Publications by authors named "Chang-Hui Chen"

66 Publications

Beyond the technology: Applying the NLN Jeffries Simulation Theory in the context of aging simulation.

Nurs Forum 2022 Jan 8. Epub 2022 Jan 8.

School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia.

Background: Caring for older people has become a focus for simulation-based education. Specifically, aging simulation has emerged as an innovative and effective educational approach that utilizes aging-suits for nurses to gain insight into the aging process and the everyday difficulties faced by older people. There is limited evidence within the literature about how researchers and educators support decision-making processes in the design, implementation, and evaluation of aging simulation programs.

Aim: This is a theoretical development paper and its purpose is to explore the practical application of the Jeffries Simulation Theory in the design, implementation, and evaluation of an aging simulation program to contribute to knowledge development and guide educational practices for nurse educators and researchers.

Results: The authors describe a practical application of the theory to an aging simulation program using the five key theory components: context, background, design, simulation experience, and outcomes. Specific theory strengths are highlighted in practical examples generated from the authors aging simulation interventional study example: engaging stakeholders, consideration of additional observer simulation roles, reflective debrief discussions, influence of facilitator and participant personal attributes, and outcomes beyond the participants.

Conclusion: The Jeffries Simulation Theory is well suited for underpinning the design, implementation, and evaluation of aging simulation programs.
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http://dx.doi.org/10.1111/nuf.12687DOI Listing
January 2022

Adiabatic versus non-adiabatic electron transfer at 2D electrode materials.

Nat Commun 2021 Dec 7;12(1):7110. Epub 2021 Dec 7.

Department of Chemistry, University of Warwick, Coventry, CV4 7AL, UK.

2D electrode materials are often deployed on conductive supports for electrochemistry and there is a great need to understand fundamental electrochemical processes in this electrode configuration. Here, an integrated experimental-theoretical approach is used to resolve the key electronic interactions in outer-sphere electron transfer (OS-ET), a cornerstone elementary electrochemical reaction, at graphene as-grown on a copper electrode. Using scanning electrochemical cell microscopy, and co-located structural microscopy, the classical hexaamineruthenium (III/II) couple shows the ET kinetics trend: monolayer > bilayer > multilayer graphene. This trend is rationalized quantitatively through the development of rate theory, using the Schmickler-Newns-Anderson model Hamiltonian for ET, with the explicit incorporation of electrostatic interactions in the double layer, and parameterized using constant potential density functional theory calculations. The ET mechanism is predominantly adiabatic; the addition of subsequent graphene layers increases the contact potential, producing an increase in the effective barrier to ET at the electrode/electrolyte interface.
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http://dx.doi.org/10.1038/s41467-021-27339-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8651748PMC
December 2021

Predictors of health-related quality of life in older New Zealanders with cardiovascular health problems.

Australas J Ageing 2021 Dec 6. Epub 2021 Dec 6.

School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia.

Objective: With longer life expectancies, cardiovascular diseases are increasingly common among older adults, which also leads to functional changes that severely impact their quality of life. This study aimed to identify the predictors of health-related quality of life (HRQOL) among older New Zealanders with cardiovascular health problems.

Methods: A cross-sectional data analysis of the 2015/16 New Zealand Health Survey was performed. In total, 2203 older New Zealanders with cardiovascular health problems were identified and included in the final analyses. The association between demographics, physical activity, health measurements, and HRQOL was examined using a multiple linear regression model.

Results: Significant differences in HRQOL were identified between the demographics and cardiovascular risk factors. Predictors of higher HRQOL among older New Zealanders with cardiovascular conditions were increased physical activity (β = 0.218), age (β = -0.067), employed (β = 0.137), lower waist circumference (β = -0.261), male (β = 0.127), and being without a history of diabetes (β = -0.071).

Conclusion: Physical activity is the strongest predictor of HRQOL in older adults with cardiovascular problems. Older female New Zealanders with cardiovascular health problems have lower perceptions of their health status. These predictors should be considered while designing and developing intervention and health education that aims to improve the HRQOL of older adults.
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http://dx.doi.org/10.1111/ajag.13021DOI Listing
December 2021

Rodent Area Prostriata Converges Multimodal Hierarchical Inputs and Projects to the Structures Important for Visuomotor Behaviors.

Front Neurosci 2021 2;15:772016. Epub 2021 Nov 2.

Key Laboratory of Neuroscience, School of Basic Medical Sciences, Institute of Neuroscience, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China.

Area prostriata is a limbic structure critical to fast processing of moving stimuli in far peripheral visual field. Neural substrates underlying this function remain to be discovered. Using both retrograde and anterograde tracing methods, the present study reveals that the prostriata in rat and mouse receives inputs from multimodal hierarchical cortical areas such as primary, secondary, and association visual and auditory cortices and subcortical regions such as the anterior and midline thalamic nuclei and claustrum. Surprisingly, the prostriata also receives strong afferents directly from the rostral part of the dorsal lateral geniculate nucleus. This shortcut pathway probably serves as one of the shortest circuits for fast processing of the peripheral vision and unconscious blindsight since it bypasses the primary visual cortex. The outputs of the prostriata mainly target the presubiculum (including postsubiculum), pulvinar, ventral lateral geniculate nucleus, lateral dorsal thalamic nucleus, and zona incerta as well as the pontine and pretectal nuclei, most of which are heavily involved in subcortical visuomotor functions. Taken together, these results suggest that the prostriata is poised to quickly receive and analyze peripheral visual and other related information and timely initiates and modulates adaptive visuomotor behaviors, particularly in response to unexpected quickly looming threats.
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http://dx.doi.org/10.3389/fnins.2021.772016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8594778PMC
November 2021

How does geriatric nursing education program change the knowledge, attitude and working intention among undergraduate nursing students? A systematic literature review.

Nurse Educ Today 2022 Jan 30;108:105161. Epub 2021 Sep 30.

School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Northfields Ave, Wollongong, NSW 2522, Australia; Illawarra Health and Medical Research Institute (IHMRI), Northfields Ave, Wollongong, NSW 2522, Australia. Electronic address:

Objective: This review aimed to examine the changes of knowledge, attitude and working intention in nursing students after an undergraduate geriatric nursing education.

Design: A systematic review of the literature.

Data Sources: Five databases which included CINAHL, MEDLINE, PubMed, Scopus and Web of Science were searched for this literature review from January 2010 to October 2020.

Review Methods: The review was registered in PROSPERO registry with registration number CRD42020215703. The review examined undergraduate nursing education programs in terms of knowledge, attitude and working intention towards geriatric care among undergraduate nursing students as outcomes. We used JBI critical appraisal tools and Mixed Methods Appraisal Tool to evaluate and assess the quality of the retrieved research papers.

