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Background: High-quality patient care requires nurses with strong clinical competency. Thus, it is essential to examine the factors associated with clinical competency. Purpose: This studywas designed to (a) investigate head nurse leadership, staff nurse demographics, and clinical competency; (b) examine the impact of demographics on the clinical competency of staff nurses; (c) analyze the correlation between head nurse leadership and staff nurse clinical competency; and (d) examine the effects of demographics on clinical competency after controlling for the head nurse leadership. Methods: A cluster sampling method was used to collect data from 200 staff nurses at a national medical center in Taiwan. Questionnaires were used to gather information on head nurse leadership style and staff nurse clinical competency. Descriptive and inferential statistical analyses were conducted, including Mann--Whitney U test, Kruskal--Wallis test, Spearman's rank correlation coefficient, and multivariate analysis of covariance. Results: The average score for transformational leadership style among the head nurses was 2.89, whereas transactional leadership style scored an average of 2.49. The average scores for the components of clinical competency, listed from highest to lowest, were as follows: patient care (3.35), professionalism (3.28), communication skills (3.18), management (2.84), and knowledge (2.73). In addition, statistically significant differences were found in clinical competency based on demographic factors, including age, marital status, educational level, job title, and length of employment. Also, a statistically significant, positive correlation between the head nurse transformational leadership style and nurse clinical competency was found. The main effect of length of employment on the five competency components was statistically significant after controlling for transformational leadership. Furthermore, post hoc analysis of covariance revealed a significant effect of length of employment on patient care, knowledge, communication skills, and management. Conclusions: The findings of this study indicate transformational leadership and employment length impact the clinical competency of staff nurses, particularly in terms of patient care, communication skills, management, and knowledge. Providing education and training in leadership and management to current and prospective head nurses may be expected to enhance clinical competency in staff nurses and create a more nurturing work environment. Moreover, targeted training may help current head nurses gain insight into their leadership styles and acquire skills to promote transformational leadership. In addition, leadership development may help equip prospective head nurses with critical competencies before assuming leadership responsibilities. [ABSTRACT FROM AUTHOR]

Background: This study explored the relationship between handgrip strength (HGS) and pulmonary function, respiratory muscle strength, and cardiopulmonary endurance in older adults. Methods: We recruited 128 community-dwelling older adults. Correlations between HGS, pulmonary function parameters, respiratory muscle strength, and cardiopulmonary endurance were analyzed. Results: Forced vital capacity (r = 0.180, P <.05), maximum voluntary ventilation (r = 0.180, P <.05), and 2-minute step test (r = 0.204, P <.05) were weakly correlated with HGS. Maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) had moderate correlations with HGS (r = 0.431 for MIP, 0.492 for MEP, P <.001). Conclusion: HGS was correlated with pulmonary function, respiratory muscle strength, and cardiorespiratory endurance. [ABSTRACT FROM AUTHOR]

Background: Irritability is a common experience of depressed Chinese patients but is understudied and poorly measured. Objective: We aimed to assess psychometric properties of a new measure of irritability in Chinese cancer patients across the social and political spectrum. Methods: The Irritability Scale–Initial Version (TISi) was translated into Chinese and tested in two samples of Chinese cancer patients undergoing treatments: 52 patients in Beijing, China, between 2018 and 2019 and 65 patients in Taipei, Taiwan, in 2020. Results: The Chinese version of TISi demonstrated high internal consistency, high reliability based on the split-half method in the two samples, and satisfactory discriminant validity using the Chinese version of the 17-item Hamilton Rating Scale for Depression and the seven-item depression subscale of the Hospital Anxiety and Depression Scale in the Beijing sample. A confirmatory factor analysis produced factor loadings in both samples, which resembled a sample of American cancer patients. Three TISi items were loaded more highly on the physical instead of the original behavioral subscale in the Beijing sample. A possible influence of cultures was explained. Conclusion: The Chinese version of TISi has satisfactory psychometric properties for assessing the level of irritability in Chinese cancer patients. Future large-sample studies are needed to further determine TISi's factorial structure, test–retest reliability, sensitivity to change, and predictive validity for depression in Chinese cancer patients. [ABSTRACT FROM AUTHOR]

The objective of this study was to explore factors influencing Taiwanese older adults' end-of-life (EOL) care preferences. A cross-sectional questionnaire survey was conducted in 2 geriatric wards of a veterans' hospital. Fifty-five older adults aged 65 years or older were included. Structured questionnaires were used to collect data regarding demographic characteristics, EOL care preferences, stages of change for advance care planning behaviors, and reluctance to burden others. The study revealed that nearly 60% of the participants preferred to let their spouses, adult children, or health care professionals make the decisions. Furthermore, 83.6% of the participants lived with their family members and were moderately to severely disabled with a certain degree of dependence on their family members. Sex, independence, discussion of advance care planning with family members, and completion of advance directives were significantly correlated with EOL care preferences. The regression model showed that the participants' discussion of advance care planning with their family members influenced their EOL care preferences. The results demonstrate that family is an essential consideration for older adults choosing EOL care. Accordingly, because Chinese culture focuses on family harmony, improving communication between older adults and their family members is crucial for promoting advance care planning. [ABSTRACT FROM AUTHOR]

Background: Recurrent falls are more likely to cause injuries and disabilities than single falls. Purpose: This study investigated the incidence and risk factors of recurrent falls among inpatients. Methods: We analyzed inpatient fall data from the anomaly event notification database and electronic medical records of a hospital. We collected data regarding 1059 inpatients who had fallen during their hospital stay. Among these inpatients, 390 (36.83%) had fallen within the previous year. Results: Inpatients in the orthopedics and neurology wards were at a higher risk of recurrent falls than those in surgical wards; inpatients who were physically dependent were at a higher risk of recurrent falls than those who were physically independent; inpatients with poor vision were at a lower risk of recurrent falls than those without this issue; and inpatients who were using antidepressants were at a higher risk of recurrent falls than those who were not using antidepressants. Conclusion: The risk of recurrent falls is highly correlated with ward type, physical independence, self-perceived good vision, and use of antidepressants. [ABSTRACT FROM AUTHOR]

Background: Nurse practitioners (NPs) play an important role in addressing growing health care needs. Among NPs, organizational empowerment is positively associated with overall practice outcomes. Therefore, efforts to promote organizational empowerment in practice are necessary to increase job satisfaction among NPs as well as decrease the stress and intention to leave. Purpose: This study investigated the relationships of organizational empowerment and practice outcomes of job satisfaction, work stress, and intention to leave in acute care practices. Methodological orientation: This study was conducted as a cross-sectional design with a national survey of 946 acute care NPs. Questionnaires contained demographic and practice characteristics, Misener Nurse Practitioner Job Satisfaction Scale, Condition for Work Effectiveness Questionnaire II, and the work stress VAS scale. Hierarchical Linear Model (HLM) was used to investigate individual NP-level or organization-level effects on job satisfaction. The factors associated with job satisfaction were examined by stepwise multiple regression. Results: The organizational empowerment was low, work stress was moderately high, and job satisfaction was between slightly unsatisfied and slightly satisfied. The HLM results indicated that organization-level effects did not affect the job satisfaction of NPs. Nurse practitioners with greater formal power, resources, and informal power had higher job satisfaction. Conversely, NPs with an intention to leave and a higher level of stress showed lower job satisfaction. Conclusions: Organizational empowerment, intention to leave, and stress affect job satisfaction of acute care NPs in Taiwan. Implications for practic: To enhance the job satisfaction of NPs, health care administrators should empower NPs by providing access to opportunity, support, information, and resources in the health care delivery system. [ABSTRACT FROM AUTHOR]

Background: The prevention and treatment of hypertension is valued globally. The World Health Organization advocates combining traditional medicines in the prevention and treatment of diseases. Traditional Chinese medicine (TCM) assumes that diseases originate from the attenuation of one's body constitution. A few studies have found that hypertension is correlated with TCM body constitution. However, body constitution is also affected by living environment. Therefore, investigating the correlation between deviations in body constitution and essential hypertension in different living environments is necessary to provide the basis for using TCM in combination with conventional Western medicine to prevent and treat hypertension. Purpose: The aim of this study was to explore the association between TCM body constitution deviation and essential hypertension. Methods: A case--control study was designed. Participants were selected from the outpatient clinics and neighboring communities of a regional teaching hospital in southern Taiwan. The study included 210 hypertension and 210 nonhypertension cases. Blood pressures were measured using an electronic sphygmomanometer to confirm the presence or absence of hypertension. The TCM Body Constitution Questionnaire, demographic datasheet, and hypertension-related factors questionnaire were used to collect data. Results: A higher proportion of patients with body constitution deviation were found in the hypertension group than the nonhypertension group. The proportions of patients with Yin-Xu, Yang-Xu, and stasis constitution were 44.8%, 32.4%, and 30.6%, respectively, in the hypertension group and 28.6%, 25.2%, and 19.6%, respectively, in the nonhypertension group. After performing univariate analysis, the results showed significant differences between the two groups in terms of average body mass index; emotional traits of anger, worry, and fear; hyperlipidemia; hyperuricemia; Yin-Xu constitution; and stasis constitution. However, the multivariate analysis revealed having a Yin-Xu constitution to be a risk factor of essential hypertension after adjusting for age, gender, body mass index, emotional traits, drinking habit, hyperlipidemia, and hyperuricemia. Conclusions/Implications for Practice: The results suggest that Yin-Xu and stasis constitutions are respectively associated with essential hypertension. The findings offer a valuable reference to governments and healthcare professionals to prevent the risk of essential hypertension. Screening and healthcare measures for TCM Yin-Xu or stasis constitution may be included in related prevention plans to minimize public exposure to the risk factors of essential hypertension. [ABSTRACT FROM AUTHOR]

