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[[alternative]]Exploring parental empathy, parental stress, parental efficacy and social support among primary caregivers of emotional disorders in children
No full text[[abstract]]本文為 探討情緒障礙兒童的主要照顧者在照顧有情緒行為障礙兒童所經歷的親職同理心、親職壓力、親職效能及社會支持程度之相關性。在 COVID 19疫情的衝擊下， 雖然 台灣情緒行為障礙兒童人數年增加，而兒童的情緒問題通常會帶給兒童和他人、家庭 高度困擾 但研究顯示 依附關係緩和了親職壓力，親子依附關係中的洞察力與反思力是親職同理心的內顯能力，近幾年興起同理心育兒觀念，同理心育兒可影響孩子對社會行為的關注。 在 台灣 研究 多 以 對情緒障礙兒童照顧者 的照顧壓力來進行深度探討，包含親職同理心、親職壓力、親職效能、社會支持 相關調查之研究 。本研究採描述性橫斷式研究，以方便取樣，經由五個問卷 對研究對象進行調查及 資料收集，分別為基本屬性、雙親同理心量表(Parental Empathy Measure)、親職壓力量表第四版簡式中文版（ Parenting Stress Index, Fourth Edition Short Form)、自我支持幫助之親職量表(Parenting Self Agency Measure) 、社會支持量表(Social Support Inventory)。 統計方法包含描述性統計、推性論統計、皮爾森相關性、多元複迴歸分析等 分析資料。本研究結果發現： 1. 情緒障礙兒照顧者家人/親友給予的社會支持為高度程度、醫療專業人員給予的社會支持為中度程度 2.情緒障礙兒照顧者的親職同理心、親職效能都是中度程度 3.親職壓力為正常壓力範圍 4.照顧者的年齡、性別、婚姻關係、庭結構、種族、宗教信仰、經濟狀況、健康狀況與情緒障礙兒的診斷、使用其他醫療資源、社會補助情形，在本研究為重要影響因子； 5.照顧者的親職效能對親職壓力、困難兒童為正相關 6.負向親職效能對親職壓力、父母困擾、親子失功能、困難兒童皆為正相關 7.社會支持、親職同理心、親職效能與親職壓力之間無共線性，故無法推論親職同理心為中介變項。[[abstract]]Objective: To explore the correlation between parental empathy, parental stress, parental efficacy and social support experienced by caregivers of children with emotional disorders in caring for children with emotional and behavioral disorders.Background: The number of children with emotional and behavioral disorders is increasing in Taiwan. Children's emotional problems can cause a high degree of distress to themselves and other people or their families. Attachment moderates parenting stress. Insight and reflection in the parent child attachment relationship are the inherent abilities of parent child empathy. In Taiwan, empathic parenting has received attention, and empathic parenting can influence children's emotion and behavior.Method: Descriptive cross sectional. Use basic attributes, Parental Empathy Measure, Parenting Stress Index, Parenting Self Support/Help Self Agency Measure and Social Support Inventory as assessment tools.Results: The social support given by family members/friends of caregivers of children with emotional disorders is high, and the social support given by medical professionals is moderate. Caregivers of children with emotional disorders have moderate levels of parental empathy and parental efficacy. Parental stress is normal pressure range. Caregiver's parenting efficacy is positively related to parenting stress and children with difficulties. There is a positive correlation between negative parenting efficacy and parenting stress, parental distress, parent child dysfunction, and children with difficulties. The research results cannot support parental empathy as a mediating variable
[[alternative]]Effects of home-based elastic band training intervention on the improvement of fatigue, sleep, muscle endurance and quality of life for patients with colorectal cancer
No full text[[abstract]]背景:結腸直腸癌是全球發生率和死亡率均居高不下的惡性腫瘤之一。依據國際癌症研究機構(International Agency for Research on Cancer, IARC)研究統計，全球結腸直腸癌新發病例數約為192萬例，死亡病例數約為90萬例，僅次於肺癌和肝癌。儘管醫療技術持續的進步，結腸直腸癌的治療效果有所提高，但仍然存在許多治療後病人身體狀態和心理健康需要康復的問題，進而影響生活品質。目的:探討彈力帶運動介入結腸直腸癌病人改善疲憊、睡眠、肌耐力及生活品質之成效。方法:本研究採隨機對照實驗性研究，收案對象為結腸直腸癌手術後三個月的病人。實驗組接受彈力帶訓練方案12週，使用磅數為3.0磅(1.4公斤力)彈力帶，以暖身及彈力帶運動設計，每週3天，每次訓練四個肌群，共12週，以視訊或電話追蹤；活性控制組給予輕度伸展運動。評估工具為結構式問卷、台灣癌症簡明疲憊量表(BFI-T)、匹茲堡睡眠品質量表(The Pittsburgh Sleep Quality Index, PSQI)、癌症生活品質問卷功能量表(EORTC QLQ-C30)、結腸直腸癌特異性生活量表(EORTC QLQ-CR29)及三日身體活動回憶紀錄法日誌(3-d Physical Activity Record, 3-dPAR)，肌耐力測量使用30秒坐站測試及六分鐘步行距離。測量時間為介入措施前(T1)、介入措施後第4週(T2)、第8週(T3)、第12週(T4)。結果:本研究收案65位病人，設計以區段隨機分派(block randomization) 1:1比例方式分成實驗組(n = 33)及活性控制組(n = 32)，採廣義估計方程式(Generalized estimating equations, GEE)來分析居家彈力帶訓練方案對結腸直腸病人在疲憊、睡眠、肌耐力及生活品質之影響。實驗組在運動介入後第12週時，EORTC QLQ-C30量表中功能層面之情緒功能(Wald χ2 = 6.00, p = 0.014)及社會功能(Wald χ2 = 4.51, p = 0.034)，症狀層面在疲憊(Wald χ2 = 6.69, p = 0.010)、疼痛(Wald χ2 = 5.95, p = 0.015)、便祕(Wald χ2 = 4.27, p = 0.039)有統計顯著差異；EORTC QLQ-CR29量表中症狀層面在頻尿(Wald χ2 = 12.47, p = <0.001)、排尿困難(Wald χ2 = 8.67, p = 0.003)、腹脹(Wald χ2 = 5.53, p = 0.019)，脹氣(Wald χ2 = 9.44, p = 0.002)等，均達統計上顯著差異。結論:彈力帶是一項方便攜帶且安全的運動工具，有助於改善結腸直腸癌病人的生活品質，並提升患者的活動能力及促進康復。本研究結果顯示，彈力帶訓練能改善脹氣、腹脹及便秘情況，對結腸直腸癌病人的腸胃道功能有多不同層面的正面影響。這顯示出居家彈力帶訓練的潛在價值，並為結腸直腸癌病患制定臨床運動計劃提供了科學依據及參考。