Results: The search yielded 19 studies included in the final review, 14 of which were quantitative studies and five were qualitative studies. Four types of education programs were identified. These were type 1, a four-year undergraduate gerontology program consisting of geriatric theory and geriatric care clinical placement; type 2, stand-alone geriatric subject and geriatric clinical placement program; type 3, integrated geriatric subject and geriatric clinical placement program; type 4, solely geriatric clinical placement program. The review found that the type 2 program demonstrated the best educational outcomes in undergraduate students.

Conclusions: This review provided the most recent literature evidence pertaining to undergraduate geriatric education program and its educational outcomes. Future research should focus on the evaluating the content of each type of geriatric education program to inform the development of undergraduate geriatric nursing education.
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http://dx.doi.org/10.1016/j.nedt.2021.105161DOI Listing
January 2022

A systematic review: Sexual well-being and perceived barriers to seeking professional help among Chinese adults living with cancer.

Eur J Cancer Care (Engl) 2021 Nov 10;30(6):e13519. Epub 2021 Oct 10.

School of Nursing, Faculty of Science Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia.

Objective: Sex and intimacy are basic needs and important aspects of quality of life among humans. This focus of this review was to synthesise and present the best available qualitative evidence on the sexual life experiences and needs of Chinese adults living with cancer. Moreover, the first-hand experience, meaning and perspective about the sexual life changes and support needs during the survival and extended treatment period were synthesised in this study.

Methods: A systematic review of qualitative studies was undertaken using the Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information (JBI-SUMARI). A comprehensive search of five databases: CINAHL, MEDLINE, PubMed, Scopus and Google Scholar were undertaken from 2010 until February 2020 using defined criteria. Methodological quality and data extraction were undertaken using JBI-SUMARI.

Results: Eight studies were included in the review. A total of 39 findings were extracted and aggregated into eight categories based on similarity of meaning. Three synthesised themes were generated: (i) misconceptions and lack of education or information regarding sexual activity exists for patients with cancer, (ii) concerns for overall health and well-being as well as physical and psychological changes can alter sexual desire and behaviours in patients with cancer and (iii) lack of sexual activity and intimacy can create relationship problems.

Conclusions: Sexual relationships are intimate, personal and private in Chinese culture and beliefs. Chinese adults living with cancer report many neglected issues on sexual well-being in various domains. Adequate and consistent education about sexual intimacy issues from health care providers was identified as an important need. Unaddressed needs might affect adults' coping strategies in managing their sexual relations during various stages of cancer treatment and beyond. It must be noted that there are many Chinese ethnic minorities living with cancer outside the Greater China region. The evidence provides valuable recommendations to health care providers globally to consider the specific sexual needs and initiate culturally sensitive sexuality education and care support for Chinese adults living with cancer.
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http://dx.doi.org/10.1111/ecc.13519DOI Listing
November 2021

Social Support as a Mediator of the Relationship between Hope and Decisional Conflict in Patients Deciding Whether to Receive Dialysis.

J Healthc Eng 2021 29;2021:5607219. Epub 2021 Sep 29.

School of Nursing, National Yang Ming Chiao Tung University, 112 Taipei, Taiwan.

Background: The incidence rate of end-stage renal disease (ESRD) in Taiwan is the highest worldwide. Patients often hesitate and feel helpless when deciding whether to receive dialysis. However, the resulting delay in starting dialysis can potentially threaten patients' lives.

Purpose: This study aimed to understand the current situation and correlations between hope, social support, and decisional conflict among patients with ESRD deciding whether to receive dialysis. In addition, the role of social support as a mediating variable of the relationship between hope and decisional conflict was investigated.

Methods: This study was a cross-sectional, descriptive correlation study. Data, including demographic information, were collected from 85 patients with ESRD who were deciding whether to receive dialysis. Research tools included the Chinese versions of the Herth Hope Index, the Interpersonal Support Evaluation List, and the Decisional Conflict Scale.

Results: When deciding whether to receive dialysis, patients with ESRD felt a low sense of hope, a moderate degree of social support, and a moderate degree of decisional conflict. Hope was significantly correlated with social support and decisional conflict. Social support demonstrated a full mediating effect of 47.7% ( < 0.001).

Conclusions: Patients with ESRD facing the decision to receive dialysis felt a low sense of hope and exhibited decisional conflict. Social support was found to be a mediating variable of the relationship between hope and decisional conflict; therefore, medical personnel should increase the social support of patients with ESRD who are deciding whether to commence dialysis to promote patients' hope and reduce their decisional conflict.
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http://dx.doi.org/10.1155/2021/5607219DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8494545PMC
January 2022

Postoperative Delirium in Older Patients: A Systematic Review of Assessment and Incidence of Postoperative Delirium.

Worldviews Evid Based Nurs 2021 Oct 4;18(5):290-301. Epub 2021 Sep 4.

School of Nursing and Midwifery, Western Sydney University, Campbelltown, NSW, Australia.

Background: Postoperative delirium is the most common complication of surgery particularly in older patients.

Aims: The current study aimed to summarize the commonly used delirium assessment tools in assessing postoperative delirium (POD) and to estimate the incidence rates of POD.

Methods: A systematic review that included empirical cohort studies reporting the use of delirium assessment tools in assessing POD between 2000 and 2019. Five core databases were searched for eligible studies. The methodological quality assessment of the included studies was undertaken using the Joanna Briggs Institute (JBI) critical appraisal checklist to examine the risk of bias. Pooled incidence estimates were calculated using a random effects model.

Results: Nineteen studies with a total of 3,533 postsurgery older patients were included in this review. The confusion assessment method (CAM) and CAM-ICU were the most commonly used tools to assess POD among older postoperative patients. The pooled incidence rate of POD was 24% (95% CI [0.20, 0.29]). The pooled incidence estimates for mixed (noncardiac) surgery, orthopedic surgery, and tumor surgery were 23% (95% CI [0.15, 0.31]), 27% (95% CI [0.20, 0.33]), and 19% (95% CI [0.15, 0.22]), respectively. More than 50% of included studies used CAM to assess POD in different types of postoperative patients. Using CAM to assess delirium is less time-consuming and it was suggested as the most efficient tool for POD detection.

Linking Evidence To Action: We identified that CAM could be implemented in different settings for assessing POD. The incidence and risk factors for POD introduced can be used for future research to target these potential indicators. The incidence rate, risk factors, and predictors of POD explored can provide robust evidence for clinical practitioners in their daily practice.
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http://dx.doi.org/10.1111/wvn.12536DOI Listing
October 2021

[Driving Cessation and Mental Health in Persons With Dementia: A Preliminary Study].

