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The imbalance between supply and demand for organs has been a global crisis, despite the efforts of transplant coordinators from healthcare institutions to promote donor registration. Because the patient’s family has legal rights over the patient’s remains, they can easily undermine any efforts spent on organ procurement by simply refusing the patient’s consent before death in practice. Most related studies seldom mention the decision-making on organ donation from patients’ families. The objectives of this study are to find what are the priorities of those factors acting as the pillars of organ donation by patients’ families. This study applied the analytic network process (ANP) to the prioritization factors contributing toward the willingness of families to donate organs of intensive care unit patients. The purposive sampling method used structured questionnaires and ANP questionnaires to enroll 180 patients’ families from five intensive care units who met the criteria in the regional teaching hospital of southern Taiwan. Through the ANP analysis, it was found that when family members made organ donation decisions, the weights of the four domains are as follows: psychology—47.6%, externality—20.3%, spirituality—19.7%, and physiology—12.3%. The main decision-making factors that influenced the weighting factors were “attitude” (31.5%), “physician’s experience” (0.88%), “religion” (19.3%), and “organ selection” (31.9%). These results could assist organ donation teams to take the best strategies for persuading people to agree with organ donation and formulating an individual organ donation plan.

This study aimed to develop consensus on a decision-making algorithm for benefit-risk assessment of complementary and alternative medicine use in people with diabetes. Delphi-analytic hierarchy process was used with an anonymous voting scheme, based on a three-round procedure, to achieve consensus regarding the important criteria of decision-making algorithm to assess the benefit-risk ratio of complementary and alternative medicine use in people with diabetes. A total of five criteria were considered, namely, the safety of usage (weightage: 46.6%), diabetes-specific patient data (14.6%), complementary and alternative medicine attributes (14.2%), institutional culture in complementary and alternative medicine use (12.8%), and applicability of complementary and alternative medicine (11.8%). The consistency of this hierarchy structure was computed based on the following indices: λmax = 5.041, consistency index = 0.01; random consistency index =1.781; and consistency ratio = 0.009. All criteria to optimize decision-making in ensuring safe use of complementary and alternative medicine in patients with diabetes should be considered by healthcare professionals.

Supportive care is a primary method for treating dengue fever. Understanding the symptoms of dengue fever and its related nursing diagnosis is crucial for nurses as references for individual care. This research study was motivated by the few literature reviews available on this topic.This study was developed to elucidate the symptoms experienced by hospitalized patients with dengue fever and to compare the consistency between symptoms and nursing diagnoses.A retrospective descriptive research method was employed. The data were collected from the electronic medical records of patients in the data pools of two regional hospitals in Kaohsiung City. A total of 105 patient records were acquired covering the period 2014-2016. IBM SPSS Statistics v22 was used to examine the descriptive statistics of patient attributes and symptoms of dengue fever using averages and percentages and the inferential statistics of symptoms, hospitalization days, and nursing diagnosis using the Chi-square test and Kappa consistency coefficient.The average age of inpatients was 51.0 ± 27.3 years and the average length of hospital stays was 6.1 ± 3.6 days. The common symptoms were fever and headache. The consistency between nursing diagnosis and symptoms ranged up to 45.4%, including hyperthermia, acute pain, nausea, risk of ineffective gastrointestinal perfusion, and risk of bleeding. Inconsistency of nursing diagnosis was found to be 27.3%, including anxiety, deficient fluid volume, and risk of falls. The rate of undiagnosed symptoms was found to be 27.3%, including diarrhea, risk of infection, and impaired oral mucous membrane.The reasons for the inconsistency between symptoms and nursing diagnoses may relate to insufficient nursing knowledge of dengue fever and inadequate nursing diagnosis education resulting in insufficient clinical experience / poor judgment amongst nursing staff. The findings of this study suggest the need for continuity of education to make the use of a dengue-fever-symptom checklist more widespread in patient care.登革熱住院病人症狀與護理診斷之相關研究.登革熱臨床處置以支持性療法為主，了解症狀及所需護理診斷可作為護理人員提供個別性照護的參考，但目前無相關研究，故進行本研究。.了解登革熱住院病人的症狀，並探討與護理診斷之一致性。.採回溯性描述性研究設計，資料庫為高雄兩家區域醫院符合疾病診斷碼之住院病人電子病歷，於2014年至2016年間共萃取105位病人資料。運用IBM SPSS Statistics v22，以平均數、百分比進行病人屬性及登革熱症狀之描述性統計，以卡方檢定及Kappa一致性係數進行症狀與住院天數、護理診斷之推論性統計。.住院病人平均51.0 ± 27.3歲，平均住院6.1 ± 3.6天，常見症狀為發燒及頭痛；分析護理診斷與症狀之一致性達45.4%，含體溫過高、急性疼痛、噁心、潛在危險性胃腸灌流失效、潛在危險性出血；無一致性佔27.3%：焦慮、體液容積缺失、潛在危險性跌倒；有症狀卻無護理診斷佔27.3%：腹瀉、潛在危險性感染、口腔黏膜障礙。.臨床症狀與護理診斷不符之可能原因是對登革熱及護理診斷教育不足，導致護理人員在臨床上缺乏經驗或判斷力，建議加強繼續教育並善用「登革熱症狀查檢表」，以提供個別性照護。.

Simulation-based learning that focuses on the development and assessment of communication and counseling skills can help nursing students achieve better skill performance and gain self-confidence with decision-making ability. It is unknown whether virtual simulation as an instructional design significantly improves educational outcomes than a traditional lecture with low-fidelity simulation in students.The aim was to explore the effect of a virtual simulation-based educational smartphone application on nursing students' beliefs and self-efficacy in communicating with patients about complementary and alternative medicine (CAM) use.A quasi-experimental study with pretest-posttest nonequivalent control group design.A total of 101 nursing students, who were in their second or third-year nursing program at a Southern Taiwan university volunteered to participate in the academic year 2020-2021. Participants were assigned to an experimental or control group in an elective course.All participants received a 4-hour lecture that included an in-class lecture with low-fidelity simulation (paper-based scenarios) about the risk-benefit assessment of a patient's CAM use. The experimental group received a series of 13 virtual simulation exercises with clinical scenarios by means of a smartphone application. Data from belief and self-efficacy scales were collected at the beginning and end of the course from September 2020 to February 2021. Descriptive and inferential statistics were analyzed using the IBM® SPSS® version 23.0.Although both groups significantly improved their belief and self-efficacy scale scores, the experimental group had significant differences in overall self-efficacy in communicating with patients about CAM use compared with the control group, specifically the CAM perceptions and self-confidence scores.Although both in-class and virtual simulation improved nursing students' belief and self-efficacy, the virtual simulation-based educational app is effective as an adjunct learning tool in significantly increasing nursing students' self-efficacy in communicating with patients about CAM use to help minimize their risks.

