結果顯著，提高病人服務品質降低成本，期此改善方案能提供有需使用鼻部局部冰敷之單位參考。
Nasal problems are a commonly encountered diseases in the ENT (ear, nose, and throat) specialty. People with nasal problems usually seek medical therapy. When the problem cannot resolved by medical therapy then surgery becomes an option. According to statistics of the ENT unit where author served in 2006, 255 patients underwent nasal surgery. Swelling and pain are the most common discomfort symptoms for patients after nasal surgery. After data collection, it was found that only 16.7% of patients were willing to use ice packs, because they attached poorly (100%), were difficult to secure (100%), and were inconvenient to use (83.3%). After seeking an alternative ice pack replacement, the group decided to use a latex glove filled with 50 gm crushed ice and water in its index and middle fingers, tied with shoe laces and tied to the ears. The project involved three periods: preparation, execution, and evaluation. The results showed that 96.7% of patients were willing to use the new ice pack. The satisfaction rate for use of the new ice pack was 96.7%. The results of this project might improve patients' quality of care, as well as cost reduction
Physical Restraints Use among Residents Living in Organization
No full text[[abstract]]臨床上，護理人員為避免病人因拔管、跌倒及跌倒復引發合併症的醫療疏失，導致家屬對照護人員的興訟糾紛，通常會對病人使用身體約束；其次，部分機構因照護人力不足，而默許身體約束為合理措施。依據臨床研究顯示，約束住民不僅未能預防跌倒或縮減照護人力，反易徒增住民跌倒、受傷、死亡的危險；但身體約束迄今仍被廣泛使用於急、慢性醫療與長期照護機構。相較於美國28%、澳洲25.5%及挪威17%之約束使用率，台灣機構住民身體被約束比率達46.6%明顯偏高。研究文獻指出護理人員的知識、態度、工作壓力、自我效能，在在影響其照護行為。綜觀目前長期照護機構之教育課程，大多侷限於如何改良約束帶、強調合理約束住民、簽署家屬同意書等議題，攸關無約束照護環境的規劃與設計，則付諸闕如。事實上，歐美各國為營造無約束的長期照護環境、減少照護人員使用身體約束，執行教育課程之作法已行之多年，可提供爾後國內長期照護職司部門擬訂約束政策參考，期冀有效降低機構住民身體約束使用率。
In clinical settings, nursing staff and other health professionals may use the physical restraints to prevent patients attempting to remove their tubes and to prevent falls. In addition, some facilities may allow caregivers to use physical restraints because of lack of manpower. They believe that their use may prevent families to sue these facilities and health professionals for injuries alleged resulting from falls. A great deal of research has shown that use of physical restraints may not only fail to prevent but actually increase the rate of falls, injuries, and even deaths., Even so, use of physical restraints continues in patient care facilities everywhere. The prevalence of physical restraint use in Taiwan is 46.6% is relatively high while compared to use rates found in the United States, Australia, and Norway with 28%, 25.5%, and 17%, respectively. Some published research has pointed out that the knowledge, attitudes, working stress, and self efficacy have had important effects on nursing staff behaviors. However, educational programs directed toward nursing home patient care in Taiwan have not promoted a restraint free environment, but rather have emphasized improving the quality of restraint materials, creating reasonable restraint protocols reasons, and for getting informed consent from families and those legally responsible. No restraint environment in many other advanced industrialized countries by giving education. The question of whether the same criteria should be applied to Taiwan's long term care facilities and this question has important policy as well as clinical implications
Using Focus Groups to Explore the Experiences of Three Management Strategies in Auditory Hallucinations in Chronic Schizophrenic Patients
No full text[[abstract]]本研究主要目的為瞭解精神分裂症患者使用三種幻聽管理策略的經驗。於北部地區某精神專科醫院之三個慢性病房帶領三輪的幻聽管理策略的焦點團體，每輪12次，每週一次，共教導10種管理策略，本研究擷取其中三種；每輪有8-10個個案參與，共有27人，而參與的研究對象為精神分裂症合併有幻聽的個案。將訪談資料轉錄為文本後，以內容分析法分析，結果有三大主題：一．基本要素：規則服藥、具洞察力、動機與因時制宜的運用；二．促進因素：全神貫注、未雨綢繆、轉移注意力、適合自己；三．障礙因素：可及性差、有益的幻聽內容、短暫的專注於管理策略。本研究結果可做為護理人員提供管理策略於精神分裂症合併有幻聽干擾病人之參考。
