Bezoars obstruction in small intestine treated with coca-cola therapy: A case study

[[abstract]]糞石嵌塞難以消化的物質在腸胃道停留過久所造成，發生小腸糞石時，易引起腸阻塞，病人會出現噁心、嘔吐、腹脹等不適症狀。本文描述一位62歲男性糖尿病病人，因下腹部持續鈍痛二天，伴隨噁心、嘔吐的情形，至某醫院急診求治，確診為：小腸糞石嵌塞（Small bowel ileus with bezoar），經給予口服可樂搭配藥物服用後，順利排出糞石之個案報告。病人之糞石阻塞的位置在小腸，無法使用胃鏡作治療，如果無法自行排出則需外科手術取出，但外科手術必定需要較長的恢復期，又糖尿病患者也是術後照顧的高危險群，故初步治療計劃是保持內科的支持性療法為優先選擇外加每日使用低卡可口可樂600cc的支持性療法。病人經由每日服用可樂600cc./day，於第三天病人開始排便、腹痛也明顯緩減，經小腸鋇劑攝影檢查確認已經沒有糞石嵌塞的情形，推論糞石已順利排出

Outlooks for the nurse practitioners' role functions and human resource management

[[abstract]]台灣人口老化情況日益嚴重，對高品質的健康照護需求殷切，再加上醫療給付制度與醫學教育的變革，致使住院醫師人力不足、工時超長等過勞現象。而醫師人類需求難以短時間供給，各醫院管理階層為符合評鑑基準、解決醫師人力缺口及節省醫療成本之考量，大量招聘及培訓專科護理師做為臨床醫療之替代人力。因應上述醫療環境的變化，衛生福利部於2016年1月1日公告施行「專科護理師於醫師監督下執行醫療業務辦法」，拓展專科護理師之執業範疇，使專科護理師能在規範下合法執行醫療業務。隨著專科護理師角色功能與執業範疇的拓展，醫療院所對稱職專科護理師的需求日益殷切，專科護理師的執業人數也隨之快速成長，逐漸成為各醫療院所不可或缺的專業人才。然而目前專科護理師的執業現況仍有許多困境與挑戰有待進一步改善與解決，因此，筆者分別就專科護理的角色定位、醫護領域對專科護理師角色功能期待之差異、醫護共管模式之困境與挑戰、以及合理合法的執業內涵與工作負荷進行剖析，期能藉由本文提升讀者對專科護理師的角色功能與人資管理現況與展望的了解與正視，進而創造專科護理師更優質的工作環境，使能全力發揮此一進階護理角色功能以符合各界之殷切期待

Concept analysis of delay in seeking medical care

[[abstract]]「延遲就醫」是一種複雜的行為，不僅受到個人生理與心理狀況的影響，也很容易受到周遭環境的左右。研究顯示「延遲就醫」常導致癌症或慢性病病人錯失接受治療的最佳時機，並對預後產生負面影響，故需積極預防之。而釐清延遲就醫的定義是有效偵測、改善及預防其發生的基石。目前雖有許多學者致力於延遲就醫相關行為的探討，但多數對此一概念缺乏清楚定義。因此，作者以Walker及Avant的步驟來分析此一概念，透過廣泛性的查證、確認定義性特徵、列舉模範、相反、邊緣及相關案例、確認行為之前因後果、佐以實證性資料並提出實務上之建議，以澄清此一概念。根據分析結果「延遲就醫」可被定義為「個人產生不適或異常之症狀後，並未立即尋求醫療照護；且此症狀若未在一定時間內接受治療將導致不良預後」。而「延遲就醫的時間」則為「個人初次產生不適或異常症狀，直到尋求醫療照護的時間」，上述定義期能作為未來發展相關測量工具及介入措施之考