Background and Objectives: Sleeper stretching (SS) can improve the shoulder&rsquo, s range of motion (ROM) for pitchers with glenohumeral internal rotation deficit (GIRD). However, no evidence has proven the effect of Kinesio taping (KT) on shoulder strength and ROM. Therefore, this study compared the effects of SS and KT on shoulder rotation ROM, muscle strength, and sub-acromial distance in pitchers with GIRD. Materials and Methods: Thirty-one pitchers with GIRD were allocated into control, KT, and SS groups. Shoulder rotation ROM, muscle strength, and sub-acromial space were measured before and after treatment with SS or KT. Results: The results revealed that KT and SS significantly enhanced shoulder rotation ROM in pitchers with GIRD. External rotator strength significantly increased following KT but significantly decreased after SS. KT and SS exerted no effects on the sub-acromial space. Conclusions: KT and SS improve shoulder rotation ROM in pitchers with GIRD. In addition, KT improves shoulder external rotator strength, and SS reduces it.

Background and objectives: Faced with the serious problem of an aging population, exercise is one of the most effective ways to maintain the health of the elderly. In recent years, with the popularization of smartphones, the elderly have increasingly accepted technological products that incorporate artificial intelligence (AI). However, there is not much research on using artificial intelligence bracelets to enhance elders&rsquo, motivation and participation in exercise. Therefore, the purpose of this study is to evaluate the effectiveness of the combination of sports smart bracelets and multi-sport training programs on the motivation of the elderly in Macau. Materials and Methods: The study was conducted with a randomized trial design in a 12 week multi-sport exercise training intervention. According to the evaluation, a total of sixty elders&rsquo, pre- and post-test data were included in this study. Results: After 12 weeks of multi-sport exercise training, the evaluation scores on the exercise motivation scale (EMS) increased significantly in the group wearing exercise bracelets and those taking part in the multi-component exercise program, and the degree of progress reached a statistically significant level, but the control group did not show any statistically significant difference. The influence of the combination of sports smart bracelets and multi-sport training programs on elders&rsquo, motivation is clearer. Conclusions: The use of sports smart bracelets by elderly people in conjunction with diverse exercise training can effectively enhance elders&rsquo, motivation and increase their participation in regular exercise. The combination of sports smart bracelets and multi-sport training programs is worth promoting in the elderly population.

Background The use of virtual simulation methods in nursing education offers potential advantages for students to experience and learn in a safe and realistic environment by acquiring skills and attitudes to prepare for clinical experiences. Objective The study's aim was to test the hypothesis that nursing students who used a mobile learning app would have significantly (1) higher levels of knowledge about medication administration and nasotracheal suctioning, (2) better development of skill performances on medication administration and nasotracheal suctioning, (3) higher satisfaction, and (4) lower cognitive load than a control group. Design A randomized experimental study with pretest and posttest design. Settings and participants One hundred nursing students were randomly assigned to an experimental or control group at a Southern Taiwan university's school of nursing. Methods The experimental group received the virtual simulation-based mobile learning app and the control group used traditional paper materials. Participants were assessed on knowledge before and after the intervention. Skill performance and intrinsic and extraneous cognitive load were measured after the intervention. Results The experimental group who used the mobile app had significantly higher knowledge scores, significantly lower intrinsic and extraneous cognitive load, better skill performance, and higher satisfaction than the control group. Conclusions The implementation of a mobile app for simulation learning had a positive impact on nursing students’ knowledge and skill performances as well as the reduction of learning cognitive loading. Nurse educators and researchers should collaborate in developing virtual learning resources to support clinical nursing education. Tweetable abstract: The mobile app for learning achieved higher knowledge and satisfaction scores, demonstrated better skill performance without increasing cognitive load.

Background Conventional healthcare professionals have insufficient knowledge about complementary/alternative medicine (CAM) and often lack competencies to overcome attitudinal barriers to communicate effectively with patients about CAM. Interacting with a virtual simulation-based educational application program may help nurses learn current evidence and acquire communication skills when consulting with patients. Objectives The aim of this pilot study was to evaluate nurses' attitudes towards patients' CAM use and their competency in communicating with patients about CAM after interacting with a virtual simulation-based educational app. Design A quasi-experimental study with one-group, pretest-posttest design. Methods A total of 49 nurses volunteered to participate in the study. Participants interacted with a virtual simulation software app on a smartphone that included audiovisual presentations about CAM, 13 exercises, and a risk-benefit decision assessment. Data about nurses' attitudes and communication competency were collected at baseline and after completing the 13 exercises. Descriptive and comparative statistics were analyzed using the IBM® SPSS® version 22.0. Results Both the nurses' attitudes about patients' CAM use and communication competency improved significantly following the completion of the 13 exercises. The risk-benefit decision scores correlated significantly with the increase in nurses' attitudes and their communication competency. Conclusions Using a virtual simulation-based educational app may help nurses not only increase their attitudes towards CAM but also increase their communication competency in consulting with patients about CAM use.

Nonalcoholic fatty liver disease (NAFLD) is a very common liver disease, and its incidence has significantly increased worldwide. The liver X receptor α (LXRα) is a multifunctional nuclear receptor that controls lipid homeostasis. Inhibition of LXRα transactivation may be beneficial for NAFLD and hyperlipidemia treatment. Ursolic acid (UA) is a plant triterpenoid with many beneficial effects; however, the mechanism of its action on LXRα remains elusive. We evaluated the effects of UA on T0901317 (T090)-induced LXRα activation and steatosis. UA significantly decreased the LXR response element and sterol regulatory element-binding protein-1c ( SREBP-1c) gene promoter activities, mRNA, protein expression of LXRα target genes, and hepatic cellular lipid content in a T090-induced mouse model. A molecular docking study indicated that UA bound competitively with T090 at the LXRα ligand binding domain. UA stimulated AMP-activated protein kinase (AMPK) phosphorylation in hepatic cells and increased corepressor, small heterodimer partner-interacting leucine zipper protein (SMILE) but decreased coactivator, steroid receptor coactivator-1 (SRC-1) recruitment to the SREBP-1c promoter region. In contrast, UA induced SRC-1 binding but decreased SMILE binding to reverse cholesterol transport-related gene promoters in intestinal cells, increasing lipid excretion from intestinal cells. Additionally, UA reduced valproate-induced LXRα mediated and rifampin-induced pregnane X receptor mediated lipogenesis, offering potential treatments for drug-induced hepatic steatosis. Thus, UA displays liver specificity and can be selectively repressed while RCT stimulation by LXRα is preserved and enhanced. This is a novel therapeutic option to treat NAFLD and may be helpful in developing LXR agonists to prevent atherosclerosis.

