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Taipei, Taiwan

I-Hsun C.,MacKay Childrens Hospital | Su-Fen C.,National Taipei University of Nursing and Health Sciences | Wei-Wen W.,National Taipei University of Nursing and Health Sciences | Hui-Ju C.,National Taipei University of Nursing and Health Sciences | Shu-Yuan L.,National Taipei University of Nursing and Health Sciences
Journal of Nursing and Healthcare Research | Year: 2015

Background: With the increasing success in treating cancers and the shortened length of cancer-related hospitalization, the primary caregivers for children with cancer must increasingly provide post-discharge care of their children at home. However, the demands of being vigilant with regard to the side effects of treatment, providing adequate nutrition, and preventing infection in these children after returning home place high levels of stress and emotional burden on the primary caregivers. Purpose: The purpose of this descriptive qualitative study was to understand the experiences of primary caregivers in providing initial care at home to their children with newly diagnosed cancer after the first round of chemotherapy. Methods: In this descriptive qualitative study, in-depth interviews with 15 primary caregivers were conducted. Results: The results revealed the following three themes and 10 sub-themes. Theme one: chaos in home life (sub-themes: family life characterized by busyness and fluster, exhaustion resulting from attempting to take control over all aspects of homecare, and inability to attend to the needs of other family members). Theme two: lack of confidence in the ability to provide home care (sub-themes: concerns regarding the safety of the home environment, apprehensions about food selection and preparation, and worries about assisting in administering medications/injections). Theme three: taking ownership and making adjustments to provide care (sub-themes: providing care independently, fears about potential emergency situations, feelings of helplessness in encountering physical or psychological changes in his/her child, and learning to make positive adjustments with thankfulness). Conclusions/Implications for Practice: The participants experienced their highest levels of stress during the first week, especially during the first 3 days after hospital discharge. Thus, the first 3 days after discharge is the optimal time for healthcare professionals to proactively provide care and resolve potential problems. The confidence of participants to provide effective care increased with time as they gradually adapted to the changes. These findings offer healthcare providers insight into providing quality post-discharge care for children with cancer.

Lee M.,Taipei Medical University Hospital | Chen S.C.-C.,Taipei Medical University Hospital | Chen S.C.-C.,Taipei Medical University | Yang H.-Y.,Ditmanson Medical Foundation Chia Yi Christian Hospital | And 3 more authors.
Medicine (United States) | Year: 2016

Biliary atresia (BA) is a significant liver disease in children. Since 2004, Taiwan has implemented a national screening program that uses an infant stool color card (SCC) for the early detection of BA. The purpose of this study was to examine the outcomes of BA cases before and after the launch of this screening program. The objectives of this study were to evaluate the rates of hospitalization, liver transplantation (LT), and mortality of BA cases before and after the program, and to examine the association between the hospitalization rate and survival outcomes. This was a population-based cohort study. BA cases born during 1997 to 2010 were identified from the Taiwan National Health Insurance Research Database. Sex, birth date, hospitalization date, LT, and death data were collected and analyzed. The hospitalization rate by 2 years of age (Hosp/2yr) was calculated to evaluate its association with the outcomes of LT or death. Among 513 total BA cases, 457 (89%) underwent the Kasai procedure. Of these, the Hosp/2yr was significantly reduced from 6.0 to 6.9/case in the earlier cohort (1997-2004) to 4.9 to 5.3/case in the later cohort (2005-2010). This hospitalization rate reduction was followed by a reduction in mortality from 26.2% to 15.9% after 2006. The Cox proportional hazards model showed a significant increase in the risk for both LT (hazard ratio [HR]=1.14, 95% confidence interval [CI]=1.10-1.18) and death (HR=1.05, 95% CI=1.01-1.08) for each additional hospitalization. A multivariate logistic regression model found that cases with a Hosp/2yr >6 times had a significantly higher risk for both LT (adjusted odds ratio [aOR]=4.35, 95% CI=2.82-6.73) and death (aOR=1.75, 95% CI=1.17-2.62). The hospitalization and mortality rates of BA cases in Taiwan were significantly and coincidentally reduced after the launch of the SCC screening program. There was a significant association between the hospitalization rate and final outcomes of LT or death. The SCC screening program can help reduce the hospitalization rate and mortality of BA cases and bring great financial benefit. © 2016 Wolters Kluwer Health, Inc. All rights reserved.

