Search

BACKGROUND No evidence is currently available to estimate the outcomes of intensity-modulated radiation therapy (IMRT) and surgery for patients with early oral cavity squamous cell carcinoma (E-OCSCC). METHODS We recruited patients from the Taiwan Cancer Registry Database who had received a diagnosis of E-OCSCC. Propensity score matching was performed, and Cox proportional hazards model was used to analyze all-cause mortality. RESULTS In the multivariate Cox regression analyses, the adjusted hazard ratio (aHR) (95% confidence interval [CI]) for surgery compared with definitive IMRT, T2N0M0 compared with T1N0M0, and male patients compared with female patients were 0.303 (0.245, 0.375), 1.340 (1.077, 1.668), and 2.012 (1.432, 2.826), respectively. The aHRs (95% CIs) for age 61 to 70, 71 to 80, and ≧81 years compared with

Background. Occupational stress is a common issue faced by workers in every discipline. Complementary and alternative medicine (CAM) therapies, such as aromatherapy massage or massage, have antistress effects in the literature. The purpose of this randomized clinical trial with triple blinds is to evaluate the immediate effects of lavender aromatherapy massage for improving work stress, burnout, and HRV parameters of female employees in a university. Methods. A total of 53 subjects in experimental group whereas 57 subjects in control group completed interventions and measurement and led to power of 0.98. Inferential statistics, as independent t-test, paired t-test, and Chi-Square test, were performed to verify the expected relationships. Results. The present study found that subjects in experimental group reported a lower role stress and less inclined to type A personality trait after aromatherapy massage with lavender. For control group, only less inclined to type A personality trait was reported after receiving massage. For burnout, a significant lower personal burnout and work-related burnout were reported after aromatherapy massage whereas only increased client-related burnout was reported in control group. For HRV, both the experimental and control groups reported higher SDNN and RMSSD in time domain after intervention. Contradictory HRT and PSI in time domain were significantly lower after intervention. In frequency domain of HRV, both groups reported significantly higher value in VLF and HF. In addition, the experimental group reported significantly higher value in TP and LF after intervention. Conclusions. Both the lavender aromatherapy massage and massage did show immediate effect on different dimensions of work stress, burnout, and HRV. These two interventions can be applied as routine leisure activities by personal preference to reduce stresses occurring in work environment.

Aim The aim of this study is to explore the effects of exercise interventions by type, duration and intensity of exercise for fatigue in breast cancer survivors who had completed their treatment. Background Most studies found that exercise has valuable outcomes for cancer survivors. This meta-analysis comprehensively summarizes the benefits of exercise intervention for fatigue in breast cancer patients who had completed their adjuvant treatments. Methods We conducted a meta-analysis on randomized control trials published during 1 January 2000 through 31 December 2019, from PubMed, Cochrane Library databases, EMBASE, Medline (ProQuest), CINAHL, PsycINFO, Chinese Electronic Periodical Service and Wan Fan Data with prespecified searching criteria. Breast cancer patients earlier than stage IIIc and completing adjuvant treatments were included, and the effects of exercise on fatigue were investigated. Results Nine randomized controlled trials (RCTs) were included (N = 581). Patients receiving exercise interventions showed reduced fatigue comparing with those without exercise. Exercise with low-moderate intensity, 20 min/day, three times per week and lasting up to 12 weeks had a significant effect on reducing fatigue for breast cancer survivors. Conclusion Our study suggested that exercise interventions can reduce fatigue for this group of cancer survivors. The duration and intensity of exercise intervention could be prescribed for this specific group of cancer patients as a basic requirement to handle their reported fatigue.

The existing concept suggests early palliative and hospice therapy for a better quality of care (QOC) and less medical expense in terminal cancer patients, but the time points of “early” initiation were defined by pre-set study protocol rather than the real-world data. The study aimed to determine the optimal timing of initiating palliative care for patients with terminal cancer. This retrospective population-based study was conducted using a nationwide database. We extracted patients with cancer who were in their last year of lives in the period from 1 January 2010 to 31 December 2013 and categorized them into two groups (“hospice-shared care” (HSC) group and “usual care” (UC) group) after a matching process. Subsequently, we used a generalized linear mixed-effects model to compare the QOC and medical expenses between groups. After the selection and matching process, we enrolled 1714 patients (67.7 ± 13.2 years, 62.7% male) categorized into the HSC and UC groups (n = 857 in each group). The HSC groups showed generally better QOC in the four indices (with emergency room visit, hospitalization, intensive care unit admission, and receiving chemotherapy) than the UC group in those who initiated HSC 8–60 days before death. The HSC group also had significantly lower medical expenses than the UC group in those who initiated HSC 15–90 days before death. Among patients with terminal cancer, HSC initiation before the last 8 days and 15 days of lives can effectively improve QOC and save medical expenses, respectively.

The optimal timing for initiating palliative care in cancer patients varied widely. This retrospective population-based study aimed to determine the optimal initiation timing of hospice-shared care (HSC), which maximizes the beneficial effects of quality of care (QOC) and medical expenses among terminal cancer patients. We extracted cancer patients who were in their last year of lives during 1 January 2010 to 31 December 2013 from a nationwide database. After the selection and matching process, 1,714 patients (67.7±13.2 years, 62.7% male) were enrolled and categorized into the HSC group and usual care (UC) group (n=857 in each group). By suing the generalized linear mixed-effects model for comparisons between groups, we found that the HSC groups showed generally better QOC in the four indices (with emergency room visit, hospitalization, intensive care unit admission, and receiving chemotherapy) than the UC group in those who initiated HSC 8-60 days before death. The HSC group also had significantly lower medical expenses than the UC group in those who initiated HSC 15-90 days before death. In conclusion, HSC initiation before the last eight days and 15 days of lives were found to effectively improve QOC and save medical expenses, respectively, among patients with terminal cancer.

Although patients aged70 years are subject to early oral cavity squamous cell carcinoma (E-OCSCC), evidence is currently lacking regarding the probable outcomes of definitive radiotherapy (RT) compared to surgery in this population.We recruited patients aged ≥70 years with a diagnosis of E-OCSCC from the Taiwan Cancer Registry Database. Propensity score matching was performed, and Cox proportional-hazards model curves were used to analyze all-cause mortality of patients at different age intervals undergoing different treatments.The matching process yielded a final cohort of 604 patients in the definitive RT and surgery cohorts who were eligible for further analysis. These patients were classified as old (70-80 years) and very old (80 years). In the multivariate Cox regression analysis, the adjusted hazard ratio (aHR) (95% confidence interval [CI]) for surgery compared with definitive RT was 0.465 (0.354-0.610, P 0.001). The aHR (95% CI) for age80 years compared with age 70-80 years was 2.370 (1.720, 3.265, P 0.001). The aHR (95% CI) for T2N0M0 compared with T1N0M0 was 1.752 (1.321-2.32, P 0.001). The aHR (95% CI) for Charlson Comorbidity Index (CCI) ≥ 2 compared with CCI = 0 was 1.264 (1.137-1.738, P = 0.011). After stratified analysis, the aHRs for surgery compared with definitive RT were 0.484 (0.352-0.665, P 0.001) and 0.411 (0.232-0.728, P = 0.002) among old and very old patients with E-OCSCC, respectively.Surgery may be more beneficial than definitive RT in selected elderly patients with E-OCSCC.