Liver X receptor α (LXRα) controls important biological and pathophysiological processes such as lipid homeostasis. Inhibiting LXRα transactivation may beneficial in the treatment of nonalcoholic fatty liver disease (NAFLD), which is one of the main causes of liver diseases and hyperlipidemia. Oleanolic acid (OA) is a naturally occurring triterpenoid found in many plants. It has several beneficial effects on biological pathways; however, the mechanisms underlying its effects on LXRα are unclear. Therefore, we evaluated the effects of OA on T0901317-induced LXRα activation and explored whether OA can attenuate hepatic lipogenesis. The results showed that OA significantly decreased the promoter activities of LXR response element and sterol regulatory element binding protein-1c (SREBP-1c). It also decreased the mRNA and protein expression of LXRα target genes. These resulted in reduced hepatocellular lipid content. Our results also revealed that the overall binding pose of OA is similar to the X-ray pose of T0901317. Furthermore, OA stimulated AMP-activated protein kinase phosphorylation in hepatic cells. Additionally, it increased small heterodimer partner-interacting leucine zipper protein (SMILE) but decreased steroid receptor coactivator-1 (SRC-1) recruitment to the SREBP-1c promoter region. OA also enhanced LXRα-mediated induction of reverse cholesterol transport (RCT)-related gene, ATP-binding cassette transporter (ABC) A1, and ABCG1 expression in intestinal cells. It was found that OA increased the binding of SRC-1 but decreased SMILE recruitment to the ABCG1 gene promoter region. Furthermore, it reduced valproate- and rifampin-induced LXRα- and pregnane X receptor-mediated lipogenesis, respectively, which indicates its potential benefit in treating drug-induced hepatic steatosis. The results also show that OA is liver-specific and can be selectively repressed of lipogenesis. Moreover, it preserves and enhances LXRα-induced RCT stimulation. The results show that OA may be a promising treatment for NAFLD. Additionally, it can be used in the development of LXRα agonists to prevent atherosclerosis.

Background Interactions between transcriptional inducers of cytochrome P450 (CYP450) enzymes and therapeutic drugs may be prevented by antagonizing the activation of a nuclear receptor (NR), pregnane X receptor (PXR, NR1I2), thus improving therapeutic efficacy. Purpose In the present study, we aim to identify that ursolic acid (UA), a widely distributed pentacyclic triterpene, may act as an effective antagonist of PXR and its sister NR receptor, constitutive androstane receptor (CAR, NR1I3). Methods The hepatocellular carcinoma cell line, HepG2, was used to evaluate the promoter activity of PXR and CAR target genes, CYP3A4 and CYP2B6, respectively. Catalytic activities, mRNA, and protein expression of CYP3A4 and CYP2B6 were evaluated in a differentiated HepaRG cell line. Coregulation of PXR with coregulators on CYP3A4 promoter response elements was also been characterized. Results Transient transfection assays showed that UA effectively attenuated CYP3A4 and CYP2B6 promoter activities mediated by rifampin (RIF, human PXR agonist) and CITCO (human CAR agonist). These inhibitory effects were well correlated with the expression and catalytic activities of CYP3A4 and CYP2B6. Furthermore, the interaction of co-regulators with PXR and the transcriptional complexes in the CYP3A4 promoter activity and CYP3A4 promoter xenobiotic response element (everted repeat 6, ER6), respectively, were disrupted in the presence of UA. UA showed an antagonistic effect against PXR, and reversed the cytotoxic effects of isoniazid (INH) induced by RIF. Taken together, these results show that UA inhibits the transactivation effects of PXR and CAR, and reduces the expression and function of CYP3A4 and CYP2B6. Conclusion The present study suggests that UA could be a powerful agent for reducing potentially dangerous interactions between transcriptional inducers of CYP enzymes and therapeutic drugs.

The gap between the expectation and the development of role competency is a dilemma that nurse practitioners (NPs) face in clinical settings.This study was designed to explore the perceived importance and actual practice of the role competencies of NPs and to compare the differences between the ideal and practical domains as well as related factors.This cross-sectional design study used Q-sort to collect data. A 56-item "Nurse Practitioner Role Capacity Questionnaire" was used as the research tool. Two questionnaires: Perceptions of Important Role Competencies and Actual Execution of Role Competencies were distributed to NPs twice, at times that were 2 weeks apart. A total of 40 participants were recruited, including 21(52.5%) internal medicine NPs and 19 (47.5%) surgical medicine NPs.The significant differences that were identified in this study between the perceived importance and actual practice of role competencies were, by domain: medical assistance (t = -5.62, p.001), clinical research (t = 4.14, p.001), professional consultation (t = 2.29, p = .027), and direct care (t = 2.21, p = .033). The correlative factors for these differences were: education level (t = -2.17, p = .036) and membership in the Nurse Practitioner Association (t = -2.36, p = .017). NPs with higher levels of education and with membership in the Nurse Practitioner Association earned higher scores for self-expectation in important clinical competency.NPs face discrepancies in their role expectations, in important part due to their role as providers of medical assistance in clinical practical settings. NPs need to learn and demonstrate the roles and functions of advanced nursing practice to enhance nursing professionalism profoundly.比較專科護理師自覺重要角色能力與實際執行角色能力之看法：以Q方法探討.專科護理師（nurse practitioner, NP）之進階護理角色在臨床期盼上仍有落差，導致NP自身對角色能力期待與發展產生困境。.本研究藉由調查NP角色能力之自覺重要性與實際執行現況，來探討理想與實務層面下的差異性及其影響因素。.以橫斷性研究設計，利用Q方法進行資料收集。測量工具以「專科護理師角色能力問卷量表」共56題，二個研究問題相隔二週做調查。研究對象共40名，含內科21位（52.5%）與外科19位（47.5%）。.NP自覺重要角色能力與實際執行角色能力有顯著差異的結構面有：醫療輔助（t = -5.62, p.001）、臨床研究（t = 4.14, p.001）、專業諮商 （t = 2.29, p = .027）及直接照護（t = 2.21, p = .033）。基本屬性中，在教育程度（t = -2.17, p = .036）與是否加入專科護理師學會（t = -2.36, p = .017）達顯著差異，顯示學歷愈高或具專科護理師會員者，對重要角色能力抱持高度自我期許。.專科護理師在面臨角色期望仍有不符，尤其在實務面極重在醫療輔助上，專科護理師需回歸及落實進階護理的角色與功能，以利護理專業之提升。.

