Browsing by Author "Liu, Hsueh-Erh"
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- ItemComparing outcomes between vascularized lymph node transfer and lymphovenous anastomosis in the primary lymphedema(2017-07-13) Lin, Chia Yu; Liu, Hsueh-Erh; Non-member
Purpose: Primary lymphedema is a devastating, debilitating disease. Much of the current treatment options demonstrate evidence in the treatment of secondary lymphedema. This study is to investigate the outcomes between vascularized lymph node (VLNT) transfers and lymphovenous anastomosis (LVA) in the treatment of primary lymphedema.
Methods: A total of 17 patients were recruited to the study with a total of 19 lower limbs with primary lymphedema at Chang Gung Memorial Hospital. All patients reported a non-hereditary occurrence of lymphedema history that originated at birth. All patients were treated with either VLNT or LVA. Postoperative quality of life and serial circumferential limb measurements were compared. Group comparisons were performed using Mann-Whitney U test for circumference comparisons, and the Wilcoxon test for pre and postoperative group comparisons.This study was approved by the Institutional Review Board (IRB) at Chang Gung Memorial Hospital and performed in accordance with the Helsinki Declaration ethical standards.
Results: 15 limbs received VLNTs and had an average of 3.8cm reduction above knee, 3.6cm below knee and 4cm above ankle. An average total reduction was 3.7cm. 4 limbs received LVA treatment and had an average of 1.3cm reduction AK, 3.0cm BK and 1.5cm AA, giving an average total reduction of 1.9cm. Patients in the VLNT group had an average drop from 5.2 episodes preoperatively to 0.1 episodes postoperatively. Patients in the LVA group reported an average reduction in cellulitic episodes from 5 preoperatively to 0.8 postoperatively. In the VLNT group, an average significant improvement in quality of life was noted by 2.5 points. In the LVA group, an average improvement in the quality of life score was seen by 2 points.
Conclusion: In conclusion, primary lymphedema can be treated adequately with improvements in both functional and quality of life outcomes if treatment options are chosen correctly. VLNT when used in severe cases of lymphedema, can provide greater relief with more impactful outcomes in both functional restoration and quality of life outcomes.
- ItemComparison of oral health and oral QOL among community residents and patients with renal insufficiency(2017-07-06) Liu, Hsueh-Erh; Huang, Jeng-Yi; Ho, Wan-Jing; Lu, Hui-Ting; Lee, Hsiu-Fang; Wang, Li-Hua; Kuo, Yi-Hsuan; Non-member
Purpose: The major purpose of this study was to assess and compare the oral health status and oral health-related quality of life of the community residents, CKD patients and ESRD patients from a medical center and neighborhood community located in northern part of Taiwan.
Methods: A cross-sectional study design was conducted. A total of 79 community residents, 120 CKD patients and 101 ESRD patients agreed to participate and completed all data collection. Instruments for data collection included: questionnaires (demographic information, oral hygiene habit, attitude and knowledge related to oral health, and geriatric oral health assessment index_GOHAI) and oral inspection (done by a trained assistant).
Results: The comparisons of demographic data showed that samples in CKD group were more male and lower educated. In addition, the age in ESRD group was significantly older than the CKD and community residents groups.
In regard to the performance of oral health, results of comparison showed that community residents had better performance than the other two groups in general. Specifically, the ESRD group reported lowest ratio in tooth brush at “after breakfast”, “after dinner” and “after eating”. Also, ESRD group reported a higher ratio in “never receive teeth examination”. The comparison of knowledge related to oral health showed that CKD group was the one with lower level than the other two groups. In addition, the comparison of attitude toward oral health found that community residents group reported more positive than the other two groups.
The results of personal inspection showed that CKD group had less untreated dental caries whereas the ESRD group had higher ratio of untreated dental caries. In addition, ESRD group had higher ratio of “0-5 loss teeth” in upper jaw whereas the CKD group had higher ratio of “11-15 loss teeth” in lower jaw. In regard to the dentures, CKD group had a higher ratio of active dentures and the ESRD group had a less ratio of full dentures.
The comparison of oral health-related quality of life showed that CKD group reported less total score than the groups of community residents and CKD patients. The comparisons of subscales showed that the CKD group had lower score in the psychosocial impact subscale than the groups of community residents and ESRD patients. For the pain and discomfort dimension, the group of community residents reported higher scores than the ESRD and CKD group. In addition, subjects in ESRD group reported higher scores than patients in CKD group.
