秀傳醫學雜誌最新文献

{"title":"微小核酸-29C/類二型賴氨酸氧化酶於肺腺癌之診斷治療意義","authors":"Yi-Heng Chen Yi-Heng Chen, Hung-Yu Lin Yi-Heng Chen, Chia-Ying Lin Hung-Yu Lin","doi":"10.53106/156104972022062101005","DOIUrl":"https://doi.org/10.53106/156104972022062101005","url":null,"abstract":"\u0000 肺腺癌的早期精準診斷以及其抗藥性的生成一直是臨床上的挑戰。近年來發現 到微核酸 29C 以及類二型賴氨酸氧化酶分別扮演的抑癌以及促癌角色。然而,微核 酸 29C/ 類二型賴氨酸氧化酶軸線的臨床意義以及生物功能尚未釐清。本研究應用 多體學策略探討微核酸 29C/ 類二型賴氨酸氧化酶軸線是否可作為肺腺癌預測模組以 及作為治療標的的潛力。自 cBioPortal 伺服器擷取 7,561 件肺腺癌檢體中,微核酸 29C 的突變光譜展現隨機分布,擴增率僅 3%,且基因套數變化不影響病人存活時 間。相比之下,低表達微核酸 29C 與短存活時間顯著相關,且與類二型賴氨酸氧化 酶呈現負相關。高表達類二型賴氨酸氧化酶與短存活時間顯著相關,並且與 CD8 陽 性 T 細胞呈現負相關,而與癌相關纖維母細胞呈現正相關,顯示出抑制免疫的腫瘤 微環境特徵。此外,微核酸 29C 與臨床分期呈現負向關聯性。TargetScan 生資工具 預測出微核酸 29C 的 3’ 端可標靶類二型賴氨酸氧化酶的兩處 3’ 端未轉譯區,核苷 酸位序 555-561 以及 757-763,表明微核酸 29C 有抑制類二型賴氨酸氧化酶的潛力。 總結本研究發現低表達微核酸 29C 連同高表達類二型賴氨酸氧化酶可預測肺腺癌不 良預後。微核酸 29C/ 類二型賴氨酸氧化酶軸線指出一肺腺癌新生物路徑以及治療 標的。\u0000 The early, precise diagnosis and drug resistance of lung adenocarcinoma (LUAD) remains a challenging issue. The tumor suppression role of microRNA- 29C (MIR29C) and the tumor promotion role of lysyl oxidase-like 2 (LOXL2) have recently been observed. However, the clinical implication and biological function of MIR29C/lysyl oxidase-like 2 (LOXL2) axis remains unclear. In this study, we utilized the multi-omic approach to investigate whether the MIR29C/LOXL2 axis can serve as a prediction panel and determine its potential as therapeutic targets. Using the cBioPortal server, the mutation landscape of MIR29C in LUAD samples showed that the mutation spectrum presented a random distribution and the amplification rate was as low as 3%, while LOXL2 presented as 6%. The copy number alteration of MIR29C had no effect on the overall survival (OS) rate, whereas that of LOXL2 was associated with poor OS. In contrast, the low expression of MIR29C was significantly associated with shorter OS. MIR29C negatively correlated with LOXL2 mRNA level. High expression of LOXL2 was significantly associated with shorter OS, and connected with lower infiltration levels of CD8+T cells and higher infiltrate levels of cancer associated fibroblast, representing hallmarks of an immunosuppressive tumor microenvironment. In addition, MIR29C showed a negative association with advanced stages. Using TargetScan Release 7.2, MIR29C-3p was predicted to target LOXL2 3’UTR at position 555-561 and position 757-763, suggesting its inhibitory potential on LOXL2 expression. In summary, this study revealed that low expression of MIR29C and high expression of LOXL2 predict poor outcomes for LUAD patients. The MIR29C/LOXL2 axis may point out a new biological pathway that could be a potential therapeutic target for LUAD.\u0000 \u0000","PeriodicalId":314615,"journal":{"name":"秀傳醫學雜誌","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123705432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"肺動脈高壓:概述及兒科近期成就","authors":"Shi-Min Yuan Shi-Min Yuan","doi":"10.53106/156104972022062101013","DOIUrl":"https://doi.org/10.53106/156104972022062101013","url":null,"abstract":"\u0000 肺動脈高壓是一種慢性肺血管系統疾病,其特徵是肺血管重構和肺動脈壓力升 高。臨床表現、實驗室檢查和心肺運動試驗以及 6 分鐘步行距離有助於正確診斷。 確診依賴於右心導管插入術。CT 肺血管造影的肺灌注成像與肺血管造影的效果相 似,顯示出重要的診斷價值。常規生化、血液學和甲狀腺功能測試以及抗核抗體 可能會有所幫助。常規藥物治療、姑息性房間隔切開術和肺移植是首選治療方法。 microRNA 、間充質幹細胞、遠程後處理等新技術已取得初步治療效果。