[[abstract]]Background: Colorectal cancer remains one of the malignancies with high incidence and mortality rates globally. According to the International Agency for Research on Cancer (IARC), there are approximately 1.92 million new cases of colorectal cancer and around 900,000 deaths annually, making it the third most common cancer after lung and liver cancer. Despite continuous advancements in medical technology, the treatment outcomes for colorectal cancer have improved, but many patients still face physical and psychological health challenges post-treatment, which in turn affect their quality of life.Objective: This study aims to investigate the effectiveness of resistance band exercise interventions in improving fatigue, sleep, muscle endurance, and quality of life among colorectal cancer patients.Methods: This research adopts a randomized controlled experimental design, targeting patients three months post-colorectal cancer surgery. The experimental group underwent a 12-week resistance band training program, using 3.0-pound (1.4 kg) resistance bands, incorporating warm-up and resistance band exercises, three days a week, training four muscle groups each session, with follow-up via video or phone. The active control group was given light warm-up exercises. Evaluation tools included structured questionnaires, the Taiwan version of the Brief Fatigue Inventory (BFI-T), the Pittsburgh Sleep Quality Index (PSQI), the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), the colorectal cancer-specific quality of life questionnaire (EORTC QLQ-CR29), and the 3-day Physical Activity Record (3-dPAR). Muscle endurance was measured using the 30-second sit-to-stand test and the 6-minute walk distance test. Measurement times were before the intervention (T1), and at the 4th week (T2), 8th week (T3), and 12th week (T4) post-intervention.Results: A total of 65 patients were enrolled in this study and were randomly assigned into the experimental group (n = 33) and the routine activity control group (n = 32) using block randomization (1:1 ratio). The Generalized Estimating Equations (GEE) were used to analyze the effects of the home-based resistance band training program on fatigue, sleep, muscle endurance, and quality of life in colorectal cancer patients. At the 12th week of exercise intervention, the experimental group showed statistically significant differences in the EORTC QLQ-C30 functional scales for emotional function(Wald χ2 = 6.00, p = 0.014) and social functioning (Wald χ2 = 4.51, p = 0.034) and symptom scales for fatigue (Wald χ2 = 6.69, p = 0.010), pain (Wald χ2 = 5.95, p = 0.015), and constipation (Wald χ2 = 4.27, p = 0.039). The EORTC QLQ-CR29 symptom scales also showed significant differences in frequency of urination (Wald χ2 = 12.47, p < 0.001), difficulty urinating (Wald χ2 = 8.67, p = 0.003), bloating (Wald χ2 = 5.53, p = 0.019), and flatulence (Wald χ2 = 9.44, p = 0.002).Conclusion: Resistance bands are convenient and safe exercise tools that help improve the quality of life for colorectal cancer patients, enhance their activity levels, and promote recovery. The results of this study indicate that resistance band training can alleviate bloating, abdominal distension, and constipation, positively impacting various aspects of gastrointestinal function in colorectal cancer patients. This demonstrates the potential value of home-based resistance band training and provides scientific evidence and references for developing clinical exercise programs for colorectal cancer patients
[[alternative]]Effects of Acupoint Intervention on Shoulder and Neck Pain in Medical Staff of the Operating Room