Objectives This study aimed to develop and validate scales to assess attitudes towards patient’ s use of TCM (APUTCM) and to measure a communicative competence in TCM (CCTCM) among nurses. Methods The instrument development process was conducted from Sep 2013 to Jul 2014, using the following steps: 1) item development; 2) internal review and refinement; 3) face and content validation; 4) instrument administration to a development sample; and 5) evaluation of validity and reliability. A convenience sample was used to recruit registered and advanced practice nurses who worked in different regions throughout Taiwan. A total of 755 respondents completed the online questionnaire. Statistical analyses were performed using the software of SPSS Version 21.0 and Analysis of Moment Structures (AMOS) version 24.0. Results The scale-level indexes (S-CVI) of content validity for both scales were over 80%. The reliabilities for the 13-item APUTCM scale and for the five-item CCTCM scale were 0.88 and 0.84, respectively. The model suitability for both scales was assessed, and the findings revealed suitable parameters for all indicators: GFI = 0.954, AGFI = 0.932, CFI = 0.959, RMSEA = 0.62, and chi-square/df = 3.891 for APUTCM; and GFI = 0.992, AGFI = 0.969, CFI = 0.992, RMSEA = 0.63, and chi-square/df = 4.04 for CCTCM. The convergent and divergent validity of scores on both scales provided evidence in the expected direction. Conclusion This scale development study provides preliminary evidence that suggests that the 13-item APUTCM and the five-item CCTCM are reliable and valid scales for assessing attitudes toward patient’s TCM use and communicative competence in TCM.

Supplemental Digital Content is available in the text, Background: Athletes with chronic ankle instability (CAI) often develop complications such as pain, instability, and reduced postural control and balance stability, all of which affect athletic performance. This study investigated the effects of a 4° medal wedge intervention on static and dynamic balance in athletes with CAI. Methods: The participants were 24 healthy and 25 CAI athletes. Participants received a 4° medial wedge applied at the rear foot insole and completed the experiment measurements before and after the wedge intervention. The main outcome measures included the area and path length of the center of pressure when participants performed single-leg standing balance in the closed eye condition and the dynamic balance scores of a multiple single-leg hop stabilization test. Results: The single-leg standing balance significantly improved in CAI (P = .027) and control groups (P = .005) after the medial wedge intervention. The dynamic balance scores significantly decreased from 53.00 ± 25.22 to 41.24 ± 21 48 (P = .015) in CAI group after medial wedge intervention. Conclusion: Wearing a 4° medial wedge applied at the rear foot insole improved static and dynamic balance immediately in athletes with CAI. We suggest that clinicians may provide the foot insole to improve balance deficit in athletes having CAI.

To evaluate the effectiveness of a mobile health (mHealth) application, based on self-regulation theory, on patients' knowledge of wound care, skills in changing dressings and anxiety.A prospective randomized controlled trial.Seventy patients (or family members) at a 1,500-bed university hospital in Taiwan were randomized into an experimental (N = 35) or control group (N = 35) from March to December 2016. The experimental group used a mHealth application for wound care; the control group received verbal instructions and a booklet. Instruments to collect data were a wound care knowledge scale, wound care skills scale, State-Trait Anxiety Inventory, and a digital heart variability device. Data were collected at baseline, after three additional demonstrations and before discharge. The generalized estimating equation was used for statistical analysis.The experimental group showed significantly higher levels of wound care knowledge, improved wound care skills, lower levels of state anxiety, and lower heart rate variability than the control group after baseline data collection.Results support hat a mHealth application may be effective in health education. Clinicians can use the results to promote patients' wound care knowledge, enhance their wound care skills, and reduce anxiety related to dressing changes.Lack of wound care knowledge and skills can affect the willingness and ability to perform effective wound dressing changes, producing anxiety and having an impact on a patient's self-care after hospital discharge. mHealth applications (apps) have the potential to deliver health information in targeted and tailored ways that strengthen the self-management of diseases. mHealth app can increase wound care knowledge, improve care skills, and reduce anxiety related to wound care. mHealth app effectively supports self-monitoring of the wound healing process, self-judgement of the wound condition, and self-reaction of wound care accuracy. mHealth app provides step-by-step visual tutorials on wound care that allow patients and family caregivers to take pictures of the wounds and monitor the wound healing process. mHealth app for wound care knowledge is an effective and individualized method for learning.This study was registered by U.S. National Library of Medicine, ClinicalTrials.gov (ID: NCT03683303).目的: 基于自我调节理论,评估移动医疗(mHealth)应用程序对患者伤口护理知识、换药技能和焦虑程度的作用。 设计: 一项前瞻性随机对照试验 方法: 2016年3月至2016年12月,台湾一所拥有1,500张床位的大学附属医院的70名患者(或家属)被随机分为实验组(N = 35)或对照组(N = 35)。实验组使用移动医疗(mHealth)应用程序申请进行伤口护理;对照组收到口头指示和小册子。数据采集工具包括伤口护理知识量表、伤口护理技能量表、状态特质焦虑问卷和数字式心率变异装置。数据收集时间点是治疗前的基础值、三次额外演示后和出院前。采用广义估计方程进行统计分析。 结果: 在进行基础数据收集之后,实验组的伤口护理知识水平、伤口护理技能改善情况、状态特质焦虑水平和心率变异性均显著高于对照组。 结论: 研究结果支持移动医疗(mHealth)应用程序在健康教育中的有效性。临床医生可利用这些结果来加强患者的伤口护理知识,提高他们的伤口护理技能,降低与换药相关的焦虑。 影响: 缺乏伤口护理知识和技能会影响患者进行有效伤口换药的意愿和能力,使患者产生焦虑,并影响患者出院后的自我护理。移动医疗(mHealth)应用程序(apps)有可能提供具有针对性的定制化健康信息,从而加强患者对疾病的自我管理。移动医疗(mHealth)应用程序可以增加患者的伤口护理知识,提高护理技能,降低与伤口护理相关的焦虑。移动医疗(mHealth)应用程序可有效支持伤口愈合过程的自我监控、伤口状况的自我判断以及伤口护理准确性的自我反应。移动医疗(mHealth)应用程序可提供有关伤口护理的分步式可视化教程,允许患者和家庭护理提供者拍摄伤口照片并监控伤口愈合过程。移动医疗(mHealth)伤口护理知识应用程序是一种有效的个性化学习方法。 临床试验: 该研究在美国国立医学图书馆ClinicalTrials.gov注册(编号:NCT03683303)。.