Background: Authors of several studies have reported differences in the prevalence of metabolic syndrome (MetS) between men and women. However, information is lacking on gender difference among military personnel. Objective: The aim of this study was to examine the prevalence of MetS and its component abnormalities among Taiwanese Air Force personnel by gender and age groups. Methods: A population-based study was conducted including 14 872 Taiwanese Air Force personnel. Data were retrieved from the military's Health Management Information System. Analyses were performed using Student t test, Χ² test, and linear-by-linear Χ² test. Statistical significance was defined as P < .05. Results: The MetS prevalence was 14.0%(15.1%in men and 5.3%in women). Metabolic syndrome was associated with age for both men and women (both Ptrend < .001), with a greater prevalence of MetS in men aged 18 to 44 years than in women, but not in the age group of 45 years or older. In men, MetS was most prevalent in those with increased waist circumference (78.2%), followed by those with elevated blood pressure (75.6%). By contrast, in women, it was most prevalent in those with increased waist circumference (86.5%), followed by those with reduced high-density lipoprotein cholesterol (84.3%). Conclusions: Our findings suggest that military nurses and other health providers should consider the gender- and age-basedMetS prevalence trend among Taiwanese Air Force personnel when designing interventions to identify vulnerable subgroups at a high risk of MetS. Health management programs should be adapted to minimize metabolic risks. [ABSTRACT FROM AUTHOR]

Background: Electronic clinical quality measures (eCQMs) are a method that automatically extract data from electronic health records (EHRs) and compute and generate the results to report and track the quality of care and patient outcomes. Purpose: The purpose of this study was to explore nurses' attitudes toward eCQMs and the factors influencing this attitude. Methods: A descriptive cross-sectional study was conducted using a closed-ended questions survey of 92 nurses in a teaching hospital. Results: The average score for nurses' attitudes toward eCQMs was 3.47 out of 4. Participants with a master's degree had more positive attitudes than those with a baccalaureate degree. Head nurses had more positive attitudes than staff nurses. Conclusions: The nurses in the study hospital have a positive attitude toward eCQMs. Health care organizations should strengthen the attitudes of nurses toward eCQMs. [ABSTRACT FROM AUTHOR]

Background: Overweight/obesity is a substantial global public health concern, which can be caused by genetic factors and energy balance-related behaviors (EBRBs). If it occurs in children with congenital heart disease (CCHD), it can yield an extra burden on their health.Most studies on CCHD have taken place inWestern societies, leaving Asian populations understudied, especially children. Objective: We sought (1) to determine body mass index distribution among school-aged CCHD in Taiwan, (2) to ascertain whether the body mass index of CCHD differs from that of the general population, (3) to describe EBRBs in CCHD, and (4) to identify factors associated with underweight and overweight/obesity among CCHD. Methods: In this cross-sectional study, 97 child-parent dyads (53.6% boys; mean age, 9.73 years; 25.8%moderate-to-severe heart conditions) were enrolled. Self-administered questionnaires were used to collect demographics, medical factors, food frequency, physical activity, and sedentary behaviors. Anthropometric measurementswere taken in the hospital. Independent predictors of EBRBs and health conditionswere calculated through logistic regression analysis. Results: Among Taiwanese CCHD, 19.6% were underweight and 14.4% were overweight/obese. Children with moderate-to-severe heart defects were more often underweight. Body mass index did not differ between CCHD and children in the general population. More complex heart defects and asthma were associated with being underweight, whereas sedentary behaviors, cardiomegaly, and the NewYork Heart Association classification II to IV were associated with being overweight/obese. Conclusions: Sedentary lifestyle is seemingly the only EBRB correlatedwith being overweight. Physical activity programs for childrenmay help prevent and treat overweight or obesity in Asian CCHD, similar to Western countries. [ABSTRACT FROM AUTHOR]

The aim of this study was to explore the relationship between changes in prehospital blood pressure (BP) and the incidence of early neurological deterioration (END) after spontaneous intracerebral hemorrhage (SICH) in patients who arrive at the emergency department (ED) with a normal Glasgow Coma Scale (GCS) score. Records of consecutive adults with SICH transported by ambulance and treated in our ED from January 2015 to December 2017 were retrospectively reviewed. The study cohort included all patients with SICH occurring within the previous 6 hr who had a normal GCS score on ED arrival. Detailed information was retrieved from our hospital's intracerebral hemorrhage databank and then cross-checked in the medical and nursing charts to confirm completeness and accuracy. Early neurological deterioration was defined as a decrease of 2 or more points in the GCS score within 6 hr after ED arrival. The change in prehospital BP was defined as the BP on ED arrival minus the initial on-scene BP. An association between a change in prehospital BP and the occurrence of END was assessed by univariate and multivariate analyses (multiple logistic regression analysis). Of the 168 patients evaluated, 36 (21.4%) developed END. Factors associated with END on univariate analysis were regular antiplatelet agent use, shorter elapsed time, on-scene systolic blood pressure (SBP), prehospital SBP increase of 15 mmHg or more, intraventricular extension of the hematoma, and the presence of 3 or more noncontrast computed tomographic signs of hematoma expansion. After adjusting for other covariates, an increase in prehospital SBP of 15 mmHg or more was significantly associated with a higher risk of END. In patients with SICH who arrive at the ED with a normal GCS score, an increase in the prehospital SBP of more than 15 mmHg is associated with a higher incidence of END. [ABSTRACT FROM AUTHOR]

The aim of this research was to describe knowledge and attitudes regarding advance directives (ADs) in patients with advanced heart failure and identify factors influencing such knowledge and attitudes. We conducted a cross-sectional survey in 75 patients with advanced heart failure at a cardiovascular outpatient clinic and an in-patient ward. Data were collected by a validated measure of knowledge and attitudes regarding ADs. We compared knowledge and attitudes regarding ADs across patient age, sex, socioeconomic status, care received, and disease status using both univariate and stepwise regression models. Only four of the 75 participants (5.3%) had signed ADs. As a result of stepwise regression analysis, positive attitudes toward ADs were higher in those who were not religious ($ = 3.10; 95% confidence interval [CI], 0.26Y5.95), and patients who had a poorer left ventricular ejection fraction had more positive attitudes ($ = 7.03; 95% CI, 3.32-10.73) toward ADs. Knowledge of ADs was higher in subjects with college level education ($ = 0.82; 95% CI, 0.13-1.50) and in subjects with heart failure for greater than 1 year of duration ($ = 2.04; 95%CI, 0.59-3.50). The use of ADs is low in patients with advanced heart failure, despite evidence regarding its benefits. [ABSTRACT FROM AUTHOR]

Background: Seeking treatment in a timely manner may prevent lower limb amputation subsequent to diabetic foot ulcers. Knowledge regarding the warning signs is one importantfactor that is related to the timely treatment seeking of patients with diabetic foot ulcers. However, there is no previousresearch on which aspects of such knowledge that patients with diabetes are lacking. Purpose: The aims of this study were to test the psychometric properties of a questionnaire that was designed to assess the knowledge of the warning signs of diabetic foot ulcer deterioration and to determine the knowledge of these warning signs among patients with a history of diabetic foot ulcers. Methods: A cross-sectional study design was used. Patients with a history of diabetic foot ulcers were recruited using convenience sampling (N = 385). Data were analyzed using Spearman's rank correlation and the Mann–Whitney U test. Results: The questionnaire showed good known-group validity, satisfied internal consistency (Kuder-Richardson Formula 20 =.82), and exhibited acceptable 2-week test–retest reliability (Spearman's rho coefficient =.75). More than 30% of the participants were unaware of the warning signs of peripheral vascular insufficiency and severe infection. Of the participants, 75.8% felt that the time to seek medical treatment of diabetic foot ulcers was when they experienced wound deterioration. Those who held this opinion had significantly less knowledge regarding the warning signs of diabetic foot ulcer deterioration than did those who had not. Other factors that were significantly associated with less knowledge included being older, having less education, not having an existing foot ulcer, having no foot ulcer treatment history, and never having received education regarding foot ulcers. Conclusions/Implications for Practice: The questionnaire showed adequate validity and reliability and thus may be used by healthcare practitioners and researchers to assess the knowledge of at-risk patients regarding the warning signs of diabetic foot ulcer deterioration. Patient education regarding the importance of timely treatment seeking and warning signs should be promoted. [ABSTRACT FROM AUTHOR]