No full text[[abstract]]肩頸疼痛已是全球性健康問題，也是造成殘疾失能原因之一，而手術室醫護人員長久以來也因工作性質、長期姿勢不良衍生肩頸疼痛問題。頸部負荷受力增加，衍生出肌肉、神經和肌腱疼痛，影響頸部活動度，使工作效率降低、影響情緒、睡眠進而影響生活品質。緩解肩頸疼痛包含藥物及非藥物處置，其中藥物雖然可以在短時間減輕疼痛，但效果有限，且存在多種副作用，令人卻步。 本研究目的為探討穴位介入對手術室醫護人員肩頸疼痛、身體生理功能與自律神經的影響。本研究採用隨機對照交叉研究設計分二階段共96人次，48位北部某區域教學醫院參與手術室執行醫療行為之醫護人員。研究對象以隨機方式分派為雷射針灸組(24名)及拔罐組(24名)兩組，以重複量測方式在研究介入前、介入後第一週、第二週，經由washout 二週後，兩組交換進入第二階段研究介入。本研究取樣於成效評量指標為頸部失能指數、肩頸活動疼痛強度、頸部活動度及心率變異。研究資料以SPSS 20.0軟體進行資料分析，描述性統計分析以次數分配、百分比、平均數和標準差、卡方檢定、獨立樣本t檢定分析。推論性統計分析以廣義估計方程式(Generalized Estimating Equations, GEE)比較兩組在研究介入前、介入後第一週、第二週的成效，以p <.05達顯著差異。 研究結果顯示，雷射針灸與拔罐介入後，兩組在頸部失能、肩頸活動疼痛強度的分數均顯著降低 (p<.05)，在頸部活動度均顯著增加 (p<.05)，在自律神經之HRV部分，高頻(HF)與LF/HF比值達顯著增加 (p<.05)。本研究顯示，雷射針灸與拔罐皆能有效緩解手術室醫護人員肩頸疼痛、改善頸部活動度，增加副交感神經活性。雷射針灸與拔罐具非侵入性且經由專業人員指導訓練後得以施行，因此，雷射針灸與拔罐可視為另一輔助照護選擇藉以緩解肩頸疼痛。[[abstract]]Shoulder and neck pain is a global health issue and one of the leading causes of disability. Operating room healthcare workers have long suffered from shoulder and neck pain due to the nature of their work and prolonged poor posture. The increased load and stress on the neck lead to muscle, nerve, and tendon pain, affecting neck mobility, reducing work efficiency, impacting mood and sleep, and thus affecting quality of life. Relieving shoulder and neck pain includes both medication and non-medication treatments. Although medications can reduce pain in a short time, their effects are limited and they have various side effects, deterring people from their use. The purpose of this study is to explore the effects of acupoint interventions on shoulder and neck pain, physical physiological function, and autonomic nervous system of operating room healthcare workers. This study adopts a randomized controlled crossover design with two phases, including a total of 96 participants: 48 healthcare workers involved in surgical procedures from a regional teaching hospital in northern Taiwan. The subjects were randomly assigned to a laser acupuncture group (24 people) and a cupping group (24 people). Repeated measurements were taken before the intervention, one week after the intervention, and two weeks after the intervention. After a two-week washout period, the two groups exchanged interventions for the second phase. The outcome measures included the Neck Disability Index, intensity of shoulder and neck activity pain, neck mobility, and heart rate variability (HRV). Data were analyzed using SPSS 20.0 software, with descriptive statistics including frequency distribution, percentage, mean, and standard deviation, chi-square test, and independent sample t-test analysis. Inferential statistical analysis used the Generalized Estimating Equations (GEE) to compare the effects between the two groups before the intervention, one week after the intervention, and two weeks after the intervention, with a significance level of p < .05. The results showed that after laser acupuncture and cupping interventions, both groups had significantly reduced scores in neck disability and intensity of shoulder and neck activity pain (p < .05), significantly increased neck mobility (p < .05), and significant increases in HRV, specifically in high frequency (HF) and the LF/HF ratio (p < .05). This study indicates that both laser acupuncture and cupping can effectively relieve shoulder and neck pain in operating room healthcare workers, improve neck mobility, and increase parasympathetic nerve activity. Laser acupuncture and cupping are non-invasive and can be performed after professional guidance and training, making them a viable alternative care option for relieving shoulder and neck pain
[[alternative]]Using grounded theory to explore the experiences of implementing palliative care in long-term care facilities
No full text[[abstract]]背景：全球人口在邁入二十一世紀後，正面臨快速老化的趨勢，聯合國列出從2019年至2050年間全球高齡人口比率成長最快的國家與地區，臺灣僅次於南韓與新加坡，名列全球第三。為維護住民最佳的生命尊嚴及品質，減少末期患者臨終前不具積極治療之醫療利用，使安寧療護之健保給付更契合臨床實務需求，中央健康保險署於2022年3月10日全民健康保險醫療服務給付項目及支付標準共同擬訂會議，通過擴大安寧療護收案對象，安寧緩和療護是一條寬廣但無法確定長度的照顧之途，安寧緩和療護對象已不限於癌症病患，尚包括其他各種疾病之臨終病患，尤其是老人此類存活期較長的末期個案，需要更多的長照機構來承接。研究目的：本研究運用紮根理論研究法來探究台灣長期照護機構提供安寧緩和療護之經驗。 研究方法：採用紮根理論研究法與深度訪談方式，以理論性抽樣進行資料收集，訪談已於機構內執行/提供安寧緩和療護之長期照護機構照護團隊成員。資料分析方法依據紮根理論研究法的持續比較進行比對分析與歸納整理。研究結果：本研究於台灣四個區域（北、中、南與東部地區）10家長期照護機構進行收案，研究參與者共31位，包含機構負責人或實際經營管理者10位、專業健康照護人員11位與照顧服務員10位。結果以【落實於長期照護機構執行安寧緩和療護的經驗架構】呈現，核心類屬為「實現生命終點的安寧（Accomplishing Peace at the End of Life）」，其中包含以下七個類屬（category）：一、住民生命末期的狀態【前置條件】；二、面對住民維生的困境【脈絡條件】；三、期待住民尊嚴的離世【脈絡條件】；四、決定採取安寧緩和療護【現象】；五、建置完善的軟硬體【行動/互動策略】；六、充分鏈結外部相關資源【行動/互動策略】；與七、完滿生命最後一程【結果】。研究結論與建議：在機構能落實執行安寧緩和療護，有下列七項重要因素：一、機構照護人員之安寧緩和療護的知能；二、機構硬體設備的運用；三、完備的安寧緩和療護團隊；四、推廣生命教育課程；五、合宜的法案和法源支持；六、連結在地醫療資源；與七、普及社會大眾對安寧緩和療護的認知。本研究僅代表提供安寧緩和療護的長照機構經驗之脈絡，至於未提供安寧緩和療護的長照機構之脈絡範疇不在本研究中，對於這類世界的探索還有待其他研究繼續鋪陳故事線，此為本研究有限之處。