Background For first-time mothers, not knowing how to interact with newborn infants increases anxiety and decreases the quality of the parent–infant interactions. A substantial lack of interactional knowledge can ultimately limit the adjustments necessary for a stable transition into motherhood. This study investigated how postpartum parenting education influenced first-time mothers’ mother–infant interaction quality and parenting sense of competence. Methods Eighty-one healthy first-time-mother and infant dyads were recruited. The control group (n = 40) received postpartum care based on the medical and cultural norms practiced in Taiwan, while the experimental group (n = 41) received, on top of typical care, education by way of a 40-min videotape on infant states, behaviors, and communication cues, as well as a handout on play practices. Data were collected at five points: within the first week, and during follow-ups in the first, second, third, and sixth months after birth. We administered the Chinese versions of the Parenting Sense of Competence Scale and Edinburgh Perinatal Depression Scale, and used the Nursing Child Assessment Teaching Scale to score videotaped mother–infant interactions. Results We observed an increase in the quality of mother–infant interaction within the experimental group only. Furthermore, at the five assessment points, we observed no significant changes in perceived parenting competence. Among all subjects, there were correlations between postpartum depression scores, parenting competency, and quality of mother–infant interaction. Conclusions Our results indicate that first-time mothers in Taiwan who are provided with extra education on infants’ abilities and how to effectively play with infants are likely to exhibit improvements in quality of interaction. Electronic supplementary material The online version of this article (10.1186/s12884-018-1979-7) contains supplementary material, which is available to authorized users.

Background The prevalence of cognitive impairment is increasing due to the aging population, and early detection is essential clinically. The Ascertain Dementia 8 (AD8) questionnaire is a brief informant-based measure recently developed to assess early cognitive impairment, however, its overall diagnostic performance is controversial. The objective of this meta-analysis was to assess the diagnostic accuracy of the AD8 for cognitive impairment. Methods All relevant studies were collected from databases including MEDLINE, EMBASE and the Cochrane Library up to April 2017. We used QUADAS-2 to assess the methodological quality after the systematic search. The accuracy data and potential confounding variables were extracted from the eligible studies which included those in English and non-English. All analyses were performed using the Midas module in Stata 14.0 and Meta-DiSc 1.4 software. Results Seven relevant studies including 3728 subjects were collected, and classified into two subgroups according to the severity of cognitive impairment. The overall sensitivity (0.72, 0.91) was superior to specificity (0.67, 0.78). The pooled negative likelihood ratio (0.17, 0.13) was better than the positive likelihood ratio (2.52, 3.94). The areas under the summary receiver operating characteristic curve were 0.83 and 0.92, respectively. Meta-regression analysis showed that location (community versus non-community) may be the source of heterogeneity. The average administration time was less than 3 minutes. Conclusion Our findings suggest that the AD8 is a competitive tool for clinically screening cognitive impairment and has an optimal administration time in the busy primary care setting. Subjects with an AD8 score ≧2 should be highly suspected to have cognitive impairment and a further definite diagnosis is needed.

Aims and objectives To determine the individual and mutual predictors of the marital satisfaction of couples in which the husband experienced prostate cancer. Background Marital satisfaction of prostate cancer patients has been insufficiently studied in Asian countries as compared with Western countries. Design This study used a prospective and repeated-measures design. Methods Seventy Taiwanese couples in which the husband had prostate cancer completed measures at 6 and 12 months post-treatment. Assessments of physical symptoms, marital satisfaction, coping behaviour, and psychological distress were conducted. Multiple linear regression was used to analyse the data. Results The marital satisfaction of prostate cancer patients and that of their spouses were significantly correlated. At 6 months, spouses’ marital satisfaction, patients’ appraisal of prostate cancer as a threat, and patients’ serum prostate-specific antigen (PSA) levels were found to be the predictors of patients’ marital satisfaction. Furthermore, patients’ marital satisfaction and their spouses’ psychological distress were predictors of spouses’ marital satisfaction. At 12 months, spouses’ marital satisfaction and patients’ appraisal of prostate cancer as harm were predictors of patients’ marital satisfaction. Finally, spouses’ marital satisfaction (at 6 months) and appraisal of prostate cancer as a threat were predictors of spouses’ marital satisfaction. Conclusions At 6 months post-treatment, patients’ and spouses’ marital satisfaction will influence each other. However, at 12 months, patients’ marital satisfaction exerts an insignificant effect on spouses’ marital satisfaction. Moreover, patients’ serum PSA level or the negative appraisal of prostate cancer affects their marital satisfaction. Spouses’ marital satisfaction is affected by psychological distress and their negative appraisal of prostate cancer. Relevance to clinical practice The results can be used to develop interventions for prostate cancer couples. Such an intervention can be used to modify couples’ appraisal of prostate cancer by changing incorrect thinking or to ease the psychological distress to improve marital satisfaction. This article is protected by copyright. All rights reserved.

OBJECTIVES This study aimed to identify the cognitive factors associated with the professional healthcare advice (PHCA) seeking behavior in breast cancer-related lymphedema (BCRL). METHODS From January 2018 to December 2018, patients with BCRL were prospectively enrolled for a cross-sectional survey of lymphedema-related perceived risks, lymphedema quality of life (LYMQoL), knowledge scale of lymphedema, and PHCA behavior at first clinical visit, 3 and 6 months postbaseline. RESULTS A total of 180 patients including 100 (55.6%) patients underwent a vascularized lymph node transfer (VLNT) and 80 (44.4%) patients received compressive decongestive therapy (CDT) were enrolled. At 6 months of follow-up, mean episodes of cellulitis (from 2.2 to 0.2 times/year), mean circumferential difference (7.8 ± 3.9%), wearing compression garments (from 29% to 0 %) in the VLNT group were statistically reduced than those in the CDT group (p = .01

OBJECTIVES An Asian Gynecologic Oncology Group phase III randomized trial was conducted to determine whether maintenance chemotherapy could improve progression-free survival (PFS) in stages III/IV ovarian cancer. METHODS Between 2007 and 2014, 45 newly-diagnosed ovarian cancer patients were enrolled after complete remission and randomized (1:1) to arm A (4-weekly carboplatin area under the curve 4 and pegylated liposomal doxorubicin [PLD] 30 mg/m², n=24) for 6 cycles or arm B (observation, n=21). The primary end-point was PFS. A post hoc translational study was conducted to deep sequence BRCA/homologous recombination deficiency (HRD) genes, because BRCA/HRD mutations (BRCA/HRDm) are known to be associated with better prognosis. RESULTS Enrollment was slow, accrual was closed when 7+ years had passed. With a median follow-up of 88.9 months, the median PFS was significantly better in arm A (55.5 months) than arm B (9.2 months) (hazard ratio [HR]=0.40; 95% confidence interval [CI]=0.19-0.87; p=0.020), yet the median overall survival was not significantly different in arm A (not reached) than arm B (95.1 months) (p=0.148). Overall grade 3/4 adverse events were more frequent in arm A than arm B (60.9% vs 0.0%) (p