Hu Li Za Zhi 2021 Aug;68(4):43-52

PhD, RN, Associate Professor, School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taiwan, ROC.

Background: The driving safety of persons with dementia (PwD) is an important public-health issue worldwide. Driving is closely related to personal autonomy, self-esteem, and independence. When PwD lose their driving privileges, this may lead to negative effects on mental health.

Purpose: The purpose of this study was to evaluate the relationship between driving cessation and mental health in PwD.

Methods: A cross-sectional design with convenient sampling was used, Data were collected using structured questionnaires. Participants were all PwDs who were recruited from a medical center in northern Taiwan.

Results: A total of 78 PwD were recruited. Two-fifths (41%) of the participants were still driving, with motorcycle the most common vehicle used. The participants who had retired from driving were older, and most did not have a spouse, were less socially active, had a lower mean level of functional ability, and perceived a lower association between driving and quality of life. Driving cessation was found to be positively correlated with age and the instrumental activities of daily living. Depression and anxiety levels in former drivers were higher than in current drivers, although the differences were not significant.

Conclusions / Implications For Practice: Among PwD, depression and anxiety is higher in former drivers. It is suggested that a prospective study should be conducted, that driving safety issues for PwD should be addressed in public health education, and that standards of driving safety for PwD should be developed and enacted.
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http://dx.doi.org/10.6224/JN.202108_68(4).06DOI Listing
August 2021

Decision-Making in People With Dementia or Mild Cognitive Impairment: A Narrative Review of Decision-Making Tools.

J Am Med Dir Assoc 2021 10 24;22(10):2056-2062.e4. Epub 2021 Jul 24.

School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia; The Illawarra Health and Medical Research Institute (IHMRI), Wollongong, New South Wales, Australia.

Objectives: This review summarized the applicability of various decision-making tools for helping people with dementia or mild cognitive impairment (MCI) and their families make decisions.

Design: This study was a narrative literature review. The protocol of this review was registered in the International Prospective Register of Systematic Reviews (PROSPERO ID: CRD42020182259).

Setting And Participants: People with dementia or MCI and their families were included in this study.

Methods: This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. We searched the Cochrane Library, PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, and Chinese Electronic Periodical Services databases from inception to May 2021. The Joanna Briggs Institute Critical Appraisal Checklists for a variety of study designs were used.

Results: Topics related to decision-making were categorized as everyday activity decisions or medical treatment decisions. Various types of decision-making tools were identified, and we observed that decision aids can be modified and used for both everyday activity decisions and medical treatment decisions. In addition to highlighting decision aids for specific decisional issues and topics, we also elucidated other validated tools that can be used to facilitate the decision-making process.

Conclusions And Implications: This study highlighted the topics involved in decision-making and using decision-making tools. The current review provides information that can help individuals and health care professionals choose optimal decision-making tools. On the basis of our findings, future studies can determine the most appropriate tools for intervention or outcome measures.
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http://dx.doi.org/10.1016/j.jamda.2021.06.034DOI Listing
October 2021

Effects of a simulation-based education programme on delirium care for critical care nurses: A randomized controlled trial.

J Adv Nurs 2021 Aug 22;77(8):3483-3493. Epub 2021 Jun 22.

Center for Nursing and Healthcare Research in Clinical Practice Application, Taipei Municipal Wanfang Hospital-Taipei Medical University, Taipei, Taiwan.

Aims: To evaluate the effects of a simulation-based education programme on critical care nurses' knowledge, confidence, competence and clinical performance in providing delirium care.

Design: Single-blinded randomized controlled trial.

Methods: Registered nurses who work in intensive care units were recruited from a university-affiliated acute major metropolitan teaching hospital. The intervention group received: (i) five online-learning delirium care videos, (ii) one face-to-face delirium care education session and (iii) a simulation-based education programme with a role-play scenario-based initiative and an objective structured clinical examination. The control group received only online videos which were the same as those provided to the intervention group. Delirium care knowledge, confidence, competence, and clinical performance as outcomes were collected at: baseline, immediately after intervention, and within 6 weeks post-intervention to test whether there were any changes and if they were sustained over time. Data were collected between 2 October and 29 December 2020. The repeated-measures analysis of variance was used to examine for changes in delirium care knowledge, confidence, and competence within groups.

Results: Seventy-two critical care nurses participated with 36 each allocated to the intervention group and control group. No statistically significant difference was observed between the two groups in outcome variables at 6 weeks post-intervention. In the intervention group, significant within-group changes were observed in terms of delirium care knowledge, confidence, and competence over time. By contrast, no significant changes were observed in outcome measures over time in the control group.

Conclusion: The simulation-based education programme is an effective and feasible strategy to improve delirium care by enhancing the knowledge, confidence, competence and clinical performance of critical care nurses.

Impact: Our findings provide evidence regarding the development and implementation of a simulation-based education programme in hospitals for health professional education in Taiwan.
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http://dx.doi.org/10.1111/jan.14938DOI Listing
August 2021

[RCT of Reduction in Catheter-Related Complications by Using Intracavitary Electrocardiogram-Assisted Guidance in Neonatal PICC Placement].

Sichuan Da Xue Xue Bao Yi Xue Ban 2021 May;52(3):497-502

Department of Pediatrics, School of Medicine, University of Electronic Science and Technology of China/Sichuan Provincial People's Hospital, Sichuan Academy of Medical Sciences, Chengdu 610072, China.

Objective: To investigate the effect of intracavitary electrocardiogram (IC-ECG) guidance on peripherally inserted central catheter (PICC) related complications in neonatal patients.

Methods: A total of 210 neonatal patients were included in the study. They were admitted to the Neonatal Intensive Care Unit, Sichuan Provincial People's Hosptial between January, 2017 and December, 2019 and had PICC lines were placed in their upper limbs. The patients were randomly assigned to the observation group, which had PICC placement through conventional anatomical landmark guidance combined with IC-ECG guidance ( =105) or to the control group, which had PICC placement through only conventional anatomical landmark guidance ( =105) for PICC catheter tip positioning. Patient baseline data and data on subsequent catheter-related complications of the two groups were collected and compared.

Results: There were no significant difference between the two groups in sex composition, gestational age, postnatal days on the day of PICC placement, duration of PICC placement, disease profile, and the site of puncture ( >0.05). The observation group showed a significantly lower overall incidence of catheter-related complications (3.8%), compared to that of the control group (21.9%) ( <0.05). The observation group showed significantly lower incidence of phlebitis and arrhthmia compared to that of the control group ( <0.05).

