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Objective: Lower serum low-density lipoprotein cholesterol (LDL-C) levels are associated with increased intracerebral hemorrhage (ICH) risk. However, reverse causality and residual confounding has not attracted public attention. Therefore, we assessed whether people with LDL-C have increased risk of mortality adjusting for potential confounders using two large Taiwan cohorts.Methods: The Mei-Jhao (MJ) cohort has 414,372 adults participating in a medical screening program with 378 ICH deaths within 15 years of follow-up (1994–2008). Cox proportional hazards regressions estimated hazard death ratios according to LDL-C levels. We identified 4,606 ICH patients from the Taiwan Stroke Registry (TSR) and analyzed the impact of LDL-C on 3-month mortality.Results: Low cholesterol (LDL-C

The current study aimed to investigate whether low testosterone predicted the recurrence and clinical outcomes after acute ischemic stroke (AIS) in males. From June 2015 through August 2017, the study prospectively enrolled 110 male AIS patients. All received detailed evaluations at admission and were followed for at least 1 year. The cumulative incidence, overall survival, length of hospital stay, and the percentage of previous stroke were compared between subjects with testosterone 440 ng/dl. The median age was 62 years (range, 35–93 years). The median serum testosterone at admission was 438 [203] ng/dl (range, 44–816 ng/dl); 55 patients (50%) had testosterone

Background: Improving rates of advance care planning (ACP) and advance directive completion is a recognized goal of health care in the United States. No prior study has examined the efficacy of standardized patient (SP)-based student interprofessional ACP trainings. Objectives: The present study aims to evaluate an interprofessional approach to ACP education using SP encounters. Design: We designed a pre?post evaluation of an innovative interprofessional ACP training curriculum using multimodal adult learning techniques to test the effects of completing ACP discussions with SPs. Three surveys (pre-training T1, post-training T2, and post-clinical encounter T3) evaluated student knowledge, Communication Self-Efficacy (CSES), ACP self-efficacy, and interprofessional teamwork (using SPICE-R2). Setting/Subjects: Students from the schools of medicine, nursing, and social work attended three training modules and two SP encounters focused on ACP. Measurements/Results: During academic year 2018?2019, 36 students participated in the training at University of Maryland. Results demonstrated statistically significant improvements in ACP self-efficacy, MT1?=?2.9 (standard deviation [SD]T1?=?0.61) compared with MT3?=?3.9 (SDT3?=?0.51), p?0.001, and CSES, MT1?=?4.6 (SDT1?=?1.35) versus MT3?=?7.3 (SDT3?=?0.51), p?

Background: Advance care planning (ACP) is a critical component of quality end-of-life care. Little is known regarding the cultural influences on health professionals' attitudes toward the discussion of ACP in China. Objective: To better understand attitudes toward ACP among Chinese healthcare professionals in China and the influence of cultural factors such as filial piety, or xiào. Methods: A mixed methods study was used. This study reports the results of a descriptive cross-sectional survey of physicians, nurses and social workers with experience in palliative and end-of-life care. Results: Some 102 completed surveys were obtained. Most Chinese health professionals had an overall positive attitude toward ACP, acknowledging that these discussions should occur. However, there was a general lack of confidence and sense of reluctance among participants to engage in ACP discussions. Conclusion: The lack of statistical difference between the various health professionals suggests that they all faced challenges in participating in ACP discussions. Future research should focus on the influences of cultural factors such as xiào on ACP discussion, and develop culturally sensitive strategies to facilitate these discussions in the Chinese community. [ABSTRACT FROM AUTHOR]