Background: Urinary tract infection (UTI) during acute ischemic stroke is associated with a longer hospital length of stay and unfavorable functional outcomes. Objective: We investigated the benefits of portable bladder ultrasound (PBU) scanning during acute ischemic stroke. Methods: We retrospectively reviewed patients with acute ischemic stroke from January 2011 to February 2017. Patients were divided into group 1 (PBU not available) and group 2 (PBU available), before or after the split date, April 9, 2014. Portable bladder ultrasound scanning was conducted by nurses to measure postvoid residual urine volume in patients with impaired consciousness and/or dependent ambulation. Results: In total, 1928 patients were enrolled, of whom 109 (5.7%) had UTI and 901 (46.7%) experienced unfavorable outcomes (modified Rankin scale score ≥ 3). Multivariate analysis revealed that factors that influenced UTI were age of 75 years or older, female gender, initial total National Institutes of Health Stroke Scale (NIHSS) score of 5 or higher, initial NIHSS conscious score of 1 or higher, initial NIHSS leg score of 2 or higher, and urinary catheterization. Factors influencing unfavorable outcomes were similar to those influencing UTI but further comprised UTI. C-statistic for UTI detection was 0.864 for model fitting, including significant factors in logistic regression. Compared with group 1, group 2 had a higher incidence of urinary catheterization (13.1% vs 8.2%), a lower incidence of UTI (4.0% vs 6.9%), and a shorter length of stay (11.9 vs 13.6 days). Conclusions: Portable bladder ultrasound scanning reduced the incidence of UTI and shortened length of stay. We suggest routine PBU procedures for patients with acute ischemic stroke who fulfill the AGN3 criteria for a high risk of UTI. [ABSTRACT FROM AUTHOR]

Background: Healthcare professionals play an important role in end-of-life care decisions. Although the factors affecting end-of-life care in long-term care facilities have been well studied in Western contexts, few studies have examined factors affecting end-of-life care discussions for residents with dementia among multidisciplinary professionals in Asian or Taiwanese contexts. Purpose: The aim of this study was to explore the factors related to the end-of-life care discussions of registered nurses, social workers, and physicians with residents with dementia and their families. Methods: This is a cross-sectional and correlational study. A stratified random sampling was conducted, and self-administered questionnaires were mailed to physicians, registered nurses, and social workers who work in long-term care facilities with accreditation ranks ≥ Grade A in Taiwan. Results: Questionnaires were returned by 478 participants (response rate = 94.1%). Fewer than 10% of the participants reported often discussing end-of-life care with residents with dementia and their families. Physicians were significantly more likely to discuss life-sustaining treatment than nurses and social workers. The frequency of professionals discussing advance directives and life-sustaining treatment for residents with dementia was predicted by higher confidence in end-of-life care skills and greater perceived facility support. Conclusions/Implications for Practice: Most professionals did not frequently discuss end-of-life care with residents with dementia and their caregivers. Discussions of end-of-life care in long-term care facilities should be promoted by enhancing the confidence of these professionals in providing end-of-life care and creating a supportive environment for end-of-life discussions and care. [ABSTRACT FROM AUTHOR]

Background: Prediabetes mellitus (pre-DM) is an important predictive indicator of Type 2 diabetes. A person with pre-DM is eight times more likely to develop diabetes than a person without pre-DM. Prior research suggests that proactive interventions may delay the progression of this disease and reduce the rate of disease development. Purpose: The purposes of this preliminary study were to develop a multitheory-driven lifestyle intervention protocol for adults with pre-DM and to evaluate its feasibility and impacts on knowledge regarding pre-DM, dietary behaviors, and physical activity (primary outcomes) as well as to describe the disease progression indicators (secondary outcomes). Methods: A single-group, longitudinal study design was used. Thirty-nine participants were included in the analysis. A generalized estimating equation model was used to determine the trends in changes in the outcomes. All of the participants underwent testing at baseline (T0) and at 3 (T1), 6 (T2), and 12 (T3) months after the 4-week lifestyle intervention. Results: There were significantly increasing trends for each study parameter (Pre-DM Knowledge Assessment Form-12, p < .01; Dietary Behavior Scale, p < .01) and significantly positive changes in body weight (p < .01), body mass index (p < .01), fasting glucose level (p < .01), and glycated hemoglobin level (p < .01) over the 12-month study period. Conclusions/Implications for Practice: This study supports the feasibility of the developed multitheory-driven lifestyle intervention protocol and suggests that its application may improve the effectiveness of diabetes prevention programs in clinical settings. Further randomized controlled trials are needed. [ABSTRACT FROM AUTHOR]

Objective: No studies comparing the effects of platelet-rich plasma (PRP) injection and placebo injection in bilateral knee osteoarthritis in the same patient, or discussing muscle strength after PRP injection, have been published. Design: Twenty patients with bilateral knee osteoarthritis were eligible, and 40 knees were randomized into two groups: PRP (knees [right or left by a coin toss] receiving a single intra-articular PRP injection) and saline group (the contralateral knee of the same patient, into which single 4-mL intra-articular injection of normal saline was administered). The primary outcome measure was Western Ontario and McMaster's Universities Osteoarthritis Index and the secondary included isokinetic test results. The evaluation was at baseline and at 2 wks, 1, 3, and 6 mos after injection. Results: The PRP group showed a significant reduction in the Western Ontario and McMaster's Universities Osteoarthritis Index pain and total scores compared with normal saline group (P < 0.05). Although a significantly greater percentage of knee strength (extensor > flexor) was found in the PRP group during a longer follow-up period, PRP treatment resulted in insignificant differences inmuscle strength compared with normal saline. Conclusions: Platelet-rich plasma treatment significantly improves pain, stiffness, and disability in patients with knee osteoarthritis compared with normal saline treatment. Additional strength training is recommended to enhance muscle strength recovery. [ABSTRACT FROM AUTHOR]

Background: Breast cancer is a major global health issue. Receiving regular breast cancer screenings aids in the early detection and treatment of breast cancer. Numerous factors influence whether a Vietnamese woman receives breast cancer screening. Purpose: The aims of this study were to understand current rates of breast cancer screening and explore the factors that influence intention to undergo breast cancer screening among Vietnamese women in transnational marriages. Methods: This was a cross-sectional, community-based study. Data were collected via snowball sampling. We enrolled 250 women aged 18 years and over from September to December 2015. Results: The percentage of participants who had received a breast self-examination, breast palpation, or breast ultrasound within the past year were 25.6%, 9.6%, and 21.2%, respectively. Moreover, only 6.8% of participants had received a mammography within the past 2 years. Participants with strong perceptions of breast cancer being a serious illness, who had fewer barriers to obtaining a breast cancer screening, or who had been advised by healthcare personnel to undergo screenings were more likely to report an intention to receive periodic breast self-examinations during the subsequent 1-year period. Participants who had lived in Taiwan for a longer period, had higher levels of perceived susceptibility to breast cancer, had prior experience with breast diseases, or had fewer barriers to obtaining a breast cancer screening were more likely to report an intention to receive a breast ultrasound during the subsequent 1-year period. Finally, participants who were older, perceived greater benefits from receiving breast cancer screening, and had not entered menopause were more likely to report an intention to receive a mammography during the following 2 years. Conclusions/Implications for Practice: Medical care personnel should promote breast cancer screening among Vietnamese women in transnational marriages. The results may be useful in promoting greater awareness among medical care personnel of breast cancer issues and efficacy in performing breast cancer screening for Vietnamese women in transnational marriages and provide references for the establishment of breast cancer prevention and control policies. [ABSTRACT FROM AUTHOR]