Conclusion: A combination of anatomical landmark guidance and IC-ECG guidance to assist the placement of PICC decreases catheter-related complications.
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http://dx.doi.org/10.12182/20210560506DOI Listing
May 2021

The impact of ageing simulation education on healthcare professionals to promote person-centred care towards older people: A literature review.

Nurse Educ Pract 2021 May 7;53:103077. Epub 2021 May 7.

School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, New South Wales, Australia; Illawarra Health and Medical Research Institute (IHMRI), Wollongong, NSW, Australia. Electronic address:

Aim: This review aimed to explore the impact of ageing simulation for healthcare professional education to promote person-centred care towards older people.

Background: Ageing simulation is an emerging educational approach to facilitate the learning of healthcare professionals on ageing and older people. However, there is limited evidence available exploring its use and impact on the person-centred care of older people.

Design: An integrative review approach was used.

Methods: Four databases were searched from January 2010 to April 2020 including CINAHL, MEDLINE, Web of Science and PsychINFO, 21 papers were identified and analysed.

Results: Three interrelating themes were identified to outline the findings across the reviewed studies: ageing simulation use (theme 1), characteristics (theme 2) and impact (theme 3). Results showed literature available on ageing simulation is varied, ranged in study quality and applied several ageing simulation iterations making comparisons across the studies difficult.

Conclusions: Despite these challenges it was clear ageing simulation is a promising educational approach currently being used to promote person-centred care for older people in healthcare professionals. Ageing simulation successfully improved the ageing knowledge, empathy levels and attitudes towards older people of healthcare professionals.
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http://dx.doi.org/10.1016/j.nepr.2021.103077DOI Listing
May 2021

The use and effect of OSCES in post-registration nurses: An integrative review.

Nurse Educ Today 2021 May 5;100:104845. Epub 2021 Mar 5.

School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Australia; Illawarra Health and Medical Research Institute (IHMRI), Australia.

Background: Objective structured clinical examinations (OSCEs) have been used in the undergraduate medical setting since the 1970s, however little is known about its use and effectiveness in post-registration nurse education.

Objectives: The purpose of this review was to critically analyse studies using OSCEs in post-registration nurse education and to explore the use and effectiveness of OSCEs in this cohort.

Design: This review was conducted using the Whittemore and Knafl's framework for integrated reviews.

Data Sources: Using the search terms OSCE OR OSCA OR objective structured clinical examination AND nursing NOT undergraduate, a comprehensive review was conducted using CINHAL and MEDLINE.

Methods: The initial search located 173 studies. After screening and checking eligibility 19 studies were critically appraised. The final number of studies included in this review was 16.

Results: Three themes were generated: (i) Application of OSCEs in post-registration level nursing (ii) OSCEs more than an exam: Learning enhancements and (iii) Participant perceived impact of OSCEs.

Conclusion: OSCEs for post-registration nurses have evolved from the original OSCE design and have been adapted to a wide range of clinical settings and specialities. OSCEs were recognized as a valuable learning and assessment tool across the world for post-registration nurses. OSCEs offered strengths in terms of learner satisfaction and increased self-efficacy for this cohort. There was limited evidence supporting the effects of OSCEs within post-registration nursing education in comparison with other educational tools. Further research is needed to explore whether the knowledge gained in OSCEs is translated into clinical practice and whether simulation-based education is more effective in achieving enhanced knowledge compared to traditional-based education. Future research is required using RCT methods to compare the impact of OSCE to traditional-based education.
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http://dx.doi.org/10.1016/j.nedt.2021.104845DOI Listing
May 2021

Delirium care knowledge in critical care nurses: A multiple-choice question-based quiz.

Nurs Crit Care 2021 05 27;26(3):190-200. Epub 2021 Feb 27.

School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia.

Background: Lack of evidence regarding whether a useful examination instrument such as an multiple choice question (MCQ) quiz is reliable for assessing delirium care knowledge.

Aim: To develop and psychometrically test a MCQ-based quiz for assessing the delirium care knowledge in critical care nurses.

Design: Instrument development and psychometric evaluation study.

Methods: The development and validation process consisted of two phases. The first Phase focused on the quiz development, which was achieved through the following steps: (a) generation of an initial 20-item pool; (b) assessment of content validity; (c) assessment of face validity; (d) conduction of a pilot test, involving the collection of data from 217 critical care nurses through an online survey; and (e) item analysis and item elimination according to item difficulty and discrimination indices. The MCQ quiz was finalized through the development process. The second phase emphasized quiz validation through estimation of the internal consistency, split-half and test-retest reliability, and construct validity using parallel analysis with exploratory factor analysis (EFA).

Results: A final 16-item MCQ quiz was emerged from the item analysis. The Kuder-Richardson formula 20 coefficient for the overall quiz indicated good internal consistency (0.85), and the intraclass correlation coefficient with a 30-day interval also indicated that the questionnaire had satisfactory stability (0.97). EFA confirmed that the quiz had appropriate construct validity, and four factors could explain 60.87% of the total variance.

Conclusion: In this study, the MCQ, and single best answer quiz for assessing delirium care knowledge was developed, and its reliability and validity for this purpose were demonstrated.

Relevance To Clinical Practice: This study introduced an evidence-based quiz designed for future use in delirium care research and education that has significant implications for MCQ-based knowledge assessment in clinical practice.
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http://dx.doi.org/10.1111/nicc.12608DOI Listing
May 2021

Mandarin version of dementia and driving decision aid (DDDA): Development and stakeholder evaluation in Taiwan.

Int J Older People Nurs 2021 May 17;16(3):e12370. Epub 2021 Feb 17.

School of Nursing and Midwifery, Western Sydney University, Campbelltown, NSW, Australia.

Background: Dementia causes cognitive and memory difficulties which can reduce the driving safety of the individuals. The decision-making process for driving retirement is challenging, and yet limited guidance is available.

Objectives: This article reports the development of the Taiwanese version of dementia and driving decision aid (DDDA) and the evaluation from stakeholders through a dementia and driving education programme.

Methods: A multi-method approach was adopted using a pre-test, post-test survey and focus group interviews. A total of 154 healthcare professionals, family caregivers and people with dementia participated education programme, and 12 experts attended the focus group discussion. The survey included demographics, knowledge, confidence, competence and awareness of using DDDA. Participants completed a survey prior and immediately after the education programme. We translated a 32-page interactive DDDA booklet from the original English version to Mandarin. The education programme consisted of three-hour dementia and driving education module delivered both face-to-face and online.