Summary Purpose Urinary catheterization is a common technique in clinical practice. There is, however, no consensus on management prior to removal of the indwelling catheter for short-term patients. This systematic review examined the necessity of clamping before removal of an indwelling urinary catheter in short-term patients. Methods A systematic literature review was conducted using eight databases and predetermined keywords-guided searches. Some 2,515 studies were evaluated. Ten studies that met the inclusion criteria were selected. Results The quality of the studies was assessed using the Jadad scoring system. Only 40.0% of studies were rated as high quality. This review found that catheter clamping prior to removal was not necessary for the short-term patient. When made a comparison with the unclamping group, there was no significant difference in recatheterization risk, risk of urine retention, patients' subjective perceptions and rate of urinary tract infection. Conclusions This review indicated that bladder training by clamping prior to removal of urinary catheters is not necessary in short-term catheter patients. In addition, clamping carries the risk of complications such as prolonging urinary catheter retention and urinary tract injury. Further investigation requires higher quality methodologies and more diverse study designs.

Published research on discharge planning is written from the perspective of hospital wards and community services. Limited research focuses on discharge planning in the emergency department (ED). The objective of this study was to identify ED nurses’ perceptions of factors influencing the implementation of discharge planning. This qualitative study collected data from 25 ED nurses through in-depth interviews and a drawing task in which participants were asked to depict on paper the implementation of discharge planning in their practice. Factors influencing discharge planning were grouped into three categories: discharge planning as a neglected issue in the ED, heavy workload, and the negative attitudes of ED patients and their families. The study highlighted a need for effective discharge planning to be counted as an essential clinical competency for ED nurses and factored into their everyday workload. Nurses perceived that organizational culture, and parents’ and relatives’ attitudes were barriers to implementing discharge teaching in the ED.

Triage classifies and prioritizes patients’ care based on the acuity of the illness in emergency departments (EDs). In Taiwan, the five-level Taiwan Triage and Acuity Scale (TTAS) computerized system was implemented nationally in 2010. The purpose of this study was to understand which factors affect decision-making practices of triage nurses in the light of the implementation of the new TTAS tool and computerized system. The qualitative data were collected by in-depth interviews. Data saturation was reached with 16 participants. Content analysis was used. The results demonstrated that the factors affecting nurses’ decision making in the light of the newly implemented computerized system sit within three main categories: external environmental, patients’ health status, and nurses’ experiences. This study suggests ensuring the patient’s privacy while attending the triage desk, improving the critical thinking of triage nurses, and strengthening the public’s understanding of the ED visits. These will make ED triage more efficient.

Background Caregiver burden may be either a predictor or an outcome of caregiver quality of life (QoL). Patient or caregiver factors that directly affect caregiver QoL, predictors that are simultaneously shared with caregiver burden and QoL, and factors that affect caregiver QoL through caregiver burden are not well understood. This study explored predictors of caregiver QoL and identified whether caregiver burden is a mediator for caregivers of first-time stroke patients. Methods This is a cross-sectional study. We recruited first-time stroke patients who had been discharged from the hospital within 1 year. We screened caregivers with two major inclusion criteria: age > 20 years old and being the family member who provides the most patient-care hours out of all family caregivers. Caregiver burden (Caregiver Strain Index, CSI), QoL (Caregiver Quality of Life Index, CQLI), and patient and caregiver characteristics were assessed with structured questionnaires. Multiple-regression and bootstrap analysis were conducted for data analysis. Results A total of 126 caregivers completed the questionnaires. Higher caregiver burdens, lower caregiver education level, lower self-rated health, lower monthly family income, and spouses who were responsible for medical fees were significant predictors of lower caregiver QoL. Poor self-rated health and monthly family income of $ 666 USD or below were the strongest predictors of caregiver QoL. Spouses who were responsible for medical fees and lower monthly family income had direct negative effects on caregiver QoL, but these factors exhibited no indirect mediating effect between caregiver characteristics and QoL through caregiver burden as a mediator. Caregiver education level at or below elementary school and poor or fair self-rated-health had direct negative effects on caregiver QoL, which were mediated by caregiver burden. Conclusions Our study indicated predictors of caregiver QoL and the relationships with caregiver burden among first-time stroke survivors in the early stage. Caregivers’ financial factors affected caregiver QoL directly. Caregivers’ poor self-rated health and lower education level negatively affected caregiver QoL indirectly through caregiver burden as a mediator. Interventions to make appropriate policies for financial subsidies, to enhance caregivers’ health and to provide tailored stroke-related education through multidisciplinary cooperation may effectively promote caregiver QoL.

Background: Kidney transplant failures are caused primarily by lack of adherence to immunosuppressive medication regimens by patients after transplantation. A number of studies have indicated that health-related beliefs are an effective predictor of health-related behavior. Purpose: The aim of this study is to understand the influence of the personal characteristics and health-related beliefs of patients on adherence to treatment with immunosuppressive medication based on the Health Belief Model. Methods: This cross-sectional study distributed questionnaires to patients who had been recruited via purposive sampling at one medical center in Taipei. All of the potential participants had undergone kidney transplantation at least 6 months previously. The self-developed questionnaire collected data in three areas: personal characteristics, health-related beliefs regarding transplant rejection, and adherence to the immunosuppressive medication regimen. One hundred twenty-two valid questionnaires were received. The collected data were analyzed using descriptive statistics, independent t test, one-way analysis of variance, Pearson's correlation, and multiple regression. Results: Participants who had received dialysis treatment or had experienced rejection perceived susceptibility to rejection more strongly than those who had not. Participants who had undergone transplantation in Taiwan, had experienced more drug-related symptoms, or had contracted severe to extremely severe infections in the past showed lower rates of adherence to treatment with immunosuppressive medication. Adherence to medication regimens correlated negatively with length of time since transplantation. Length of time since transplantation, drug-related symptoms, perceived susceptibility to rejection, and perceived benefits of treatment were identified as major predictors of adherence to immunosuppressive medication regimens. Conclusions: The results partially conformed to the concepts of the Health Belief Model. Perceived susceptibility to rejection and perceived benefits of adherence to treatment were found to predict adherence rates. Patient education should be enhanced to reduce the risks of rejection and increase adherence rates to improve outcomes.

