Search

Objectives: The objective of this study was to describe the body image experience of children and adolescents with cancer.This review considered studies that utilised qualitative methods to examine the experience of children and adolescents with cancer. The phenomena of interest were experiences of children and adolescents with cancer living in acute care, home, and community settings of any cultural context. The research was limited to studies published in Chinese or English only.The search strategy sought to find both published and unpublished studies. CINAHL, MEDLINE, Mednar, Scius, ProQuest Dissertations and Theses, electronic theses and dissertations system and Chinese electronic periodical services were used to search the articles.Methodological quality: Each paper was assessed independently by two reviewers for methodological quality. The Joanna Briggs Institute Qualitative Assessment and Review Instrument was used to appraise the methodological quality of the articles. Any disagreements that arose between the reviewers were resolved through discussion with a third reviewer.Qualitative research findings were extracted and pooled using the Joanna Briggs Institute Qualitative Assessment and Review Instrument.Eight papers were included in the review. Four meta-syntheses emerged from the analysis: (1) Being kept away from body: Clinicians should be aware that children and adolescents with cancer feel that they are kept away from normal body, (2) Loss of self-identity: Clinicians should be aware that children and adolescents with cancer feel that they have lost their self-identity, (3) Self-protective strategies and support: Clinicians should understand the protective strategies that children and adolescents with cancer develop and utilise with support from family and friends, and (4) Getting rid of shackles of the body: There should be a strategy to facilitate the development of positive attitudes toward the illness and body image change in children and adolescents with cancer.Children and adolescents with cancer also experience various problems associated with body image change. Repeated courses of treatment lead to loss of a normal orderly life, and may even result in changes in interpersonal interactions. In response to body image change, self-protective coping strategies are developed. Children and adolescents who experience life-threatening cancer come to face body image change positively and may hold a confident attitude towards future life.The implications for practice include: (1) Clinicians should be aware that children and adolescents with cancer feel that they are kept away from normal body; (2) Clinicians should be aware that children and adolescents with cancer feel that they have lost their self-identity; (3) Clinicians should be understand the protective strategies that children and adolescents with cancer develop and utilise with support from family and friends; (4) There should be a strategy to facilitate the development of positive attitudes toward the illness and body image change in children and adolescents with cancer.The research tools concerning social support and guidance can be further developed in the future to increase the confidence and capacity of children and adolescents with cancer to face body image change and reduce psychological stress.

Aims and objectives To probe into parents’ anticipatory loss of school-age children with Type I or II spinal muscular atrophy. Background Spinal muscular atrophy is a rare disorder that causes death. Children die early due to either gradual atrophy or an infection of the lungs. Therefore, family members experience anticipatory loss, which causes grief before the actual loss. Family members feel physically and mentally exhausted, which results in a family crisis. Therefore, it is important to explore their experiences related to anticipatory loss to assist with the adjustment of the families to their circumstances. Design This study applied a phenomenology method and purposive sampling. Participants The 19 parents who participated in this study were referred to us by two medical centers in Taiwan. Their average age was 32–49 years. Methods Using in-depth interviews, this study explored parents’ anticipatory loss. The interviews were recorded and transcribed. Meanings were extracted using Giorgi analysis, and precision was assessed according to Guba and Lincoln, which was treated as the evaluation standard. Results Four themes were identified from the parents’ interviews. The themes included enduring the helplessness and pressure of care, suffering due to the child's rare and unknown condition, loss of hope and a reinforcement of the parent–child attachment, and avoiding the pressure of death and enriching the child's life. Conclusions The research findings help nurses identify anticipatory loss among parents of school-age children with type I or II spinal muscular atrophy. They enhance health professionals’ understanding of the panic that occurs in the society surrounding the families, family members’ dynamic relationships, and the families’ demands for care. Relevance to clinical practice In an attempt to providing intersubjective empathy and support with family having a child with type I and II SMA, nurses may recognize relevant family reactions and enhancing their hope and parent-child attachment. Encourage family members and child go beyond the pressure of death and create customized care plans meeting families’ emotional and medical needs.