最近的研 究表明一氧化氮吸入、米力農、磷酸二酯酶 5 抑制劑和前列環素類似物對治療兒 科患者的潛在有效性。\u0000 Pulmonary arterial hypertension is a chronic pulmonary vasculature disorder characterized by pulmonary vascular remodeling and elevated pulmonary artery pressures. Clinical manifestations, laboratory work-ups, cardiopulmonary exercise testing and 6-minute walk distance are helpful in reaching the correct diagnosis. The definite diagnosis relies on right heart catheterization. Pulmonary perfusion imaging with computed tomographic pulmonary angiography is similar to the effect of pulmonary angiography, showing important diagnostic values. Routine biochemistry, hematology and thyroid function tests as well as antinuclear antibodies can be helpful. Conventional medication, palliative septostomy and lung transplantation are treatments of choice. Novel techniques including microRNA, mesenchymal stem cell and remote postconditioning treatments have achieved initial therapeutic effects. Recent studies have demonstrated the potential effectiveness of inhaled nitric oxide, milrinone, phosphodiesterase-5 inhibitors and prostacyclin analogues for the treatment of PAH in pediatric patients.\u0000 \u0000","PeriodicalId":314615,"journal":{"name":"秀傳醫學雜誌","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123718304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"日本腦炎併發身體功能障礙合併症護理經驗","authors":"黃維瑢 黃維瑢, 林美華 林美華, 沈郁惠 沈郁惠, 黃梅 Yu-Hui Shen, 謝嘉琪 謝嘉琪, 李銘宗 Chia-Chi Hsieh","doi":"10.53106/156104972022062101011","DOIUrl":"https://doi.org/10.53106/156104972022062101011","url":null,"abstract":"\u0000 本文描述個案因日本腦炎導致身體活動出現異常,併發痰液清除功能不佳需長期照護而住入慢性病房,以及長期住院產生心理反應等相關問題。護理期間 2018/9/27-11/19 以 Gordon 進行十一項功能性評估,藉由觀察、身體評估、查閱病歷等收集資料,健康護理問題有呼吸道清除功能失效;身體活動功能障礙;焦 慮。護理措施 : 維持半坐臥式;背部叩擊;深呼吸及有效咳嗽技巧,強化咳痰能力;漸進式復健計劃合併中醫療法,提升肢體功能及自我照顧能力,讓個案拾獲自信心 參與復健;主動關懷讓個案表達更換管路感受,陪伴降低不適。藉由音樂、嗅覺 /冥想等減輕焦慮程度,正向因應疾病,建議未來住院的病人,在中醫醫療有針灸治 療健保給付,提供日後照護此類個案之經驗參考。\u0000 This article describes the care experience of a case of Japanese encephalitis complicated with physical disability from September 27, 2018 to November 19, 2018. The patient was admitted to a chronic ward due to poor sputum clearance, required long-term care and had psychological problems due to a long hospital stay. Gordon’s Functional Health Patterns were applied for health assessment. Data collection was completed through observation, physical assessment, and medical records review. Health problems were identified as ineffective airway clearance/thick sputum, impaired physical mobility/Japanese encephalitis infec- tion with neuromuscular injury, and anxiety/worry about disease prognosis. Nursing interventions included: maintaining semi-Fowler’s position; chest percus- sion; deep breathing and effective coughing techniques to strengthen sputum production; a progressive rehabilitation plan combined with acupuncture treat- ment of Chinese medicine to improve part of the physical function and self-care ability, so that the case could find self-confidence and participate in rehabilita- tion; active care and letting the case to express feelings about changing tubes, and accompanying reduction of discomfort; and relieving anxiety by listening to Taiwanese songs, practicing meditation, and responding positively to the illness. It is recommended that future hospitalized patients using traditional Chinese acupuncture therapy should be covered by health insurance. We hope the sharing of this nursing experience can be beneficial to the care of similar patients.