Conclusion: The oral health status in the community residents, CKD patients, and ESRD patients were no good, measured by both subjective and objective methods. And limited patients had searched for medical treatment actively. The health care professions need to pay more attention to the oral health status of these specific subjects and referred them to dentist timely. Thus a holistic care could be achieved.
- ItemComparison of professional commitment and value between students under two different programs for BS degreeLiu, Hsueh-Erh; Kuo, Yi-Hsuan; Chang, Tsai-Hsiu; Chang Gung University, Taoyuan, Taiwan; Non-member
The purpose of this cross-sectional study was to compare the levels of professional commitment and professional value for student nurses under two different programs for BS degree. Certain variation of professional commitment and profession value existed at these two groups of students. Longitudinal follow-up is strongly suggested.
- ItemEffects of combined teaching strategies in evidence-based learning for student nurses and clinical nurses(2016-07-13) Liu, Hsueh-Erh; Chang, Karen; Lee, Hsin-Fang; Yu, Kuang-Hui; Chang, C. W.; Non-member
Session presented on Sunday, July 24, 2016:
This two-year quasi-experimental study was conducted during August, 2013 to July, 2015. Student nurses (SN) and clinical nurses (RN) were recruited from one university and one medical center. These who selected the elective course 'evidence-based health care' were treated as experimental group (n=16) whereas the rest of students at the same year were treated as control group (n=71). For clinical nurses, the willing to learn the contents of evidence-based health care was selected as criteria to be experimental group (n=29) or control group (n=77). The experimental group received teaching and web learning and regular contacts whereas the control group received regular contacts only. Data was collected at 6 points of times, which were: beginning of class (T0, baseline); class over (T1, 3rd month), T2(6th month), T3(9th month), T4(15th month), and T5(23th month). Questionnaires included: computer literacy, knowledge and attitude towards science, critical thinking, Evidence-Based Practice Questionnaire, and The EBP beliefs scale. All data were managed by SPSS-PC 18.0. Descriptive statistics and GEE analysis were performed where p<.05 was selected as level of significance. F test and post hoc comparison found that SN were younger than RNs. In addition, the ratio of lost follow-up was between 19.48% to 50%. The baseline comparison of outcomes showed a statistical difference existed in the computer literacy, critical thinking, and certain subscales in EBPQ. Results of GEE found that certain outcome and the interactions between outcomes and time factors reached statistical significance when compared with the baseline, such as: In regard to the EBPQ scale, the RN control group reported less knowledge and worse behaviors then the SN control group; compared with the baseline, RN experimental group reported better knowledge and behaviors than its interaction at 6th and 23th months. The impact of this combined teaching strategies were discussed. The impact of this combined teaching strategies were discussed. Also, the ways to reduce the dropout rate were also mentioned within text.
- ItemImpact of different types of oral care on oral mucositis and quality of life for head and neck cancer patients during radiotherapy(2014-11-17) Huang, Yi-Ying; Liu, Hsueh-Erh; Chi, Kwan-Hwa; Hao, Sheng-Po; Tsay, Pei Kwei; Non-member
Session presented on Saturday, July 26, 2014:
Aim: The purpose of this longitudinal study was to examine the impact of different types of oral care on grades of radiation-induced oral mucositis, body weight, and quality of life for the head and neck cancer patients during radiotherapy.
Introduction: Oral cavity is the major location that exhibits the toxic effects of radiotherapy and chemotherapy for head and neck cancer patients. Oral mucositis is one of the most common complications among these patients. Severe oral mucositis can lead to secondary complications (ie. loss of body weight) and delay the planned treatment protocols. Literature shows that oral care or used honey as agent can reduce the incidence of oral mucositis. What will happen if we combine these two strategies as a protocol for oral care? Therefore, we conducted this clinical trial to find the impact of combination.