IntroductionTardive dyskinesia (TD), an often-irreversible movement disorder, develops in patients treated withantipsychotics. Although antipsychotic dose reduction has been utilized in the management of TD, the benefits and risks of lowering doses have not been well studied and could cause additional burden to patients.ObjectiveTo analyze the healthcare burden of antipsychotic dose reduction in patients with schizophrenia.MethodsMedical claims from six US states spanning 6 years are retrospectively analyzed for ≥10% or ≥30% antipsychotic dosereductions and compared with those from patients receiving stable doses. Outcomes measured include inpatient admissions and emergency room (ER) visits for schizophrenia, all psychiatric disorders, and all causes.ResultsBaseline analysis revealed 17,984 patients with ≥10% and 14,029 patients with ≥30% dose reduction. Patients with≥10% dose reduction and matched controls were similar in age (mean 45.5 years), gender (51% male) and healthcare plan type. Preliminary analyses indicate that ≥10% dose reduction is associated with increased risk of admission or ER visit for schizophrenia (hazard ratio [HR] 1.26; 95% confidence interval [CI] 1.18, 1.35; PConclusionsPatients with antipsychotic dose reductions may be at risk for significant increases in hospital utilization rates. This suggests that dose reductions may increase overall healthcare burden in some schizophrenia patients, and highlights the need for alternative strategies in the management of TD.Presented at: Psych Congress; September 16–19, 2017; New Orleans, Louisiana, USA.Funding AcknowledgementsThis study was funded by Teva Pharmaceutical Industries, Petach Tikva, Israel.

Granular nanowires with a diameter of about 60 nm were fabricated from cuprous oxide (Cu2O) by an electrochemical method using anodic aluminium oxide as the template. A non-enzymatic sensor for hydrogen peroxide (H2O2) was then developed on the basis of a gold electrode modified with Cu2O nanowires and Nafion. The resulting sensor enables the determination of H2O2 with a sensitivity of 745 μA mM−1 cm−2, over a wide linear range (0.25 μM to 5.0 mM), and with a low detection limit (0.12 μM). The results demonstrate that the use of such granular nanowires provides a promising tool for the design of non-enzymatic chemical sensors.

The Y-branched Ni nanowires were fabricated inside the as-synthesized nanochannels of anodic aluminum oxide (AAO) template by the electrochemical deposition method. Investigation results demonstrated that the stem and the two branches of the branched Ni nanowires were different in structural characteristics. A corresponding growth process was proposed to describe the formation of Y-branched Ni nanowires. The tailored angle-dependent magnetic properties were also measured and discussed. The special branched structure accompanied by its magnetic properties may endow the product presented here with some potential applications in future electromagnetic nanodevices.

Children and adolescents with cancer are confronted with many challenges. This review considered studies that used qualitative methods to examine the body image experience of children and adolescents with cancer. A systematic literature search of English and Chinese databases was undertaken, covering the period between 1960 and October 2010. Qualitative research findings were extracted and pooled using the Joanna Briggs Institute Qualitative Assessment and Review Instrument. Eight papers met the inclusion criteria. The derived four metasyntheses included being distanced from the body, loss of self-identity, self-protective strategies and support, and getting rid of the shackles of the body. In conclusion, children and adolescents with cancer also experience various problems associated with changes in their body image. Repeated courses of treatment lead to loss of a normal, orderly life, and might even result in changes in interpersonal interactions. In response to body image change, individuals with cancer develop self-protective, coping strategies. Children and adolescents who experience life-threatening cancer come to face body image change positively, and might hold a confident attitude toward their future.

Tubular tetrapod magnesium oxide (tt-MgO) can be synthesized by thermal evaporation of Mg metal powder with a pre-grown tetrapod ZnO template. The morphology and structure of the tt-MgO were characterized by X-ray diffraction, scanning electron microscopy and transmission electron microscopy. A composite prepared from tt-MgO, nafion and horseradish peroxidase was employed to modify a gold electrode to result in an electrochemical biosensor for hydrogen peroxide that displays excellent sensitivity and rapid response in the presence of hydroquinone as a mediator. Its sensitivity is 335.4 μA mM-1 cm-2, its response is linear in the range from 1.0 to 450 μM, and the detection limit is 0.3 μM. These results demonstrate that tt-MgO provides a promising material for the designs of biosensors.