Alteration of elbow range of motion (ROM) has been observed in baseball pitchers. This study aims to compare dominant elbow ROM between early-puberty, late-puberty, and young-adult pitchers.We recruited 62 pitchers, consisting of 17 early-puberty (mean age 13.1 years old), 22 late-puberty (mean age 17.7 years old), and 23 young-adult players (mean age 19.4 years old). Dominant elbow ROMs was measured. One-way ANOVA was used to compare the differences in elbow ROM variables between 3 groups.Late-puberty pitchers exhibited a significantly lower elbow hyperextension and flexion than early-puberty or young-adult pitchers (P .05). Valgus angle was significantly lower in young-adult (7.7°±5.5°) versus early-puberty (12.1°±2.3°) and late-puberty pitchers (13.0°±4.1°; P .05). Young-adult pitchers had the largest forearm supination range (101.2°±18.1°), followed by early-puberty (82.5°±6.5°; P .05) and late-puberty pitchers (70.6°±15.8°). Elbow flexion-hyperextension total range was smallest in late-puberty pitchers (130.3°±7.4°), followed by young-adult (142.6°±9.3°) and early-puberty pitchers (144.6°±8.3°; P .05). Forearm pronation-supination total range was also smallest in late-puberty pitchers (142.0°±20.3°), followed by early-puberty (159.8°±9.5°) and young-adult pitchers (177.2°±20.8°; P .05).These results indicate that careful monitoring of the elbow and forearm range of motion should be undertaken in adolescent baseball pitchers to prevent and or minimize injury risk.

Previous study has showed superior sensory organisation ability in rhythmic gymnasts, but mostly in longitudinal data. With a cross-sectional design, this study used a dual-task paradigm to examine the above phenomenon. Fifteen female rhythmic gymnasts (15.0 ± 1.8 yr.) and matched peers (15.1 ± 2.1 yr.) were recruited. The Sensory Organization Test (SOT) was administered with a concurrent lower-demand (serial subtraction of three, serving as the baseline) or higher-demand (serial subtraction of seven, serving as the dual-task) arithmetic task. The results showed no main effect of group, but a group by level of arithmetic task (P = 0.001) interaction effect on SOT equilibrium score. The higher-demand task facilitated balance performance in the gymnasts, but it impeded performance in the controls, with the differences more pronounced in challenging SOT conditions. With the higher-demand task, the gymnasts adopted a sensory strategy with a higher visual ratio but a smaller somatosensory ratio compared to the controls. Better visual utilisation of sensory organisation ability was apparent in gymnasts, but only when the SOT test was performed with a higher-demand secondary task. We have demonstrated the efficacy of using the dual-task paradigm to identify the superior sensory organisation ability of adolescent rhythmic gymnasts.

Apart from drug control, diabetes management should pay more attention to how lifestyle and daily routine affect blood sugar. This study aimed to explore the impact of m-health programme using a minimal psychological intervention on diabetes patients' knowledge, behavioural, and psychological health. A pretest-posttest single-group pre-experimental study was undertaken with 30 individuals to recruit patients with diabetes. A total of 22 participants completed the 10-week online programme. The pretest-posttest results demonstrated the differences in health behaviour, including foot care, diet control, and exercise. The adoption of m-health that changed and improved patient's self-care; however, the acceptance of using m-health remains a challenge for public dissemination.

BACKGROUND This study was to investigate the effects of prophylactic Kinesio taping and athletic taping on the functional performance of the lower extremities in healthy collegiate players with tapes applied to the dominant leg. METHODS The study design was a prospective, randomized, clinical trial with comparison of groups. The 32 healthy collegiate players who participated in this study were randomly assigned to 2 groups, an athletic taping group and a Kinesio taping group. Active range of motion of ankle joint, ankle plantar-flexor strength, endurance, vertical jump performance, and dynamic balance were used to measure the player's functional performance of the lower extremities. These tests were conducted 2 times at 4-hour intervals before and after different tapes were applied. The repeated measures analysis of variance was used to examine the interaction in functional performance between the groups before and after the tapes applied. RESULTS The results found less limitation of range of motion in active ankle dorsiflexion and significant improvement in dynamic balance in the Kinesio taping group (F=5.150, P=0.031, F=18.766, P

Aims and objectives This study reviewed existing literature to investigate how frequently nurses include complementary and alternative forms of medicine in their clinical practice. In so doing, we investigated nurses' knowledge of and attitudes towards complementary and alternative medicine as well as their ability to communicate the risks and benefits of these therapies with patients. Background Little information is available concerning nurses' knowledge and attitudes towards complementary and alternative medicine or how they incorporate these therapies into their practice. In addition, little is known about the ability of nurses to communicate the risks and benefits of complementary and alternative medicine to their patients. Study design This study used a scoping review method to map and synthesise existing literature. Data sources Both electronic and manual searches were used to identify relevant studies published between January 2007 and January 2014. Review methods The review was conducted in five stages: (1) identification of research question(s), (2) locate studies, (3) selection of studies, (4) charting of data, and (5) collating, summarising, and reporting of results. Results Fifteen papers met the inclusion criteria for this review, among which 53·7% referenced how frequently nurses include complementary and alternative medicine in their practice. We found that 66·4% of nurses had positive attitudes towards complementary and alternative medicine; however, 77·4% did not possess a comprehensive understanding of the associated risks and benefits. In addition, nearly half of the respondents (47·3–67·7%) reported feeling uncomfortable discussing complementary and alternative medicine therapies with their patients. Conclusion The lack of knowledge about complementary and alternative medicine among nurses is a cause for concern, particularly in light of its widespread application. Relevance to clinical practice Findings from this study suggest that health care professionals need to promote evidence informed decision-making in complementary and alternative medicine practice and be knowledgeable enough to discuss complementary and alternative medicine therapies. Without involvement of complementary and alternative medicine communication on the part of our profession, we may put our patients at risk of uninformed and without medical guidance.

Interactions between transcriptional inducers of cytochrome P450 (CYP450) and pharmacological agents might decrease drug efficacy and induce side effects. Such interactions could be prevented using an antagonist of the pregnane X receptor (PXR) and constitutive androstane receptor (CAR). Here, we aimed to determine the antagonistic effect of oleanolic acid (OA) on PXR and CAR. OA attenuated the promoter activities, expressions, and enzyme catalytic activities of CYP3A4 and CYP2B6 mediated by rifampin (RIF) and CITCO. Moreover, OA displayed species specificity for rodent PXR. Interaction of coregulators with PXR and transcriptional complexes on the CYP3A4 promoter was disrupted by OA. Additionally, OA reversed the cytotoxic effects of isoniazid induced by RIF. These data demonstrate that OA inhibited the transactivation of PXR and CAR, reduced the expression and function of CYP3A4 and CYP2B6, and may therefore serve as an effective agent for reducing probability adverse interactions between transcriptional inducers of CYP450 and therapeutic drugs.