\u0000 \u0000","PeriodicalId":314615,"journal":{"name":"秀傳醫學雜誌","volume":"82 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127197206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"新型冠狀病毒病患呼吸器使用的感染控制及拔管後使用高流量氧氣鼻導管之呼吸照護經驗","authors":"林佳誼 林佳誼, 張恩銘 張恩銘, 侯建良 侯建良","doi":"10.53106/156104972022062101010","DOIUrl":"https://doi.org/10.53106/156104972022062101010","url":null,"abstract":"\u0000 嚴重特殊傳染性肺炎是受嚴重急性呼吸系統症候群冠狀病毒 2 型(severe acute respiratory syndrome coronavirus 2, SARS-CoV-2)所感染而引發的肺炎,嚴重特殊 傳染性肺炎重症患者常會導致呼吸衰竭,機械通氣是發生嚴重呼吸衰竭的患者最有 效的治療策略之一。本個案是因感染嚴重特殊傳染性肺炎導致低血氧性呼吸衰竭因 而插管使用侵襲式呼吸器,照護過程中,侵襲式呼吸器的管路和相關的零組件可能 成為主要的污染源,因此,如何在使用侵襲式呼吸器的過程中同時保護醫護人員與 病患的安全,以及在拔管後該如何善用侵襲式呼吸器以外的治療策略來縮短病患使 用侵襲式呼吸器的時間與預防病患重插管率,就顯得十分重要。因此,本個案報告 主要是在探討使用呼吸器時的感染控制與拔管後使用高流量鼻導管氧氣治療於嚴重 特殊傳染性肺炎病患之治療策略及氧合療效。\u0000 Severe pneumonia with novel pathogens presents as pneumonia caused by the infection of severe acute respiratory syndrome coronavirus type 2 (SARS- CoV-2). Severe pneumonia with novel pathogens often leads to respiratory failure, and mechanical ventilation is one of the most effective treatment strate- gies for patients who are suffering from severe respiratory failure. In this case, mechanical ventilation was used due to severe pneumonia with novel pathogens leading to hypoxic respiratory failure. However, the ventilator circuit and related components of the ventilator may become the main source of pollution. There- fore, preventing infection when using a ventilator to protect the safety of medical staff and patients, and making good use of treatment strategies after extubation to prevent patients from reintubation are very important. As a result, this case report mainly discusses infection control during the use of ventilators and treat- ment strategy and oxygenation efficacy of high flow nasal cannula in patients with severe and severe pneumonia with novel pathogens after extubation.\u0000 \u0000","PeriodicalId":314615,"journal":{"name":"秀傳醫學雜誌","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131621439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"老年病患發生譫妄症的診斷與處置","authors":"陳 杰 陳 杰","doi":"10.53106/156104972022062101012","DOIUrl":"https://doi.org/10.53106/156104972022062101012","url":null,"abstract":"\u0000 譫妄症是急性腦功能受損的一種表現,同時譫妄症也是一種以意識障礙為主的 急性症狀;發生譫妄症之後往往會造成龐大的醫療花費(例如延長住院天數),且 臨床上容易被忽略,造成老年疾病的預後不佳,更可能進一步造成病患的死亡,是 病患安全重要指標;基於其病因的多重因子特性,且與其他老年病症候群(如:跌 倒、失禁)的高度聯結性,因此在處置上也需要多方向並進的治療,針對譫妄症的 完善處理,可明顯改善病患預後,並增進醫療的品質。本文為敘述性文獻回顧,以 老年症候群及急性譫妄症處置為關鍵字,藉由文獻搜尋並整理譫妄症的診斷與處 置,期望可作為醫療人員遭遇病患時不只使用約束帶或藥物,可以有更周全的評估 與治療。