Background: Patients with heart failure (HF) have multiple distressing symptoms that are associated with poor outcomes. These symptoms do not occur in isolation from each other but likely occur as discrete clusters that may prove helpful to clinicians trying to counsel patients about symptom monitoring and management. Defining common symptom clusters and determining the associations between symptom clusters and outcomes may improve patient management. Purpose: The aim of this study was to define symptom clusters and their association with event-free survival in terms of cardiac hospitalization and all-cause mortality in patients with HF. Methods: Patients were recruited from outpatient HF clinics. Physical symptoms (dyspnea, fatigue, edema, sleeplessness, anorexia, and poormemory)weremeasured using themodified Pulmonary Function Status and Dyspnea Questionnaire and the Minnesota Livingwith Heart FailureQuestionnaire. A two-stage cluster analysis was conducted to identify subgroups of patients based on the self-perceived severity of the six symptoms. The KaplanYMeier survival curve and log-rank test were used to assess whether symptom clusters were associated with eventfree survival through a 12-month follow-up. Results: Two hundred fifty-eight patients (mean age = 61.2 ± 12.3 years, 75% male, 41% New York Heart Association class III/IV) participated. Three symptom clusters were identified based on the severity of symptoms. These clusters were called the nonsevere symptom cluster (all symptoms were rated with low severity), the typical severity symptom cluster (high level of severity for dyspnea and fatigue, low level of severity for edema, and moderate level of severity for all other symptoms), and the atypical severity symptom cluster (low level of severity for dyspnea and fatigue, high level of severity for edema, and moderate level of severity for all other symptoms). Symptom clusters were associated with event-free survival (p < .001). A post hoc comparison showed that the prognosis was better in the nonsevere symptom cluster than both the typical symptom (p < .001) and nontypical symptom (p < .001) clusters and that the prognoses for the latter two clusters did not differ significantly. Conclusions/Implications for Practice: Symptom clusters play an important role in the prognoses of patients with HF. Both patients and healthcare providers may use the information that is provided by this study to improve the surveillance and management of related symptoms. [ABSTRACT FROM AUTHOR]

Background: Adolescents who have experienced peer victimization face a higher risk of negative health outcomes. However, little is known about the factors that are associated with peer victimization among adolescents in Taiwan. Purpose: The aim of this study was to examine the factors related to peer victimization among Taiwanese adolescents. Methods: A cross-sectional design was employed. Three hundred seventy-seven adolescents aged 13Y16 years from seven middle schools in southern Taiwanwere recruited as participants. Validated, self-reported questionnaires were used to gather data on demographic characteristics, resilience, peer relationship, parental monitoring, school connectedness, social support, and peer victimization. Logistic regression analysis was used to examine the factors that were related to peer victimization. Results: About 17% (n = 64) of the participants experienced peer victimization during the previous 1-year period. Logistic regression analysis indicated that parental monitoring of daily life, school connectedness, and peer support were significant predictors of a reduced risk of peer victimization. The final model explained 23.1% of the total variance in less peer victimization and predicted 80.1% of peer victimization. Conclusions/Implications for Practice: School connectedness and peer support were identified as important factors facilitating the avoidance of peer victimization among adolescents in Taiwan. Healthcare providers and school personnel should consider school-based programs to improve school connectedness and to build an atmosphere of peer support to reduce peer victimization. Educating parents to monitor their adolescents' daily activities is also encouraged in concert with these school-based programs. [ABSTRACT FROM AUTHOR]

Background: Respect for the autonomy of patients is essential in life-threatening medical decisions such as surgery. Even if a patient has the competency to make decisions, many obstacles exist that may influence his or her willingness to participate in the surgical decision-making process. Purpose: The aim of this study was to explore the perceived difficulties in surgical decision making and related factors among elective surgical patients. Methods: This was a cross-sectional correlational study. A convenience sampling method was used to recruit patients from a medical center in southern Taiwan. Patients who had received elective surgery, were older than 20 years old, and were competent to make medical decisions were invited to participate. A structured questionnaire was developed by the researchers to collect demographic data, decision patterns, and perceived difficulties in surgical decision making. Acceptable validity and reliability of the questionnaire were confirmed before data collection. Results: Over 80% of the participants made the surgical decision by themselves or in collaboration with their family or physician. Less than 15% expected to make the surgical decision by themselves. Illness-related suffering was the greatest difficulty that participants faced. The patients who tended toward passive decision making faced greater difficulties in the dimensions of "do not understand information," "physician's lack of concern," and "difficulty in freely communicating with the physician" than their active decision-making peers. Male participants reported having more difficulty in communicating with their physician than their female peers. Age, education, and marital status were not significantly associated with perceived difficulties in surgical decision making. Conclusions: Family participation in the medical decision-making process is expected by most patients. Although less than 20% of the participants in this study were categorized as passive decision makers, this group reported more difficulties than the active decision-making group. Healthcare professionals should be more active in communicating with patients who are largely silent during the decision-making process to elicit their preferences and needs with regard to surgical decisions. [ABSTRACT FROM AUTHOR]

Background: Nurses account for a significant percentage of staff in the healthcare system. The religious beliefs of nurses may affect their competence to provide spiritual care to patients. No reliable and valid instruments are currently available to measure the religious beliefs of nurses in Taiwan. Purposes: The aims of this study were to develop a religious belief scale (RBS) for Taiwanese nurses and to evaluate the psychometric properties of this scale. Methods: A cross-sectional study design was used, and 24 RBS items were generated from in-depth interviews, a literature review, and expert recommendations. The RBS self-administered questionnaire was provided to 619 clinical nurses, who were recruited from two medical centers and one local hospital in Taiwan during 2011-2012. A calibration sample was used to explore the factor structure, whereas a validation sample was used to validate the factor structure that was constructed by the calibration sample. Known-group validity and criterion-related validity were also assessed. Results: An exploratory factor analysis resulted in an 18-item RBS with four factors, including "religious effects," "divine," "religious query," and "religious stress." A confirmatory factor analysis recommended the deletion of one item, resulting in a final RBS of 17 items. The convergent validity and discriminate validity of the RBS were acceptable. The RBS correlated positively with spiritual health and supported concurrent validity. The known-group validity was supported by showing that the mean RBS between nurses with or without religious affiliation was significant. Conclusions/Implications for Practice: The 17-item RBS developed in this study is a reliable, valid, and useful scale for measuring the religious beliefs of nurses in Taiwan. This scale may help measure the religious beliefs of nurses and elicit the relationship between these beliefs and spirituality. [ABSTRACT FROM AUTHOR]

Background: Few studies have evaluated completely the changes in quality of life (QOL) that occur from pretreatment through the first four consecutive cycles of chemotherapy or determined its determinants in patients with advanced nonsmall-cell lung cancer (NSCLC). Purpose: The aim of this study was to explore the changes to and determinants of QOL in patients with advanced NSCLC under initial chemotherapy from pretreatment through Cycle 4 of chemotherapy. Methods: The QOL of 139 patients with advanced NSCLC was assessed from prechemotherapy through Cycle 4 of chemotherapy. Changes to and determinants of QOL were evaluated using multivariate linear regression, which used generalized estimation equation models. Results: No significant changes were observed in the global QOL or the physical, role, emotional, or cognitive functional domains of QOL during the course of chemotherapy. However, the social functional domain of QOL improved significantly at Cycle 3 in comparison with the prechemotherapy values. Better global QOL was determined as better performance status, less frequent physical symptoms, and less severe anxiety and depressive symptoms. Important determinants of better QOL in the five functional domains included youngerage, better performance status, less frequent physical symptoms, less severe anxiety and depressive symptoms, and weaker perceived social support. Furthermore, patients who achieved a partial response after chemotherapy enjoyed stronger improvements in global QOL and the QOL emotional functional domain than those who did not. Conclusions: To help patients with advanced NSCLC optimize their QOL, healthcare professionals should enhance theirability to identify patients who are at elevated risk of poor QOL throughout the course of chemotherapy and to appropriately detect and manage the related physical symptoms and side effects, strengthen patients' social support, and lessen the anxiety and depressive symptoms of patients. [ABSTRACT FROM AUTHOR]

Background: Drinking is largely viewed as a socialized behavior; however, our understanding of factors associated with levels of risky drinking is limited in cultures where underage drinking is relatively unacceptable. PURPOSE: The aims of this study were to define the different levels associated with risky drinking and to examine the factors that are associated with these levels. Methods: We used data from the Child and Adolescent Behavior in Long-Term Evolution project. Of the 2184 students who participated in the 2006 Child & Adolescent Behavior in Long-Term Evolution survey, 1591 self-reported prior use of alcohol and had complete questionnaire data that could be used in secondary data analysis. The main study variables that were used in this study to assess levels of risky drinking included frequency of drinking, amount of drinking, and frequency of intoxication. We used ordinal logistic regression to analyze the relationships between levels of risky drinking and associated factors. Results: In the study sample, 9.55% were classified with high-risk drinking behavior, 22.51% were classified with medium-risk drinking behavior, and 67.94% were classified with low-risk drinking behavior. Having a mother or peers who used alcohol, being encouraged to consume alcohol by older adults or peers, high alcohol availability, high positive alcohol expectancies, low negative alcohol expectancies, and low alcohol refusal efficacy were all associated with higher levels of risky drinking. Conclusions/Implications for Practice: Decreasing the availability of alcohol, developing appropriate alcohol expectancies, and increasing alcohol refusal skills may help decrease the development of high-risk drinking behavior in adolescents. Our study furthers the understanding of underage alcohol use in societies with low alcohol consumption. [ABSTRACT FROM AUTHOR]

