Sun, W.-N., & Kao, C.-Y. (2024). J Med Internet Res, 26, e47017. Read this article

The mortality rate in intensive care units (ICUs) is notably high, with patients often relying on surrogates for critical medical decisions due to their compromised state. This study then introduces eHealth literacy and the assessment tools to evaluate users’ capability and literacy levels in using eHealth resources. A clinical scenario involving surrogate decision-making is presented. This simulated case involves a patient with a hemorrhagic stroke who has lost consciousness and requires medical procedures such as tracheostomy. However, due to the medical surrogate’s lack of familiarity with eHealth devices and limited literacy in using eHealth resources, difficulties arise in assisting the patient in making medical decisions. This scenario highlights challenges related to eHealth literacy and solution strategies are proposed. In conclusion, effective ICU decision-making with eHealth tools requires a careful balance between efficiency with inclusivity. Health professionals should adopt a patient-centered approach to enhance the decision-making experience, particularly for individuals with limited eHealth literacy.

加護病房死亡率相當高，病人通常因病情危急而需要代理人做出重要的醫療決策。本文介紹智慧醫療素養及其評估工具，來評估使用者對於智慧醫療資源使用及健康素養水平。本文模擬臨床情境，假設一位病人因出血性中風喪失意識，但須要面臨氣管切開術等醫療處置，然而，代理人對於使用智慧醫療相關設備不熟悉，且健康素養水平有限的情況下，使代理人出現決策困難，這樣的情境凸顯現今推行智慧醫療設備使用及健康素養水平不同的困境。特別在加護病房時，醫療團隊使用智慧醫療設備進行決策輔助時，需在決策效率及代理人的差異上取得平衡，醫療團隊應以病人為中心，提升代理人決策歷程感受，特別在健康素養較低的代理人。

Chiang, C.-J., Hsu, W.-L., Su, M.-T., Ko, W.-C., Hsu, K.-F., & Tsai, P.-Y. (2024). Vaccines, 12(2), 164. Read this article

A pregnancy booster dose significantly reduces the risk and severity of COVID-19, and it is widely recommended. A prospective cohort study was conducted to compare the transplacental passage of maternal antibodies from vaccination or infection during three trimesters against both the vaccine-targeted Wuhan strain and the Omicron strain of SARS-CoV-2. Maternal-infant dyads from vaccinated mothers were collected between 6 June 2022 and 20 September 2022. We analyzed 38 maternal-infant dyads from mothers who had been infected with COVID-19 and 37 from mothers without any previous infection. Pregnant women who received their last COVID-19 vaccine dose in the third trimester exhibited the highest anti-spike protein antibody levels and neutralizing potency against both the Wuhan strain and Omicron BA.2 variant in their maternal and cord plasma. Both second- and third-trimester vaccination could lead to a higher level of neutralization against the Wuhan and Omicron strains. COVID-19 infection had a negative effect on the transplacental transfer ratio of SARS-CoV-2 antibodies. A booster dose during the second or third trimester is encouraged for the maximum transplacental transfer of humoral protection against COVID-19 for infants.

妊娠追加疫苗可顯著降低感染 COVID-19 的風險和嚴重程度，因此受到廣泛推薦。進行了一項前瞻性研究，比較了針對疫苗的武漢株和 SARS-CoV-2 的 Omicron 株，在三個月內接種疫苗或感染而產生的母源抗體的經胎盤傳遞情況。 在2022 年6 月6 日至2022 年9 月20 日期間收集已接種疫苗的母嬰檢體。在妊娠晚期接受最後一劑 COVID-19 疫苗的孕婦在母體和臍帶血漿中表現出最高的抗尖峰蛋白抗體水平和針對武漢毒株和 Omicron BA.2 變種的中和效力。妊娠中期和晚期的疫苗接種都可能導致針對武漢病毒株和 Omicron 病毒株的更高水平的中和作用。 COVID-19 感染對 SARS-CoV-2 抗體的經胎盤轉移率有負面影響。鼓勵在妊娠中期或晚期注射加強劑，以最大程度地透過胎盤轉移針對嬰兒的 COVID-19保護。

Tsai, C.-H., Munch, S. B., Masi, M. D., & Stevens, M. H. (2024). ICES Journal of Marine Science. Read this article

The paper introduces Empirical Dynamic Modeling (EDM) as a cutting-edge approach to improve sustainable management for short-lived species like Penaeidae brown shrimp, which exhibit highly fluctuating and chaotic dynamics. Traditional methods often overlook critical factors such as unobserved species interactions, leading to less accurate predictions. EDM stands out by effectively capturing these hidden interactions, providing more reliable forecasts of population responses to fishing pressures. Applied to U.S. Gulf of Mexico brown shrimp, EDM proved highly effective, leading to more sustainable and adaptive fisheries management that truly reflects the complexity of marine ecosystems.