This study examined the relationships between asthma knowledge, behavior management, and social adaptation among school-age children with asthma. A total of 210 school-age asthmatic children and their parents were recruited from a medical hospital in Taiwan. The children completed asthma knowledge and behavior management questionnaires, and their parents completed the Child and Adolescent Adjustment Profile. There was a statistically significant positive correlation between behavior management and social adaptation among asthmatic children. Asthma knowledge and behavior management were positively associated but did not correlate with children's social adaptation. The behavior management of the children acted as a predictor of their social adaptation. These findings suggest that efforts to raise children's asthma knowledge will benefit these individuals in terms of behavior management. The introduction of asthma behavior management plans could facilitate the social adaptation of asthmatic children and, in particular, increase their independence and reduce their withdrawal as well as enhance their self-confidence and self-esteem.

Fatigue is one of the most distressing and prevalent symptoms reported by paediatric oncology patients. With the increase in cancer survival rate, how to control children's cancer-related fatigue during treatments or the coexisting period with the disease to further increase their quality of life has become the focus of medical teams who provide care to children with cancer.The objective of this systematic review was to synthesise the best available evidence concerning the effectiveness of non-pharmacological interventions on fatigue in children and adolescents with cancer.The search strategy aimed to find studies published between 1960 and 2010, in either the English or Chinese languages. Reference lists of studies that met the inclusion criteria were also searched for additional studies.This review included randomised controlled trials and quasi-experimental studies that examined the effectiveness of non-pharmacological interventions for fatigue in children and adolescents with cancer.Children and adolescents aged between one to 18 years old, with cancer either during or after the chemotherapy. The types of cancer included were acute lymphoblastic leukaemia, acute myeloid leukaemia, lymphoma and solid tumours.Non-pharmacological interventions for fatigue in children and adolescents with cancer including: activity enhancement (exercise, physical activity), psychosocial interventions, cognitive behavioural therapy, stress management, relaxation, nutrition consultation, massage and educational interventions. The intervention descriptions included the length, frequency, setting and intervention providers.The outcome measures considered fatigue scores assessment.The review considered studies conducted either in a hospital or a community setting.The data were extracted and synthesised using the standardised data extraction tool and synthesis function offered by the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument.The review included six studies - five English-language papers and one Chinese-language paper. Meta-analysis did not show a statistically significant impact on the effectiveness of exercise interventions in reducing overall fatigue in children and adolescents with cancer. Exercise interventions did lead to a statistically significant improvement (p = 0.01) in general fatigue (i.e. tiredness, physical weakness) (effect size = -0.76; 95% Confidence Interval -1.35 to -0.17).The results of this systematic review show that exercise interventions can effectively reduce the level of general fatigue of children aged six to 18 years. No strong conclusions can be made for the use of massage therapy or health education measures, as there was only one article for each of these interventions.The review provides an evidenced-based guide to future priorities for clinical practice. Exercise intervention could reduce the level of general fatigue of children aged six to 18 years. In particular, exercise interventions for fatigue are feasible and safe.There is still a lack of rigorous research on this specific topic. Further research requires more rigorous study design and reporting of methodological issues, such as randomised controlled trials using concealment of allocation. Other non-pharmacological interventions for this problem should also be examined, including cognitive behavioural therapy, stress management, relaxation, support groups and massage therapy.

The composition of Deoxidized Samples of Bayan Obo Oxidized Iron Ore is complex with high content of residual reducing C, Fe phase in the RDP is ferrous metal what is hard and malleable resulting in pessimistic grindability. Gravity-magnetic separation process flow is adopted with C pre-rejecting, stage grinding (-0.074mm -57.18%, -0.074mm -85.66%) and coarse-fine fraction separate treatment base on RDP process characteristic. The final concentrate has 92.02% Fe with 93.27% Fe recovery, 94.18% Fe metallization which may utilize as rough materials for steelmaking and the final tailings has 15.10% REO with 97.15% REO recovery which may utilize as rough materials for REO concentration.