Aims To investigate the effects of threshold inspiratory muscle training (IMT) in patients with stages II through IV chronic obstructive pulmonary disease (COPD) using maximum inspiratory pressure (PImax), baseline dyspnoea index (BDI), 6-minute walk test (6MWT), and quality of life (QoL). Background A threshold inspiratory muscle training device provides pressure for inspiratory muscle strength, but there is limited information on the effects of threshold inspiratory muscle training starting at low pressure training. Design Randomized experimental design Methods A total of 55 patients completed this study between September 2013 and April 2014. The experimental group (n=27) was provided medical treatment and routine care, along with five sessions of threshold IMT per week (21-30 minutes per session), accompanied by a progressive increase in the pressure threshold over a period of eight weeks. The control group (n=28) was provided medical treatment and routine care only, without intervention. In the inferential analysis, p values

Compared with regulation-weight baseballs, lightweight baseballs generate lower torque on the shoulder and elbow joints without altering the pitching movement and timing. This study investigates the throwing accuracy, throwing velocity, arm swing velocity, and maximum shoulder external rotation (MSER) of adolescent players after 10 weeks of pitching training with appropriate lightweight baseballs. We assigned 24 adolescent players to a lightweight baseball group (group L) and a regulation-weight baseball group (group R) based on their pretraining throwing velocity. Both groups received pitching training 3 times per week for 10 weeks with 4.4- and 5-oz baseballs. The players' throwing accuracy, throwing velocity, arm swing velocity, and MSER were measured from 10 maximum efforts throws using a regulation-weight baseball before and after undergoing the pitching training. The results showed that the players in group L significantly increased their throwing velocity and arm swing velocity (p0.05) after 10 weeks of pitching training with the 4.4-oz baseball, whereas group R did not (p0.05). Furthermore, the percentage change in the throwing velocity and arm swing velocity of group L was significantly superior to that of group R (p0.05). Thus, we concluded that the 10 weeks of pitching training with an appropriate lightweight baseball substantially enhanced the arm swing velocity and throwing velocity of the adolescent baseball players. These findings suggest that using a lightweight baseball, which can reduce the risk of injury without altering pitching patterns, has positive training effects on players in the rapid physical growth and technique development stage.

Background Adolescent tennis players require sufficient hip and shoulder flexibility to achieve the kinetic chain of a tennis stroke or serve. Hence, the objective of this study is to measure the glenohumeral joint internal and external rotation (IR and ER, respectively) and hip ER range of motion (ROM) and to compare these parameters between experienced and beginner-level adolescent tennis players. Methods Twenty-three adolescent tennis players were divided into experienced (N.=12) and beginner groups (N.=11) on the basis of the adolescent national ranking of the Taiwan Tennis Association. For all participants, the shoulder IR and ER at 90° of abduction were measured, and hip ER which used Partick's Test was also evaluated on the dominant and nondominant sides. The total rotation ROM of the shoulder and the difference in shoulder ER, IR, and total rotation and hip ER between the dominant and nondominant sides were also calculated after measurements. An independent-samples t-test was applied to test the homogeneity of the participants' demographic data and the difference in shoulder IR, ER, and total rotation and hip ER values between the dominant and nondominant sides. Subsequently, a repeated-measured two-way analysis of variance (2 × 2) was used to compare the dominant and nondominant shoulder and hip ROM of the participants between the experienced and beginner groups. Results The experienced group exhibited a significantly less total rotation ROM than the beginner group. In addition, both groups showed less dominant shoulder IR ROM and more dominant shoulder ER ROM compared with the nondominant side. Compared with the experienced group, the beginner group showed an obvious difference in total shoulder rotation between dominant and nondominant sides. More tightness for the hip ER was observed in the experienced group than in the beginner group, but no difference was observed between the dominant and nondominant sides in both groups. Conclusions Beginner adolescent tennis players differ more in the degree of total shoulder ROM between the dominant and nondominant sides than experienced players. Beginner and experienced adolescent tennis players also have more shoulder ER and less IR on the dominant side. The results suggest that beginner-level adolescent tennis players should undergo a stretching and strengthening program to reduce the potential risk of injury and possibly enhance performance.

Rhythmic gymnasts specialise in dynamic balance under sensory conditions of numerous somatosensory, visual, and vestibular stimulations. This study investigated whether adolescent rhythmic gymnasts are superior to peers in Sensory Organisation test (SOT) performance, which quantifies the ability to maintain standing balance in six sensory conditions, and explored whether they plateaued faster during familiarisation with the SOT. Three and six sessions of SOTs were administered to 15 female rhythmic gymnasts (15.0 ± 1.8 years) and matched peers (15.1 ± 2.1 years), respectively. The gymnasts were superior to their peers in terms of fitness measures, and their performance was better in the SOT equilibrium score when visual information was unreliable. The SOT learning effects were shown in more challenging sensory conditions between Sessions 1 and 2 and were equivalent in both groups; however, over time, the gymnasts gained marginally significant better visual ability and relied less on visual sense when unreliable. In conclusion, adolescent rhythmic gymnasts have generally the same sensory organisation ability and learning rates as their peers. However, when visual information is unreliable, they have superior sensory organisation ability and learn faster to rely less on visual sense.

Background/Purpose This study compares heart rate variability (HRV) and systolic blood pressure (SBP) changes of spinal cord injury (SCI) patients during urodynamic study (UDS) with able-bodied controls. Methods Twenty four complete suprasacral SCI patients (12 tetraplegia and 12 paraplegia) and 12 age-matched able-bodied volunteers received BP and HRV evaluation throughout urodynamic examination. We chose seven time points during the examinations: resting, Foley catheter insertion, start of infusion, and infused volume reaching 1/4, 2/4, 3/4 and 4/4 of maximal capacity. At each time point, electrocardiogram with a duration of 5 min was used for power spectral density analysis of HRV. Results Only control subjects displayed significant elevation of SBP during Foley catheter insertion compared to resting values. Both control and tetraplegic groups experienced significant elevation of SBP at maximal bladder capacity compared to resting values. Tetraplegic values were also significantly greater than the other two groups. Control subjects displayed significant elevation of low frequency/high frequency (LF/HF) ratios during Foley catheter insertion and when approaching maximum bladder capacity. These findings were not seen in the paraplegic and tetraplegic groups. However, subgroup analysis of tetraplegic subjects with SBP elevation >50 mmHg demonstrated a similar LF/HF response to the able-bodied controls. Conclusion Tetraplegic patients experienced BP elevation but did not experience significant changes in HRV during bladder distension. This finding may imply that different neurological pathways contribute to AD reaction and HRV changes during bladder distension. However, profound AD during UDS in tetraplegic patients was associated with corresponding changes in HRV. Whether HRV monitoring would be beneficial in SCI patients presenting with significant AD, it needs further studies to elucidate.