[[abstract]]Background: As the global population enters the 21st century, it is facing a trend of rapid aging. The United Nations lists the countries and regions with the fastest growing elderly population ratio in the world from 2019 to 2050. Taiwan ranks second in the world after South Korea and Singapore. third. In order to protect the residents' best dignity and quality of life, reduce the medical utilization of terminally ill patients without active treatment before death, and make the health insurance benefits of palliative care more in line with clinical practice needs, the Central Health Insurance Agency announced the National Health Insurance on March 10, 2022 A meeting was held to jointly formulate medical service payment items and payment standards. By expanding the scope of palliative care, palliative care is a broad but uncertain path of care. The scope of palliative care is not limited to cancer patients, but also includes End-of-life patients with various other diseases, especially terminal cases such as the elderly with long survival times, require more long-term care institutions to take care of them.Research purpose: This study uses grounded theory research to explore the experience of providing palliative care in long-term care facilities in Taiwan. Research Methodology: The grounded theory research method and in-depth interview method were used to collect data through theoretical sampling. The members of the long-term care institution's care team who have implemented/ provided palliative care in the institution were interviewed. The data analysis method is based on the continuous comparison of grounded theory research method for comparative analysis and summary.Research results: This study was conducted in 10 long-term care institutions in four regions of Taiwan (northern, central, southern and eastern regions). There were a total of 31 research participants, including 10 institutional directors or actual managers, and 11 professional health care personnel. There are 10 waiters and attendants. The results are presented in the form of "Experiential Framework for Implementing Palliative Care in Long-term Care Institutions". The core category is "Accomplishing Peace at the End of Life", which includes the following seven categories. : 1. The state of the residents at the end of their lives [prerequisites]; 2. Faced with the dilemma of the residents making a living [context conditions]; 3. Expecting the residents to die with dignity [context conditions]; 4. Deciding to adopt palliative care [phenomenon] ]; 5. Establish complete software and hardware [action/interaction strategies]; 6. Fully link external relevant resources [action/interaction strategies]; and 7. Complete the last journey of life [results].Research Conclusions and Recommendations: To implement palliative care in long-term care facilities, there are the following seven important factors: 1. The knowledge and ability of the institution’s nursing staff in palliative care; 2. The use of institutional hardware and equipment; 3. A complete palliative care team; 4. Promote life education courses; 5. Support appropriate bills and legal sources; 6. Connect local medical resources; and 7. Popularize public awareness of palliative care. This study only represents the context of the experience of long-term care institutions that provide hospice and palliative care. The context of long-term care facilities that do not provide hospice and palliative care is not included in this study. The exploration of this kind of world needs other studies to continue to lay out the storyline. , this is the limitation of this study
[[alternative]]Strategy and Management of Healthy Aging Operation:A Case Study from the Houston-Apollo Model of National Taiwan University Hospital Yunlin Branch