Background: Research on cross-national marriages in Taiwan has concentrated on development and adaptation issues related to the children of such relationships. Taiwan has seen a dramatic increase in immigration and cultural diversity over the past 2 decades. Understanding the dynamics of cross-national families from initial courtship through marriage and having and raising children is, thus, important. Little research has been done on the role or caring experiences of the father in cross-national families.Purpose: This study used the lived experiences of fathers in cross-national marriages with children to explore the essence of their role.Methods: Colaizzi's phenomenological approach was used to investigate subject experiences. Subjects were purposively chosen from a general hospital in Taiwan. Subject selection criteria included being a father in a cross-national marriage, having a child born in that marriage and the child was free of major health problems. Eleven fathers participated in the study. Sample size was determined by the saturation principle of phenomenology. Data collected included family demographic characteristics and open interview information. Narrative data were analyzed using Colaizzi's phenomenological approach. Trustworthiness was examined using principles from Lincoln and Guba.Results: Subject experiences concentrated on four themes: (a) achievement of a life mission, (b) marital difficulties, (c) activities external to the framework of family life, and (d) majesty and responsibility.Conclusions/Implications for Practice: Fathers in the childbearing stage of cross-national marriages have experienced preparation for marriage, constructed a marital life together including relationships with other family members, and experienced the majesty and responsibility associated with their marriage. These findings provide knowledge for nurses that will help further enhance the role of fathers while developing and promoting family health within this subpopulation in Taiwan.

Aim and objectives. The aim of the study was to examine the effect of a programme designed to reduce family boundary ambiguity in families who care for children with epilepsy. Background. When parents are caring for an epileptic child, they may experience unclear perceptions about whether the child is psychologically included in the family and develop unclear expectations regarding role performance in the family. Some studies have identified boundary ambiguity as a possible antecedent to relationship problems that are associated with negative outcomes in the areas of parental well-being and family functioning. There is a need to develop family nursing interventions that will reduce family boundary ambiguity when the family is caring for children with epilepsy. Design. A pretest, post-test, one group, quasi-experimental design was used in this study. Methods. This study was made up of three phases: first, the establishing of a parental needs checklist and the development of a parental education information handbook; second, the carrying out of a family assessment including the analysis of the meaning of their experiences and needs and the construction of an educational dialogue and finally, an outcomes evaluation after three months. Seventeen mothers participated in the study. Results. The study found that there were statistically significant improvements in family boundary ambiguity and maternal depression was reduced. Conclusions. This study illustrates nursing intervention that involves the integrating of phenomenological principles into the nursing care process. Specifically, Husserlian phenomenology is able to be helpful to nursing practice, especially the concepts of intentionality, intersubjectivity, empathy and bracketing. Relevance to clinical practice. This study supported the conceptual framework involved in the construction of the meaning of the situation, the enhancement of mastery over the situation and reconstruction of identity. These items are resiliency factors that provided a mechanism that helps to reduce boundary ambiguity when a family is caring for a child with epilepsy.

The objective of this meta-synthesis study was to describe the nature of the experience of adult ventilator-dependent patients.This review considered studies utilized qualitative methods to examine the experience of adult with ventilator. The phenomena of interest were experiences of patients who were treated with ventilator for both short term and long term in ICU settings or home settings. The research was limited to studies published in Chinese or in English language.The searching strategy sought to find both published and unpublished studies. The CINAHL, PubMed, MEDLINE, Cochrane Library, Chinese Periodicals Index and JIB website were used to search the articles. The preliminary keywords were drawn from the natural language terms of the topic, in the title, abstract and subject descriptors.Each paper was assessed independently by two reviewers for methodological quality. The Joanna Briggs Institute's Qualitative Assessment and Review Instrument were used to appraisal the methodological quality of the articles. Any disagreements that arose between the reviewers were resolved through discussion with a third reviewer.Qualitative research findings were pooled and the data analysis process involved synthesizing findings to generate a set of statements that represent the nature of the experiences of ventilator-dependent adult patients. The categories and themes/meta-syntheses were emerged from the analysis process.A total of 997 papers were identified from various database and hand searches. Nineteen papers were critically appraised and 15 met inclusion criteria. Four papers were excluded because they did not meet the inclusion criteria. Five themes/meta-syntheses emerged from the analysis: 1). The feelings of fear due to being dependent on ventilator and the loss of control of life, 2). Disconnection with reality, 3). Impaired embodiment (body image and body boundary), 4). Construction of coping patterns, 5). Trust and caring relationship.The five themes/meta-syntheses derived from the review represent the patients' experiences in regarding the threatening of the integrity of self, self-other and self-environment relationships, the coping patterns and resilient resources to maintain their self-identify and the meaning of life. These findings also illustrate the resiliency factors for those patients to cope with this stressful situation.The implications to practice include enhancing the trust relationship with health professionals, as well as the nursing actions prior to suction, during the suction procedure and post suction in related to release their psychological distress and empower their resilience factors was suggested.Furthermore, the further research could focus on the development and implementation of support programs for the patients, families, and health professionals, as well as the research regarding the reduction of psychological distress and empower the coping patterns.