BACKGROUND: The investigation of hospital air quality has been conducted in wards, ICUs, operating theaters, and public areas. Few studies have assessed air quality in respiratory care centers (RCCs), especially in mechanically ventilated patients with open suctioning. METHODS: The RCC air quality indices (temperature, relative humidity, levels of CO2, total volatile organic compounds, particulate matter [PM], bacteria, and fungi) were monitored over 1 y. The air around the patient9s head was sampled during open suctioning to examine the probability of bioaerosol exposure affecting health-care workers. RESULTS: This investigation found that the levels of indoor air pollutants (CO2, PM, bacteria, and fungi) were below the indoor air quality standard set by the Taiwan Environmental Protection Agency. Meanwhile, the levels of total volatile organic compounds sometimes exceeded the indoor air quality standard, particularly in August. The identified bacterial genera included Micrococcus species, Corynebacterium species, and Staphylococcus species, and the predominant fungal genera included yeast, Aspergillus species, Scopulariopsis species, and Trichoderma species. Additionally, airborne PM2.5, PM1, and bacteria were clearly raised during open suctioning in mechanically ventilated patients. This phenomenon demonstrated that open suctioning may increase the bacterial exposure risk of health-care workers. CONCLUSIONS: RCC air quality deserves long-term monitoring and evaluation. Health-care workers must implement self-protection strategies during open suctioning to ensure their occupational health and safety in health-care settings.

We evaluated changes in psychosocial adjustment over time and its associated factors in prostate cancer patients. A total of 69 patients with prostate cancer were surveyed at pre-diagnosis, 1 month and 6 months post-treatment. The questionnaires distributed to the patients consisted of the Psychosocial Adjustment to Illness Scale and the UCLA Prostate Cancer Index. The generalized estimating equations were used to analyse the collected data. The results of adjustments to psychological distress, the domestic environment and the social environment worsened post-treatment. However, the adjustment to health-care orientation was worst at the time of pre-diagnosis and improved during post-treatment. Patients who perceived an unfavourable health status reported poor adjustment in psychological distress. Patients exhibiting poor urinary function poorly adjusted to the domestic environment. Patients with sexual dysfunction exhibited poor adjustment to the social environment. Patients with low education demonstrated poor adjustment to health-care orientation. Further studies should assess the psychosocial adjustment among prostate cancer patients and provide interventions following pre-diagnosis.

Aims and objectives - The purpose of this research was to explore the medical decision-making processes of patients in emergency departments. Background - Studies indicate that patients should be given enough time to acquire relevant information and receive adequate support when they need to make medical decisions. It is difficult to satisfy these requirements in emergency situations. Limited research has addressed the topic of decision-making among emergency patients. Design - This qualitative study used a broadly defined grounded theory approach to explore decision-making in an emergency department in Taiwan. Methods - Thirty emergency patients were recruited between June and December 2011 for semi-structured interviews that were audio-taped and transcribed verbatim. Results - The study identified three stages in medical decision-making by emergency patients: predecision (interpreting the problem); decision (a balancing act) and postdecision (reclaiming the self). Transference was identified as the core category and pattern of behaviour through which patients resolved their main concerns. This transference around decision-making represents a type of bricolage. Conclusions - The findings fill a gap in knowledge about the decision-making process among emergency patients. Relevance to clinical practice - The results inform emergency professionals seeking to support patients faced with complex medical decision-making and suggest an emphasis on informed patient decision-making, advocacy, patient-centred care and in-service education of health staff.

Sleep disturbance is a major problem for older adults, calling for the development of alternative medicine techniques to help improve sleep quality in this population.The purpose of this study was to explore the effectiveness of a Baduanjin exercise program on sleep quality in Taiwanese elderly.A randomized controlled trial, longitudinal research design was employed.This study was conducted in an urban area of northern Taiwan. The inclusion criteria for participants were as follows: (1) community-dwelling older adults age 60 years or older; (2) no regular exercise within 6 months; (3) able to communicate; and (4) independent in self-care. Subjects were excluded if they had (1) depression tendency as demonstrated by the Chinese version of the Geriatric Depression Score of eight or higher; (2) impaired mobility; or (3) unstable health status. A total of 202 older people were screened for this study, 87 of whom were eligible according to the inclusion criteria. Of these, 55 completed the 12-week study.Fifty-five participants were randomly assigned to the exercise group (27) or the control group (28). Those in the exercise group received 12 weeks of Baduanjin exercise training, while those in the control group had no intervention. The Pittsburg Sleep Quality Index was administered to subjects at four time points: before the intervention, and at the 4th, 8th, and 12th week after intervention.Subjects in the Baduanjin exercise group had significantly improved overall sleep quality, subjective sleep quality, sleep latency, sleep duration, sleep efficiency, and daytime dysfunction after 12 weeks of intervention (p0.001), while those in control group showed no significant difference in sleep quality. Compared with the control group, the Baduanjin exercise group reported significantly better sleep quality after four weeks of intervention which was maintained throughout the 12-week exercise period.This study confirmed that the Baduanjin exercise program can improve sleep quality for Taiwanese community-dwelling older adults. We recommend application of this simple, gentle exercise program in older persons to improve their sleep quality.

Background Implementation of clinical practice guidelines (CPGs) can reduce medical practice variations and enhance effectiveness. In 2008, the Taiwan Department of Health delegated the development of CPGs on six health topics. By February 2010, these CPGs had been completed. Methods The Appraisal of Guidelines Research and Evaluation (AGREE) instrument was used to assess the quality of the guidelines. We organized groups to develop CPGs and called on 131 experts with various specialties. Results The average AGREE scores for the six major domains were 86% (scope and purpose), 63% (stakeholder involvement), 77% (rigor of development), 72% (clarity and presentation), 53% (applicability), and 69% (editorial independence). Conclusion We recommend the following: (1) opinions from all stakeholders, especially patients, should be considered to improve the content of the guidelines; and (2) health education resources, audit forms, and other tools should be emphasized more in the development of CPGs.

Aim. The aim of this study was to describe and understand the lived experience of people with lower extremity amputation. Background. The loss of a body part can cause physical, psychological and social disturbances. The majority of previous studies in this area focus on the impact of amputation or the effectiveness of rehabilitation programmes. This is the first study in Taiwan exploring the holistic experiences of persons with amputation. Design. A phenomenological research design was used. Methods. Semi-structured interviews were performed with 22 people with lower extremity amputation. Interviews were tape-recorded and transcribed verbatim. Data were analysed using Colaizzi’s phenomenological analysis method. Results. The lived experience of persons with lower extremity amputation could be categorised into the following four themes: ‘lost in the dark woods’, ‘emotional collapse’, ‘difficulty in passing through the shadow’ and ‘igniting a gleam of hope’. Conclusions. Participants described suffering in physical, psychological and sociocultural realms and the ways they strived to cope with these challenges. The findings of this study provide an enhanced understanding of the experiences of people with lower extremity amputation and underscore the importance of truly listening and responding to their concerns. The need to appreciate cultural context and to develop the peer-based support programme was highlighted. Relevance to clinical practice. Health professionals need to acknowledge the real needs of people with lower extremity amputation and provide them a clear explanation regarding the short-term and long-term health issues associated with amputation during the pre- and post-amputation phase. Health professionals also need to expand the scope of services beyond a physical and prosthetic focus. Supportive psychological and social interventions such as formal support groups and peer support programmes may provide a powerful and inexpensive addition to routine care. Currently, such programmes are unavailable in Taiwan.