No full text[[abstract]]依據政府統計數據，台灣人口平均臨終前，超過7年處於不健康的狀態，如果沒有足夠的準備，不論是個人或社會都將面臨嚴峻的挑戰。證據顯示，有效的健康促進可以預防疾病，有助於福祉，並且具有成本效益，中介措施納入初級衛生保健可以改善健康結果和認知功能。然而多數醫療院所的健康老化部門沒有健康的財務收入可確保可持續性的服務。因此系統性的理解健康老化的策略發展要素與經營上可能會面臨的挑戰，顯得格外重要。我們從臺大醫院雲林分院的健康老化團隊所進行的阿波羅計畫進行個案研究，嘗試歸納探索上述的問題。結果呈現，策略上醫療服務中心的資源優勢所支持的價值主張與服務對象必須明確，對於提供照護關係的建立也必須與價值主張相呼應。與服務對象的互動途徑上，通過遠距醫療平台串聯日常群聚據點與在地醫療是一個很有效率的組合。經營管理上，健康的財務收入會是很大的挑戰。從銀髮經濟的受益產業中跨業結盟，以總體服務擴大行銷市場與服務優勢，追求共同的成本效益，提高總體利潤或許能突破困境。此外，服務過程提供適當的機制與活動，收集客戶的回饋意見也格外重要，過於重視服務過程而忽略使用者的回饋，可能會在沒注意到的環節失去受照護對象的信任或持續性的互動機會。[[abstract]]The Taiwanese population spends more than seven years in an unhealthy state before dying, according to government statistics. Without good preparation, both individuals and society will face severe challenges. Evidence shows that effective health promotion can prevent disease, contribute to well-being, and is very cost-effective. Besides this, intervention integrated into primary health care can improve health outcomes and cognitive function. However, most healthcare institutions' healthy aging departments do not have the healthy financial revenue to ensure sustainable services. Therefore, it is important to understand the strategic development elements of healthy aging and the challenges systematically.We conducted a case study on the Houston-Apollo Model of National Taiwan University Hospital Yunlin Branch to summarize and explore the above issues. The results show that strategically, the value proposition and elderly people under care supported by the medical service center's advantages must be clear, and the care-providing relationship must echo the value proposition. In terms of interaction with elderly people, it is a very efficient combination to connect daily activity locations and local medical care through a telemedicine platform.Healthy financial income will be a big challenge for primary care services in healthy aging management. It may be a good way to alliance industries that benefit from the silver economy, expand markets with package services, and pursue total costs efficiency and profit growth. It is important to collect elderly people's feedback during the service process. Without this, the care system may lose confidence or the continuous interaction of the care recipients in unnoticed links
[[alternative]]Applying Convolutional Neural Networks and Self-Attention in Cognitive Rehabilitation Training: AI Design Based on the Board Games
No full text[[abstract]]本研究深入探討卷積神經網絡（CNN）與自注意力（Self-Attention）機制在棋盤遊戲AI模型中的應用，特別是在其模型在認知康復訓練中的運用可能性。隨著AI技術的進步，尤其是在從「弱人工智慧」轉向追求「強人工智慧」的過程中，這項研究旨在透過棋盤遊戲來模擬和理解人類的認知和決策過程。在此過程中，我們特別關注AI在處理局部與全局信息的能力，並比較Self-Attention與傳統CNN在這方面的效能差異。本研究強調了棋盤遊戲與文本分析的複雜性，不同棋子或文字之間可能存在著遙遠的相互關聯，對於AI的策略結果至關重要。CNN專注於提取局部特徵所以對INPUT進行了局部分割，導致在訓練時全局信息的捕捉和長距離依賴性方面表現不佳。相對而言，自注意力機制則是將整個INPUT進行訓練，所以在處理全局信息和長距離依賴性方面具有優勢，特別是在涉及到遠距離關聯的問題中，像是ChatGPT在自然語言處理(NLP)的成功甚至至今還在不斷的進化當中。因此，本研究計劃深入探討如何將自注意力機制引入AlphaGo Zero的程式設計中，以克服傳統CNN在全局信息和長距離依賴性中的局限性，並提高全局策略的表現。本研究著重於探索自注意力機制在棋盤遊戲AI中的應用，特別是在全局信息處理和長距離依賴性的表現提升。雖然引入自注意力機制的AlphaGo Zero模型與傳統CNN模型在性能上無顯著差異，但其在模擬人類認知過程與決策模式上展示出獨特的優勢。這不僅增進了我們對AI於複雜策略遊戲中應用的理解，亦為認知康復訓練開拓新的可能性。本研究的比較分析強調了自注意力機制在理解棋盤遊戲全局動態方面的重要性，且展望了其在增強認知康復活動中的潛在應用。[[abstract]]This study delves into the application of Convolutional Neural Networks (CNNs) and Self-Attention mechanisms within board game AI models, particularly focusing on their potential use in cognitive rehabilitation training. With the advancement of AI technology, especially in the shift from 'narrow AI' to the pursuit of 'general AI,' this research aims to simulate and understand human cognitive and decision-making processes through board games. In this process, special attention is paid to AI's ability to handle both local and global information, comparing the effectiveness of Self-Attention with traditional CNNs in these aspects.The study highlights the complexity of board games and text analysis, where distant associations between different pieces or words can be crucial for AI's strategic outcomes. CNNs, focusing on extracting local features, segment the input to handle it, which often results in poor performance in capturing global information and long-range dependencies during training. In contrast, the Self-Attention mechanism trains on the entire input, offering advantages in handling global information and long-range dependencies, particularly in situations involving distant associations, such as the ongoing advancements of ChatGPT in Natural Language Processing (NLP). Therefore, the research explores in-depth how to integrate the Self-Attention mechanism into the programming of AlphaGo Zero to overcome the limitations of traditional CNNs in global information processing and enhance strategic outcomes on a global scale.The