• 期刊

腦中風急性後期患者物理治療介入之成效

前言：本研究目的為描述南部某區域教學醫院有接受急性後期照護品質試辦計劃腦中風患者物理治療介入前後之成效。方法：南部某區域教學醫院接受急性後期照護品質試辦計畫的腦中風患者，給於適當物理治療計畫，治療前後由專業物理治療師進行評估，評估工具為巴氏量表、柏格氏平衡量表、5公尺行走測試與六分鐘行走測試。以成對T檢定來檢定介入前後在日常生活活動功能、平衡能力與行走能力的成效。結果：本研究於2014年2月至10月期間，共收治55位急性後期腦中風患者，平均年齡63.96 ± 12.40歲。經過物理治療介入前後，在巴氏量表方面、柏格氏平衡量表、五公尺行走測試與六分鐘行走測試皆有統計學上顯著差異。(p＜0.05)結論：接受急性後期照護計劃腦中風患者經過物理治療介入後能有效改善日常生活活動功能、平衡能力、行走速度與心肺適能。

• 期刊

運用看圖對話衛教工具於第2型糖尿病病患之代謝指標成效

前言:臨床上常藉由許多衛教工具的輔助來提升糖尿病衛教效能，本研究探討使用「糖尿病看圖對話」衛教工具介入後的第2型糖尿病病患，在6個月及12個月的追蹤下， 其健康指標的變化，以了解衛教工具在臨床衛教上的成效，提升衛教資源在糖尿病健康照護管理的有效使用。方法:第2型糖尿成年患者為受試者，以「糖尿病看圖對話」衛教工具為研究介入工具，參加前、6個月與12個月的生化檢驗數據做為本研究資料來源。以敘述統計、重複量測變異數(Repeated measures ANOVA)分析做各變項間之探討。結果:本研究有效樣本101人，年齡集中在50 - 69歲之間佔72.3%。介入前與6個月後之比較，血壓、糖化血色素、空腹血糖、飯後血糖、高密度膽固醇與低密度膽固醇皆具顯著進步。介入前、12個月後之比較，糖化血色素、空腹血糖、飯後血糖、高密度膽固醇與低密度膽固醇皆具顯著進步。在介入前、6個月與12個月後之差異，發現飯後血糖、高密度膽固醇與低密度膽固醇具顯著進步。結論:研究結果發現「糖尿病看圖對話」衛教工具介入第2型糖尿病患者衛教中，6個月短期成效優於12個月長期，不論短或中長期，其效果皆優於介入前。藉由「糖尿病看圖對話」做為糖尿病患者的衛教工具可有效並長期的維持患者的健康調適及自我管理的目標。

• 期刊

輻射曝露與新生兒出生體重不足

目的：主要在探討產婦在懷孕期間接受放射線檢查，對於新生兒出生體重不足是否有影響。方法：本研究採用回溯性研究(Retrospective Study) ，使用2008-2010年健保資料庫百萬歸人檔進行分析。研究樣本的特性將用百分比、平均值和標準差表示。將懷孕婦女分為兩個族群：一為懷孕過程有接受過放射線檢查之孕婦，另一為沒有接受過放射線檢查之孕婦。對於新生兒出生體重不足(小於2,500g)為研究變項， 使用卡方檢定與羅吉斯迴歸去分析，懷孕過程是否接受過放射線檢查的關聯性與勝算比。結果：剔除多胞胎及沒有產檢紀錄之產婦，取得總產婦共14,133人次。其中懷孕期間接受放射線檢查產婦為1,101人次;懷孕期間沒有接受放射線檢查產婦為13,032人次。研究結果顯示新生兒出生體重不足與接受放射線檢查不具顯著關聯性。結論：本研究推論，懷孕期間接受放射線檢查不會增加新生兒體重不足的風險，但不代表可以無上限的接受放射線檢查。在臨床上對於女性患者，不確定是否懷孕可能前，應將放射線檢查視為第三線工具，以超音波和磁振造影為主。

• 期刊

Acute Kidney Injury Caused by Near-Drowning: A Case Report

Drowning and near-drowning events are most frequently reported in young individuals, and these events often result in unexpected tragedies. Rhabdomyolysis is one of the complications in victims of submersion. Although rhabdomyolysis after submersion is usually asymptomatic, potential life-threatening complications such as acute kidney injury may occur and be overlooked due to delayed manifestation. A 34-year-old near-drowning patient who was resuscitated and discharged after two hours of observation. Unfortunately, rhabdomyolysis developed after the event and resulted in acute kidney injury. He underwent two successive of hemodialysis due to persistent oliguria despite medical treatment. After treatment, the patient's renal function improved and hemodialysis therapy was discontinued. Rhabdomyolysis after submersion is often omitted, which may delay the treatment. For patients rescued after submersion, clinicians should be aware of rhabdomyolysis as a potential confounding factor and aggressive treatment for rhabdomyolysis may prevent the development of acute kidney injury.

• 期刊

Salmonella Nonaneurysmal Abdominal Aortitis in a Hemodialysis Patient: A Case Report

Infectious aortitis is a rare, but life-threatening disease. Uremia is a state of decrease in cellular immunity, which may predispose dialysis patients more easily to develop Salmonella infections comparing to those with normal renal function. Herein, we report an unusual case involving a 75-yearold woman on maintenance hemodialysis, who developed nontyphoidal Salmonella bacteremia and nonaneurysmal abdominal aortitis with psoas muscle abscess. As our patient refused surgery, the natural history of nonaneurysmal infectious aortitis are shown. We conclude it is very important to establish an early diagnosis of infectious aortitis and to prescribe prolonged antibiotics in uremic patients with Salmonella bacteremia.

• 期刊

The Intervention Experience Combining the ＂take PRIDE＂ Program with Home Physical Therapy on A Guillain-Barre Syndrome Patient: A Case Report

The ＂take PRIDE＂ program is a health behavior modification program that is based on social cognitive theory and applied to self-regulate health status among chronic disease patients. An 18-year-old female was admitted to our hospital due to flaccid paralysis over four limbs and paresthesia over both lower extremities for several days. She was diagnosed as a case of Guillain-Barre syndrome. The patient received rehabilitation for 4 weeks with partial improvement of her symptoms. She could not receive outpatient physical therapy, so we utilized the ＂take PRIDE＂ program to help her for the physical therapy exercises at home. After 3 rounds of evaluations, her functions improved considerably after performing the ＂take PRIDE＂ program for one year. This report describes our experience of the ＂take PRIDE＂ program in home physical therapy and reviewing of the literature.

• 期刊

不同的皮膚照護方案對成人失禁性皮膚炎之改善成效：系統性文獻回顧

失禁排泄物會浸潤肛門、會陰皮膚導致對失禁性皮膚炎(Incontinence-associated dermatitis, IAD) ，即使臨床照護者已經勤於清潔與更換尿布，亦會因缺乏皮膚清潔及防護品的知識，照護方式不一致而無法有效改善臨床症狀。為探討不同的皮膚照護方案對IAD之改善成效，以系統性文獻回顧的方式，查閱1987年1 月至2016年5月的文獻， 依關鍵字檢索，選取符合篩選標準及排除重複出現文獻，最後納入12篇隨機臨床試驗文獻。這些證據支持良好的皮膚清潔、隔離防護、尿布選擇及護理頻率，能改善IAD， 並可供臨床照顧者參考， 以提升照護品質。