Tzu Chi Medical Journal最新文献

{"title":"Effectiveness of Vitamin D supplementation in combination with calcium on risk of maternal and neonatal outcomes: A quasi-experimental clinical trial","authors":"Deldar Morad Abdulah, Jinan Nori Hasan, Sheelan Bapir Hasan","doi":"10.4103/tcmj.tcmj_184_23","DOIUrl":"https://doi.org/10.4103/tcmj.tcmj_184_23","url":null,"abstract":"Abstract Objectives: We examined the effectiveness of combining Vitamin D supplementation with calcium on maternal and neonatal outcomes, as opposed to using Vitamin D supplements alone. Materials and Methods: Pregnant women in their third trimester were divided into two groups. The control group received a daily dose of 1000 IU of Vitamin D, but, the experimental group received a combined daily dosage of 1000 IU of Vitamin D and 500 mg of calcium, until delivery. Results: The women in the Vitamin D + calcium group were less likely to develop gestational diabetes (2.78%; vs. 19.51%; P = 0.0318), preeclampsia (2.78% vs. 26.83%; P = 0.004), newly onset gestational hypertension (11.11% vs. 46.34%; P = 0.001), proteinuria (5.56% vs. 39.02%; P = 0.0004), and impaired glucose tolerance (2.78% vs. 21.95%; P = 0.0163) and had lower blood pressure at 20 th and 39 th weeks of gestation. The newborns in the Vitamin D + calcium group were less likely to experience low birth weight (5.71% vs. 31.58%; P = 0.0066), low birth length (5.71% vs. 44.74%; P = 0.0007), were less likely to be admitted to the neonatal intensive care unit (14.29% vs. 42.11%; P = 0.0105), have a larger head circumference (35.00 vs. 33.63; P < 0.0001), longer gestational age at birth (40.0 vs. 37.56 weeks; P < 0.0001), and higher APGAR scores (9.58 vs. 6.31; P < 0.0001.) compared to Vitamin D group, respectively. Conclusions: Taking Vitamin D and calcium by pregnant women in the third trimester is an effective treatment to decrease maternal, fetal, and neonatal outcomes.","PeriodicalId":45873,"journal":{"name":"Tzu Chi Medical Journal","volume":"643 ","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135869360","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":"Folic acid: The key to a healthy pregnancy – A prospective study on fetomaternal outcome","authors":"Madhusudan Dey, Pranjali Dhume, Sanjay K Sharma, Suyash Goel, Sunil Chawla, Ankur Shah, G Madhumidha, Reshu Rawal","doi":"10.4103/tcmj.tcmj_110_23","DOIUrl":"https://doi.org/10.4103/tcmj.tcmj_110_23","url":null,"abstract":"A BSTRACT Objective: The objective of the study is to study the fetomaternal outcome associated with folic acid deficiency in pregnancy. Materials and Methods: This hospital-based observational study was conducted in the Department of Obstetrics and Gynaecology at Base Hospital, Delhi Cantt, and a total of 351 participants were enrolled who were fulfilling the inclusion criteria. The plasma folic acid level of the selected patients was measured in the booking visit by automated chemiluminescence assay. The cutoff levels of folic acid were taken at 8.6 ng/mL. Based on these values, the study population was divided into two groups, one with folic acid values <8.6 ng/mL and the other with values ≥8.6 ng/mL. Plasma Vitamin B12 levels were measured to check for any concurrent deficiencies. Obstetric outcomes included first- and second-trimester miscarriages, development of anemia, gestational hypertension/preeclampsia, gestational diabetes mellitus, hypothyroidism, placental abruption, and intrauterine fetal growth restriction (FGR). Furthermore, the period of gestation at delivery, fetal weights, APGAR scores at 5 min were documented. The study also considered fetal neural tube defects, intrauterine fetal demise for data collection. Collected data were analyzed statistically to find the association of the above-mentioned outcomes with levels of folic acid. Results: The rate of preterm deliveries was significantly higher in the folic acid group with levels <8.6 ng/mL (16.94%). The incidence of small for gestational age/FGR was higher in the folic acid group with levels <8.6 ng/mL (27.11%) compared to the high folic acid group with levels ≥8.6 ng/mL (13.38%). The differences in the incidence of anemia, gestational hypertension, gestational diabetes, and preeclampsia between the two groups were not statistically significant and no cases of intrauterine fetal demise or placental abruption were observed in either group. Moreover, there was no significant difference in the relative risk of low Apgar scores at 5 min between the two groups. Conclusion: The present study suggests that low folic acid levels during pregnancy are associated with a higher risk of adverse pregnancy outcomes such as anemia, miscarriages, preterm delivery, and FGR. Therefore, adherence to nutritional recommendation