study emphasizes exploring the application of the Self-Attention mechanism in board game AI, particularly in enhancing performance with global information processing and long-range dependencies. Although the AlphaGo Zero model incorporating Self-Attention showed no significant performance differences compared to traditional CNN models, it demonstrated unique advantages in simulating human cognitive processes and decision-making patterns. This not only enriches our understanding of AI applications in complex strategy games but also opens new possibilities for cognitive rehabilitation training. The comparative analysis underscores the importance of the Self-Attention mechanism in understanding the global dynamics of board games and discusses its potential applications in enhancing the effectiveness of cognitive rehabilitation activities
[[alternative]]The impact of pelvic floor muscle training in menopausal women with incontinence：a systematic review
No full text[[abstract]]目的：台灣衛生福利部民國94年統計台灣55歲以上婦女30％患有尿失禁。治療尿失禁除了侵入性方法外，亦有非侵入性介入方式。本研究目的即以系統性文獻回顧的方式，彙整與探討一、探討骨盆底肌訓練介入對更年期婦女尿失禁之影響二、探討有效的訓練時間、訓練量。方法：本研究方法為系統性文獻回顧，運用形成問題、文獻搜尋、篩選標準、文獻品質評析整合。搜尋PubMed、Cochrane library、CINAHL、Google，4個資料庫英文文獻，輸入Menopause、Postmenopause、Perimenopause、Pelvic floor muscle training、pelvic floor contraction、Kegel、Stress urinary incontinence 、pad weight test、Voiding diary，文獻性質以隨機對照實驗 (RCT)隨機試驗設計。結果：經過篩選後收尋到6篇，以Joanna Briggs Institute (JBI) 的標準來評定本研究文章，再進行文獻資料彙整。更年期尿失禁婦女介入骨盆底肌訓練6週以上的訓練都會有效果，每週進行2次，最少60分鐘的訓練。結論：根據結果，骨盆底肌訓練連續6週即達到1320分鐘即有效果，不僅提供了實際的臨床指導，也強調了骨盆底肌訓練在更年期婦女健康管理中的重要性。關鍵詞：更年期、盆底收縮、壓力性尿失禁、棉墊、排尿日誌[[abstract]]Objective:In 2005, the Taiwanese Ministry of Health and Welfare reported that 30% of women over 55 years old in Taiwan suffer from urinary incontinence. Besides invasive treatments, non-invasive interventions for urinary incontinence are also available. This study aims to systematically review and analyze:1.The impact of pelvic floor muscle training (PFMT) on urinary incontinence in menopausal women.2.The effective training duration and volume.Methods:This study employs a systematic literature review methodology, which includes problem formulation, literature search, selection criteria, and quality assessment and integration of the literature. Searches were conducted in four databases: PubMed, Cochrane Library, CINAHL, and Google, using keywords such as Menopause, Postmenopause, Perimenopause, Pelvic floor muscle training, pelvic floor contraction, Kegel, Stress urinary incontinence, pad weight test, and Voiding diary. The nature of the literature primarily consisted of randomized controlled trials (RCTs).Results:After screening, six studies were selected. These studies were assessed using the Joanna Briggs Institute (JBI) standards and then integrated for analysis. The findings indicate that for menopausal women with urinary incontinence, engaging in PFMT for at least 6 weeks, with sessions twice a week and lasting a minimum of 60 minutes each, is effective.Conclusion:According to the results, consistent PFMT totaling 1320 minutes over 6 weeks proves to be effective. This not only provides practical clinical guidance but also emphasizes the importance of PFMT in the health management of menopausal women.Keywords:Menopause, Pelvic floor contraction, Stress urinary incontinence, Pad weight test, Voiding diar
[[alternative]]Using podcast and simulation to improve student’s empathy and communication skills in psychiatric nursing
No full text[[abstract]]背景：同理心與溝通技巧有助與病人建立治療性人際關係，為精神科護理的核心能力。由於精神疾病的特殊性，護理學生對與精神科病人溝通常感到壓力，缺乏信心，因而影響治療性人際關係建立。當前溝通教學多以口語講述為主，學者建議可採用多元教學策略，如情境模擬與自主學習，以提升教學成效，及加強學生之實習前準備。目的： 發展同理心溝通課程，驗證結合podcast與情境模擬教學，能否有效提升護理學生之同理心與溝通能力。 方法：本研究採類實驗研究設計(quasi-experimental research design)，以方便取樣 (convenience sampling)進行雙組重複測量，邀請77位護理專科學生參與本研究。課程前實驗組（n=34）接受「podcast音訊」，對照組（n=43） 接受「紙本講義」教材，之後為實體課程，與標準病人進行小組客觀結構式臨床測驗(Group Objective Structured Clinical Examination, GOSCE)，並分別於課程前、教材提供後、實體課程後立即及課後一個月測量其學習成效。研究工具包括：護理學生基本資料、人際反應量表、溝通能力量表、溝通自信量表、學習滿意度及教材滿意度問卷。 結果：結合podcast與情境模擬教學可有效提升同理心，podcast教材可提升同理心之「同理關懷」，整體課程可增加「觀點取替」與降低「身心憂急」，實驗組之溝通能力與溝通自信提升，且學習滿意度高於對照組。結論與建議：「同理心溝通」對護理學生在同理心、溝通能力及溝通自信具有正面效果，學生對本課程有高度滿意。本研究之podcast教材與模擬教案可作為精神科溝通教學之參考。未來研究可進行長期追蹤，持續修訂教材，培養學生對精神科病人的同理與溝通能力。