Background. Laparoscopic donor nephrectomy (LDN) has become the method of choice for living-donor kidney transplantation. However, LDN may result in decreased renal function in the donor, and risk of end-stage renal failure has been reported. Objective. To evaluate changes in renal function after LDN. Patients and Methods. The study included 51 living donors of renal transplants between March 2002 and December 2008. Before kidney donation, we computed the initial function of the kidney preserved in the donor using 24-hour creatinine clearance (Ccr) and functional ratio as revealed at technetium 99m dimercaptosuccinic acid renal scanning. After kidney donation, serum creatinine concentration (sCr) and Ccr were calculated on postoperative day 2 and every 3 months thereafter. Results. After LDN, mean sCr increased immediately, from 0.90 to 1.31, as did Ccr of the kidney preserved in the donor, from 58.2 to 79.6, a 36.9% increase. A greater percent increase in function was observed in younger donors and those with lower initial Ccr of the preserved kidney. Although 9.8% of donors demonstrated slightly decreased renal function of the preserved kidney at last follow-up, renal function was adequately preserved in most donors. Conclusion. Younger donors and those with lower initial function of the preserved kidney before nephrectomy demonstrate a greater increase in function after nephrectomy. Age might be a risk factor for decreased renal function after LDN. Older potential living donors may need more careful evaluation before kidney donation.

Needle-protective devices have been investigated for decades for preventing health-care workers from infecting blood-borne pathogens. This initial evaluation of a new safety needle system in a disposable conventional syringe (new safety syringe) in a clinical setting was to see how nurses view its safety, usability and compatibility. A convenient sample of 205 nurses was involved and completed a user evaluation questionnaire. The results showed 163 nurses (88.1%) would use the safety syringes if the hospital provided safety syringes. Over 50% agreed that the new device was able to maintain the sterile principles and was easy to operate. Less than 25% disagreed that the new device ‘does not spend more work time’ and ‘does not affect the standard procedure while changing needle’. Positive attitude towards the new device associated with higher ‘job position’ and more ‘work experience’. Further evaluation of reducing incidence of needle-stick injuries is required.

The aim of the present study was to scrutinize the evidence on the use of acupoint stimulation for managing therapy-related adverse events in breast cancer. A comprehensive search was conducted on eight English and Chinese databases to identify clinical trials designed to examine the efficacy of acupressure, acupuncture, or acupoint stimulation (APS) for the management of adverse events due to treatments of breast cancer. Methodological quality of the trials was assessed using a modified Jadad scale. Using pre-determined keywords, 843 possibly relevant titles were identified. Eventually 26 papers, 18 in English and eight in Chinese, satisfied the inclusion criteria and entered the quality assessment stage. The 26 articles were published between 1999 and 2008. They assessed the application of acupoint stimulation on six disparate conditions related to anticancer therapies including vasomotor syndrome, chemotherapy-induced nausea and vomiting, lymphedema, post-operation pain, aromatase inhibitors-related joint pain and leukopenia. Modalities of acupoint stimulation used included traditional acupuncture, acupressure, electroacupuncture, and the use of magnetic device on acupuncture points. Overall, 23 trials (88%) reported positive outcomes on at least one of the conditions examined. However, only nine trials (35%) were of high quality; they had a modified Jadad score of 3 or above. Three high quality trials revealed that acupoint stimulation on P6 (NeiGuang) was beneficial to chemotherapy-induced nausea and vomiting. For other adverse events, the quality of many of the trials identified was poor; no conclusive remarks can be made. Very few minor adverse events were observed, and only in five trials. APS, in particular acupressure on the P6 acupoint, appears beneficial in the management of chemotherapy-induced nausea and vomiting, especially in the acute phase. More well-designed trials using rigorous methodology are required to evaluate the effectiveness of acupoint stimulation interventions on managing other distress symptoms.

Aims and objectives. The aim of this survey was to examine changes of satisfaction with appearance and working status of head and neck tumour patients after tumour excision and micro-reconstructive surgery. Background. Most research related to head and neck tumour reconstruction deals with surgical techniques and complications. No reports discussed impact on personal appearance and working status. Design. This is a retrospective cross-sectional study design with systematical sampling. Methods. One questionnaire which included three instruments was mailed to patients selected systematically from a patient list; 525 questionnaires were mailed to the potential participants and 125 returned. However, only 97 effective questionnaires were analysed. Non-parametric statistics such as Spearman correlation, Wilcoxon signed rank test, Kolmogorov–Smirnov Z test and Kruskal–Wallis test were performed as the data were not normally distributed. Results. Participants reported that they were least satisfied with their face (mean = 2·88 SD 1·34). Compared with presurgery condition, the satisfaction with current appearance was significantly lower (Wilcoxon signed rank test, Z = −6·39, p

Aims. The purpose of this study was to compare the effectiveness between ice towel (moist cryotherapy) and ice-pack (dry cryotherapy) in postoperative care. Background. Orthognathic surgery is often performed to modify the facial appearance of individuals. Cryotherapy was used to reduce the postoperative discomfort, such as local heat, pain and swelling. However, studies to compare the difference in effectiveness between moist and dry cryotherapy are lacking. Design. A quasi-experimental design with follow-ups at regular intervals was conducted. The study involved data collection at the preoperative, postoperative 60, 90, 120, 180 minutes, 24 hours and 48 hours. Methods. Subjects were recruited and assigned to group I (n = 27) and group II (n = 21) by locations. Group I received ice towels whereas group II used ice-packs as a strategy to reduce postoperative discomfort. Subjective indicators of local heat, pain and swelling were measured on postoperative days 1 and 2. When subjects went to postoperative recovery room, local temperatures on both sides of four facial areas and forehead were measured and repeated at scheduled intervals. Results. Both subjective and objective indicators changed during the research period in these two groups. Group I subjects reported less postoperative discomfort, such as heat, swelling and pain. Group II subjects had higher reduction of local temperature in certain areas within 180 minutes. Conclusions. Both moist- and dry cryotherapy reduced postoperative discomfort effectively. The moist cryotherapy was more effective in reducing subjective discomfort caused by the operation. The dry cryotherapy reduced local temperature more effectively in certain areas after surgery. Relevance to clinical practice. Cryotherapy could reduce postoperative discomfort, such as local heat, pain and swelling. When patient comfort is the major outcome of nursing intervention, moist cryotherapy is strongly suggested.