of folic acid supplementation during pregnancy is essential to prevent these adverse outcomes.","PeriodicalId":45873,"journal":{"name":"Tzu Chi Medical Journal","volume":"13 5","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135813907","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":"Ellagic acid ameliorates renal fibrogenesis by blocking epithelial-to-mesenchymal transition","authors":"Po-Yu Huang, Yi-Hsien Hsieh, Yi-Hsuan Ting, Chu-Che Lee, Jen-Pi Tsai","doi":"10.4103/tcmj.tcmj_106_23","DOIUrl":"https://doi.org/10.4103/tcmj.tcmj_106_23","url":null,"abstract":"A BSTRACT Objective: Ellagic acid (EA), a kind of polyphenol found in numerous fruits and vegetables, has anti-inflammatory, anti-apoptotic, anti-oxidant, and anti-fibrotic effects against a variety of diseases, but its role in mediating renal fibrogenesis remains unknown. Materials and Methods: We used an in vivo mouse unilateral ureteral obstruction (UUO) model and an in vitro model with HK-2 cell lines treated with EA and transforming growth factor β1 (TGF-β1). The expression of epithelial-to-mesenchymal transition (EMT)-related proteins of UUO mice was examined using immunohistochemical staining. Liver function and renal function were evaluated using biochemical testing. Western blot analysis was used to determine the proteins related to EMT, and MTT assay was used to determine cell viability. Results: In UUO mice fed EA, both microscopical examination with immunohistochemical staining and western blotting protein analysis showed reduced expression of fibrotic (α-SMA, fibronectin, and collagen I)- and EMT (vimentin and N-cadherin)-related proteins, compared with sham control. In HK-2 cells treated with TGF-β1, EA decreased motility as well as expression of α-SMA, collagen-I, fibronectin, N-cadherin, and vimentin. Conclusion: EA reduced the progression of the morphological transformations and concomitantly suppressed the expression of fibrotic- and EMT-related proteins in vitro and in vivo. These findings improved our understanding of the role of EA in suppressing renal fibrogenesis and demonstrated the promising role EA may play in the management of chronic kidney disease.","PeriodicalId":45873,"journal":{"name":"Tzu Chi Medical Journal","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135317015","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":"The beneficial effects of conservative treatment with biofeedback and electrostimulation on pelvic floor disorders","authors":"Mei-Chen Chen, Pei-Hsuan Lai, Dah-Ching Ding","doi":"10.4103/tcmj.tcmj_174_23","DOIUrl":"https://doi.org/10.4103/tcmj.tcmj_174_23","url":null,"abstract":"A BSTRACT Objectives: Pelvic floor disorders (PFDs) such as stress urinary incontinence (SUI) and pelvic organ prolapse (POP) can be managed through conservative treatments, such as conservative management involving biofeedback (BF) and electrostimulation. This study aimed to investigate the therapeutic effects of conservative treatments on PFDs. Materials and Methods: A retrospective cohort study was conducted. Women with PFD who underwent 1–3 months of BF and electrostimulation between January 1, 2020, and January 31, 2021, were included in the study. BF treatment was administered using three sensors to monitor pelvic floor muscle activity, providing patients with immediate feedback and guidance on muscle exercises. One session lasted for 5–10 min. Electrostimulation treatment utilized a specially made pelvic belt with electrode sheets to stimulate and contract pelvic floor muscles passively. One session lasted for 15 min. Six therapies in 1 month were prescribed. Pre- and post-treatment Pelvic Floor Distress Inventory (PFDI-20) scores, including POP distress inventory 6 (POPDI-6), colorectal-anal distress inventory (CRAD-8), and urinary distress inventory 6 (UDI-6) scores, were compared. Subgroup analysis by age, menopause, body mass index (BMI), and child delivery mode was performed. Results: The study included 51 women with PFDs (SUI, POP, frequency or urgency or nocturia, and pain) treated with BF and electrostimulation, with a mean age of 49.94 ± 13.63 years. Sixteen patients (37.1%) were menopausal, with a mean menopause age of 50 ± 5.20 years. Twenty-six patients (68.4%) had a history of normal vaginal delivery. The mean PFDI-20 scores before and after treatment were 32.67 (standard deviation [SD] 10.05) and 25.99 (SD 9.61), respectively ( P < 0.001). This decrease in scores reflected an improvement in subjective perceptions of symptoms and quality of life. The POPDI-6, CRAD-8, and UDI-6 scores significantly decreased after treatment. Subgroup analysis of scores change regarding age, menopause, BMI, and child delivery mode was not statistically significant. Conclusions: The study demonstrated the effectiveness of BF and electrostimulation for treating women with PFDs. The findings contributed to the understanding of treatment duration, patient characteristics, and the potential benefits of a multimodal approach. Moreover, the study’s diverse participant population and the use of validated outcome measures enhance the generalizability and scientific rigor of the findings.","PeriodicalId":45873,"journal":{"name":"Tzu Chi Medical Journal","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136099809","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":"Reliability and validity of the Taiwanese version of the collaborative practice assessment tool: A pilot study.","authors":"Chen-Pei Ho,&nbsp;Hsiu-Chen Yeh,&nbsp;Ming-Shinn Lee,&nbsp;Wei-Chun Cheng","doi":"10.4103/tcmj.tcmj_200_22","DOIUrl":"https://doi.org/10.4103/tcmj.tcmj_200_22","url":null,"abstract":"<p><strong>Objectives: </strong>To promote teamwork communication and collaboration between health-care professionals, educators emphasized proper training programs to develop interprofessional collaborative practice (IPCP) among postgraduate (PG) trainees. A literature review indicated that the faculty necessarily measured the competency in IPCP with structured and applicable assessment tools in collocation to training programs domestically. A cross-sectional psychometric study was conducted to construct a reliable assessment tool for measuring PG learning outcome in Taiwan through a bidirectional translation. The study aimed to assess the interprofessional team behavior of trainees using the Taiwanese version of the collaborative practice assessment tool (T-CPAT).</p><p><strong>Materials and methods: </strong>The study recruited 43 participants to undergo a PG training program in a single institute and to complete T-CPAT. Data were analyzed using SPSS 22.0 software. We employed descriptive analysis of demographic variables. The validity of T-CPAT was analyzed by experts in different specialties and its availability was assessed by item-level analysis. Furthermore, the T-CPAT reliability was tested using Cronbach's α.</p><p><strong>Results: </strong>The average score was 305.2 (standard deviation = 38.08), and the expert validity of the T-CPAT was 0.96. In the item-level analysis, there were no failure items in T-CAPT. Cronbach's α reached 0.94 (95% confidence interval = 0.90-0.96).</p><p><strong>Conclusion: </strong>The study demonstrated good reliability and validity for the T-CPAT. Thus, the T-CPAT can be used to accurately measure and assess the competence of IPCP in PG trainees in general medicine in Taiwan. The results were deemed sufficient to provide faculties with related arrangements for future teaching plans.</p>","PeriodicalId":45873,"journal":{"name":"Tzu Chi Medical Journal","volume":"35 3","pages":"267-276"},"PeriodicalIF":1.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/12/1c/TCMJ-35-267.PMC10399841.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9943336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effects of rehabilitation on functional independence of Eastern Taiwanese children with rare or genetic diseases.","authors":"Yu-Chuan Lin,&nbsp;Chun-Ying Weng,&nbsp;Chung-Chao Liang,&nbsp;Shao-Yin Chu","doi":"10.4103/tcmj.tcmj_170_22","DOIUrl":"https://doi.org/10.4103/tcmj.tcmj_170_22","url":null,"abstract":"<p><strong>Objectives: </strong>This study investigated the effects of outpatient rehabilitation therapy (RT) on the functional performance of children from Eastern Taiwan with rare or genetic diseases.</p><p><strong>Materials and methods: </strong>This retrospective observational cohort study included 73 children from Eastern Taiwan who were affected with rare or genetic diseases, with an average age of 8.57 ± 5.33 years (47 boys and 26 girls). Each child received the goal-directed therapy known as outpatient RT, which was delivered by a multidisciplinary team of specialists. To assess the effectiveness of RT, the WeeFIM-C questionnaire data were collected and analyzed.</p><p><strong>Results: </strong>After receiving outpatient RT, most of the children only required low-to-moderate assistance with self-care tasks (4.36 ± 2.38), and they could perform mobility-related activities under supervision or independently (5.70 ± 2.29). Moreover, most only required minimal assistance with tasks related to cognitive functioning and tended to complete such tasks under supervision (4.97 ± 2.05). The functional performance was significantly different among three studied groups, in terms of self-care (<i>F</i>_{[2, 68]} = 5.42, <i>P</i> < 0.007), mobility (<i>F</i>_{[2, 68]} = 8.17, <i>P</i> < 0.001), cognitive functioning (<i>F</i>_{[2, 68]} = 3.31, <i>P</i> < 0.042), and overall (<i>F</i>_{[2, 68]} = 6.44, <i>P</i> < 0.003) functional performance.