關鍵字：精神科、護理學生、情境模擬、podcast、同理心、溝通能力[[abstract]]Background:Empathy and communication skills are essential core competencies in psychiatric nursing, crucial for establishing therapeutic interpersonal relationships with patients. However, the unique nature of mental illnesses often causes nursing students to feel stressed and lack confidence when communicating with psychiatric patients, hindering their ability to build these therapeutic relationships. Current teaching methods primarily rely on verbal instruction. Scholars recommend adopting diverse teaching strategies, such as situated simulations and self-learning, to enhance teaching effectiveness and better prepare students for clinical practice.Objective: To develop an empathy communication course and evaluate the effectiveness of integrating podcasts and situated simulations in enhancing nursing students' empathy and communication skills.Methods: This study employed a quasi-experimental research design with repeated measurements on two groups. A total of 77 nursing students were conveniently selected from an associate degree nursing program to participate. The experimental group (n=34) received "podcast audio" materials, while the control group (n=43) received "printed" materials. Both groups then attended in-person courses and participated in a Group Objective Structured Clinical Examination (GOSCE) with standardized patients. Learning outcomes were measured at four time points: before the course, one week after receiving the teaching materials, immediately after the course, and one month post-course. Research tools included demographics, the Interpersonal Reactivity Index, Communication Ability Scale, Communication Confidence Scale, the Learning Satisfaction Questionnaire, and Teaching Material Satisfaction Questionnaire.Results: The empathy communication course, integrating podcasts and situated simulations, effectively enhanced empathy among nursing students. Podcast audio specifically increased "sympathetic concern," while the overall course improved "perspective-taking" and reduced "psychological distress." The experimental group showed improvements in communication ability and confidence, along with higher levels of learning satisfaction compared to the control group.Conclusion and Recommendations: The empathy communication course enhances nursing students' empathy, communication skills, and confidence, with high levels of student satisfaction. Podcast materials and simulation-based teaching plans are valuable resources for teaching psychiatric communication. Future research should focus on long-term tracking, continuous refinement of teaching materials, and further development of students' empathy and communication skills in psychiatric care.Keywords: psychiatry, nursing students, simulation, podcast, empathy, communication skill
[[alternative]]Effects of a contextual decision-making learning materials on nurses in two years learning performance for abdominal-pelvic traumatic severe bleeding care
No full text[[abstract]]腹部骨盆外傷意外的病人是急診常見意外前三名，可能伴隨外傷與內部嚴重出血的可能性，將此類病人的照護變得更加困難，由於目前外傷護理的教育著重在急診醫療，除了外傷緊急醫療的知識教學不足外，學習更是仰賴臨床實習的安排，腹部骨盆外傷的護理實習更是可遇不可求。現今數位學習蓬勃發展的時空下，讓學習可以較多元且不限時間及地點限制，同時必須搭配適當的引導策略，才得以使的學習更有效率，促進有意義的學習。因此，本研究將決策樹導入腹部骨盆嚴重出血外傷照護互動式情境學習環境中，引導學習者釐清其迷思概念，進而解決臨床情境問題。本研究採用真實驗研究設計，研究對象為北部醫學中心醫院兩年期護理師共59位，實驗組採用腹部骨盆外傷嚴重出血照護情境決策互動教材，對照組採用腹部骨盆外傷嚴重出血照護情境互動教材。研究結果顯示，在腹部骨盆外傷嚴重出血照護臨床推理能力後測，以及科技接受度，實驗組皆顯著優於對照組，腹部骨盆外傷嚴重出血照護情境決策互動教材，確實能提升學習者的臨床推理評估能力及教材使用上的有用性。然而，在知識測驗與自我效能部份則未達顯著差異。關鍵詞：決策引導、腹部骨盆外傷嚴重出血照護、情境式學習、臨床推理能力[[abstract]]Patients with abdominal and pelvic trauma are among the top three most common emergencies in the emergency department. These cases often involve both external injuries and severe internal bleeding, making their care particularly challenging. Current trauma nursing education mainly focuses on emergency medical care. In addition to insufficient teaching of trauma emergency medical knowledge, learning heavily relies on clinical practice arrangements, and opportunities for clinical practice in the care of abdominal and pelvic trauma are rare. With the flourishing development of digital learning today, learning can be more diverse and not limited by time and place