Background: The results of numerous studies indicate that people with disabilities seek more healthcare than those who are not disabled, particularly for conditions such as chronic kidney disease, cardiovascular disease, and obesity. However, little is known about the incidence of impaired kidney function and its associated factors among adults with disabilities in Taiwan. Purpose: The aim of this study was to explore the prevalence and factors associated with impaired kidney function among adults with disabilities. Methods: This descriptive study was nurse led and was conducted as part of a health promotion program for disadvantaged rural adults with disabilities in Chiayi County, Taiwan. Health screening and a health needs survey were conducted between July and December 2013. Kidney function, physiological biomarkers, health-related behaviors, and demographic characteristics were examined. Results: Eight hundred ten rural adults with disabilities were enrolled. The most common disabilities included physical-related disability (33.1%), intellectual-related disability (26.7%), and hearing and vision impairment (18.6%). The prevalence of impaired kidney function in this population was 85%. According to classification for chronic kidney disease, 68.6% were in Stages 1--2, and 16.8% were in Stages 3--4. Univariate analysis showed that impaired kidney function was significantly associated with lower educational level (p < .001), hearing or vision impairment (p < .001), being overweight or obese (p < .05), high systolic blood pressure (p < .01), fasting blood glucose (p < .001), total cholesterol (p < .001), total triglyceride (p < .05), older age (p < .001), smoking (p < .05), chewing betel nuts (p = .001), and low levels of participation in social activities (p < .05). The final logistic regression model showed that residents with disabilities who were older or had less education, high fasting blood glucose, and high total cholesterol tended to have impaired kidney function after adjustment for other potential confounding variables. Conclusions/Implications for Practice: Most participants showed impaired kidney function. The factors that were found to relate significantly to this impairment include being overweight, having hyperlipidemia, having hypertension, having high fasting blood glucose, and having an unhealthy lifestyle. Because of the lack of symptoms during the early stages of chronic kidney disease, a community-based health promotion program for these factors is an important element in health advocacy for this vulnerable population. [ABSTRACT FROM AUTHOR]

Background: A report published by the World Health Organization indicates that depression typically first manifests during youth. However, adolescents usually lack the capacity for self-help or to seek help proactively from health professionals or other related resources to relieve their emotional distress. Failing to manage depression appropriately places adolescents at risk for self-harm and suicide. Purpose: This study explored the correlations among the depressive symptoms, resourcefulness, and self-harm behaviors of adolescents. In addition, the impact of depressive symptoms and resourcefulness on the self-harm behaviors of adolescents was examined. Methods: A cross-sectional and correlational design was used. One hundred forty secondary school (junior and senior high school) students in southern Taiwan were recruited for data collection using three questionnaires that measured, respectively, their depressive symptoms, resourcefulness, and self-harm behaviors. Results: Depressive symptoms and self-harm behaviors correlated significantly and positively (r = .79, p < .001). Resourcefulness correlated significantly and negatively with both depressive symptoms (r = -.35, p < .001) and self-harm behaviors (r = -.29, p < .001). Finally, depressive symptoms significantly predicted self-harm behaviors. Conclusions/Implications for Practice: This study provides new findings regarding the significant relationship between resourcefulness and self-harm behaviors in adolescents. Future research is suggested to explore the effect of interventions about resourcefulness training on the mental health of adolescents. [ABSTRACT FROM AUTHOR]

Background: Postoperative exercise rehabilitation helps patients recover normal joint functions after total hip arthroplasty (total hip replacement surgery or THR) by strengthening the muscles that surround the replaced hip joint. However, the high cost of professionally supervised exercise rehabilitation programs limits access to program participation and, thus, to optimal recovery of normal joint functions. Therefore, the development of an effective home-based, self-monitored exercise rehabilitation program is critical to promote the optimal recovery of THR patients. Purpose: This study tests the efficacy of a home-based resistance-band exercise programon mobility, functional exercise capacity, and health-related quality of life in THR patients. Methods: This study uses a preexperimental repeated measures design. A convenience sample of 30 patients who underwent total hip replacement for osteoarthritis was recruited. All patients participated in a 12-week home-based resistance training program. Data were collected at baseline and at 2, 6, and 12 weeks postoperation on the following dimensions: up-and-go time, timed walking distance, and quality of life. In addition, intervention-related adverse events and the exercise adherence rate were monitored. Generalized estimation equations were used to analyze changes in the outcome variables across time. Results: The study included 21 women and nine men. Themean age of the participants was 67.9 years (SD = 8.1 years, range = 55Y86 years). Results of the generalized estimation equations showed a statistically significant time effect for up-and-go time, 6-minutewalking distance, and health-related quality of life. After 12 weeks of training, the participants' up-and-go time decreased 40.33% from the baseline measurements, with a mean change of 6.38 seconds (p < .001). The 6-minute walking distance increased 41.34%, with a mean change of 117.12 meters (p < .001). The score for health-related quality of life decreased 78.94%, with a mean change of 39.10 (p < .001). The average exercise adherence rate was 72.63%. The average score for the feasibility of the intervention was 8.8 (range = 6-10). Conclusions/Implications for Practice: The results of this study support the hypothesis that a home-based resistance training program is safe, feasible, and effective for improving the mobility, functional exercise capacity, and health-related quality of life of THR patients. Considering the low cost and convenience of a home-based resistance training program, health professionals should consider this and similar exercise programs when providing guidance to THR patients. [ABSTRACT FROM AUTHOR]

Background: Peer support groups for people with diabetes are increasingly considered a part of the healthcare system. Understanding the functions of peer support groups assist healthcare professionals to provide critical assistance. Purpose: The purpose of this study was to develop and assess the psychometric properties of the Functions of Diabetes Peer Support Group (F-DPSG) scale. Methods: This study used a cross-sectional design. A 16-item F-DPSG scale was developed and administered to 589 patients with Type 2 diabetes who were selected from 34 diabetes peer support groups in Taiwan. Construct validity was evaluated using exploratory and confirmatory factor analyses and by examining the correlation with the score of the Chinese Diabetes Management Self-Efficacy Scale. Reliability was tested using internal consistency and test--retest reliability. Results: The 16-item F-DPSG scale, including four subscales, was supported by a second-order confirmatory factor analysis, with the following fit indices: χ&178;/ ratio = 2.60, comparative fit index = .94, normed fit index = .91, and root mean square error of approximation = .07. The four subscales were "enhancing self-care practice." "obtaining knowledge and skills," "psychological support," and "collective identification." The score of the F-DPSG scale correlated significantly with the score of the Chinese Diabetes Management Self-Efficacy Scale (r = .45, p G .001). The Cronbach's α and test-retest reliability of the F-DPSG global scale and subscales were all above .70. Conclusions/Implications for Practice: The F-DPSG scale showed satisfactory reliability and validity. Healthcare providers may use the F-DPSG scale to assess the functions of peer support groups for people with diabetes and to provide necessary assistance. [ABSTRACT FROM AUTHOR]

Background: According to World Health Organization, depressive disorder will be a Top 2 disease in the world by 2020. In light of Taiwan's rapidly increasing elderly population, elderly psychological health is expected to become an increasingly important issue in healthcare. Purpose: This study examines the association between regular exercise and depressive symptoms in community-dwelling older adults by gender in northern Taiwan. Methods: The participants were selected using a probability-proportional-to-size procedure from community-dwelling adults who were aged 65 years or older and living in northern Taiwan. A cross-sectional study and interviews were used to collect information about their exercise behaviors, depressive symptoms, and the factors influencing the depressive symptoms. Percentage, chi-square, t test, and logistic regression were used to analyze the data. Result: One thousand twenty elderly individuals completed the questionnaires. Among the participants with the average age of 73.5 years, 44.5% were men, and 55.5% were women. Two hundred seventeen of the participants (21.3%) had depressive symptoms. Five hundred eighty-five of the participants (57.4%) exercised regularly. The result of logistic regression showed that regular exercise was a significant predictor of depressive symptoms in elderly individuals (odds ratio = 3.54, 95%confidence interval [1.76, 7.12]). Other factors such as gender, chronicle diseases, and health status were not related to depressive symptoms. Moreover, both for male and female individuals, regular exercise was a significant predictor of depressive symptoms (odds ratio = 4.76, 95% confidence interval [1.65, 13.72] and odds ratio = 3.03, 95% confidence interval [1.18, 7.69], respectively). Other factors were not related to depressive symptoms. Conclusions/Implications for Practice: This study shows regular exercise to be a significant predictor of depressive symptoms in both men and women. Therefore, senior citizens should be encouraged to exercise regularly as away to promote good mental health. [ABSTRACT FROM AUTHOR]