Results: The majority of participants described the booklet as balanced (91.7%) with the information presented in a 'good' or 'excellent' manner (93.4%). Most participants (85.3%) felt that DDDA helps them in making decisions about driving. Five themes were extracted from the focus group interview: (1) approach targeted to people with dementia, (2) specific content and additional information, (3) culturally appropriate modification, (4) having the right to drive and (5) booklet dissemination. The knowledge, confidence, competence and awareness of using the DDDA increased significantly (p < 0.001) after the education programmes.

Conclusion: We anticipate that use of the DDDA booklet will raise awareness of this social and health issue among the general public and facilitate collaborations with clinicians, municipalities and related organisations in providing a decision-making resource material for those with people living with dementia and their families. This study was not a clinical trial and the focus of this study was development and evaluation of the DDDA booklet. As mentioned in the methods section, participants were invited to attend the education program and provided their thoughts on the DDDA booklet based on their satisfaction level. Moreover, the education program was a one-day, workshop type program. This study was neither "prospectively assigns human participants or groups of humans to one or more health-related interventions" nor "to evaluate the effects on health outcomes", according to the definition of clinical trial by WHO. Therefore, we did not consider this study was a clinical trial.

Implications For Practice: There is an urgent need for supporting people with dementia and their families to negotiate the complex decision-making involved in deciding to change their approach to driving. The DDDA booklet can fill an important gap in service delivery to people with dementia who are adjusting to life without driving.
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http://dx.doi.org/10.1111/opn.12370DOI Listing
May 2021

Review of Food Intake Difficulty Assessment Tools for People with Dementia.

West J Nurs Res 2021 Dec 28;43(12):1132-1145. Epub 2020 Dec 28.

School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia.

This review aimed to summarise the validity and reliability of feeding difficulties assessment tools for Individual with dementia. PubMed, PsycINFO, MEDLINE, CINAHL and Scopus were searched for feeding difficulty measurements studies published between 1990 and 2019. Sixteen publications were included and identified three tools: Edinburgh Feeding Evaluation in Dementia (EdFED), Feeding Behaviour Inventory (FBI), and Feeding Difficulty Index (FDI). Results showed the EdFED was translated and tested in various languages. The EdFED and FDI demonstrated high content and construct validity. The FBI was not validated. The EdFED had high inter-rater reliability, with Cronbach's alpha ranging from 0.75 to 0.90. The FDI and FBI showed moderate inter-rater reliability. Although the EdFED has been tested and widely used, unlike FDI, which addresses multi-aspects of feeding difficulty. The FDI have higher clinical utility but future research needs to test the psychometric properties of FDI to determine its effectiveness in assessing feeding difficulties.
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http://dx.doi.org/10.1177/0193945920979668DOI Listing
December 2021

Afferent Projections to Area Prostriata of the Mouse.

Front Neuroanat 2020 27;14:605021. Epub 2020 Nov 27.

Key Laboratory of Neuroscience, School of Basic Medical Sciences, Institute of Neuroscience, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China.

Area prostriata plays important roles in fast detection and analysis of peripheral visual information. It remains unclear whether the prostriata directly receives and integrates information from other modalities. To gain insight into this issue, we investigated brain-wide afferent projections to mouse prostriata. We find convergent projections to layer 1 of the prostriata from primary and association visual and auditory cortices; retrosplenial, lateral entorhinal, and anterior cingulate cortices; subiculum; presubiculum; and anterior thalamic nuclei. Innervation of layers 2-3 of the prostriata mainly originates from the presubiculum (including postsubiculum) and anterior midline thalamic region. Layer 5 of the prostriata mainly receives its inputs from medial entorhinal, granular retrosplenial, and medial orbitofrontal cortices and anteromedial thalamic nucleus while layer 6 gets its major inputs from ectorhinal, postrhinal, and agranular retrosplenial cortices. The claustrum, locus coeruleus, and basal forebrain provide relatively diffuse innervation to the prostriata. Moreover, Cre-dependent tracing in cortical areas reveals that the cells of origin of the prostriata inputs are located in layers 2-4 and 5 of the neocortical areas, layers 2 and 5 of the medial entorhinal cortex, and layer 5 of the retrosplenial cortex. These results indicate that the prostriata is a unique region where primary and association visual and auditory inputs directly integrate with many limbic inputs.
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http://dx.doi.org/10.3389/fnana.2020.605021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7728849PMC
November 2020

Homotopic Commissural Projections of Area Prostriata in Rat and Mouse: Comparison With Presubiculum and Parasubiculum.

Front Neural Circuits 2020 13;14:605332. Epub 2020 Nov 13.

Key Laboratory of Neuroscience, School of Basic Medical Sciences, Institute of Neuroscience, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China.

Area prostriata in primates has recently been found to play important roles in rapid detection and processing of peripheral visual, especially fast-moving visual information. The prostriata in rodents was not discovered until recently and its connectivity is largely unknown. As a part of our efforts to reveal brain-wide connections of the prostriata in rat and mouse, this study focuses on its commissural projections in order to understand the mechanisms underlying interhemispheric integration of information, especially from peripheral visual field. Using anterograde, retrograde and Cre-dependent tracing techniques, we find a unique commissural connection pattern of the prostriata: its layers 2-3 in both hemispheres form strong homotopic commissural connections with few heterotopic projections to bilateral medial entorhinal cortex. This projection pattern is in sharp contrast to that of the presubiculum and parasubiculum, two neighbor regions of the prostriata. The latter two structures project very strongly to bilateral medial entorhinal cortex and to their contralateral counterparts. Our results also suggest the prostriata is a distinct anatomical structure from the presubiculum and parasubiculum and probably plays differential roles in interhemispheric integration and the balancing of spatial information between two hemispheres.
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http://dx.doi.org/10.3389/fncir.2020.605332DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7724997PMC
November 2021

Diagnostic accuracy of the CAM-ICU and ICDSC in detecting intensive care unit delirium: A bivariate meta-analysis.

Int J Nurs Stud 2021 Jan 3;113:103782. Epub 2020 Oct 3.

School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Research Center of Sleep Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. Electronic address:

Background: Delirium is a critical and highly prevalent problem among critically ill patients. The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and the Intensive Care Delirium Screening Checklist (ICDSC) are the most recommended assessment tools for detecting intensive care unit (ICU) delirium.

Objectives: To synthesize the current evidence and compared the diagnostic accuracy of the two tools in the detection of delirium in adults in ICUs.

Design: Systematic review and meta-analysis.