Nursing care is changing dramatically given the need for students to address complex and multiple patient comorbidities. Students experience difficulties applying knowledge gained from didactic instruction to make important clinical decisions for optimal patient care. To optimize nursing education pedagogy, innovative teaching strategies are required to prepare future nurses for practice. This integrative review synthesized the state of the science on flipped classroom models from 13 empirical studies published through May 2016. The purpose of the review was to evaluate studies conducted on flipped classroom models among nursing students using a validated framework by Whittemore and Knafl. Multiple academic databases were searched, ranging in scope including PubMed, Embase (Elsevier), CINAHL (Ebsco), Scopus, Web of Science, and Google Scholar, resulting in 95 unique records. After screening and full-text reviews, 82 papers were removed. Thirteen empirical studies were included in the final analysis and results provided (a) design and process information on flipped classroom models in nursing education, (b) a summary of the state of the evidence to inform the implementation of flipped classrooms, and (c) a foundation to build future research in this area of nursing education. To develop sound evidence-based teaching strategies, rigorous scientific methods are needed to inform the implementation of flipped classroom approaches. [ABSTRACT FROM AUTHOR]

Purpose: National reports on end-of-life symptom management reveal a gap in the evidence regarding symptoms other than pain and studies of diseases other than cancer. This study examines the frequency and severity of symptoms and quality of life (QOL) in persons with advanced cancer, amyotrophic lateral sclerosis (ALS), and congestive heart failure (CHF). Methods: The present study is a cross-sectional examination of symptoms and QOL measured using the McGill QOL Questionnaire, among 147 participants. Results: Forty one percent of participants had advanced cancer, 22% had ALS, and 37% had advanced CHF. A total of 266 symptoms were reported, with the common symptom categories being discomfort/pain, weakness/fatigue/sleep, and respiratory. Participants with CHF had the highest mean symptom severity and the lowest QOL. Conclusion: Clinicians should be aware and attentive for symptoms other than pain in patients with advanced illness. Studies on diseases other than cancer, such as CHF and ALS, are important to improve symptom management in all disease groups. [ABSTRACT FROM AUTHOR]

There is increasing interest in the rote of advance care planning (ACP) and advance directives (ADs) in eliciting patient preferences for future medical care. Whereas Americans from many cultures embrace the concept of autonomy and AD, elements of the Chinese culture may lead to disagreement with ACP. Filial piety, an important concept in Chinese culture, may hinder truth-telling, discussion of poor prognosis, and ACP. The purpose of this systematic review was to examine the empirical evidence about ACP and AD in Chinese people from Eastern and Western cultures. Databases searched were PubMed, EMBASE, CINAHL, PsychInfo, and Cochrane Database of Systematic Reviews. Fifteen publications met the inclusion criteria. Narrative analysis was used and five major themes were extracted: (a)factors predicting preferences for ACP/AD, (b) Chinese-specific considerations related to ACP, (c) decision making in ACP, (d) ACP and AD knowledge, and (e) Chinese cultural aspects of ACP, There was little difference in results from Eastern versus Western countries. Culturally sensitive ACP must be approached with compassion and respect and provide a sense of dignity. A family decision-making model may be more appropriate for discussions with Chinese people about ACP and AD. [ABSTRACT FROM AUTHOR]

BACKGROUND In recent years, using the 1,064-nm Q-switched neodymium-doped yttrium aluminium garnet (Nd:YAG) laser (QSNYL) with or without exogenous topical carbon solution application for facial skin rejuvenation has become popular in Southeast Asia, but there has not been any published clinical report discussing the rejuvenation effect of QSNYL for Asian patients. OBJECTIVE To evaluate the efficacy of QSNYL in improvement of pore size, sebaceous secretion, skin texture, and skin tone of Asian patients. We also observed whether there is any enhancement of application of topical carbon solution before the therapy. METHODS Twenty-four female patients completed four sessions of treatments at 4-week intervals. The assessment was evaluated by the patients, two independent physicians, and Canfield VISIA Complexion Analysis. In addition, we conducted a split-face study such that, in each case, topical carbon solution was applied to the right side of the face before the laser treatment. RESULTS All evaluations showed significant improvement in rejuvenation effect. There was no difference in improvement in skin texture even after the application of topical carbon solution in our split-face study. CONCLUSION The QSNYL is a safe and effective rejuvenation modality in Asian patients. Topical carbon solution application did not enhance laser efficacy. [ABSTRACT FROM AUTHOR]