Background: Nonventilator hospital-associated pneumonia (NV-HAP) is a nosocomial infection with a multifactorial etiology that is particularly prevalent in individuals with poor oral health. Purpose: This study was designed to determine the effect of a 0.12% chlorhexidine gluconate oral rinse intervention on oral health and on reducing NV-HAP in inpatients. Methods: A randomized, double-blind, and triple-arm clinical trial was conducted on a sample of 103 patients aged ≥ 50 years. Using the blocking sample method, patients were randomly assigned into three groups. These included Group A, using an oral rinse solution of 0.12% chlorhexidine; Group B, using Listerine; and Group C, using a standard saline oral rinse. In addition to routine hospital-associated pneumonia preventative nursing care, the participants used the oral rinse solutions twice a day with a period of at least 9 hours between each use. Oral health, the degree of bacterial exposure, and the clinical pneumonia index scale were evaluated in each of the groups at baseline (first day), on Intervention Days 3 and 7, and at discharge. The clearance rate was calculated by dividing the number of bacteria cleared by the total frequency of oral bacteria in the collected culture × 100%. Results: Each arm of the study was composed of 34–35 participants, with an average hospitalization duration of 7.5 days. There was no incidence of NV-HAP or any changes in clinical pulmonary infection score among the three groups. Group A achieved a more significant improvement in oral health assessment tool scores between baseline and discharge than either Group B or C (p =.03), particularly in the tongue, gums, and tissues; saliva; and oral cleanliness subscales. In addition, Group A reported higher clearance rates for Staphylococcus (100.00% vs. 66.67% vs. 66.67%, respectively), Escherichia coli (100.00% vs. 60.00% vs. 66.67%, respectively), and Pseudomonas aeruginosa (75.00% vs. 46.30% vs. 25.00%, respectively) than Groups B and C. Conclusions/Implications for Practice: Although the results do not provide evidence supporting the use of a 0.12% chlorhexidine oral rinse as better in terms of preventing NV-HAP in middle-aged and elderly inpatients, nursing supervision was found to have an overall positive effect on oral health. The use of oral rinse with 0.12% chlorhexidine for nonventilated patients with poor oral health may be recommended. [ABSTRACT FROM AUTHOR]

Background: Fear of cancer recurrence (FCR) is a major concern for family caregivers (FCs) caring for patients with head and neck cancers (HNCs). Purpose: This study (a) investigated the FCR experience of HNC FCs, (b) compared the differences in the FCR levels of FCs while taking care of patients with different lengths of time since completing major treatments (posttreatment durations), and (c) examined the correlation between FCR and quality of life (QOL) in these FCs. Methods: A cross-sectional study was conducted in the radiation outpatient department of a medical center in northern Taiwan. A set of questionnaires, including the Fear of Cancer Recurrence Inventory-Caregiver version and the Medical Outcomes Short-Form Health Survey, and a background information form were employed. One-way analysis of variance was used to examine the differences in the FCR and QOL among groups of FCs taking care of patients with different posttreatment durations (typically concurrent chemoradiotherapy). Pearson's correlation was used to identify the relationship between FCR and QOL. Results: Two hundred fifty FCs were recruited in this study. The FCs used several coping and reassurance strategies to address their FCR experiences. Those FCs who cared for patients with short posttreatment durations (3-6 and 6-12 months) showed significantly higher overall FCR levels and higher FCR severity levels than those who cared for patients with long posttreatment durations (more than 5 years). High FCR was negatively correlated with physical and mental QOL. Conclusions/Implications for Practice: The results suggest that FCs caring for patients with a relatively short posttreatment duration experience higher levels of FCR than those caring for patients with a longer posttreatment duration. In clinical settings, healthcare providers should use posttreatment duration as an indicator of risk of FCR in caregivers to address FCR and provide appropriate support. Future research should develop and examine interventions to help HNC FCs cope effectively with their FCR and improve their QOL. [ABSTRACT FROM AUTHOR]

Background: Patients with advanced dementia (PwAD) often have difficulty expressing their needs verbally because of cognitive impairments. PwAD thus often communicate these needs through behaviors and psychological symptoms. Understanding the behavioral characteristics of certain needs is critical for caregivers and clinicians when caring for PwAD. Purpose: The purpose of this study was to develop a checklist that may be used to assess the thirst status of PwAD. Methods: A mixed method design was used. The checklist was developed using qualitative interviews and surveys. The initial items were developed through interviews with 10 professional nurses who were caring for PwAD. Four experts in dementia assessed the content validity of these items. PwAD caregivers from eight facilities were then invited to complete the checklist based on their current PwAD patient care experience. Data obtained in this study were analyzed with regard to content validity, interrater reliability, internal consistency, and exploratory factor analysis. Results: The content validity of the initial 18 items was .96, interrater reliability was -.33 to 1, and internal consistency reliability was .52. Exploratory factor analysis identified seven checklist items, including repetitive movements, squirming, restlessness or anxiety, persistent or unreasonable demands, pacing back and forth, repeating a sentence or question without purpose, and slow reaction. The factor loadings of these seven items accounted for 49.3% of the total variance. The reassessed internal consistency reliability was .66. Conclusions/Implications for Practice: Caregivers may use this checklist as an aid to identify the thirst or fluid needs of PwAD who are unable to communicate their needs effectively. [ABSTRACT FROM AUTHOR]

Background: Colonoscopy is currently considered the best screening tool in the diagnosis of colon diseases. However, this procedure often causes pain and discomfort in patients, thus reducing patient willingness to undergo and comply with this procedure. Purpose: This study explores the effects of providing procedure-related information to patients receiving colonoscopy in terms of anxiety and pain reduction and identifies factors that influence the pain and anxiety experienced by patients during this procedure, Methods: This study adopted a quasi-experimental design that targeted colonoscopy patients in outpatient clinics. Two hundred thirteen patients were recruited, with 103 patients in the experimental group and 110 in the control group. Participants were recruited between January and April 2011. All of the participants received standard care, and only those participants who were assigned to the experimental group were asked to watch "A Guide to the Colonoscopy Procedure,'' a multimedia health informatics CD-ROM. Results: Anxiety scores of the experimental group dropped from 48.7 + 11.6 to 39.2 + 8.7 after the intervention. The average pain score of the experimental group was significantly lower than that of the control group (3.8 ± 2.5 vs. 5.0 ± 2.7). Furthermore, trait anxiety, gender, and educational level were identified as the main predictors for state anxiety, and state anxiety was identified as an important predictor for pain during the colonoscopy examination. Conclusions/Implications for Practice: This study found that using a multimedia health informatics CD-ROM to provide information on the colonoscopy procedure effectively reduced the examination-related anxiety and pain of patients. [ABSTRACT FROM AUTHOR]

Introduction: Although Internet-based learning is widely used to improve health professionals' knowledge and skills, the selfregulated learning (SRL) activities of online continuing education in pharmacy are seldom discussed. The main purpose of this study was to explore the relationships between pharmacists' Internet self-efficacy (ISE) and their SRL in online continuing education. Methods: A total of 164 in-service pharmacists in Taiwan were surveyed with the Internet Self-Efficacy Survey, including basic ISE (B-ISE), advanced ISE (A-ISE) and professional ISE (P-ISE), as well as the Self-Regulated Learning Questionnaire consisting of preparatory SRL (P-SRL) and enactment SRL (E-SRL). Results: Results of a 1-by-3 (educational levels: junior college versus bachelor versus master) analysis of variance and a 1-by-4 (institutions: community-based versus hospital versus clinic versus company) analysis of variance revealed that there were differences in ISE and SRL among different education levels and working institutions. The hierarchical regression analyses indicated that B-ISE and P-ISE were significant predictors of P-SRL, whereas P-ISE was a critical predictor of E-SRL. Moreover, the interaction of P-ISE × age was linked to E-SRL, implying that P-ISE has a stronger influence on E-SRL for older pharmacists than for younger pharmacists. However, the interactions between age and ISE (A-ISE, B-ISE, and P-ISE) were not related to P-SRL. Discussion: This study highlighted the importance of ISE and age for increasing pharmacists' SRL in online continuing education. [ABSTRACT FROM AUTHOR]