</p><p><strong>Conclusion: </strong>The results of this study demonstrated that the functional status was different among three studied groups in terms of self-care, mobility, and cognitive functioning after receiving outpatient RT.</p>","PeriodicalId":45873,"journal":{"name":"Tzu Chi Medical Journal","volume":"35 3","pages":"221-225"},"PeriodicalIF":1.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/13/76/TCMJ-35-221.PMC10399839.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9943340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Finite element analysis to assess stress and deformation in bone with glass fiber-reinforced-poly-ether-ether-ketone, zirconia, and titanium implants.","authors":"Syeda Amtul Haseeb,&nbsp;Anju S Kumar,&nbsp;M P Chaitra,&nbsp;K C Vinaya,&nbsp;Soumya Shivananda Gudal,&nbsp;Fathima Parveen Rahmam,&nbsp;Prashant Babaji","doi":"10.4103/tcmj.tcmj_184_22","DOIUrl":"https://doi.org/10.4103/tcmj.tcmj_184_22","url":null,"abstract":"<p><strong>Objectives: </strong>Recently, zirconia ceramic and glass or carbon fiber-reinforced poly-ether-ether-ketone (PEEK) composites have been introduced as newer implant biomaterials. This study was done to evaluate stress and deformation in bone with glass fiber-reinforced (GFR)-PEEK, zirconia, and titanium implants.</p><p><strong>Materials and methods: </strong>A geometric model of mandibular molar replaced with implant-supported crown was generated. Implant of 12 mm length and 4.5 mm diameter was used in study. Finite element analysis models of implant assemblies of three materials GFR-PEEK, zirconium, and titanium were generated. 150 N loads were applied obliquely and vertically along the long axis of implant. Von Mises stresses and deformation generated were compared using ANSYS Workbench 17.0 and finite element software.</p><p><strong>Results: </strong>All three implant assemblies, i.e., GFR-PEEK, zirconia, and titanium, demonstrated similar stresses and deformation in bone without significant difference.</p><p><strong>Conclusion: </strong>It was concluded that GFR-PEEK and zirconia implants can be used as a substitute to titanium implants.</p>","PeriodicalId":45873,"journal":{"name":"Tzu Chi Medical Journal","volume":"35 3","pages":"231-236"},"PeriodicalIF":1.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/29/ff/TCMJ-35-231.PMC10399843.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9943335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pathophysiology, clinical presentation, and management of ketamine-induced cystitis.","authors":"Jia-Fong Jhang,&nbsp;Lori A Birder,&nbsp;Hann-Chorng Kuo","doi":"10.4103/tcmj.tcmj_94_23","DOIUrl":"https://doi.org/10.4103/tcmj.tcmj_94_23","url":null,"abstract":"<p><p>Ketamine is illegally used as a recreational drug in many Asian countries. Long-term ketamine abusers often develop irritable bladder symptoms that gradually develop into more severe urinary frequency and urgency and eventually into a painful ulcerated bladder. These patients typically have reduced functional bladder capacity, increased bladder sensation, detrusor overactivity, severe urgency, urinary incontinence, and bladder contracture. Ketamine metabolites can cause severe inflammation of the urothelium, urothelial barrier deficits, vascular endothelial fibrinoid changes, increased oxidative stress, and bladder wall fibrosis. A decrease in bladder compliance, urinary tract infection, severe bladder pain with a full bladder, and painful micturition are also common symptoms. Finally, with continued abuse of ketamine, hydronephrosis, ureteral stricture, vesicoureteral reflux, and renal failure may develop. Cessation of ketamine is the mainstay of treatment. Lower urinary tract symptoms usually relapse if patients reuse ketamine after stopping. In cases of severe ketamine cystitis, only augmentation enterocystoplasty can relieve bladder pain and restore normal lower urinary tract function. This article reviews the underlying pathophysiology, clinical characteristics, and management of ketamine cystitis.</p>","PeriodicalId":45873,"journal":{"name":"Tzu Chi Medical Journal","volume":"35 3","pages":"205-212"},"PeriodicalIF":1.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/4b/ff/TCMJ-35-205.PMC10399845.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10006289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The differences in the adrenergic receptors of proximal urethra between sexes.","authors":"Po-Chun Hsieh,&nbsp;Shang-Jen Chang,&nbsp;Hsi-Hsien Chang,&nbsp;Stephen Shei-Dei Yang","doi":"10.4103/tcmj.tcmj_221_22","DOIUrl":"https://doi.org/10.4103/tcmj.tcmj_221_22","url":null,"abstract":"<p><strong>Objectives: </strong>The bladder and urethra work as a physiologically functional unit to facilitate continence in the storage and voiding phase. Sex differences have been found in the urethral contraction in response to α-adrenergic receptor activation. This study aimed to investigate the role of adrenergic receptors in the proximal urethra of male and female mice.