Background: Advance directives (AD) and advance care planning (ACP) are critical to making patient-centered end-of-life decisions. Despite their importance, completion rates for AD in the United States remain low at about 18-36%. Lack of education related to AD and not understanding AD have been cited as key reasons for not participating in ACP or completing AD. Purpose: The purpose of this quasi-experimental pilot study was to assess the effectiveness of a nurse led educational AD seminar that used the Five Wishes on attitudes related to AD, AD completion, and participation in ACP conversations. Methods: A post-test repeated measures design was used. Results: Of the 86 participants who attended the seminar, most (n = 71, 82.6%) found the seminar useful, and 97.7% (n = 84) reported that they were likely to complete an AD and participate in ACP conversations with family or friends. Overall attitudes about ADs were high. Older females were more likely to complete AD than their younger male counterparts, and women were more likely than men to have ACP conversations. Conclusion: The results of this study lend support to the role of nursing-driven community-based educational interventions to improve AD completion and participation in the ACP process. [ABSTRACT FROM AUTHOR]

This investigation reports a 68-year-old man with a history of hepatocellular carcinoma (HCC) diagnosed 2 years previously who developed a single, easy-bleeding, pyogenic granuloma (PG)-like lesion on his right upper abdomen, located in the area of previous therapeutic percutaneous ethanol injection (PEI) for HCC treatment. The lesion developed 3 months after the injection. The tumor was found to be identical to his previous HCC. To describe a case of cutaneous seeding of HCC during PEI presented as a PG-like lesion. To our knowledge, this is the first such case reported in the literature. This is a case report and review the literature. Immunostainings for α-fetoprotein and hepatocyte monoclonal antibody confirmed the diagnosis. Besides, the patient had no other metastatic lesion. This tumor is believed to be caused by cutaneous seeding of HCC during PEI and is simulated clinically as a PG. M.-C. LEE, MD, Y.-L. HUANG, MD, PHD, C.-H. YANG, MD, T.-T. KUO, MD, PHD, AND H.-S. HONG, MD HAVE INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPORTERS. [ABSTRACT FROM AUTHOR]

The purpose of this research is to explore behavioral, normative, and control beliefs in the discussion of advance care planning (ACP) among older and younger Chinese Americans. Ethnic minority groups have been identified as less engaged in ACP and this represents an ethnic and cultural gap. Older Chinese American adults often have different beliefs and values compared to the younger generation who are more acculturated to American mainstream culture. These differences may hinder the discussion of ACP with Chinese older adults. A qualitative design was used. The Theory of Planned Behavior guided the development of the interview guide. We recruited 60 Chinese Americans. Prior experience was identified as a theme that influenced attitudes about ACP. We found that older and younger Chinese participants had different beliefs in the norm and control related to ACP discussions, but not in the belief of attitudes about ACP discussions. Both younger and older Chinese American participants believed that ACP was important and necessary. Participants in both clusters expressed that they were ready and willing to engage in ACP discussions with their family members but hesitant to initiate these discussions. The reluctance in discussing ACP with Chinese older adults may be related to the expectations and obligations of Xiao (filial piety) in Chinese culture. This study describes the similarities and differences of beliefs in ACP between older and younger Chinese Americans. We identified barriers and facilitators in behavioral, normative, and control beliefs that can be used to promote ACP for Chinese Americans.

Background: To provide optimal end-of-life (EOL) care in the Chinese American population, we need to have a better understanding of what matters most at EOL from their perspective. Experiencing a “good death” at the EOL is the optimal goal of palliative care. Studies show that the meaning and description of good death varies across cultures in different populations. In the United States, Chinese Americans comprise the largest Asian demographic. Aim: To describe EOL wishes, which define a good death for Chinese Americans. Method: Qualitative study using focus groups. A convenience sample of 60 Chinese Americans was recruited from a community organization in Maryland. Ten focus group discussion sessions were conducted. Results: Wishes at the EOL that defined a good death for the participants in this study included being pain-free, not being a burden to family, being with family, having a trusted physician, maintaining dignity, and prayer. Conclusion: A good death is a complex concept. What matters most to patients at the EOL differs depending on their cultural background. When caring for Chinese Americans, a comprehensive EOL care plan should include cultural considerations in addition to physical, psychosocial, and spiritual needs.