這篇論文介紹了一種經驗動態建模（EDM），用以改善對於如Penaeidae棕蝦等生命週期短、族群動態波動劇烈物種的永續管理方法。傳統漁業管理模型往往忽略了關鍵因素，例如生態系統中許多無法觀察到的物種間交互作用，導致模型預測的準確性降低。而EDM能有效捕捉這些隱藏的交互作用，提供在不同捕撈影響下的族群動態反應可靠預測。在應用EDM於美國墨西哥灣的棕蝦族群時，EDM可以有效地增進可持續性和適應性的漁業管理，更真實地反映了海洋生態系統的複雜性。

Sun, W.-N., Hsieh, M.-C., & Wang, W.-F. (2024). J Med Internet Res, 26, e57327. Read this article

In a medical center in southern Taiwan, the study involved 102 nurses divided into an AR group and a control group receiving traditional lecture-based instruction. The AR group used an interactive crash cart learning system developed with AR technology. Both groups were assessed on knowledge and practical skills, with subgroup analyses focusing on nurses with less than two years of experience. Results demonstrated that the AR group significantly outperformed the control group in overall ACLS outcomes and crash cart usage (P = .002; P = .01). Nurses with less experience showed the most substantial improvements in knowledge and skills (P < .001). Additionally, the AR group reported higher motivation (IMMS mean: 141.65), better usability (SUS mean: 90.47), and reduced cognitive load (mean: 15.42) compared to traditional methods. These findings highlight AR as an effective tool for enhancing ACLS training, especially for less experienced nurses.

這個研究在南台灣的醫學中心進行，共納入102名護理師。實驗組使用AR技術開發的互動式急救車學習系統，而對照組使用傳統授課方式。兩組參與者均接受了知識與技能的評估，並對工作小於兩年的護理師進行次分析。研究結果發現，實驗組在ACLS進階心臟救命術整體學習成效，和急救車的學習成效顯著優於對照組（P = .002；P = .01）。其中，工作小於兩年的護理師在知識和技能方面的提升最為顯著（P < .001）。此外，相較於傳統方法，實驗組在學習動機（IMMS平均值：141.65）、系統可用性（SUS平均值：90.47）以及降低認知負荷（平均值：15.42）方面也表現更佳。這些結果突顯了AR技術在增強ACLS訓練方面的有效性，尤其對於經驗較少的護理師具有顯著幫助。

Kao, C.-Y., Kuo, P.-Y., Lin, C.-C., Cheng, Y.-Y., Wang, M.-C., Chen, Y.-C., & Lin, W.-H. (2024). Journal of Infection and Public Health, 17(12), 102588. Read this article

This study investigates colistin-resistant Klebsiella pneumoniae (CoRKp) isolated from patients with urinary tract infections and bacteremia at a Taiwanese teaching hospital from 1999 to 2022. Among 1966 K. pneumoniae isolates, 21 were CoRKp, including 12 multidrug-resistant (MDR) and 4 extensively drug-resistant (XDR) strains. Whole genome sequencing revealed diverse sequence types (STs) and capsular types. Two isolates, SC-KP169 and SC-KP585, carried transferable mcr-1 and mcr-8 plasmids, respectively. The mcr-1-carrying plasmid enhanced virulence in K. pneumoniae, while mcr-8 did not affect virulence in Escherichia coli. Mutations in phoQ, pmrA, pmrB, and mgrB genes and insertion elements contributed to resistance mechanisms. The study highlights the potential public health risk posed by the spread of mcr-mediated resistance and emphasizes the need for surveillance and control strategies.

本研究調查1999年至2022年間台灣某醫學中心從泌尿道感染及菌血症患者中分離的抗黏菌素耐藥型克雷伯氏肺炎桿菌(CoRKp)。在1966株分離株中，有21株為CoRKp，其中12株為多重抗藥性(MDR)，4株為廣泛抗藥性(XDR)。全基因組測序揭示其具多樣的序列型(ST)和莢膜型。兩株菌株SC-KP169和SC-KP585攜帶可轉移的mcr-1與mcr-8質粒。mcr-1質粒增加了克雷伯氏肺炎桿菌的毒力，而mcr-8對大腸桿菌的毒力無顯著影響。基因phoQ、pmrA、pmrB及mgrB的突變和插入序列是引起抗藥性機制的關鍵。本研究凸顯mcr介導的抗藥性傳播對公共衛生的潛在威脅，並強調持續監測與控制策略的重要性。