Background: Whether oral anticoagulant use should be considered in patients undergoing hemodialysis with atrial fibrillation (AF) remains controversial because of the uncertainty regarding risk-benefit assessments. The purpose of this study was to investigate the risk of ischemic stroke in patients undergoing hemodialysis with new-onset AF, in comparison with those without arrhythmia.Methods and Results: This nationwide, population-based, propensity score-matched cohort study used data from Taiwan's National Health Insurance Research Database during 1998 to 2011 for patients on hemodialysis with new-onset nonvalvular AF and matched subjects without arrhythmia. The clinical end points were ischemic stroke (fatal or nonfatal), all-cause death, and other serious adverse cardiovascular events. In comparison with the matched cohort, patients with AF (n=6772) had higher risks of ischemic stroke (adjusted hazard ratio [aHR], 1.27; 95% confidence interval [CI], 1.13-1.43), all-cause death (aHR, 1.59; 95% CI, 1.52-1.67), in-hospital cardiovascular death (aHR, 1.83; 95% CI, 1.71-1.94), myocardial infarction (aHR, 1.33; 95% CI, 1.17-1.51), and hospitalization for heart failure (aHR, 1.90; 95% CI, 1.76-2.05). After considering in-hospital death as a competing risk, AF significantly increased the risk of heart failure (HR, 1.56; 95% CI, 1.45-1.68), but not those of ischemic stroke and myocardial infarction. Additionally, the predictive value of the CHA2DS2-VASc score for ischemic stroke was diminished in the competing-risk model.Conclusions: The risk of stroke was only modestly higher in patients undergoing hemodialysis with new-onset AF than in those without AF, and it became insignificant when accounting for the competing risk of in-hospital death. [ABSTRACT FROM AUTHOR]

Purpose: Physical exercise or hypoxic exposure influences hemorheology and acid-base homeostasis. Band 3 protein in erythrocytes modulates cells_ rheological properties and anion transport ability. This study investigated how cycling aerobic interval training (AIT) and moderate continuous training (MCT) affect the rheological function and band 3 activity of erythrocytes under hypoxic exercise (HE) stress. Methods: Forty-five healthy sedentary men were randomized to engage in either AIT (3-min intervals at 40% and 80% of ...O2max, n = 15) or MCT (sustained 60% of ...O2max, n = 15) on a bicycle ergometer for 30 min⋅d-1 (5 d⋅wk-1 for 5 wk) or to a control group that did not perform any exercise (n = 15). Erythrocyte rheological responses to HE (100 W under 12% O2 for 30 min) were determined before and after various regimens. Results: Acute HE increased the aggregation and osmotic fragility of erythrocytes, decreased the deformability of erythrocytes, and depressed erythrocyte band 3 activity, as indicated by lowered anion transport ability. Following 5 wk of intervention, the AIT group exhibited maximal work rate and ...O2max higher than those in the MCT and control groups. Moreover, cycling AIT and MCT diminished the extent of erythrocytes_ enhanced aggregation and osmotic fragility and reduced their deformability and band 3 activity caused by HE. Additionally, erythrocyte band 3 activity was directly related to erythrocyte deformability and inversely related to erythrocyte aggregation and osmotic fragility. Conclusions: Cycling AIT is superior to cycling MCT in enhancing aerobic capacity. Moreover, either cycling AIT or MCT effectively alleviates HE-evoked impairments of erythrocyte rheological characteristics and band 3 function. [ABSTRACT FROM AUTHOR]

Objective: This investigation explored how aerobic interval training influences central or peripheral hemodynamic response(s) to exercise in patients with heart failure (HF) with preserved ejection fraction (HFpEF) or those with HF with reduced ejection fraction (HFrEF). Design: One hundred twenty HF patients were divided into four groups: HFpEF and HFrEF with aerobic interval training (3-min intervals at 40% and 80% VO2peak for 30 mins/day, 3 days/wk for 12 wks) and general health care groups. Exercise hemodynamics in the heart, frontal cerebral lobe, and vastus lateralis muscle, and oxygenation in the frontal cerebral lobe and vastus lateralis muscle were measured before and after the intervention. Results: Aerobic interval training significantly (1) improved pumping function with enhanced peak cardiac power index in the HFrEF group and improved dia-stolic function with reduction of the E/E' ratio in the HFpEF group, (2) increased blood distribution to the frontal cerebral lobe/vastus lateralis muscle and O2 extraction by vastus lateralis muscle during exercise in the HFpEF group compared with the HFrEF group, (3) heightened VO2peak in both HFpEF and HFrEF groups and lowered the VE/VCO2 slope in the HFpEF group, and (4) increased the Short Form-36 physical/mental component scores and decreased the Minnesota Living with Heart Failure questionnaire score in both HFpEF and HFrEF groups. Conclusions: Aerobic interval training effectively enhances cardiac hemodynamic response to exercise in HFrEF patients while increasing the delivery/use of O2 to exercising skeletal muscles and frontal cerebral lobe tissues in HFpEF patients, thereby improving global/disease-specific quality-of-life measures in these H F patients. [ABSTRACT FROM AUTHOR]

Background: High prevalence rates of delirium have been found in intensive care units (ICUs), ranging from 20%to 80%. The development of delirium may prolong length of stay, impair cognition, and result in placement in a nursing home for the patient. Purpose: There is a lack of research focused on the aging population, so the purpose of this study was to establish the incidence rate of delirium among ICU elderly patients and to identify its risk factors. Methods: An observational design with repeated measures was used. Subjects older than 65 years who had been admitted to the ICU within 24 hours were recruited. The Confusion Assessment Method for the Intensive Care Unit and Richmond Agitation--Sedation Scale were used twice a day to identify subjects experiencing delirium by RA. The demographic data, history of illness, Acute Physiology and Chronic Health Evaluation II scores, and laboratory data of the participants were recorded. Results: Ninety participants were included from a medical ICU. The incidence rate of delirium was 75.6% (n = 68). Average age was 78.28 T 7.6 years; Acute Physiology and Chronic Health Evaluation II scores ranged from 7 to 35. Most participants were diagnosed with respiratory failure (73.3%), and 86.76% of participants developed delirium within 24 hours. The most frequently experienced type of delirium was the mixed subtype (47.05%); the second most frequently experienced was hypoactive next. The risk factors were analyzed using logistic regression. The number of anesthetic analgesics used, total number of medications prescribed, duration of dehydration, use of corticosteroids before admissions, and shock were identified and explained 31.3% of variance. Conclusions/Implications for Practice: Delirium is a severe problem among elderly patients in the ICU. Healthcare professionals should pay more attention to elderly patients at greater risk for experiencing delirium. [ABSTRACT FROM AUTHOR]

Background: Understanding the predictors of glycemic control in adolescents of various age groups with type 1 diabetes (T1D) is crucial for nurses to cultivate developmental-specific interventions to improve glycemic control in this age group. However, research has rarely addressed this issue, particularly in the context of Asian populations. Purpose: We explored the predictive influence of demographic characteristics, self-care behaviors, family conflict, and parental involvement on glycosylated hemoglobin (HbA1C) levels 6months after the baseline measurement in adolescents of various age groups with T1D in Taiwan. Methods: A prospective survey design was applied. At baseline, adolescents with T1D completed a self-care behavior scale. Parents or guardians finished scales of parental involvement and family conflict. The HbA1C levels 6 months after baseline measurement were collected from medical records. Two hundred ten adolescent--parent/guardian pairs were enrolled as participants. Multiple stepwise regressions examined the significant predictors of HbA1C levels 6 months after the baseline measurement in the three adolescent age groups: 10-12, 13-15, and 16-18 years. Results: Family conflict was a significant predictor of HbA1C level within the 10-12 years of age group 6 months after the baseline measurement. Self-care behaviors were a significant predictor of HbA1C level within the 13-15 years of age group 6 months after the baseline measurement. Being female and self-care behaviors were each significant predictors of HbA1C level in the 16-18 years of age group 6months after the baseline measurement. Conclusions/Implications for Practice: Nurses should design specific interventions to improve glycemic control in adolescents of various age groups with T1D that are tailored to their developmental needs. For adolescents with T1D aged 10-12 years, nurses should actively assess family conflict and provide necessary interventions. For adolescents with T1D aged 13-18 years, nurses should exert special efforts to improve their self-care behaviors. In addition, female adolescents aged 16-18 years should be considered an at-risk group. [ABSTRACT FROM AUTHOR]

The article presents a study focused on analyzing the impact of diet and physical exercise program on the patients suffering from metabolic syndrome (MetS). A quasiexperimental study was conducted on 65 year old patients living in rural areas of Taiwan. According to the results, programs are effective on MetS patients.