constraints. However, appropriate guiding strategies must be paired to make learning more efficient and promote meaningful learning. Therefore, this study introduces decision trees into an interactive learning environment for the care of patients with severe abdominal and pelvic trauma and internal bleeding. This approach guides learners to clarify their misconceptions and solve clinical situational problems. This study adopts a true experimental research design, with 59 two-year nurses from a medical center in northern Taiwan as research subjects. The experimental group used an interactive instructional material for decision-making in severe abdominal and pelvic trauma care, while the control group used an interactive instructional material for severe abdominal and pelvic trauma care without decision-making elements. The results showed that the experimental group significantly outperformed the control group in post-test clinical reasoning abilities and technology acceptance. The interactive instructional material for decision-making in severe abdominal and pelvic trauma care effectively enhanced learners' clinical reasoning and assessment abilities, as well as the perceived usefulness of the instructional material. However, no significant differences were observed in knowledge tests and self-efficacy.Keywords: decision guidance, severe abdominal and pelvic traumatic bleeding care, situated learning, clinical reasoning abilit
[[alternative]]The Changes Over Time of Disease Uncertainty, Coping Behavior, Subjective Well-Being, and Its Related Factors in Newly Diagnosed Colorectal Cancer Patients
No full text[[abstract]]背景：大腸直腸癌為台灣常見癌症之一，現今醫療進步，手術及同步放化療逐漸成主流，可顯著延長罹癌者的存活期，但罹癌者仍須面對生活重大改變，面對無法控制及預測的變化下，容易產生不確定感，影響到病人之因應方式及後續健康結果。目的：探討新診斷大腸直腸癌病人接受手術治療前、接受手術治療後1個月及6個月時之疾病不確定感、因應行為及幸福感之變化及其相關影響因子。方法：採縱貫式研究設計，於北部地區某醫學中心大腸直腸外科病房進行收案，以方便取樣方式，收案117位新診斷大腸直腸癌預行腫瘤切除手術者，於病人診斷後，接受手術治療前（T0）、手術後一個月（T1）及手術後六個月（T2），使用結構性問卷進行資料收集，問卷包括：基本屬性表、疾病特性表、「症狀困擾量表」、「疾病不確定感量表」、「簡明因應量表」及「WHO-5幸福指標量表」，資料以SPSS統計軟體進行資料建檔及統計分析。結果：本研究顯示新診斷大腸直腸癌病人之疾病不確定感隨時間改善；趨近及逃避型態因應隨時間減少；幸福感於手術後一個月降低，手術後六個月改善。病人之症狀困擾越高，疾病不確定感越高，幸福感越低；疾病不確定感越高，越常採取逃避型態因應；疾病不確定感越高，越少採取趨近型態因應及越常採取逃避型態因應，幸福感越低。結論：醫護人員需評估疾病不確定感之來源，一對一提供清晰的醫療資訊，視情況提供專業介入及支持，共同制定最合適的照護計畫。除了改善疾病治療導致之症狀困擾外，亦需提供心理支持，協助引導並鼓勵其採取趨近型態因應，提升幸福感，適應疾病。[[abstract]]Background: Colorectal cancer is one of the most common cancers in Taiwan. Advances in medical technology, particularly surgery combined with concurrent chemoradiotherapy, have significantly prolonged patient survival. However, colorectal cancer patients still face major life changes and uncertainties that can affect their coping behaviors and health outcomes.Objective: This study explores changes and influencing factors of disease uncertainty, coping behavior, and subjective well-being in newly diagnosed colorectal cancer patients at three time points: before surgery, one month after surgery, and six months after surgery.Methods: A longitudinal study was conducted with 117 newly diagnosed colorectal cancer patients from a medical center in northern Taiwan. Data were collected at diagnosis and before surgery (T0), one month after surgery (T1), and six months after surgery (T2). Structured questionnaires included demographic and disease characteristics, the Symptom Distress Scale, Mishel Uncertainty in Illness Scale, Brief COPE Inventory, and WHO-5 Well-Being Index. Data were analyzed using SPSS.Results: Disease uncertainty improved over time. Both approach and avoidance coping behaviors decreased over time. Subjective well-being decreased one month after surgery but improved six months after surgery. Higher symptom distress was linked to higher disease uncertainty and lower subjective well-being. Greater disease uncertainty correlated with more frequent avoidance coping, less frequent approach coping, and lower subjective well-being.Conclusion: Healthcare professionals should assess disease uncertainty sources, provide clear medical information, and offer tailored professional support to develop appropriate care plans. Efforts should be made to reduce symptom distress and offer psychological support, encouraging patients to adopt approach coping behaviors to enhance their well-being and adaptation to the disease