The major objective of the study was to determine the incidence and prevalence of acute and delayed chemotherapy-induced nausea and vomiting (CINV) among patients receiving chemotherapy and assess the accuracy with which medical providers perceive the incidence of CINV in their practice.Specialists, residents and nurses (medical providers) from two cancer centers in Taiwan estimated the incidence of acute and delayed CINV. Chemotherapy-naive patients from the same centers then completed a 5-day nausea and vomiting diary following highly and moderately emetogenic chemotherapy (HEC and MEC) to determine the actual incidence of acute and delayed CINV. Daily nausea ratings were recorded on a 100-mm visual analogue scale (VAS). No nausea was defined as a nausea VAS score5 mm. Vomiting episodes were also recorded. Nausea and vomiting were defined as acute and delayed based on whether they occurred during the first 24 h after chemotherapy, or during days 2-5 after chemotherapy, respectively.In the two oncology centers, 37 medical providers (13 specialists, 4 residents, 20 nurses) and 107 patients were enrolled. The mean patient age was 49.2 years with 76% female and 74% having breast cancer. Of the 107 patients, 39% received HEC and 61% received MEC, and 77% received a 5-HT3 receptor antagonist and 94% received dexamethasone. There were no significant differences between patients with acute CINV and delayed CINV in terms of demographics, chemotherapy treatment or antiemetic treatment. The proportion of patients without alcohol use was significantly higher among patients with delayed CINV than among those with non-delayed CINV. Good control of CINV during the acute period correlated with the control of delayed emesis. There were no significant differences between specialists', residents', and nurses' estimations of the incidence rates of CINV. For HEC given to chemotherapy-naïve patients, the medical providers estimated acute CINV to be 44/41% and delayed CINV to be 61/53%, respectively. However, patient diaries revealed acute CINV to be 43/21% and delayed CINV to be 64/60%, respectively. For MEC given to chemotherapy-naive patients, medical providers estimated acute CINV to be 39/36% and delayed CINV to be 44/39%, respectively. However, patient diaries revealed acute CINV to be 55/18% and delayed CINV to be 74/55%, respectively.Medical providers significantly overestimated the incidence of acute vomiting by 20% and 18% in HEC and MEC patients, respectively. While they correctly estimated the rate of delayed vomiting in HEC patients, they underestimated it by 16% in MEC patients. With respect to nausea, medical providers correctly estimated rates of both acute and delayed nausea in HEC patients, but significantly underestimated rates of acute and delayed nausea by 16% and 30%, respectively, in MEC patients.

Background. Thyroid cancer patients have a survival rate of over 90% after thyroidectomy. However, quality of life with a generic focus has rarely been studied in thyroid cancer survivors. Aim. This paper reports a study to examine and describe factors associated with quality of life among patients with thyroid cancer after operation. Methods. Adult patients who had a thyroidectomy for cancer between January 1999 and June 2001 in a Taiwan city participated in the study. Telephone interviews was completed with 146 (67%) of those 218 eligible, asking about sociodemographic variables, disease/treatment characteristics and social support. Quality of life was measured by the Chinese version of the Quality of Life Index. Multivariate analyses were performed using multiple linear regressions. Result. The regression model showed that patients at 19–36 months after operation had lower quality of life compared with those within 18 months of operation. Current symptoms of fatigue and chills were negatively associated with quality of life. Those who rated the impact of operational scar on activities as ‘high’ had lower quality of life scores. Social support from families and friends had positive effects on quality of life. The model r2 was 48·1%. Conclusions. Nurses could improve quality of life among patients with thyroid cancer by strengthening their social support and educating them in self-management of uncomfortable symptoms. Surgeons should consider types of operation in which the scar would be less likely to influence the patients’ activities.

Severe Acute Respiratory Syndrome (SARS) is a newly identified respiratory disease that threatened Taiwan between April 14 and July 5, 2003. Chang Gung University experienced various SARS-related episodes, such as the postponement of classes for 7 days, the reporting of probable SARS cases, and the isolation of students under Level A and B quarantines. Ninety-eight percent of the students at the university live in dormitories; thus the prevention of SARS became an important issue. Preventive strategies are classified into primary, secondary, and tertiary prevention, with a different focus and strategy for each level of prevention. The university emphasized personal hygiene and a healthy lifestyle as the key to SARS prevention. Our experiences as school nurses during this crisis can help other school nurses to prevent the spread of SARS during similar situations.

Studies exploring the mediating and predictive factors of anxiety and depression for prostate cancer patients in Eastern countries are scant. Guided by the transactional model of stress and coping, this study determined the predictors and mediators of anxiety and depression in prostate cancer patients. The participants comprised 115 prostate cancer patients and 91 partners. The patients and partners completed questionnaires regarding physical symptoms, disease appraisals, coping behaviours, anxiety and depression in the period before confirmation of treatment decisions and 1, 3, 6 and 12 months after treatment. The results revealed that partner anxiety engendered a stressful situation and aggravated patient anxiety. Patients' threat appraisals and affective-oriented coping behaviours mediated the relationships between their anxiety levels and those of their partners. The patients' most recent prostate-specific antigen (PSA) levels and hormonal symptoms were key predictors of their anxiety and depression levels. The patients' harm appraisals mediated the relationships between their most recent PSA levels and hormonal symptoms and depression. Their threat appraisals and affective-oriented coping behaviours mediated the relationships between their hormonal symptoms and anxiety and depression. To manage those key factors, reframing, appraising disease and improving coping behaviours may reduce anxiety and depression levels in prostate cancer patients.

Studies have shown that having breast reconstruction has a positive influence on patient satisfaction and health-related quality of life (HRQoL) at the conclusion of treatment. However, no study has critically evaluated changes to these patient-reported outcomes during the process of undergoing breast reconstruction. This study was to prospectively evaluate changes to patient-centered metrics through the progression of breast reconstruction. An IRB-approved prospective, multi-institutional study was performed for all patients undergoing breast reconstruction between 2009 and 2011. The Breast-Q reconstruction questionnaire was used for evaluation of HRQoL and was administered at five intervals in the perioperative period. Longitudinal evaluation was performed to assess changes to HRQoL metrics during this perioperative interval. One hundred and ten patients were enrolled, and 100 patients (91.9 %) completed appropriate follow-up. Preoperative HRQoL scores were higher in patients electing to forgo reconstruction (P < 0.004), while postoperative HRQoL scores consistently deteriorated at multiple time points following mastectomy as compared to reconstructed patients. On subgroup analysis, results indicated lower initial HRQoL scores in delayed reconstruction (P < 0.05) as compared to immediate reconstruction. These scores did, however, merge at approximately 9 months postoperatively. Changes to HRQoL outcomes occur through progression of breast reconstruction. Within the first year of surgery, early decreases are mirrored by significant increases at later time points above baseline levels when evaluating most forms of reconstruction. Choosing against reconstruction will likely result in continued deterioration of HRQoL for patients undergoing cancer surgery, but steady improvements can be expected if delayed reconstruction is chosen.

