ORCID Profile
0000-0001-9772-482X
Current Organisations
Taipei Medical University
,
Taipei Municipal Wan-Fang Hospital
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Publisher: Elsevier BV
Date: 10-2021
Publisher: Elsevier BV
Date: 12-2020
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 22-04-2022
DOI: 10.1097/JNR.0000000000000487
Abstract: Delirium remains significantly undetected in the intensive care unit (ICU). Little is known regarding the level of delirium care knowledge among critical care nurses in Taiwan. This study was designed to investigate the level of knowledge about delirium care among critical care nurses using a multiple-choice question quiz. A descriptive, cross-sectional approach was used, and data were collected using a web-based survey. The demographic characteristics including age, years worked as critical care nurse, gender, advanced ICU training, educational level, and type of ICU, along with a delirium care knowledge quiz, were collected. The quiz consisted of 16 items measuring (a) symptoms, types, and outcomes (b) high-risk groups (c) predisposing and precipitating factors and (d) assessment and detection of delirium. Data were collected between October 6 and November 16, 2020. In total, 324 critical care nurses completed the survey. The rate of correct response on the delirium care quiz for each domain was measured: (a) symptoms, types, and outcomes: 67.1% (b) high-risk groups: 76.2% (c) predisposing and precipitating factors: 78.9% and (d) assessment and detection: 41.5%. The item with the lowest correct response rate was related to the interpretation of delirium assessments. The findings of this study suggest that future studies and education should focus on the use and interpretation of the assessment using a valid delirium assessment tool to improve the ability of critical care nurses to detect delirium in ICU settings.
Publisher: Elsevier BV
Date: 04-2020
DOI: 10.1016/J.ICCN.2019.102784
Abstract: To review and examine the evidence on diagnostic test accuracy of PRE-DELIRIC (PREdiction of DELIRium in ICu patients) for predicting delirium risk in critically ill patients. This meta-analysis included studies reporting the diagnostic performance of PRE-DELIRIC between 2012 and 2019. The Cochrane Library, MEDLINE, Embase, CINAHL and Chinese Electronic Periodical Services databases were searched for eligible diagnostic studies. Risk of bias was assessed using a standard procedure according to the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) criteria. We included seven studies involving a total of 7941 critically ill patients in intensive care units settings. Results indicated that PRE-DELIRIC had a summary sensitivity of 0.76 (95% CI 0.60-0.87), and specificity of 0.66 (95% CI 0.45-0.82), suggesting that diagnostic performance of PRE-DELIRIC is useful to predict delirium risk in ICU patients. The area under the summary receiver operator characteristics (SROC) curve was 0.78 (95% CI 0.74-0.81), which also confirmed good accuracy of PRE-DELIRIC. We suggest that the PRE-DELIRIC model can be applied in the intensive care unit according to its good diagnostic test accuracy. However, this finding should be interpreted with caution due to the heterogeneity of this meta-analysis.
Publisher: Wiley
Date: 02-05-2023
DOI: 10.1111/WVN.12649
Abstract: With the increase in life expectancy around the globe, the incidence of postoperative delirium (POD) among older people (≥65 years) is growing. Previous studies showed a wide variation in the incidence of POD, from 4% to 53%, with a lack of specific evidence about the incidence of POD by specific surgery type among older people. The aim of this systematic review and meta‐analysis was to determine the incidence of POD by surgery type within populations 65 years and over. Databases including PubMed, Cochrane library, Embase, and CINAHL were searched until October 2020. Due to the relatively higher number of meta‐analyses undertaken in this area of research, a streamlined systematic meta‐analysis was proposed. A total of 28 meta‐analyses (comprising 284 in idual studies) were reviewed. Data from relevant in idual studies ( n = 90) were extracted and included in the current study. Studies were grouped into eight surgery types and the incidence of POD for orthopedic, vascular, spinal, cardiac, colorectal, abdominal, urologic, and mixed surgeries was 20%, 14%, 13%, 32%, 14%, 30%, 10%, and 26%, respectively. POD detection instruments were different across the studies, with Confusion Assessment Method (CAM & CAM‐ICU) being the most frequently adopted. This study showed that POD incidence in older people undergoing surgery varied widely across surgery type. The more complex surgeries like cardiac and abdominal surgeries were associated with a higher risk of POD. This highlights the need to include the level of surgery complexity as a risk factor in preoperative assessments.