\u0000 Delirium is a manifestation of acute impaired brain function. At the same time, delirium is also an acute sign/symptom dominated by disturbances in consciousness. The occurrence of delirium often causes huge medical expenses (ex: prolonged hospitalization days) and often results in poor prognoses for senile diseases. It is more likely to cause further death of patients, which is an important indicator of patient safety, based on its multifactorial etiology and high connectivity with other senile diseases (such as falls, incontinence, etc.). It is also necessary for patients to receive multi-directional treatment that can signifi- cantly improve the prognoses of patients and improve the quality of medication. This article is a narrative literature review with geriatric syndrome and acute delirium management as the keywords. Through a literature survey and sorting out the diagnosis and treatment of delirium, it is hoped that medical staff can not only use restraint bands or sedative drugs when encountering patients, but also provide comprehensive assessment, evaluation and treatment.\u0000 \u0000","PeriodicalId":314615,"journal":{"name":"秀傳醫學雜誌","volume":"102 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116470104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"一位慢性阻塞肺病重症個案肺部復健之案例報告","authors":"黃思緯 黃思緯, 王文璇 王文璇, 沈郁惠 沈郁惠","doi":"10.53106/156104972022062101008","DOIUrl":"https://doi.org/10.53106/156104972022062101008","url":null,"abstract":"\u0000 本文探討一位罹患慢性阻塞肺病,首次因急性呼吸衰竭,放置氣管內管入住加 護病房之護理經驗,於 2017/12/18 至 2018/01/20 護理期間,以直接照護、觀察、 身體評估與家屬會談及病歷查閱等方式蒐集資料。運用羅氏適應模式進行整體性系 統評估,確立護理問題有:呼吸道清除功能失效、活動無耐力及家庭因應能力失 調。照護過程中,透過良好護病關係的建立,提供照護措施,在呼吸道清除功能失 效方面:教導正確呼吸且有效的咳嗽技巧及胸腔物理治療,以利清除痰液;在活動 無耐力方面:偕同跨領域團隊與個案及家屬規劃肺部復健運動,增強呼吸肌耐力, 順利拔除氣管內管;在家庭因應能力失調方面 : 安排家庭會議,增加家人間對後續返 家的共識及照護,增強其家庭因應能力。建議運用跨團隊合作建立一套國台語雙聲 帶的肺部復健運動多媒體影音光碟,在急重症等重負荷的工作下,短時有效的指導 此類個案,又能提升個案之學習成效,因此改善呼吸道症狀與減少急性發作次數及 再住院率,得以減輕家庭負擔,藉此照護經驗分享,以供臨床實務參考之用。\u0000 This paper aims to explore the nursing experience for a patient with chronic obstructive pulmonary disease who was hospitalized in an intensive care unit for the first time because of acute respiratory failure requiring endotracheal tube intubation. The data were collected through direct nursing care, observations,physical evaluations, interviews and reviews of medical record during the nursing period from December 18 2017 to January 20 2018. Roy’s adaptation model was applied to carry out comprehensive system assessments. The problems observed from the nursing process were as follows: ineffective airway clearance, activity intolerance and family adjustment disorders. During the nursing processes, good relationships were established between medical staff and the patient in order to provide necessary nursing measures. Regarding ineffective airway clearance, the patient was taught to breath in an appropriate way, effective coughing techniques and chest physical therapy for better sputum clearance. As to activity intolerance, an inter-professional collaborative team was invited to work with the patient and the family for planning pulmonary rehabilitation exercises in order to strengthen respiratory muscle endurance followed by smoothly removing the endotracheal tube. When it comes to improving family adjustment disorders, meetings with the family were arranged to enhance the family’s consensus and nursing skills for the patient after returning home. It is suggested that an inter-professional team can work together to produce a set of multimedia DVDs both in Chinese and Taiwan- ese to provide guidance on pulmonary rehabilitation exercise. This set of DVDs can help effectively instruct patients like this case for the short-term when there are heavy workloads from acute and severe diseases and then increase patients’learning results. Therefore, respiratory tract symptoms can be improved and the numbers of acute attacks and readmission rates can be reduced. After these steps, the burdens imposed on families can be relieved accordingly. This nursingexperi- ence is hereby shared and serves as a reference for clinical practices.