To evaluate the effectiveness of clinical pathways (CPs) for paediatric asthma on length of hospital stay, additional visits due to asthma exacerbations, hospital cost, manpower and workload required for implementing CPs.Studies were eligible if they met the following criteria: children (≦18 years) with asthma, hospital or emergency department based, and study designs were (1) randomised controlled trial, (2) controlled clinical trial or (3) controlled before and after study. Two reviewers independently screened references, extracted data and assessed the risk of bias. We resolved disagreement by discussion between authors. Due to an insufficient number of studies and the heterogeneity of interventions and outcomes, we conducted a narrative systematic review with forest plots but did not pool results.About 3155 relevant articles were identified through a literature search, 628 were duplicates removed, 2037 were excluded based on review of titles and abstracts and 117 were excluded because they did not meet inclusion criteria. Seven studies involving 2600 participants met the inclusion criteria. Using asthma CPs may decrease the length of hospital stay; however, CPs did not appear to reduce additional visits due to asthma exacerbations or reduce hospital costs. No eligible studies were found that quantified the manpower and workload for implementing CPs.Current studies suggest CPs may reduce the length of hospital stay, but insufficient evidence is available on total costs or readmissions to justify extensive uptake of asthma CPs in paediatric inpatient care. Higher quality, large randomised controlled trials are required that measure costs and a wider range of outcomes.

The effect of biochemical modulation of weekly high-dose 5-fluorouracil (5-FU) 24 h infusion by leucovorin (LV) in the treatment of 39 consecutive patients with advanced gastric cancer without prior chemotherapy from October 1996 to August 1997 was examined. There were 21 male and 18 female patients with a median age of 56 years. The regimen consisted of 5-FU 2600 mg/m2 and LV 150 mg administered by 24 h infusion weekly for 6 weeks followed by a 2 week break. The treatment was repeated every 8 weeks until disease progression, patient refusal or unacceptable toxicity. Placement of a central vascular device and a portable external infusion pump was required in all patients and was used for outpatient treatment. The response to treatment was evaluated every 8 weeks. A total of 395 chemotherapy treatments were given with a mean of 10 (2-24). This response rate was: 33% (12 of 36) partial response (PR) rate, 33% (12 of 36) stable disease (SD) and 33% (12 of 36) progressive disease (PD). In general, the toxicity was mild but two toxic deaths occurred, one due to neutropenic sepsis and the other due to hyperammonemia. The median time to progression was 4 months. The overall median survival was 7 months. The survivals of the PR, SD and PD were 12, 8 and 5 months, respectively. This regimen showed a modest activity against gastric cancer with acceptable toxicity. Weekly 24 h infusion of high-dose 5-FU with LV in an outpatient setting for patients with gastric cancer is feasible and deserves further study as a basis for combination therapy.

Psychosocial strategies are commonly used to alleviate anxiety and depression in patients with prostate cancer. However, previous studies have shown inconsistent results.This study examined the effects of psychosocial strategies on anxiety and depression in prostate cancer patients.A systematic literature review was conducted using 4 English databases (Pubmed, Cochrane Central Register of Controlled Trials, Cinahl, and PsycInfo) and 2 Chinese databases (Wanfang data and Chinese Electronic Periodical Service) with predetermined keyword searches. We first evaluated 8144 titles and/or abstracts. Fourteen studies that met the inclusion criteria were selected. The criteria for study inclusion were as follows: (1) randomized controlled trial design; (2) control group received usual or standard care; (3) focus on testing psychosocial strategies to improve anxiety and depression symptoms; and (4) studies conducted with prostate cancer patients at any stage of the disease.The quality of the studies was assessed using the Jadad scoring system. Only 35.7% of studies were regarded as high quality. The majority of studies (85.7%) delivered informational and educational or cognitive-behavioral interventions. The results show that psychosocial strategies have a substantial effect on reducing anxiety 3 months after intervention (standard mean difference -1.13, p0.0001) and have a short-term effect on depression symptoms (immediately after intervention: standard mean difference -0.43, p0.001; 3 months after intervention: standard mean difference -0.78, p=0.04).The results indicate that psychosocial strategies were more effective in reducing anxiety and depression compared with routine care, although the effect was not sustainable. However, high-quality methodologies, longer follow-up designs, and innovative psychosocial strategies are suggested for further study.

Background The purpose of this study was to explore the relationship between optimism and life satisfaction among patients with end-stage renal disease who decide to wait or not to wait for kidney transplantation. This cross-sectional, correlation design study was performed from July 2007 to June 2008. Subjects were recruited by purposive sampling in the clinics of kidney transplantation, renal disease, hemodialysis, and peritoneal dialysis. Three hundred fifty questionnaires were distributed, we analyzed the 335 returned including 196 subjects in the waiting group and 139 in the non-waiting group. Parameters included patient basic information, optimism, and life satisfaction scales. Data were analyzed by independent t -student's, chi-square, Pearson correlation, and stepwise multiple regression tests. The subjects in both the waiting and non-waiting groups reported moderate levels of life satisfaction; whereas, the latter reported a greater life satisfaction in general. All participants had good optimism that was positively related to their life satisfaction. Other factors of optimism, age, work ability, waiting transplantation or not, and marriage status were also significantly associated with life satisfaction.

This study is to establish a preliminary computer assisted simulation model for cryoablation of a prostate cancer. It is hoped that the results from this study can supply valuable data for the clinician to refer to before a real cryosurgery or cryotherapy. In order to reach the goal of real implementation, a radiologist and an urologist in a medical center in addition to the engineering specialist from the university participated in this interdisciplinary research program. Firstly, hundreds of the two-dimensional medical imaging photos for the patient are obtained from the magnetic resonance imaging (MRI) in the imaging department of hospital. Through the imaging reconstructive software, these photos are trimmed into building a three-dimensional solid modeling. In this step, the urethra, bladder, prostate and rectum are segmented separately into an engineering graphic solid model with high resolution. Secondly, the number of probes, the position of each probe, and the operating time duration of each probe are determined in advance according to the clinical experience from a surgeon. Meanwhile, these data are transferred into the software package of thermal calculation for numerical simulations. Thirdly, the energy equation in the commercial software is modified to behave bio-heat transfer model by the input of user subroutines. Moreover, the occurrence of phase change during some specified temperature range and the latent heat of fusion are also incorporated into bio-heat transfer model to simulate the clinical situation for cryoablation of prostate cancer. In the simulation model, the three-dimensional transient temperature distributions based on cryosurgery for prostate cancer have been demonstrated precisely. The cryoprobes with various freezing time are considered to observe the temperature distribution. In addition, the frozen rectum is displayed in a region enclosed by a critical isotherm of 0°C. The simulated results for cryosurgery of prostate cancer can be supplied for practicing physicians as reference to greatly improve the effectiveness of cryosurgery.Copyright © 2010 by ASME