Tsao P.-C.,Taipei Veterans General Hospital | Tsao P.-C.,National Yang Ming University | Shiau Y.-S.,Taipei Veterans General Hospital | Chiang S.-H.,Foundation Medicine | And 14 more authors.
PLoS ONE | Year: 2016

Background: Early detection of critical congenital heart disease (CCHD) can significantly reduce morbidity and mortality among newborns.We investigate the feasibility of implementing a communitybased newborn CCHD screening program in Taipei. Methods: Twelve birthing facilities in Taipei participated in a trial screening program between October 1, 2013, and March 31, 2014. Newborns underwent pulse oximetry at 24-36 h old, with probes attached to the right hand and one lower limb. Any screening saturation ≥95% in either extremity, with an absolute difference of ≤3% between the right hand and foot, was accepted as a screening pass. A screening result was considered as a fail if the oxygen saturation was <95% at either probe site, on 3 separate occasions, each separated by 30 min or the first result was <95% at either probe site, and any subsequent oxygen saturation measurement was <90%. Public health nurses would follow up all missed or refused cases. Results: Of the 6,387 live births, 6,296 newborns (coverage rate: 6,296/6,387 = 98.6%) underwent appropriate pulse oximetry screening. Sixteen newborns (0.25%) were reported to have a failed screening result. Five of these screen positive newborns were confirmed with CCHD; two of them were diagnosed solely attributed to the failed screening results. The falsepositive rate was 0.18%. Implementing a 6-month screening program for CCHD produced good case detection rate, while using efficient screening and referral systems. Conclusion: This program was successful in integrating screening, referral and public health tracking systems. The protocol outlined in this report could provide a community-based model for worldwide implementation. © 2016 Tsao et al.2016 Tsao et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Chang C.-L.,Cathay General Hospital | Chang C.-L.,Center for Medical Education and Research | Hung K.-L.,Cathay General Hospital | Hung K.-L.,Fu Jen Catholic University | And 3 more authors.
Pediatric Neurology | Year: 2015

Background Corpus callosum atrophy has been associated with cognitive and motor deficits in elderly people. However, the role of the corpus callosum in infant development is unclear. The aim of this study was to assess the impact of corpus callosum size on motor development in infants. Methods We investigated cerebral ultrasonograms performed on healthy infants aged 4 to 6 months. The correlation between the development of rolling over and corpus callosum size was calculated for determining odds ratios. Covariates, including gestational age, sex, age in months, and head circumference were tested using logistic regression. Results We investigated 244 cerebral ultrasonograms performed on term infants from 2009 to 2011. The percentage of rolling over development in the examined infants increased with age (47.8%, 78.4%, and 97.5% at ages 4, 5, and 6 months, respectively). There was no significant difference in the development of rolling over between male (67.9%) and female (73.6%) children or among different gestational age groups. After the other covariates in the logistic model were adjusted, only age and corpus callosum size (length and thickness) were significantly associated with the development of rolling over: 3.86 times the odds (confidence interval, 2.1 to 7.0) for age in months, 1.14 times the odds (confidence interval, 1.0 to 1.3) for corpus callosum length, and 3.92 times the odds (confidence interval, 1.6 to 9.6) for corpus callosum thickness. Conclusions Corpus callosum size is positively associated with the development of rolling over in healthy term infants, independent of the gestational age, sex, age, and head circumference. © 2015 Elsevier Inc. All rights reserved.

Chen I.-L.,MacKay Childrens Hospital | Chiu N.-C.,MacKay Childrens Hospital | Chiu N.-C.,Mackay Medical College | Chi H.,MacKay Childrens Hospital | And 5 more authors.
Journal of Microbiology, Immunology and Infection | Year: 2015

Background/Purpose: Bloodstream infections (BSIs) are associated with high mortality and morbidity in neonatal intensive care units (NICUs). The epidemiology of these infections may change after the application of new infection control policies. The aims of this study are to reveal the changing epidemiology of BSIs in our NICU and inspect the effects of infection control efforts. Methods: We reviewed and analyzed the clinical characteristics of culture-proven BSIs in our NICU from 2008 to 2013 and compared them with our two previously reported data (1992-2001 and 2002-2007). Results: The mortality rate decreased from 16.3% in 1992-2001 to 5.6% in 2008-2013. In the recent study period, Gram-positive infections became predominant (58.0%). Coagulase-negative staphylococci remained the most commonly isolated organisms (26.0%). Group B Streptococcus (GBS) BSIs had the highest mortality rate (30.0%). Most GBS-infected infants' mother did not perform prenatal GBS screening. There was a decrease in the total fungal infection rate after fluconazole prophylaxis for very-low-birth-weight (VLBW) neonates, but the infections of fluconazole-resistant Malassezia pachydermatis increased. The incidence of central line-associated BSI increased to 10.6% in 2011. After restricting the catheter duration to <21 days, the incidence decreased to 4.2% in 2013. Conclusion: Through the years, the overall mortality rate of BSIs in our NICU decreased. Maternal GBS screening is an important issue for avoiding early onset GBS mortality. Fungal infection rate decreased after antifungal prophylaxis policy for VLBW infants, but we should be aware of resistant strains. Restriction of the catheter duration may decrease the incidence of catheter-related BSI. © 2015.

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