Objective: To examine the effect of ascent rate on the induction of acute mountain sickness (AMS) in young adults during a climb to Jiaming Lake (3350 m) in Taiwan. Design: Prospective, nonrandomized. Setting: Climb from 2370 to 3350 m. Participants: Young adults (aged 18 to 26 years) (N = 91) chose to participate in either the fast ascent (3 days; n = 43) or slow ascent (4 days; n = 48) group (1 and 2). Assessment of Risk Factors: Two criteria were used to define AMS. A Lake Louise score ≥3 and Lake Louise criteria [in the setting of a recent gain in altitude, the presence of headache and at least 1 of gastrointestinal discomfort (anorexia, nausea, or vomiting), fatigue or weakness, dizziness or lightheadedness, or difficulty sleeping]. Main Outcome Measures: Heart rate, blood oxygen saturation (SaO2), and symptoms of AMS were monitored each morning and evening. Results: Baseline characteristics were similar between groups, except for significant differences in history of alcohol consumption (P = 0.009) and climbing experience above 3000 m (P < 0.001). The incidence of AMS was not associated with the rate of ascent. Acute mountain sickness was most prevalent in group 1 on day 2 in the evening and in group 2 on day 3 in the evening. In both groups, AMS correlated with the initial reduction in SaO2. Body mass index (BMI) .24 kg/m2 was identified as a significant risk factor for AMS. Conclusions: The development of AMS was closely associated with an initial reduction in SaO2. A BMI .24 kg/m2 also contributed to the occurrence of AMS. Clinical Relevance: These findings indicate that factors other than ascent rate should be considered when trying to ameliorate the risk of AMS. [ABSTRACT FROM AUTHOR]

The article discusses research which investigated the length ratio from the second or index finger to the fourth or ring finger (2D:4D ratio) in elite collegiate tennis athletes. Topics explored include the athletic ability and physiological traits associated with this 2D:4D ratio, the use of intercollegiate athletics data in comparing 2D:4D values in tennis athletes and nonathletes, and the practical application of this 2D:4D ratio data by collegiate tennis coaches.

The article presents findings of a study conducted to investigate the factors that could help in balancing quality of sleep and successful weaning from mechanical ventilation in patients at respiratory care centers. The study showed strong relationship between disease severity and quality of sleep, and both factors are significant predictors of successful weaning from mechanical ventilation.

As the selection of a medical modality is not completely independent, environmental and sociocultural contexts of ecological validity are desired. This study aimed to apply a multilevel analysis using the Hierarchical Linear Modeling software to examine predictors of traditional medicine (TM)/complementary and alternative medicine (CAM) use in Taiwan on both individual and division levels. Individual-level data were obtained from the government database involving TM/CAM use and its impact on the population, whereas division-level data were obtained from a government annual report. A total of 2310 individuals from 22 administrative divisions of Taiwan were evaluated in the data analysis, of which 86.9% had used at least 1 TM/CAM modality in the past year. The average division of TM/CAM use was 2.86 modalities in the null model and 4.15 in the full model. Significant relationships were found between TM/CAM use and individual-level variables of gender, educational level, monthly income, perceived health status, experience with Western medical treatment, and the cost, effect, and degree of satisfaction with TM/CAM. At the division level, TM/CAM use was significantly related to aging population, employment status, and the number of medical institutions. With a simultaneous evaluation of the individual-level and division-level influences, it was found that the average division of TM/CAM use increased significantly. The place of residence is an important predictor of TM/CAM use. The age factor in predicting TM/CAM use in this study may be overestimated in the population of 26 to 60 years of age, whereas an aging population is important in the average division of TM/CAM use. Efforts to reform health insurance to completely cover the costs of TM/CAM and to better facilitate equality of access of health care in rural and remote areas are deemed necessary. [ABSTRACT FROM AUTHOR]

Purpose: The study aimed to provide evidence-based recommendations for the prescription of a single session of exercise to improve cognitive performance. In particular, the purpose was to determine the dose-response relation between exercise duration and cognitive performance for a moderate-intensity session of aerobic exercise. Methods: Twenty-six healthy young men participated in a reading control treatment and three exercise treatments presented in a random order. The exercise treatments were designed on the basis of the American College of Sports Medicine guidelines and consisted of a 5-min warm-up, a 5-min cooldown, and cycling at moderate intensity (approximately 65% HR reserve) for 10, 20, or 45 min. The Stroop test was administrated after completion of each assigned treatment. Results: Exercise at moderate intensity for 20 min resulted in significantly better cognitive performance, as assessed by shorter response time and higher accuracy. This result was found regardless of the type of cognitive function assessed. In addition, a curvilinear dose-response relation between exercise duration and cognitive performance was observed. Conclusions: An exercise session consisting of a 5-min warm-up, 20 min of moderate-intensity exercise, and a 5-min cooldown improves cognition, whereas shorter or longer durations of moderate exercise have negligible benefits. This study provides the foundation for the prescription of a single session of moderate exercise to facilitate cognitive function in healthy younger adults. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the prevalence and characteristics of acute kidney injury (AKI) in 100-km ultramarathon runners. Design: Prospective observational study. Setting: The 2011 Soochow University ultramarathon, in which each athlete ran for 100 km. Participants: All Taiwanese entrants who participated in the 100-km race and lived in the northern part of Taiwan were invited to participate in the study. Main Outcome Measures: Acute kidney injury was defined using the Acute Kidney Injury Network criteria. Blood and urine samples were collected 1 week before, immediately after, and 1 day after the race. Results: Immediately after the race, 85% (22) of the 26 subjects were diagnosed with AKI, 65% (16) with moderate dehydration, 23% (6) with muscle cramps, and 12% (3) with hematuria. Body weight was significantly decreased from prerace to all postrace measurements. Plasma levels of potassium ion, creatinine, renin, and aldosterone were significantly elevated immediately after the race and then significantly reduced 1 day after the race. Changes in plasma levels of sodium, creatine kinase, and creatine kinase–MB, as well as urine potassium and creatinine, were indicative of AKI. Conclusions: Transient AKI and muscle cramps are very common in 100-km ultramarathon runners. All transient ultra-runners who developed AKI in this study recovered their renal function 1 day later. Clinical Relevance: Ultramarathon running is associated with a wide range of significant changes in hematological parameters, several of which can be associated with potentially serious renal and physiological abnormalities. [ABSTRACT FROM AUTHOR]

The article discusses research which was conducted to investigate whether whole-body vibration (WBV) combined with extra-load training would enhance the strength and speed of trained athletes better than WBV training or loaded training (LT) only. Researchers evaluated 21 male track and field athletes. They found that the combined training increased the speed and muscle strength more than single forms of training.

The article presents a randomized controlled trial of the effect of yoga exercise on reducing depression, anxiety and fatigue in women with breast cancer. It examines the effectiveness of an eight-week yoga exercise program in promoting both psychological and physical health of women with breast cancer undergoing adjuvant chemotherapy. Results showed that the program significantly reduced fatigue in patients but failed to reduce depression or anxiety.

Background: Adequate physical activity is believed to help decrease readmission and improve quality of life for patients with heart failure (HF). Objective: The aim of this study was to explore the predictors of physical activity level 1 month after discharge from hospital in Taiwanese patients with HF. Method: A prospective research design was used. Overall, 111 patients with HF from a medical center in Southern Taiwan were recruited. Symptomatic distress, self-efficacy for physical activity, physical activity knowledge, and demographic and disease characteristics of patients with HF were collected at their discharge. One month later, patients' total daily energy expenditure (DEE), DEE for low-intensity physical activities (PAlow DEE; strictly <3 metabolic equivalents [METs]), DEE for high-intensity physical activities (PAhigh DEE; 3-5 METs), and DEE for intensive-intensity physical activities (PAintensive DEE; strictly >5 METs) were collected. Results: The mean total DEE was 8175.85 ± 2595.12 kJ 24 h-1, of which 19.12% was for PAlow DEE, 7.20% was for PAhigh DEE, and only 1.42% was for PAintensive DEE. Body mass index (BMI), age, self-efficacy for instrumental activities of daily living, and educational level were predictors of total DEE of patients with HF 1 month after discharge. Self-efficacy for instrumental activities of daily living, gender, and BMI were predictors of PAhigh DEE. Age, BMI, and symptom distress were predictors of PAintensive DEE. Conclusions: Taiwanese patients with HF practiced lower intensity physical activities. Factors related to physical activity of patients with HF in Taiwan were similar to those of Western countries. Nurses should emphasize the importance of physical activity to patients with HF who are male, of older age, with lower educational level, or with lower BMI. Improving self-efficacy for instrumental activities and decreasing symptom distress should be incorporated into discharge planning programs for patients with HF. [ABSTRACT FROM AUTHOR]

The article presents a study which explores the Psychological Cigarette Dependence Scale (PCDS) among male smokers in Taiwan. Assessed is the development of PCDS through domain identification, interviews for item generation, and testing for construct validity and instrument stability. Results indicate the developed scale as a valid measure of psychological cigarette dependence that can be helpful on smoking cessation interventions depending on the patient's severity of dependence.