</p><p><strong>Materials and methods: </strong>Urinary bladder and proximal urethral smooth muscle (USM) samples from male and female C57BL/6 mice were isolated and mounted in an organ bath.</p><p><strong>Results: </strong>Acetylcholine-induced contraction of the urinary bladder was compared in male and female mice. Phenylephrine and norepinephrine (NE) induced little contraction at a lower concentration, but a relaxing phase of female proximal USM was observed at a higher concentration. This contraction profile was inhibited by N^G-nitro-L-arginine, lidocaine, and capsaicin. In addition, the NE-induced contraction was greater in the incubation of propranolol than that of L-NNA or lidocaine. These results suggested that the β-adrenoceptor may be the dominant receptor of female proximal USM, and the activity of calcitonin gene-related peptide sensory nerves and nitrergic nerves may pose an anti-contraction effect on the proximal urethra in female mice.</p><p><strong>Conclusion: </strong>β-adrenoceptor may be the dominant receptor of female proximal USM. The use of β-adrenergic receptor blocker agents might have the potential for the treatment of female voiding dysfunction.</p>","PeriodicalId":45873,"journal":{"name":"Tzu Chi Medical Journal","volume":"35 3","pages":"253-259"},"PeriodicalIF":1.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/54/41/TCMJ-35-253.PMC10399842.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9943337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nurse-led coaching of shared decision-making for wound treatment of pressure injury: A pilot study of a randomized trial.","authors":"Mei-Yu Hsu,&nbsp;Yu-Sin Chen,&nbsp;Ying-Chun Chen,&nbsp;Yu-Lin Wu","doi":"10.4103/tcmj.tcmj_256_22","DOIUrl":"https://doi.org/10.4103/tcmj.tcmj_256_22","url":null,"abstract":"<p><strong>Objectives: </strong>International guidelines for managing pressure injury (PI) and ulcers recommend that family members and caregivers should be involved in making decisions for appropriate wound care. However, the effect of shared decision-making (SDM) in the context of PI remains unknown. This study investigated the efficacy of nurse-led medical SDM for PI treatment.</p><p><strong>Materials and methods: </strong>We constructed a patient decision aid (PDA) for PI treatment on the basis of nursing evidence. Subsequently, we conducted a pilot randomized controlled trial to evaluate the efficacy of SDM compared with that of usual care (control group, [CG]) for PI treatment. Participants with stage 3, stage 4, or unstageable PI were included and randomized into two groups. In the SDM group (SDMG), 10 participants received the SDM intervention for PI before treatment. All participants were followed up for 4 weeks. Primary outcomes were measured using the nine-item SDM Questionnaire (SDM-Q-9) and Decisional Conflict Scale (DCS). Secondary outcomes included wound size and cost of wound management.</p><p><strong>Results: </strong>The expert validity (medical professors and general population) of the PDA designed for PI was measured, and the content validity index was 0.96-0.97. A total of 20 participants were enrolled (10 received SDM and 10 received usual care). The mean age of the participants was 55.7 ± 8.8 years. No significant difference in baseline characteristics (sex, age, staging, or wound area) was observed between the two groups. The SDMG had higher SDM-Q-9 (<i>P</i> < 0.001) and DCS (<i>P</i> < 0.01) scores than did the CG. For the secondary outcomes, the SDMG had a decreased change of wound size and lower wound management costs than did the CG; nevertheless, the differences were not statistically significant.</p><p><strong>Conclusion: </strong>We constructed a PDA for PI treatment, which can be applied in clinical care. The pilot test results revealed that the participants had a lower cost related wound treatment and decreasing wound size in SDMG than CG after the intervention of SDM-PI for 4 weeks. In the future, clinical studies should conduct large-scale randomized trials based on the results of this pilot study.</p>","PeriodicalId":45873,"journal":{"name":"Tzu Chi Medical Journal","volume":"35 3","pages":"260-266"},"PeriodicalIF":1.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a5/31/TCMJ-35-260.PMC10399837.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9943338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}