Data Source: A comprehensive search of the following electronic databases was performed using PubMed, Embase, CINAHL and ProQuest Dissertations and Theses A&I. The date range searched was from database inception to April 26, 2019.

Review Methods: Two researchers independently identified articles, systematically abstracted data and evaluated the sensitivity and specificity of the CAM-ICU or the ICDSC against standard references. Bivariate diagnostic statistical analysis with a random-effects model was performed to summarize the pooled sensitivity and specificity of the two tools.

Results: In total, 29 CAM-ICU and 12 ICDSC studies were identified. The pooled sensitivity was 0.84 and 0.83 and pooled specificity was 0.95 and 0.87 for the CAM-ICU and the ICDSC, respectively. The CAM-ICU had higher summary specificity than the ICDSC did (p = 0.04). The percentage of hypoactive delirium, ICU type, use of mechanical ventilation, number of participants, and female percentage moderated the accuracy of the tools. Most of the domains of patient selection, index test, reference standards, and flow and timing were rated as having a low or unclear risk of bias.

Conclusions: Although both the CAM-ICU and the ICDSC are accurate assessment tools for screening delirium in critically ill patients, the CAM-ICU is superior in ruling out patients without ICU delirium and detecting delirium in patients in the medical ICU and those receiving mechanical ventilation. Further investigations are warranted to validate our findings. The study protocol is registered at PROSPERO (CRD42020133544).
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http://dx.doi.org/10.1016/j.ijnurstu.2020.103782DOI Listing
January 2021

Developing an ontology for representing the domain knowledge specific to non-pharmacological treatment for agitation in dementia.

Alzheimers Dement (N Y) 2020 1;6(1):e12061. Epub 2020 Sep 1.

Illawarra Health and Medical Research Institute Wollongong New South Wales Australia.

Introduction: A large volume of clinical care data has been generated for managing agitation in dementia. However, the valuable information in these data has not been used effectively to generate insights for improving the quality of care. Application of artificial intelligence technologies offers us enormous opportunities to reuse these data. For health data science to achieve this, this study focuses on using ontology to coding clinical knowledge for non-pharmacological treatment of agitation in a machine-readable format.

Methods: The resultant ontology-Dementia-Related Agitation Non-Pharmacological Treatment Ontology (DRANPTO)-was developed using a method adopted from the NeOn methodology.

Results: DRANPTO consisted of 569 concepts and 48 object properties. It meets the standards for biomedical ontology.

Discussion: DRANPTO is the first comprehensive semantic representation of non-pharmacological management for agitation in dementia in the long-term care setting. As a knowledge base, it will play a vital role to facilitate the development of intelligent systems for managing agitation in dementia.
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http://dx.doi.org/10.1002/trc2.12061DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7507392PMC
September 2020

One single-center cross-sectional investigation on varicella antibody level of all age groups in Chinese people.

Hum Vaccin Immunother 2021 02 23;17(2):358-362. Epub 2020 Sep 23.

Key Laboratory of Major Diseases in Children, Ministry of Education, National Key Discipline, Laboratory of Dermatology, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health , Beijing, China.

Varicella outbreaks were mainly reported in developed regions with high vaccine coverage, but not in undeveloped areas. It is still not clear that whether the published data of varicella epidemiology could reflect the reality in China or not. In 2019, 657 subjects from People's Hospital of Chongqing Youyang County were included. Anti-varicella-zoster virus (VZV) IgG antibodies were determined by ELISA. The anti-VZV IgG levels were categorized as positive when values were ≥100 mIU/mL. Our results showed that the rates of anti-VZV IgG seropositivity (χ = 328.957, < .0001) and geometric mean titers ( < .0001) were significantly influenced by age. The seropositivity declined dramatically from 84.5% in subjects ≤3 m of age, to 7.9% in subjects of >3 m-1 y ( < .0001). Then, the positivity rate increased slowly as age to 26.7% in >1-<3 y ( = .0006), and 34.5% in 3-<7 y ( = .4294). A steady rise (45.6%) in positivity was observed in subjects aged 7-<18 y. After then, the positivity began to increase robustly. A total of 87.8% of adults aged 18-<40 y had acquired VZV-specific immunity ( < .0001). The highest positivity rate was found in 40-<60 y  (98.3%) and ≥60 y (98.2%) group. In conclusion, most subjects of >3 m-<7 y age were susceptible to VZV. The proportion of subjects with natural infection-induced immunity increased with age. Nearly all subjects over 40 ages had positive anti-VZV IgG antibodies, which proved that they were infected by this virus in the past. These results suggested that VarV should be included in the national immunization program in China.
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http://dx.doi.org/10.1080/21645515.2020.1784653DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7899669PMC
February 2021

Exploring the use of ageing simulation to enable nurses to gain insight into what it is like to be an older person.

J Clin Nurs 2020 Dec 23;29(23-24):4561-4572. Epub 2020 Sep 23.

Faculty of Science, Medicine and Health, School of Nursing, University of Wollongong, Wollongong, NSW, Australia.

Aim And Objectives: To explore the thoughts and experiences of aged care nurses following participation in an ageing-suit simulation intervention.

Background: Globally, people are living longer, and for nurses, there are increasing challenges to meet the needs of the higher numbers of older people in hospital. Educating nurses to understand the ageing process and the experiences of older people in hospital is crucial to addressing these challenges. Ageing-suits were identified as a possible approach to assist with these educational needs.

Design: This study adopted a qualitative descriptive design.

Method: A convenience sample of nurses (n = 15) were selected from a single aged care ward. Volunteered nurses participated in a four-hour ageing-suit simulation session. Their immediate thoughts and experiences were explored via postsimulation debriefs, and three 30-to 50-min follow-up focus groups were conducted at 3 months to explore perceptions on the impact of their experience on clinical practices. The data were analysed with the Braun and Clarke's six-step thematic analysis method. To ensure quality reporting of this study, the COREQ checklist was utilised (see Appendix S1).

Results: Data analysis generated three main themes. Nurses in the study highlighted that the experience of the ageing-suit resulted in "it feels real" (theme 1) and helped them in "enhancing understanding" (theme 2) about older people and their practices and supported a process of "changing me" (theme 3).

Conclusion: Ageing-suits are emerging as a promising innovative educational approach for aged care nurses to gain insight into the challenges of ageing and subsequently making changes to themselves and their individualised practices towards older people. Future research is required to determine whether this educational approach is useful for a broader population of healthcare professionals.

Relevance To Clinical Practice: Ageing-suits were identified as a worthwhile educational approach for aged care nurses to improve their specialised clinical practices with older people.
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http://dx.doi.org/10.1111/jocn.15484DOI Listing
December 2020

Why has COVID-19 not hit the countries like Nepal yet?