Exercise for Cancer Survivors

[[abstract]]癌症存活者在不同時期常須面對來自疾病與治療的獨特挑戰，癌症治療期間及治療後的體能活動不足，可能進一步導致心肺適能下降、骨質流失和肌肉萎縮等情形，進而增加罹患其他常見慢性疾病的風險。越來越多的研究證據顯示體能活動或運動介入在癌症的預防及控制上佔有重要的角色，規律運動可降低多種癌症的風險，對癌症存活者有改善短期與長期生理與心理健康的效益。癌症存活者運動訓練相關研究仍在發展階段，至今並無實證基礎的癌症特異運動指引，致使醫護人員在進行復健運動建議時缺乏指引甚或感到遲疑，因此本文內容主要介紹癌症存活者運動的安全性和效益與運動處方的基本原則，包括運動訓練前的醫療評估與測試、訓練禁忌症、訓練目標、運動訓練原則與不同癌症部位的特殊考量，目的是為提供一個初略的大綱作為健康照護者對癌症存活者在治療期間與治療後進行運動訓練的參考。 This article reviews safety, effects of exercise, and basic principles of exercise recommended for cancer survivors, including medical evaluation and testing, training, contraindications, training objectives, training principles, and specific considerations for people with a variety of types of cancer. Cancer survivors encounter challenges from both disease and cancer-related treatments. Physical inactivity is a further detriment to these patients' cardiopulmonary fitness, bone and muscle mass, resulting in a greater risk for development of other chronic diseases. Research evidence supports that regular exercise reduces cancer risk and improves both short term and long term physical and psychological health outcomes. However, there is a lack of evidence- based guidelines on an exercise program for cancer patients. This article provides a reference for healthcare providers in exercise training for cancer patients during and post cancer treatments

以文獻回顧探討精準健康照護模式之概念與臨床應用

[[abstract]]目的：透過精準健康照護的研究結果證據，提供臨床照護上最新的健康介入策略。方法：本文採用文獻回顧搜尋，以國內外知名資料庫搜尋2014至2019文獻，篩選後萃取整合結果。結果：搜尋1605篇後；扣除重複72篇及刪除不適合文章1521篇，最後納入10篇文獻分析，歸納出名詞定義、適用族群與六大核心元素：團隊共訂健康目標（Purpose of health）、病人照護喜好（care Preferences）、病人優先導向照護（patient Priority-directed care）、跨領域團隊合作照護（inter-Professional collaborative practice）、應用群眾生物資料庫（Popular bio-databases）與病人自我管理科學（Patient's self-management），簡稱6P。接著，發展精準照護模式在結構、過程面介入，強化結果面的照護品質。結論：建構以團隊基礎、病人優先導向之精準健康照護模式，期注入新模式，提供臨床之醫療照護、政策及未來研究趨勢

The development and examples of pre-established medical processes for nurse practitioners in practicing medicine

[[abstract]]「專科護理師」於2000年立法正名後，開始有執業的法源依據，但工作內容與角色定位仍常有界定不清與缺乏共識的情形，特別是針對輔助醫師執行醫療業務的部分僅能以護理人員法第24條護理人員之業務中的「醫療輔助行為」予以解釋，常使專科護理師在執行醫療業的適法性上有所爭議。在醫護共同努力下，於2014年8月立法院臨時會期通過護理人員法第24條條文修正，擴充專科護理師之業務，除原護理師的法定業務外，增列專科護理師與接受專科護理師訓練期間之護理師，得於醫師監督下執行醫療業務。衛福部因應此項條文之修訂以及確保專師執行醫療行為之品質與安全性，於2015年10月公告「專科護理師於醫師監督下執行醫療業務辦法」，規範專師於醫師監督下得執行之醫療業務內涵以及監督之定義及方式，同時明定得由醫師預立醫療流程及相關規定。自此專科護理師執行醫療業務有了更具體的法源依據，工作內容與執業範圍也更為明確。然而，預立醫療流程的發展與訂定並無過去經驗可以參照，為縮短摸索期與凝聚共識，特以本文分享發展預立特定醫療流程的經驗，主要內容包括臺灣專科護理師執業範圍的發展、專科護理師於醫師監督下得執行之醫療業務、預立特定醫療流程之精神與內涵、制訂時應注意事項與挑戰、及其對專科護理師執業的保障與衝擊，同時也提供三個範例作為後續發展之參考