Publisher: Wiley
Date: 04-09-2021
DOI: 10.1111/WVN.12536
Abstract: Postoperative delirium is the most common complication of surgery particularly in older patients. The current study aimed to summarize the commonly used delirium assessment tools in assessing postoperative delirium (POD) and to estimate the incidence rates of POD. A systematic review that included empirical cohort studies reporting the use of delirium assessment tools in assessing POD between 2000 and 2019. Five core databases were searched for eligible studies. The methodological quality assessment of the included studies was undertaken using the Joanna Briggs Institute (JBI) critical appraisal checklist to examine the risk of bias. Pooled incidence estimates were calculated using a random effects model. Nineteen studies with a total of 3,533 postsurgery older patients were included in this review. The confusion assessment method (CAM) and CAM‐ICU were the most commonly used tools to assess POD among older postoperative patients. The pooled incidence rate of POD was 24% (95% CI [0.20, 0.29]). The pooled incidence estimates for mixed (noncardiac) surgery, orthopedic surgery, and tumor surgery were 23% (95% CI [0.15, 0.31]), 27% (95% CI [0.20, 0.33]), and 19% (95% CI [0.15, 0.22]), respectively. More than 50% of included studies used CAM to assess POD in different types of postoperative patients. Using CAM to assess delirium is less time‐consuming and it was suggested as the most efficient tool for POD detection. We identified that CAM could be implemented in different settings for assessing POD. The incidence and risk factors for POD introduced can be used for future research to target these potential indicators. The incidence rate, risk factors, and predictors of POD explored can provide robust evidence for clinical practitioners in their daily practice.
Publisher: Informa UK Limited
Date: 26-02-2014
DOI: 10.3109/02770903.2014.887728
Abstract: To evaluate the effectiveness of clinical pathways (CPs) for paediatric asthma on length of hospital stay, additional visits due to asthma exacerbations, hospital cost, manpower and workload required for implementing CPs. Studies were eligible if they met the following criteria: children (≦18 years) with asthma, hospital or emergency department based, and study designs were (1) randomised controlled trial, (2) controlled clinical trial or (3) controlled before and after study. Two reviewers independently screened references, extracted data and assessed the risk of bias. We resolved disagreement by discussion between authors. Due to an insufficient number of studies and the heterogeneity of interventions and outcomes, we conducted a narrative systematic review with forest plots but did not pool results. About 3155 relevant articles were identified through a literature search, 628 were duplicates removed, 2037 were excluded based on review of titles and abstracts and 117 were excluded because they did not meet inclusion criteria. Seven studies involving 2600 participants met the inclusion criteria. Using asthma CPs may decrease the length of hospital stay however, CPs did not appear to reduce additional visits due to asthma exacerbations or reduce hospital costs. No eligible studies were found that quantified the manpower and workload for implementing CPs. Current studies suggest CPs may reduce the length of hospital stay, but insufficient evidence is available on total costs or readmissions to justify extensive uptake of asthma CPs in paediatric inpatient care. Higher quality, large randomised controlled trials are required that measure costs and a wider range of outcomes.
Publisher: Elsevier BV
Date: 07-2023
Publisher: Wiley
Date: 27-02-2021
DOI: 10.1111/NICC.12608
Publisher: Wiley
Date: 08-2020
DOI: 10.1111/WVN.12462
Abstract: Critical care nurses are in the best position to detect and monitor delirium in critically ill patients. Therefore, an optimum delirium assessment tool with strong evidence should be identified with critical care nurses to perform in the daily assessment. To evaluate and compare the diagnostic performance of delirium assessment tools in diagnosing delirium in critically ill patients. We searched five electronic databases including the Cochrane Library, PubMed, Embase, CINAHL, and a Chinese database for eligible diagnostic studies published in English or Mandarin up to December 2018. This diagnostic test accuracy meta-analysis was limited to studies in intensive care unit (ICU) settings, using the Diagnostic and Statistical Manual of Mental Disorders (DSM) as a standard reference to test the accuracy of delirium assessment tools. Eligible studies were critically appraised by two investigators independently. The summary of evidence was conducted for pooling and comparing diagnostic accuracy by a bivariate random effects meta-analysis model. The pooled sensitivities and specificities, summary receiver operating characteristic curve (sROC), the area under the curve (AUC), and diagnostic odds ratio (DOR) were calculated and plotted. The possibility of publication bias was assessed by Deeks' funnel plot. We identified and evaluated 23 and 8 articles focused on CAM-ICU and ICDSC, respectively. The summary sensitivities of 0.85 and 0.87, and summary specificities of 0.95 and 0.91 were found for CAM-ICU and ICDSC, respectively. The AUC of the CAM-ICU was 0.96 (95% CI, 0.94-0.98), with DOR at 99 (95% CI, 55-177). The AUC of the ICDSC was 0.95 (95% CI, 0.92-0.96), and the DOR was 65 (95% CI, 27-153). CAM-ICU demonstrated higher diagnostic test accuracy and is recommended as the optimal delirium assessment tool. However, the results should be interpreted with caution due to the between-study heterogeneity of this diagnostic test accuracy meta-analysis.