This is a qualitative research study of chronic schizophrenic patients' experiences in the use of auditory hallucination management strategies. This report includes results of three focus groups with a total of 27 patients from a psychiatric hospital in the northern Taiwan. Each focus group consisted of 8 to 10 patients who met weekly for 12 weeks. Content analysis of the interview scripts showed three main themes: (1) basic elements, including compliance to prescribed medications, insightful observation, motivation and acting properly in the situation; (2) contributing factors, such as maintaining focus, predicting, distraction and adjusting self to the situation; and (3) impeditive factors, including inaccessibility, positive content in the auditory hallucinations and inability to maintain attention to management strategies
Samarium diiodide-mediated asymmetric reactions of 8-phenylmenthyl esters
No full text[[abstract]](−)-8-Phenylmenthol was used as a chiral auxiliary to direct asymmetric reactions of its preformed carboxylates. Reduction of xanthates 1a and 1b by SmI2 likely proceeded via HMPA-bound samarium enolate intermediates. Self- and cross-pinacolic coupling reactions of 8-phenylmenthyl α-oxoesters were achieved in a highly stereoselective manner by treatment with SmI2 at −78°C. The stereochemical outcome was consistent with a chelated mode of transition states
Acute glucose fluctuation impacts microglial activity, leading to inflammatory activation or self-degradation
No full text[[abstract]]Diabetes mellitus is associated with an increased risk of Alzheimer's dementia and cognitive decline. The cause of neurodegeneration in chronic diabetic patients remains unclear. Changes in brain microglial activity due to glycemic fluctuations may be an etiological factor. Here, we examined the impact of acute ambient glucose fluctuations on BV-2 microglial activity. Biochemical parameters were assayed and showed that the shift from normal glucose (NG; 5.5 mM) to high glucose (HG; 25 mM) promoted cell growth and induced oxidative/inflammatory stress and microglial activation, as evidenced by increased MTT reduction, elevated pro-inflammatory factor secretion (i.e., TNF-α and oxygen free radicals), and upregulated expression of stress/inflammatory proteins (i.e., HSP70, HO-1, iNOS, and COX-2). Also, LPS-induced inflammation was enlarged by an NG-to-HG shift. In contrast, the HG-to-NG shift trapped microglia in a state of metabolic stress, which led to apoptosis and autophagy, as evidenced by decreased Bcl-2 and increased cleaved caspase-3, TUNEL staining, and LC3B-II expression. These stress episodes were primarily mediated through MAPKs, PI3K/Akt, and NF-κB cascades. Our study demonstrates that acute glucose fluctuation forms the stress that alters microglial activity (e.g., inflammatory activation or self-degradation), representing a novel pathogenic mechanism for the continued deterioration of neurological function in diabetic patients
Kruger strict morphology and post-thaw progressive motility in cryopreserved human spermatozoa
No full text[[abstract]]The purpose of this prospective study was to evaluate Kruger strict morphology and conventional semen analysis in predicting cryosurvival and the progressive motility recovery rate of frozen spermatozoa. Our study included 56 semen samples with >10 million spermatozoa per ejaculate. The main outcome measures were conventional semen analysis, strict morphology analysis by the Kruger method, cryosurvival rate and post-thaw sperm motility. A significant reduction in sperm motility after cryopreservation was demonstrated. The freeze-thawing process caused a 66% reduction in rapid progressive motile spermatozoa, a 45% reduction in slow progressive motile spermatozoa and a 2% reduction in nonprogressive motile spermatozoa. The cryosurvival and progressive motility recovery rates were not correlated with parameters of conventional semen analysis, such as sperm concentration, motility, WHO morphology and total motile count, but the progressive motility recovery rate was significantly correlated with the percentage of spermatozoa exhibiting Kruger normal morphology (P = 0.028). The recovery rate of rapidly progressive motility was profoundly decreased compared with slow progressive motility following the frozen-thaw procedure of semen. Kruger strict morphology assessment was a better predictor of the progressive motility recovery rate following the freezing-thaw procedure than parameters of conventional semen analysis