新生兒假性醛固酮低下症之罕見案例報告 A Rare Case Report of Pseudohypoaldosteronism in a Neonate

[[abstract]]本案例報告一位12天大女嬰，因延遲性黃疸合併危急性高血鉀低血鈉住院，從臨床診斷、治療到復原的過程。住院期間黃疸於接受照光、輸液補充治療，持續性高血鉀、低血鈉徵象未見改善，也潛藏心律不整猝死危機。經過身體評估，未見外生殖器有陰蒂肥大、皮膚無黑色素沈著樣貌，配合新生兒篩檢項目的17-OHP（17-hydroxyprogesterone）報告未有異常，假性醛固酮低下症，終而確立診斷。經過適當口服mineralocorticoid藥物治療與鹽份補充，體重與危急性的高血鉀、低血鈉徵象獲得改善。當新生兒呈現無法解釋的持續性黃疸、不佳的體重增長、電解質不平衡、以及脫水徵象，假性醛固酮低下症，就必須列入考慮之中。盼藉由此罕見案例報告，分享照護過程與經驗，作為日後照護此類兒科罕見案例之參考，進而正確診斷與把握有效治療的黃金時間。 This case report is about a 12-day-old female neonate hospitalized for prolonged jaundice with acute hyperkalemia and hyponatremia from diagnosis to recovery. During hospitalization, her jaundice got improved after treatment, but hyperkalemia and hyponatremia still endured after intravenous rehydration therapy, with potential risk of sudden death from arrhythmias. The results of physical examination showed no external genital clitoris hypertrophy or dermal pigmentation. The result of 17-hydroxyprogesterone (17-OHP) test from the neonatal screening program was normal. The neonate was diagnosed with pseudohypoaldosteronism (PHA) and showed weight gain and recovered from hyperkalemia and hyponatremia after treated with oral mineralocorticoid and sodium replacement. The diagnosis of PHA should be considered while a neonate showed unexplained prolonged jaundice, unhealthy weight gain, electrolyte imbalance and dehydration. This case report is to share our experience in managing PHA and to server as a reference for caring pediatrics rare cases in order to reach timely diagnosis and treatment

專科護理師的角色功能與人資管理之展望Outlooks for the nurse practitioners' role functions and human resource management

[[abstract]]台灣人口老化情況日益嚴重，對高品質的健康照護需求殷切，再加上醫療給付制度與醫學教育的變革，致使住院醫師人力不足、工時超長等過勞現象。而醫師人類需求難以短時間供給，各醫院管理階層為符合評鑑基準、解決醫師人力缺口及節省醫療成本之考量，大量招聘及培訓專科護理師做為臨床醫療之替代人力。因應上述醫療環境的變化，衛生福利部於2016年1月1日公告施行「專科護理師於醫師監督下執行醫療業務辦法」，拓展專科護理師之執業範疇，使專科護理師能在規範下合法執行醫療業務。隨著專科護理師角色功能與執業範疇的拓展，醫療院所對稱職專科護理師的需求日益殷切，專科護理師的執業人數也隨之快速成長，逐漸成為各醫療院所不可或缺的專業人才。然而目前專科護理師的執業現況仍有許多困境與挑戰有待進一步改善與解決，因此，筆者分別就專科護理的角色定位、醫護領域對專科護理師角色功能期待之差異、醫護共管模式之困境與挑戰、以及合理合法的執業內涵與工作負荷進行剖析，期能藉由本文提升讀者對專科護理師的角色功能與人資管理現況與展望的了解與正視，進而創造專科護理師更優質的工作環境，使能全力發揮此一進階護理角色功能以符合各界之殷切期待。 The need for high quality healthcare has been increasing due to an aging population in Taiwan. Moreover, reforms in healthcare insurance policies and the medical education system have resulted in a staffing shortage and a work overload for resident physicians. The demand for physicians cannot be fulfilled in such a short period to come; therefore, a great number of nurse practitioners were recruited by medical centers as temporary workforce substitutes to meet the standards of the medical survey, solve the insufficiency of resident physicians, and save healthcare costs. Due to current changes in the healthcare environment, the Ministry of Health and Welfare has developed and enacted the regulation ＂Nurse Practitioners Performing Medical Practice under Supervision of Physicians＂ on January 1, 2016. This regulation expands the scope of practice for nurse practitioners and allows them to perform medical practice legitimately. The expansion of scope of practice and role function of nurse practitioners result in a rapid increase in the demand of nurse practitioners. Currently, existing difficulties and challenges in the daily practice of nurse practitioners still need to be resolved. Therefore, the author attempts to address and analyze the following subjects: roles of nurse practitioner, variance of role function between medical clinicians and nursing practitioners, difficulties and challenges of a dual management model, and the reasonable legitimate workload and scope of practice for nurse practitioners. We hope to bring them up for readers' understanding and attention to the current situation, as well as for the outlook of the role function of nurse practitioners in Taiwan. Furthermore, we can create a better work environment for nurse practitioners to perform their expected role functions and broaden the scope of practice in their specialties