\u0000 \u0000","PeriodicalId":314615,"journal":{"name":"秀傳醫學雜誌","volume":"104 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131830521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"多發性骨髓瘤病人施行造血幹細胞移植之醫療資源耗用分析","authors":"葉淑婷 葉淑婷, 李金德 李金德, 卓士峯 卓士峯","doi":"10.53106/156104972022062101004","DOIUrl":"https://doi.org/10.53106/156104972022062101004","url":null,"abstract":"\u0000 目的:探討多發性骨髓瘤病人施行造血幹細胞移植之醫療資源耗用分析。\u0000方法:本研究為回溯性之研究,研究樣本取自單一醫學中心,2010 年至 2017 年為 新診斷多發性骨髓瘤且有進行造血幹細胞移植的病人。結果:結果顯示接受造血幹細胞移植的病人年齡為 57.77 ± 8.24 歲,平均門診次數為 97.77 ± 64.72 次,住院次數為 5 ± 3.09 次,急診次數為 3.04 ± 5.02 次, 門診總花費為 1,318,724.23 ± 1,009,450.62 元,住院總花費為 1,020,685.5 ±478,821.88 元。\u0000結論:接受治療的病人在第一年的門診及住院費用為最高,第二年之後會開始遞 減,而不接受治療的人則有相反的表現,第一年門診及住院費用最低,之後開始逐年上升,所花的醫療費用比接受治療的人更高。\u0000 Objectives: We conducted a medical resource consumption analysis in multiple myeloma patients who received hematopoietic stem cell transplantation at a single center.Methods: This was a retrospective study, and the subjects were newly diagnosed multiple myeloma patients who received hematopoietic stem cell transplantation from January 2010 to 31 December 2017 at a single medical center.\u0000Results: The mean age of patients who received hematopoietic stem cell transplantation was 57.77 ± 8.24 years. The mean number of outpatient visits was 97.77 ± 64.72, mean number of hospitalizations was 5 ± 3.09, mean number of emergency department visits was 3.04 ± 5.02, total outpatient cost was 1,318,724.23 ± 1,009,450.62 NTD, and total hospitalization cost was 1,020,685.5 ± 478,821.88 NTD.\u0000Conclusions: This study showed that the cost was the highest during the period of active treatment, and if the patient’s condition improved, the cost would decrease accordingly. This result was similar to that of our study, in which the outpa-tient and hospitalization expenses of the treated patients were the highest in the first year and began to decrease after the second year. The opposite was true for untreated patients whose outpatient and hospitalization expenses were the lowest in the first year and then increased annually. The medical expenses of untreated patients were higher than those of treated patients.\u0000 \u0000","PeriodicalId":314615,"journal":{"name":"秀傳醫學雜誌","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123982032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COVID-19 疫情下畢業後一般醫學訓練醫師參與防疫意願之探討","authors":"陳偉權 陳偉權, 李智雄 Wei-Chuan Chen, 李維哲 Chee-Siong Lee, 陳正生 Wei-Che Lee, 林育志 Cheng-Sheng Chen","doi":"10.53106/156104972022062101007","DOIUrl":"https://doi.org/10.53106/156104972022062101007","url":null,"abstract":"\u0000 目的:探究影響一般醫學訓練(PGY)醫師在 COVID-19 疫情下參與防疫意願之相關因素。\u0000方法:運用結構式問卷蒐集資料。問卷包含個人特質、專業化特質、體系功能、參 與防疫意願等面向。\u0000結果:不同個人特質的 PGY 醫師在參與防疫意願程度上沒有明顯差異,但其角色認同、資源可近性及 PGY 制度認可與參與防疫意願具有顯著正相關,PGY 制度 認可與角色認同之對於參與防疫意願的影響具有增強調節效果。