Patients and methods: Patients were recruited from a medical center, Taiwan. During May 2012 and August 2013, a total of 97 head and neck cancer patients undergoing radiotherapy were contacted and 94 subjects completed the whole study protocol. The reasons of drop out were: side-effect (1), too afraid of treatment(1), and move to other hospital(1). Informed consent was obtained before the study started. Inclusion and exclusion criteria: Those who diagnosed with head and neck cancer, plan to receive radiotherapy with least doses of 6000cGy as part of their treatment protocol, and older than 20 years were recruited. Those who have been diagnosed as DM with HbA1C > 7% within 3 months, Karnofsky Performance Scale < 60, or suffering from grade 4 oral mucositis were all excluded. Study design: They were randomly stratified into three groups, where group 1 received honey mouthwash, instruction of oral care, and routine care; group 2 received instruction of oral care and routine care; and group 3 as control group, received routine care only. The honey mouthwash was to swish 20 cc nature and undiluted honey in mouth for 2 minutes and then swallowed it prior to RT, at 15 minutes and 6 hours after RT respectively. Prior to radiotherapy, all patients completed Chinese version of EORTC QLQ-C30 and EORTC QLQ-H&N35. An evaluation of their oral mucosa was conducted at the same time by a single researcher. These questionnaires also need to be completed while the cumulative RT dose at 40Gy and at the end of RT course. Their oral mucosa was evaluated when the RT doses were cumulated up to 10, 20, 30, 40, 50, 60 Gy and at the end of RT course respectively. Their body weight was measured at the beginning of the study and weekly during the period of treatment. Statistical analysis: Data were analyzed by the Statistical package for the Social Sciences 18 (SPSS) program. Descriptive (mean, SD, %) and inferential statistics (chi-square, Survival Analysis, One way ANOVA, Generalized Estimating Equation) were performed.
Results: The results showed that these three groups were homogeneous in their demographic variables and disease-related variables prior to radiotherapy. Mucositis (Primary Outcome): The first onset of grade 1 mucositis was significantly different among these three groups by Log-Rank test survival analysis (F= 8.29, p<.001) whereas the results of Post Hoc Bonferroni analysis showed that the first onset of grade 1 mucositis in control group was significant quicker than group 1 and 2. Mean value of the first onset of these 3 groups were: 11th day (group?, SD= 4.20, range= 6~26 day); 10th day (group?, SD= 4.47, range= 4~30 day); and 9th day (control group, SD= 2.63, range= 4~14 day) respectively. In regard to the ratio for occurrence of oral mucositis at each point of assessment, group and had a trend of lower ratio than the control group at the 3rd, 4th, and 6th assessment. None of the patients developed grade 4 mucositis. However, when the dose of RT cumulated > 40 Gy, the ratio of grade 3 mucositis was significant lower in group 1 and 2 when compared with control group (X2 = 19.06~40.98, p<.001). Body Weight (Secondary Outcome): The comparisons of weekly changes in body weight showed that group 1 and 2 had less changes than the control group (X2= 15.88~.9.00, p<.001). The range of changes in body weight were 0.95 to -2.52 kg (group?), 0.75 ~ -1.81 kg (group?), and -0.81 ~ -4.77 kg (control group) respectively. Quality of Life (Secondary Outcome): The study found that, for all patients, the overall quality of life were significantly decreased along with the cumulated doses of radiation (Wald X2= 44.99, p <.001). After adjusting the group, time and interaction effects, the results of GEE for EORTC QOL-C30 and EORTC QOL-H&N35 found that, at RT 40 Gy, the symptom scales of "appetite(Wald X2= 5.47, p=0.02)" and "sociability eating(Wald X2= 4.74, p=0.03)" were significantly less problems in group 1 when compared with control group. At the end of RT, the functional scales of "physical functioning(Wald X2= 7.23, p=0.01; Wald X2= 4.43, p=0.04)" in group 1 and group 2 were significantly better than the control group. In addition, the functional scales of "role functioning(Wald X2= 4.28, p=0.04)" in group?was significantly better and the symptom scales of "appetite(Wald X2= 6.38, p=0.01)", "speech problems(Wald X2= 7.13, p=0.01)", "sociability eating(Wald X2= 4.28, p=0.04)", and "social contact (Wald X2= 5.68, p=0.02)" were significantly less problems than the control group.
Conclusion: This study showed that, when compared with the control group, patients in both experimental group reported less occurrence and late onset of first mucositis, less severe oral mucositis, less weekly body changes, and even better quality of life during research period. Therefore, the application of honey mouthwash plus instruction of oral care or instruction of oral care alone were strongly suggested in clinical practice.
- ItemA prospective evaluation of health-related quality of life in lymphedema treatment(2017-07-27) Lin, Chia Yu; Liu, Hsueh-Erh; Chang Gung University, Taoyuan, Taiwan; Non-member
Vascularized lymph node flap transfer was the flap of choice for lower extremity lymphedema. Although physical rehabilitation is important for lymphedema treatment, there is no standardized procedure for different stage lymphedema. Nurses should update knowledge at the same time.