Objectives To determine the immediate effects of applied forearm Kinesio taping on maximal grip strength and force sense of healthy collegiate athletes. Design Single group, repeated measures study. Setting Clinical sports medicine laboratory at a university hospital. Participants Twenty-one healthy collegiate athletes voluntarily participated in this study. All subjects were male (average height: 181.24 ± 7.60 cm; average body weight: 72.86 ± 7.03 kg; average age: 20.86 ± 2.59 years). Main Outcome Measures First, maximal grip strength of the dominant hand was assessed by hand-held dynamometer. Then, 50% of maximal grip strength was established as the reference value of force sense. Absolute and related force sense errors and maximal grip strength were measured under three conditions: (1) without taping; (2) with placebo taping; and (3) with Kinesio taping. Results Results revealed no significant differences in maximal grip strength between the three conditions ( p = 0.936). Both related and absolute force sense errors in grip strength measurements significantly increased the accuracy of the results under the three conditions (related force sense errors: p p Conclusion Forearm Kinesio taping may enhance either related or absolute force sense in healthy collegiate athletes. However, Kinesio taping did not result in changes in maximal grip strength in healthy subjects.

OBJECTIVE To test the hypothesis that recreational tennis players transmit more shock impact from the racket to the elbow joint than experienced tennis players during the backhand stroke. Also, to test whether recreational tennis players used higher electromyographic (EMG) activities in common wrist extensor and flexor around epicondylar region at follow-through phase. DESIGN A repeated-measure, cross-sectional study. SETTING National College of Physical Education and Sports at Taipei, Taiwan. PARTICIPANTS Twenty-four male tennis players with no abnormal forearm musculoskeletal injury participated in the study. According to performance level, subjects were categorized into 2 groups: experienced and recreational. MAIN OUTCOME MEASUREMENTS Impact transmission and wrist extensor-flexor EMG for backhand acceleration, impact, and follow-through phases were recorded for each player. An independent t test with a significance level of 0.05 was used to examine mean differences of shock impact and EMG between the 2 test groups. One-way ANOVA associated with Tukey multiple comparisons was used to identify differences among different impact locations and EMG phases. RESULTS Experienced athletes reduced the racket impact to the elbow joint by 89.2%, but recreational players reduced it by only 61.8%. The largest EMG differences were found in the follow-through phase (P

Tai chi has been increasingly applied in osteoporosis patients. However, systematic reviews of the efficacy of this practice have been few and of limited scope.This study reviews previous experimental research work using tai chi as an intervention in postmenopausal women with osteoporosis and to appraise the reported research designs used, tai chi methods used, and outcomes.A systematic review method was used to search 14 databases for articles published between January 1980 and July 2013. Searched keywords included: "tai chi," "osteoporosis," and "postmenopausal women". The 2,458 articles initially identified were reduced to 4 valid articles based on considerations of criteria and repeatability. The 4 valid articles used either a randomized clinical trial (RCT) or a controlled clinical trial (CCT). They were further analyzed and synthesized in terms of common variables such as balance, muscle strength, and quality of life.Three of the 4 studies identified significant pretest / posttest differences in physiological aspects of quality of life in participants but did not obtain consistent results in terms of the psychological aspects. While reports identified a significant and positive tai chi effect on balance, they all used different measurements to do so. Only one of the four studies identified significant improvement in muscle strength. Therefore, this review could not identify clear support for the effectiveness of tai chi on balance or muscle strength.This review did not definitively support the positive effects of tai chi on balance, muscle strength, and quality of life in postmenopausal women with osteoporosis. The designs used in the tai chi interventions may be referenced for future studies. We suggest that future studies use data triangulation rather than a single-item tool to validate the research in order to cross-verify the same information. This may strengthen the research and increase the credibility and the validity of related findings.運用太極拳於停經後骨質疏鬆婦女之成效探討—系統性文獻回顧太極拳是近年來常用於骨質疏鬆症患者的運動介入方案，但目前仍缺乏以停經後骨質疏鬆婦女為族群之系統性文獻探討。本文是回顧以太極拳為介入措施於停經後骨質疏鬆婦女之臨床實驗性研究，對於研究方法、太極拳法及其成效品質做評價，期以利太極拳運動訓練的推廣。以系統文獻回顧法搜尋1980年1月～2013年7月年間發表於14個電子資料庫，關鍵字含太極拳、骨質疏鬆、停經後婦女等字彙群組，搜尋共2,458篇文獻，排除重複性及未符合篩選標準文獻，最後剩下4篇等級較高的隨機控制實驗性研究，並針對文中相同的變項（平衡感、肌力、生活品質）進行整理與分析。4篇研究中，有3篇太極拳對於停經後骨質疏鬆婦女生活品質之生理層面項目較有顯著性成效，但心理成效研究結果較不一致，在平衡感評估，雖使用不同測量工具但都有其成效。肌力只有一篇有顯著性成效，故較難整體評價太極拳對於平衡感與肌力之影響。太極拳對停經後骨質疏鬆婦女於生活品質、平衡感與肌力之影響仍待商確，但其研究操作手法仍可提供未來介入之參考。另建議使用多元化工具測量同一項量以提供更完善的成效評價，增加研究的信效度。