Publisher: Wiley
Date: 22-06-2021
DOI: 10.1111/JAN.14938
Abstract: To evaluate the effects of a simulation‐based education programme on critical care nurses’ knowledge, confidence, competence and clinical performance in providing delirium care. Single‐blinded randomized controlled trial. Registered nurses who work in intensive care units were recruited from a university‐affiliated acute major metropolitan teaching hospital. The intervention group received: (i) five online‐learning delirium care videos, (ii) one face‐to‐face delirium care education session and (iii) a simulation‐based education programme with a role‐play scenario‐based initiative and an objective structured clinical examination. The control group received only online videos which were the same as those provided to the intervention group. Delirium care knowledge, confidence, competence, and clinical performance as outcomes were collected at: baseline, immediately after intervention, and within 6 weeks post‐intervention to test whether there were any changes and if they were sustained over time. Data were collected between 2 October and 29 December 2020. The repeated‐measures analysis of variance was used to examine for changes in delirium care knowledge, confidence, and competence within groups. Seventy‐two critical care nurses participated with 36 each allocated to the intervention group and control group. No statistically significant difference was observed between the two groups in outcome variables at 6 weeks post‐intervention. In the intervention group, significant within‐group changes were observed in terms of delirium care knowledge, confidence, and competence over time. By contrast, no significant changes were observed in outcome measures over time in the control group. The simulation‐based education programme is an effective and feasible strategy to improve delirium care by enhancing the knowledge, confidence, competence and clinical performance of critical care nurses. Our findings provide evidence regarding the development and implementation of a simulation‐based education programme in hospitals for health professional education in Taiwan.
Publisher: S. Karger AG
Date: 2021
DOI: 10.1159/000519497
Abstract: b i Background: /i /b Total serum bilirubin (TSB) is used in managing neonates with jaundice, but clear evidence on its association with major outcomes is lacking. b i Objectives: /i /b We evaluated the association between TSB and kernicterus spectrum disorder (KSD). b i Methods: /i /b We searched PubMed, EMBASE, and CENTRAL till July 2021. Two authors independently selected relevant cohort studies, extracted data (CHARMS checklist), assessed risk of bias (RoB) (QUIPS tool), and rated certainty-of-evidence (Grades of Recommendation, Assessment, Development, and Evaluation). We pooled adjusted odds ratio (aOR) (random-effect) via generic inverse variance methods. b i Results: /i /b From 2,826 records retrieved, we included 37 studies ( i n /i = 648,979). Fifteen studies had low, 16 moderate, and 6 high RoB, with majority having concerns on confounder adjustment and statistical analysis. Twenty-two studies contributed meta-analysis data, and 15 were summarized narratively. TSB appears associated with KSD in infants with certain risk factors (aOR 1.10, 95% CI: 1.07–1.13 5 studies [ i n /i = 4,484]). However, TSB (aOR 1.10, 95% CI: 0.98–1.23 1 study [ i n /i = 34,533]) or hyperbilirubinemia (aOR 1.00, 95% CI: 0.51–1.95 2 studies [ i n /i = 56,578]) have no clear association with kernicterus or neurological diagnosis in overall neonatal population (moderate-certainty-evidence). One study shows that infants with hyperbilirubinemia appear likelier to develop attention-deficit disorder (aOR 1.90, 95% CI: 1.10–3.28) and autistic spectrum disorder (aOR 1.60, 95% CI: 1.03–2.49, i n /i = 56,019) (low-certainty-evidence). Certain clinical factors appear associated with KSD, although very few studies contributed to the analyses. b i Conclusions: /i /b Despite the importance of this question, there is insufficient high-quality evidence on the independent prognostic value of TSB for adverse neurodevelopmental outcomes in most neonatal populations. Future studies should incorporate all known risk factors alongside TSB in a multivariable analysis to improve certainty-of-evidence.
Publisher: Springer Science and Business Media LLC
Date: 08-10-2021
DOI: 10.1186/S13643-021-01822-2
Abstract: Purpose of this letter was to explore the trends regarding methodological flaws of systematic review and meta-analyses (SRMAs) based on retraction notes in the past decades, and the categories of reasons for the retractions. Content analysis with descriptive statistics, Cochran Q test, and multinomial logistic regression were used. Based on 187 records of retracted SRMAs, retraction announcements can be categorized into academic ethical violation, methodological flaw, and writing or reporting problem. The numbers of academic ethical violation were significantly higher than those with methodological flaw ( z = 3.51 p 0.01) or writing problem (z = 8.58 p 0.001). The numbers of methodological flaw were also higher than that with writing problem ( z = 6.47 p 0.001). Moreover, an increased proportion of methodological flaw was observed since 2006, and the retraction year was significantly associated with increased proportion of methodological flaw when academic ethical violation as the reference group.
Location: Taiwan, Province of China
Location: Taiwan, Province of China
Location: Taiwan, Province of China
Location: Taiwan, Province of China
Location: Taiwan, Province of China
No related grants have been discovered for Kee-Hsin Chen.