專科護理師執行醫療業務辦法之臨床衝擊與展望 The Clinical Impacts and Prospects from the New Regulation regarding Nurse Practitioners Practicing Medicine

[[abstract]]由於醫療政策的演變，醫師人力不足的情形日益嚴重，使得專科護理師在醫療的角色日顯重要。為使專科護理師的獨特角色功能及執業範疇更為明確，2014年8月立法院通過「護理人員法第24條修正條文」，並於同年由衛生福利部訂定及公告實施「專科護理師於醫師監督下執行醫療業務辦法」，專科護理師除了護理師業務外並於醫師監督下得執行醫療業務，自此專科護理師的執業範疇更為明確，不再處於模綾兩可的灰色地帶。然而，由於考量醫療業務之風險程度，該辦法中規範專科護理師可執行之醫療項目未能全然反應臨床實際現況與需求，易使專科護理師在職場上陷入情、理、法膠著的困境。因此，筆者分別就專科護理師的發展、專科護理師的角色功能、專科護理師執業範疇之立法進展、「專科護理師於醫師監督下執行醫療業務辦法」對臨床工作的衝擊與後立法時期專科護理師執業之展望進行剖析，期能藉由本文提升讀者對專科護理師執業範疇立法過程、衝擊與展望的了解與共識，進而繼續推動與調整專科護理師執業範疇使其更為合理合法且貼近臨床實務現況；並使此一進階護理角色功能更為明確與執業更有保障。 Because of the complexity of modern healthcare and severe shortage of clinicians, roles of nurse practitioners have become more important in today's clinical practice. To clarify the unique role of a nurse practitioner and its practice scopes, Legislative Yuan of Taiwan passed the Nurses Law Amendment Act provisions of Article 24 in August 2014. Health and Welfare Decree announced and implemented a supervision rule that ＂nurse practitioner must perform medical practices under the supervision of a physician＂ in the same year. Thereafter, the scopes of practice for nurse practitioners have clearly defined that in addition to nursing practice, nurse practitioners may perform medical practice under a physician's supervision without ambivalence and confusion. However, considering clinical medical practice's high risk, the medical practices that nurse practitioners were allowed to perform do not fully reflect real clinical situations and needs. Moreover, it may put nurse practitioners in a problematic position while facing the challenges of judgement, temperament, and reasoning. This article aims to analyze these acts to make readers better understand and have consensus on the legislative process, impacts, and prospects of the scope of practice for nurse practitioners. Then, the scope of practice for nurse practitioners can be further developed for legitimate and reasonable practice in real clinical situations. Therefore, the role and function of nurse practitioners can be more distinct, and supervised medical practice can be competent and protected