Rev Environ Health 2021 Jun 3;36(2):185-191. Epub 2020 Sep 3.

Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia.

Noble CORONA Virus (COVID-19) is an infectious disease similar form of pneumonia/ SARS-CoV-2- impacting globally. The fear of coronavirus looks pandemic, but its severity is uncertain. Nepal was one of the first nine countries outside of China to report a COVID-19 case. Also, its unpredictability of mode or range of surface, the lifespan of the virus, objects of transmission (a distance of air/air currents, living duration in air, humidity, duration on objects, surface). The first case was found in Wuhan in December 2019 in China. The purpose is to summarize the current information about COVID-19 and to explore in terms of why Nepal is not hitting severely, while other countries are on death toll? We summarized the published articles form the web sources and news, Academic Journals, Ministry of health and population Nepal, WHO/CDC update reports/guidelines, Google search engine. Thematic analysis is made to explore the situation. Although, Nepal has a lack of health services, testing kits, advance lab and protecting equipment (PPE), why COVID-19 does not hit Nepal than China, Europe and North America, it still tremendous uncertainty. Is lockdown, isolation, social distance and quarantine the best ways of prevention? The hypothesis is floating globally - do BCG vaccinated countries are safer than non-user OR due to not having enough kits to screen populations at risk for the virus - while lack of testing a big cause for missing case OR Nepalese have better immune systems? It has attracted global attention. We believe that the COVID-19 is still evolving and it is too early to predict of an outbreak in Nepal. The government needs to increase funding for local health departments, begin planning for future epidemics and be prepared to bolster the economy by supporting consumer spending the midst of a serious outbreak. COVID-19 is a serious health challenge for Nepal, but so far the number of death has been lower than was foretell. It is, therefore essential to carry out more scientific evidence to explore results. Nepalese health services need to maintain up than today and follow lockdown, isolation, social distance and an advance screening test kit through the country.
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http://dx.doi.org/10.1515/reveh-2020-0085DOI Listing
June 2021

Effectiveness of acupoint pressure on older people with constipation in nursing homes: a double-blind quasi-experimental study.

Contemp Nurse 2020 Oct-Dec;56(5-6):417-427. Epub 2020 Sep 18.

School of Nursing and Midwifery, Western Sydney University, Campbelltown Campus, Buidling 7.G. 11 Locked Bag 1797, Penrith, NSW 2751 Australia.

To compare the differences between acupoint pressure, abdominal massage and laxatives in treatment of constipation for residents in two nursing homes. There is lack of evidence on the utility of complementary therapies in the management of constipation among older adults. Quasi-experimental. A total of 90 participants from two nursing homes in Taiwan were assigned to three groups: the control group (with laxatives only), group I (with laxatives and abdominal massage) and group II (with laxatives, acupoint pressure therapy [APT] and abdominal massage). The intervention was performed over 10 days. A double-blind technique was applied in both participants and the outcome assessors. Constipation as main outcome was evaluated and recorded for 10 days. Observation of the frequency of defecation and the consistency, particularly firmness of faeces over each 24 h' period was recorded. The Transparent Reporting of Evaluations with Nonrandomized Designs (TREND) checklist was utilised in reporting methods and findings. Three variations were revealed as interface factors and showed significant differences in each group. The results showed a statistically significant decrease in constipation in the experimental groups I and II. The scores of defecation frequency, difficulty degree and time of defecation, stool quality and awareness of defecation were obviously improved after treatment. We concluded APT could be used in conjunction with laxatives and must be considered as a long-term intervention. The combination of APT, abdominal massage and laxatives is superior to both abdominal massage with laxatives and laxatives alone. Acupoint pressure as an effective complementary therapy of constipation among older adults living in nursing home provides a non-pharmacological, independent nursing intervention that nurses could use. This is relevant to nursing home settings where nurses make autonomous decision on important clinical assessments and interventions.
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http://dx.doi.org/10.1080/10376178.2020.1813042DOI Listing
October 2021

Diagnostic Performance of Delirium Assessment Tools in Critically Ill Patients: A Systematic Review and Meta-Analysis.

Worldviews Evid Based Nurs 2020 Aug 12;17(4):301-310. Epub 2020 Aug 12.

Cochrane Taiwan Taipei Medical University, Taipei, Taiwan.

Background: Critical care nurses are in the best position to detect and monitor delirium in critically ill patients. Therefore, an optimum delirium assessment tool with strong evidence should be identified with critical care nurses to perform in the daily assessment.

Aim: To evaluate and compare the diagnostic performance of delirium assessment tools in diagnosing delirium in critically ill patients.

Methods: We searched five electronic databases including the Cochrane Library, PubMed, Embase, CINAHL, and a Chinese database for eligible diagnostic studies published in English or Mandarin up to December 2018. This diagnostic test accuracy meta-analysis was limited to studies in intensive care unit (ICU) settings, using the Diagnostic and Statistical Manual of Mental Disorders (DSM) as a standard reference to test the accuracy of delirium assessment tools. Eligible studies were critically appraised by two investigators independently. The summary of evidence was conducted for pooling and comparing diagnostic accuracy by a bivariate random effects meta-analysis model. The pooled sensitivities and specificities, summary receiver operating characteristic curve (sROC), the area under the curve (AUC), and diagnostic odds ratio (DOR) were calculated and plotted. The possibility of publication bias was assessed by Deeks' funnel plot.

Data Synthesis: We identified and evaluated 23 and 8 articles focused on CAM-ICU and ICDSC, respectively. The summary sensitivities of 0.85 and 0.87, and summary specificities of 0.95 and 0.91 were found for CAM-ICU and ICDSC, respectively. The AUC of the CAM-ICU was 0.96 (95% CI, 0.94-0.98), with DOR at 99 (95% CI, 55-177). The AUC of the ICDSC was 0.95 (95% CI, 0.92-0.96), and the DOR was 65 (95% CI, 27-153).

Linking Evidence To Action: CAM-ICU demonstrated higher diagnostic test accuracy and is recommended as the optimal delirium assessment tool. However, the results should be interpreted with caution due to the between-study heterogeneity of this diagnostic test accuracy meta-analysis.
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http://dx.doi.org/10.1111/wvn.12462DOI Listing
August 2020

Delirium Among Hospitalized Older Adults in Thailand: An Integrative Review.