Purpose of the research Oral cancer is a common malignant disease in Taiwan. The purpose of this prospective follow-up study was to identify the changes in quality of life for newly diagnosed oral cancer patients during the acute stage. Methods and sample Subjects were recruited from the outpatient department (OPD) in a medical center located in the northern part of Taiwan. 22 subjects completed both the EORTC QLQ-C30 and the EORTC QLQ-H&N35 at diagnosis, postoperative discharge, and the first postoperative follow-up. In addition, 91% of the subjects received surgery only as their main treatment. Key results During the three assessments, as measured by the EORTC QLQ-C30, subjects reported that their physical function was much better at diagnosis than at both postoperative discharge and first postoperative follow-up. Their role functioning was much better at diagnosis than at postoperative discharge. Nevertheless, subjects reported better emotional functioning at the first postoperative follow-up than at the other two points of assessment. Only less financial difficulty was reported in the first postoperative follow-up than at diagnosis and postoperative discharge. For QLQ-H&N35, subjects reported that several symptoms (i.e., swallowing) were more severe at postoperative discharge than at diagnosis. Usage of nutritional supplements at first postoperative follow-up was higher than that at diagnosis. Conclusion Newly diagnosed oral cancer patients reported significant changes in certain domains of both the EORTC QLQ-C30 and QLQ-H&N35. Health professionals need to identify the pattern of changes and to provide supportive care to these new oral cancer patients throughout the treatment process, especially during the planning of discharge.

Cryosurgery is also called as cryoablation or cryoleision. The third generation of cryo-machine use argon gas for cooling and helium for rewarming to destroy cancer cells. The probes may be put into the tumor during surgery or through the skin (percutaneously). After cryosurgery, the frozen tissue thaws and is either naturally absorbed by the body (for internal tumors), or it dissolves and forms a scab (for external tumors). The main purpose of this paper is to establish a preliminary computer assisted simulation in prostate tumor cryosurgery. A radiologist and an urologist in a medical center in addition to the engineering specialist from the university participated in this interdisciplinary research program. The first step of this simulation protocol is to trim hundreds of two-dimensional medical imaging photos from a patient through the imaging reconstructive software into building a three-dimensional solid modeling. The image data for each patient can be obtained from the x-ray computed tomography (CT), or magnetic resonance imaging (MRI) in the imaging department of hospital. It has successfully built up the related knowledge to overcome the complicacy between the medical imaging modalities and engineering graphic solid modeling with high resolution. It is worthy to mention here that the present solid modeling of prostate can demonstrate the variable diameters and courses of the prostate urethra in vivo. The second step focuses on thermal calculation. So far, there has been no existing commercial software for the specific purpose of the bioheat transfer problem. Hence, user subroutines must be added to the existing commercial software to simulate the clinical situation of cryosurgery. For example, the occurrence of phase change during some specified temperature range and the latent heat of fusion are also incorporated into bio-heat transfer model. It has successfully incorporated bioheat transfer model into the software program to fit the reality in thermal medicine. The third step supplies the data and knowledge concerned with the position of a tumor and the related mechanism of metabolism of living tissue and vessels. The number of probes, the position of each probe, and the operating time of each probe will be explored to ensure a complete killing of the tumor tissue while saving as much healthy surrounding tissue as possible. In this study, the three-dimensional transient temperature distributions based on cryosurgery for prostate tumors have been performed for several cases to find the optimal operating conditions. Different cryoprobes with different freezing time are considered to find the temperature distribution. The simulation results for cryosurgery of prostate tumors will be supplied for practicing physicians as reference to greatly improve the effectiveness of cryosurgery.Copyright © 2009 by ASME

Oral tumors and their treatment cause obvious changes in disfigurement and functions of cancer patients. Therefore, some kind of strategy to improve personal appearance is important in nursing care. This prospective study intended to verify the effects of a cosmetic rehabilitation program on the body image of oral cancer patients.A single-blind quasi-experimental design with repeated-measures design was used in this study. The experimental group received instruction on cosmetic rehabilitation, whereas the control group received regular nursing care. The experimental group and control group each had 22 subjects who were requested to complete the questionnaires throughout the regular follow-up (during admission, after 6 weeks, and after 12 weeks). The Multidimensional Body-Self Relations Questionnaire-Appearance Scales (MBSRQ-AS) was selected for data collection.The results showed that subjects in both experimental and control groups reported similar levels of body image in each subscale of MBSRQ-AS before conducting cosmetic rehabilitation. The appearance evaluation subscale was the only one that changed significantly in both the experimental and control groups during the research period. Nevertheless, results of item comparison showed that cosmetic rehabilitation had improved the scores of "I like the way I am," "most people think that I am good looking," "body weight," and "face" in the experimental group.Present study confirmed that cosmetic rehabilitation had similar effects on the body image of oral cancer patients. Integration of cosmetic program into the routine nursing care for oral cancer patients is highly recommended.

The purpose of this study was to explore the prevalence of workplace violence (WPV) committed by patients and their family members against healthcare workers in south Taiwan. WPV incident questionnaires were completed by 205 nurses from a medical facility in south Taiwan. Sixty-two percent of the nurses reported experiencing WPV. The majority of the cases consisted of verbal abuse including threats of violence or threatening words from patients or families. The verbal expressions of violence were mainly due to misunderstanding and drunkenness on the part of patients and their families, and personal problems in the nurses' relationships with doctors and co-workers. The cases of physical WPV reported by the nurses were perpetrated by patients who were mentally unstable. The findings of this study may help hospitals and nurses in avoiding, reducing, and controlling incidents of WPV.

Background: A phase II clinical trial was performed to evaluate the activity and toxicity of bimonthly cisplatin and weekly 24-h infusion of high-dose 5-fluorouracil and leucovorin in patients with advanced gastric cancer. Patients and methods: From September 1997 to March 1998, 23 chemo-naive patients of advanced gastric cancer were enrolled in this study. The regimen consisted of weekly 24-h infusion of 5-FU (2600 mg/m 2 ) and LV 150 mg and bimonthly cisplatin (25–50 mg/m 2 ) bolus for 12 weeks followed by a 2-week break. Results: There were 10 male and 13 female patients with a median age of 52 years. A total of 428 chemotherapy treatments were given with a mean of 11. Seventeen patients were evaluable for response. There were 41% (7/17) partial response, 18% (3/17) stable disease and 41% (7/17) progressive disease. The grade III or IV toxicity included anorexia 35% (8/23), fatigue 26% (6/23), vomiting 17% (4/23) and mucositis 9% (2/23). One patient developed perforated duodenal stump after chemotherapy. One patient died of hyperammonemia-related coma. The median times to disease progression and overall survival were 3.5 and 7 months, respectively. Conclusions: This regimen showed modest activity against gastric cancer. However, there was no survival advantage and there was greater toxicity than with weekly high-dose 5-FU–LV alone.