\u0000結論:PGY 醫師投入防疫的意願取決於個人在防疫義務、責任角色之認可與醫療體 系提供足夠的醫療人力、物力資源。此外,PGY 醫師對 PGY 制度認可,對參與防疫意願而言是一重要情境變數,建議醫學教育組織在 COVID-19 疫情下, 應重新檢視 PGY 醫學臨床實務訓練課程,提供 PGY 醫師完整臨床感控訓練與發展計劃,減少 PGY 醫師面對嚴峻疫情恐懼不安,增強 PGY 醫師投入防疫的 信心與意願。\u0000 Objective: The aim was to investigate the factors influencing PGYs’ willingness to partic-ipate in medical service during the COVID-19 pandemic.\u0000Methods: Data were collected using structured questionnaires. The questionnaire consisted of the perception of medical professionalism, system function, will-ingness to participate, and demographic data.\u0000Results: There was no significant difference in willingness among different demo- graphic characteristics of PGY. Role identity, resource accessibility, and iden-tity of the PGY system were significantly and positively related to the willing- ness to participate in medical service. The identity of the PGY system was a moderator influencing the effect of role identification on willingness.\u0000Conclusion: PGYs’ willingness to participate in medical service during the pandemic depends on the individual’s recognition of the role of obligation and respon-sibility, and the medical system’s provision of sufficient human and mate- rial resources. In addition, the enhancing moderating role of identity of the PGY system between role identity and willingness to participate during the COVID-19 pandemic have been confirmed. Our results suggest that medical education organizations should reform the PGY medical clinical practice train- ing courses under the COVID-19 epidemic, and provide PGY physicians with complete clinical infection control. The training and development plan can reduce PGYs’ fear and anxiety in the face of severe epidemics, and strengthen PGYs’ confidence and willingness to invest in epidemic prevention.\u0000 \u0000","PeriodicalId":314615,"journal":{"name":"秀傳醫學雜誌","volume":"36 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123509715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"食道裂孔疝氣 - 不容忽視的老年人疾病","authors":"楊惠卿 楊惠卿, 吳菡芸 吳菡芸, 吳明和 吳明和","doi":"10.53106/156104972022062101006","DOIUrl":"https://doi.org/10.53106/156104972022062101006","url":null,"abstract":"\u0000 背景:橫膈食道裂孔疝氣是指橫膈膜上食道通過的孔道肌肉退化,導致胃或腹部器官向胸腔推擠。常造成老年人食慾下降、體重減輕;嚴重者有心律不整與呼 吸困難等危及生命之症狀。\u0000目的:探討食道裂孔疝氣類型、臨床表徵與手術預後。\u0000方法:採用病歷回溯方式,調查南部某區域醫院,自 2009 年 6 月至 2019 年 11 月接 受食道裂孔疝氣修補術之個案。\u0000結果:共有 25 位病患接受腹腔鏡輔助剖腹執行食道裂孔疝氣修補,分類以第三型居多有 15(60%)位,平均住院天數 7.4(±5.1)天。術前以胃酸逆流的症狀為 最常見有17位(68%);術後追蹤約三個月後,嘔吐(p <.000)、胃灼熱感(p=.005)、上腹痛(p =.008)以及胃酸逆流(p <.000)等症狀皆達顯著改善。\u0000結論:腹腔鏡輔助剖腹執行食道裂孔疝氣修補,術後住院時間短,病患的生活品質 大幅改善且術後三個月內無裂孔疝氣的復發。\u0000 Background: Hiatal hernia (HH) refers to the degeneration of the cruse muscle around the esophagus through the diaphragm, which causes the stomach or abdomi- nal organs to push into the thoracic cavity. It often causes poor appetite and weight loss in the elderly; severe cases even have life-threatening symptoms such as arrhythmia and respiratory distress.\u0000Objective: To evaluate the types, clinical manifestations and prognosis of hiatal hernia after laparoscopy-assisted repair of hiatal.\u0000Methods: A retrospective study was conducted from June 2009 to November 2019 through medical records to investigate the surgical results of hiatal hernia in a regional hospital of southern Taiwan.