Aging and age-related health problems are major issues of concern for community health services. Yoga is an exercise with both physiological and psychological effects on aging. Although many studies have assessed the effectiveness of yoga in the elderly, little information is available in the literature to support empirical conclusions.This review synthesizes and characterizes findings related to the effects of yoga on depression and quality of sleep in the elderly.Researchers used keywords including yoga, elderly, aged / older adult, depression, sleep, and quality to search 6 electronic databases for relevant studies published prior to March 2013. Inclusion and exclusion criteria were used to screen identified study abstracts. The Jadad scale appraised the quality of identified studies.Seven studies met the inclusion criteria. Five studies found significant changes in participant depression symptoms after doing yoga. Three studies found significant effects on the quality of sleep of participants after 6 months of doing yoga.Yoga significantly reduced the depressive symptoms of elderly participants and improved their quality of sleep after 6 months. Findings were similar for elderly living in institutions and in the community. However, the majority of participants in the assessed studies were women characterized by a high level of social participation and proactive participation in health promotion activities. Future studies should broaden the scope of research to address different aging populations and use long-term cohort observations in order to better elicit the effectiveness of yoga and to develop strategies to introduce yoga into daily activities.瑜珈於老年人憂鬱及睡眠品質之系統性文獻回顧老年健康議題，隨人口老化逐年上升而倍備受重視。瑜珈對促進老年健康之身心運動，雖有多位學者曾探討老年人執行瑜珈的成效，但文獻中鮮少提供具體實證性結論。本文經由系統性文獻回顧，整合及探討瑜珈運用於老年人憂鬱及睡眠品質之成效。搜尋六個中英文資料庫，使用關鍵字瑜珈（yoga）、老年人（elderly, aged, or older adult）、憂鬱（depression）、睡眠品質（sleep and quality）進行搜尋，時間至2013年3月前，於摘要為根據篩選納入及排除條件，並以modified Jadad score評定文獻品質。最後納入七篇文獻，其中有五篇文獻顯示在執行瑜珈後老年人的憂鬱症狀有顯著改善；三篇測量睡眠品質文獻，顯示瑜珈課程六個月後睡眠品質達到顯著改善。不論居住於機構或社區的老人，其憂鬱症狀及睡眠品質在執行六個月瑜珈後皆有顯著性改善。但由於受試者大多為女性、社會參與度高及具有健康促進的觀念者，建議未來可針對不同族群老年人進行探討，此外，亦建議進行世代研究，長期觀察瑜珈者的身心狀態，藉以了解瑜珈應用於老年人之效益，使老年人能將運動與日常生活結合。

The aim of this study was to apply the International Classification of Functioning, Disability and Health - Child and Youth (ICF-CY) framework to identify the factors related to the participation of children with autism.A convenience sample included 162 preschool children with autism ages 36 to 72 months. The raters collected data using the ICF-CY-based questionnaire as an instrument to construct the structural equation modeling of factors associated with participation.The internal structure of the model was acceptable, indicating that the observed variables would suffice in accounting for latent variables. The structural model showed that the performance of participation in children with autism was influenced by body functions and personal factors. All the variables accounted for 77% of the explained variance for activities and for participation by 71% of the children with autism.These findings may provide critical information pertaining to predictive factors of participation for parents, educators, and professionals who work with children with autism.

A nosocomial outbreak of multi-drug-resistant Acinetobacter calcoaceticus-A. baumannii (MDR-ACB) complex infection occurred in a newly constructed building at a 2,500-bed tertiary medical center in Taiwan.An investigation was carried out by molecular approaches to trace the bacteria. Antimicrobial susceptibilities, risk factors, and the occurrence of nosocomial MDR-ACB infections were investigated. From January to December 2009, 53 patients were infected with MDR-ACB, and 23 environmental surveys were performed in two surgical intensive care units (ICUs) within the new building. Forty-two clinical isolates were obtained from patients and 22 samples from nine environmental surveys.Forty clinical isolates (95.2%) and 18 environmental samples (81.8%) were positive for MDR-ACB of type A, the predominant outbreak strain. This strain was identical to that isolated in an outbreak in the old hospital in 2006, as proved by repetitive extragenic palindromic-based polymerase chain reaction and pulsed-field gel electrophoresis. Although the outbreak isolates contained blaOXA-23-like and blaOXA-51-like genes, analysis of the antimicrobial susceptibilities demonstrated increases in resistance to cefepime and imipenem-cilastatin in MDR-ACB isolated in the later outbreak.Not only patients or healthcare workers, but also medical equipment, might have carried the predominant outbreak strain from the old district to the new building. Therefore, even in a new environment, infection control programs must be enforced continually, and healthcare providers must be educated repeatedly to prevent recurrent outbreaks of MDR-ACB infection in the hospital setting.

Ethnopharmacological relevance Helicobacter pylori is associated with the majority of gastric disorders and the antibiotic resistant rates have increased annually worldwide. Anisomeles indica and its constituent, ovatodiolide (OVT), were shown to have bactericide activity against Helicobacter pylori. The aim of this study was to manufacture extracts containing the effective constituent, OVT, and evaluate their bactericidal function and the inhibition of inflammatory responses to Helicobacter pylori infection. Materials and methods Various concentrations of ethanol for extraction of Anisomeles indica were performed and the content of OVT was analyzed by high-performance liquid chromatography (HPLC). The anti-bacterial activity of Anisomeles indica ethanol extracts and the constituent OVT were determined. Additional experiments were performed to investigate the Anisomeles indica ethanol extracts and OVT to inhibit the Helicobacter pylori-induced inflammation of both gastric epithelial cells and macrophages. Results Amongst the extracts tested, 50% and 95% ethanol extracts contained large amount of OVT and showed potent anti-Helicobacter pylori activity. An in vitro Helicobacter pylori-infection model revealed that 95% ethanol extract attenuated Helicobacter pylori-induced nuclear factor kappa B (NF-κB) activity and interleukin (IL)-8 secretion of gastric epithelial cells. In addition, 95% ethanol extract significantly inhibited lipopolysaccharide (LPS)-induced expression of inducible nitric oxide synthase (iNOS), as well as production of nitric oxide (NO) and tumor necrosis factor α (TNF-α) by macrophages. Conclusions This study reveals that Anisomeles indica ethanol extracts containing OVT may be a potent and economic therapeutic agent for Helicobacter pylori infection and attenuation of Helicobacter pylori-mediated inflammation.

Background There is little understanding of the reasons for the limited communication between patients and conventional healthcare professionals regarding patients’ use of complementary and alternative medicine (CAM). The purpose of this study is to explore the predictors of outpatients’ decision to disclose their use of natural products to conventional healthcare professionals. Methods A mixed method design was used. Quantitative data were obtained through a survey and qualitative data were obtained from semi-structured interviews. A total of 257 outpatients who fulfilled the criteria of having used natural products prior to the interview were recruited for this study. Subsequently, 39 patients of those who completed the survey were further selected to take part in an in-depth qualitative interview. Results Predictors of the decision to disclose the use of natural products to conventional healthcare professionals included age, frequency of clinic visits, knowledge of the natural products and the attitude towards the benefits of CAM use. The themes that emerged from the qualitative data included safeness of the natural products, consulting alternative sources of information, apprehension regarding the development of negative relationships with healthcare professionals and reactions from the healthcare professionals. Conclusions Understanding the factors and reasons affecting patients’ decision as to whether to disclose their use of natural products provides an opportunity for conventional healthcare professionals to communicate better with patients. It is important to encourage patients to disclose their use of natural products in order to provide responsible health care as well as increasing patient safety regarding medication usage.