J Gerontol Nurs 2020 Jun;46(6):43-52

The current integrative review explored the prevalence of delirium among Thai older adults and the role of nurses and physicians in detecting delirium. Several academic databases were searched for relevant studies using a set of predetermined search terms and limits. Study quality was assessed using the National Health and Medical Research Council's Principles of Peer Review. Thirteen studies were reviewed, and three themes were identified: (a) Epidemiology (n = 9), (b) Detection (n = 5), and (c) Role of Nurses and Physicians (n = 4). Higher priority cases were treated for immediate problems by physicians, but they did not routinely screen for delirium, which remained underdiagnosed. Lack of delirium screening guidelines or protocols was found to be the greatest barrier to detection. The ability of nurses to perform delirium screening was disregarded in most studies. There is limited research exploring delirium in Thai older adults, including lack of guidelines or protocols for health care professionals and lack of knowledge of delirium detection, management, and prevention. Further validation of screening tools and developing the training of health care professionals, specific to detecting delirium, is required. [Journal of Gerontological Nursing, 46(6), 43-52.].
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http://dx.doi.org/10.3928/00989134-20200504-01DOI Listing
June 2020

Diagnostic test accuracy meta-analysis of PRE-DELIRIC (PREdiction of DELIRium in ICu patients): A delirium prediction model in intensive care practice.

Intensive Crit Care Nurs 2020 Apr 24;57:102784. Epub 2019 Dec 24.

School of Nursing and Midwifery, Western Sydney University, Narellan Road, Cnr David Pilgrim Drive & Goldsmith Avenue, Campbelltown, NSW 2560, Australia. Electronic address:

Objectives: To review and examine the evidence on diagnostic test accuracy of PRE-DELIRIC (PREdiction of DELIRium in ICu patients) for predicting delirium risk in critically ill patients.

Research Methodology: This meta-analysis included studies reporting the diagnostic performance of PRE-DELIRIC between 2012 and 2019. The Cochrane Library, MEDLINE, Embase, CINAHL and Chinese Electronic Periodical Services databases were searched for eligible diagnostic studies. Risk of bias was assessed using a standard procedure according to the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) criteria.

Results: We included seven studies involving a total of 7941 critically ill patients in intensive care units settings. Results indicated that PRE-DELIRIC had a summary sensitivity of 0.76 (95% CI 0.60-0.87), and specificity of 0.66 (95% CI 0.45-0.82), suggesting that diagnostic performance of PRE-DELIRIC is useful to predict delirium risk in ICU patients. The area under the summary receiver operator characteristics (SROC) curve was 0.78 (95% CI 0.74-0.81), which also confirmed good accuracy of PRE-DELIRIC.

Conclusion: We suggest that the PRE-DELIRIC model can be applied in the intensive care unit according to its good diagnostic test accuracy. However, this finding should be interpreted with caution due to the heterogeneity of this meta-analysis.
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http://dx.doi.org/10.1016/j.iccn.2019.102784DOI Listing
April 2020

Validation and evaluation of the Mandarin version of the oral health literacy adult questionnaire in Taiwan.

Public Health Nurs 2020 03 19;37(2):303-309. Epub 2019 Nov 19.

School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei, Taiwan.

Objectives: This study aimed to translate the Oral Health Literacy Adult Questionnaire into a Mandarin version (MOHL-AQ) and to examine its psychometric properties.

Methods: A methodological research using psychometric testing and evaluation of a translated instrument. A convenience sample of 402 participants from northern Taiwan were recruited for the validation of the MOHL-AQ. Internal consistency reliability, split-half reliability, inter-rater reliability, face validity, content validity, and construct validity were evaluated.

Results: The value of internal consistency and split-half reliability of the MOHL-AQ were 0.77 and 0.78, respectively. Content validity reported a high content validity index (CVI = 95%). Exploratory factor analysis (EFA) and parallel analysis (PA) were used to determine a unidimensional model and confirmatory factor analysis (CFA) was employed to confirm the model. The indices of good fit model were achieved at GFI = 0.93, AGFI = 0.92, RMSEA = 0.04, CFI = 0.90, PGFI = 0.73, χ /df = 1.86 (p < .001). Most of the item-total correlations indicated adequate and acceptable convergent validity (r > .30).

Conclusion: MOHL-AQ demonstrates adequate psychometric properties for measuring the oral health literacy in Mandarin-speaking population. Public health nurses can use MOHL-AQ to assess oral health literacy in the community settings and further screen potential population with inadequate oral health literacy.
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http://dx.doi.org/10.1111/phn.12688DOI Listing
March 2020

Molecular characteristics and antimicrobial susceptibility of Staphylococcus aureus among children with respiratory tract infections in southwest China.

World J Pediatr 2020 Jun 16;16(3):284-292. Epub 2019 Oct 16.

Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, NanLiShi Road 56, Xicheng District, Beijing, 100045, China.

Background: The molecular characteristics and antimicrobial susceptibility of Staphylococcus aureus (S. aureus) in general pediatric wards and county-level hospitals were rarely reported in China.

Methods: Staphylococcus aureus was isolated from children hospitalized with respiratory tract infection (RTI) in Zhongjiang and Youyang counties in 2015. All isolates were typed by multilocus sequence, staphylococcal protein A, accessory gene regulator (agr), and staphylococcal cassette chromosome mec [SCCmec, for methicillin-resistant S. aureus (MRSA) only]. Polymerase chain reaction was used to screen 21 super-antigen (SAg) genes and panton-valentine leukocidin (pvl). Antimicrobial susceptibility testing was performed by E test.

Results: A total of 2136 children were enrolled. Overall, 125 (5.9%) children carried S. aureus, among which MRSA accounted for 42.4%. ST59-SCCmec type IV-t437-agr group I (58.5%) was the most prevalent genotype in MRSA, and ST188-t189-agr group I (22.2%) was the top genotype in methicillin-sensitive S. aureus (MSSA). The pvl carriage rate in MRSA and MSSA was 15.1% and 9.7%, respectively (P = 0.4112). About 96.8% of S. aureus isolates were positive for at least one SAg gene. The most common SAg gene profile in the dominant ST59 clone was seb-sek-seq (42.8%). All S. aureus isolates were resistant to penicillin and erythromycin (minimum inhibitory concentration 90 was > 32 and 256 mg/L to penicillin and erythromycin, respectively), but usually susceptible to other tested non-β-lactam antimicrobials.

Conclusions: Staphylococcus aureus and MRSA were detected with a high frequency in children with RTI in county-level hospitals of China. ST59-SCCmec type IV-t437-agr group I was the dominant MRSA clone. The S. aureus isolates exhibited high resistance to penicillin and erythromycin.
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http://dx.doi.org/10.1007/s12519-019-00317-4DOI Listing
June 2020
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