\u0000Results: A total of 25 patients underwent surgical repair of hiatal hernia, of which 15 (60%) were classified as type III HH. The average hospital stay was 7.4 (±5.1) days. Preoperatively, gastroesophageal reflux symptoms were the most common in 17 patients (68%). Upon postoperative follow-up after more than three months, the symptoms including vomiting (p < .000), heartburn (p = .005), epigastric pain (p = .008), and gastroesophageal reflux (p < .000) were significantly improved.\u0000Conclusion: Laparoscopy-assisted laparotomy to perform repair of hiatal hernia can shorten postoperative hospitalization. In a 3-month follow-up period, the patients’quality of life was greatly improved, and there was no recurrence of hiatal hernia within three months after surgery.\u0000 \u0000","PeriodicalId":314615,"journal":{"name":"秀傳醫學雜誌","volume":"266 4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131642625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"降低急診室血液培養汙染率","authors":"黃沛榆 黃沛榆, 洪敏慧 洪敏慧, 沈郁惠 沈郁惠, 謝嘉琪 Yu-Hui Shen, 朱志民 Chia-Chi Hsieh","doi":"10.53106/156104972022062101003","DOIUrl":"https://doi.org/10.53106/156104972022062101003","url":null,"abstract":"\u0000 血液培養採檢為急診室常見的護理技術,然而血液培養汙染容易間接造成病人傷害,鑑於單位血液培養污染率高達 7.77%,遠超出設定之閾值 <3%,需立即改善 為專案成立動機,為降低血液培養汙染率,專案小組人員分析發現護理人員執行血液培養採檢技術錯誤率高、認知測驗答對率低、採血工具不符需求且未稽核,經安 排在職教育課程、引進 3M 低敏護手乳(Cavilon)提高洗手遵從性、針對特定族群增加皮膚清潔次數、導入讀秒機制概念、稽核和回饋機制,成功降低血液培養污染 率至 2.3%、血液培養採檢錯誤率降至 3%、血液培養認知測驗答對率提升至 100%達專案目的,經由本專案推行針對特定族群較年長者和長照機構住民,增加皮膚清 潔次數與運用讀秒機制,落實等待消毒液乾燥,推行成效良好,建議可平行展開至其他科室,提升病人照護品質。\u0000 Blood culture sampling is a common nursing technique in emergency rooms. However, blood culture contamination is likely to indirectly cause patient harm. Given that the unit blood culture contamination rate is as high as 7.77%, which far exceeds the set threshold of <3%, it needs to be immediately improved as the motivation for project establishment. To reduce the contamination rate of blood cultures, the task force analysis found that the nursing staff had a high error rate in performing blood culture sampling, a low rate of correct answers to cognitive tests, and blood sampling tools that did not meet the requirements and were not audited. After arranging an on-the-job education course, providing 3M hyposensi-tive hand cream (Cavilon), increasing the frequency of skin cleansing for specific ethnic groups, introducing the concept of the countdown mechanism, and devel-oping an audit and feedback mechanism, we successfully reduced the blood culture contamination rate to 2.3%, the blood culture sampling error rate to 3%, and increased the blood culture cognitive test answer rate to 100% of the project purpose, This project was aimed at older people and residents of long-term care institution. We aimed to increase the frequency of skin cleaning and used a count- down mechanism to wait for the disinfectant to dry. According to our findings, the improvement effect was good. Currently, the plan is being implemented in other parallel wards.\u0000 \u0000","PeriodicalId":314615,"journal":{"name":"秀傳醫學雜誌","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114155012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}