Aims and objectives. This study used purposive sampling through semi-structured interviews to obtain the experiences of mothers of 7–11-year-old children with asthma who were assisting their child’s adaptation to school life. Background. Children with asthma often have problems with social adaptation, including school absenteeism, limits to their activity and bullying by peers. From kindergarten to elementary school, it is a transitional process where the child experiences multiple changes in the body, mind and social situations. It can be difficult for mothers of children with asthma to assist their children with their adaptation to school life. Design. A qualitative enquiry design was used. Methods. A total of 15 mothers having elementary school children with asthma in grades 1–3 were interviewed. Participants were contacted at the outpatient department of a medical centre in Taiwan. Verbatim transcriptions of the interviews were examined by the content analysis method. After analysis of the interview data of the 15 informants, no new themes had emerged. Lincoln and Guba’s trustworthiness criteria were employed to evaluate methodological rigour. Results. There were four themes that formed part of the mothers’ experiences. Those were: (1) being concerned about the child’s adaptation to school life, (2) improving attitudes and relieving symptoms, (3) establishing the child’s self-management abilities and (4) bearing role strain and normalising the life of the child. Conclusions. The findings of this study should help health professionals and schoolteachers to understand the needs of families and mothers who have a child with asthma. The findings provide appropriate information and resources to assist the children’s adjustment to school life. Relevance to clinical practice. The findings indicate that nursing professionals should provide child-focused and family-centred care that will assist parents of children with asthma to adjust to school life.

Background: Almost 80% of patients in the intensive care unit are intubated and on mechanical ventilation. Thus, their airway clearance ability is compromised and their risk of lung collapse increased. A variety of interventions are used to enhance airway clearance with the goal of preventing atelectasis and infection. The purpose of this study was to evaluate the effect of a chest vibration nursing intervention on the expectoration of airway secretions and in preventing lung collapse among ventilated critically ill patients. Methods: This was a randomized, single-blind experimental study. A total of 95 patients were enrolled from 2 ICUs and randomly assigned into either the experimental group (n = 50) or control group (n = 45). Patients in the control group received routine positioning care, which consisted of a change in body position every 2 hours. Patients in the experimental group received routine positioning care plus the use of chest vibration nursing intervention for 72 hours. This intervention consisted of placing a mechanical chest wall vibration pad on the patient’s back for 60 minutes when the patient was in a supine position. The chest vibration intervention was performed 6 times a day. Outcome variables were dry sputum weight (DSW) per 24 hours and lung collapse index (LCI); these were measured at 24, 48 and 72 hours. Results: Patients who received the chest vibration nursing intervention had greater DSW and lower LCI after 24 hours. Pre-test DSW and group could explain 48.2% of the variance in DSW at 24 hours. The LCI at 24, 48 and 72 hours were all significantly improved in the intervention group compared to the control group. The previous LCI measured was the most significant predictor of the next LCI measured. A significant difference was found between the control and experimental groups in their 24-, 48- and 72-hour DSW and LCI after vibration, when monitored by the generalized estimating equation in time sequence. Conclusion: The results suggest that chest vibration may contribute to expectoration and thus improve lung collapse among ventilated patients in an ICU. Chest vibration nursing intervention is a safe and effective alternative pulmonary clearance method and can be used on patients who are on ventilators in ICUs. [J Chin Med Assoc 2009;72(6):316–322]

Review Question The specific question of this review are: What are the experience of nurses telling a terminal cancer patient of a diagnosis or prognosis? Inclusion criteria Phenomena of interest This review will consider studies that explore the nurse’s experiences of truth telling of a diagnosis and prognosis to the terminal cancer patient. Types of Participants This review will consider studies that include nurses involved in truth telling to terminal cancer patients, and who have worked in an oncology unit or hospice care unit for greater than one year.

Aim. The purpose of this study was to explore the essence of family experiences in terms of family resources and how these assist a single-parent caring for a child with cancer. Background. When families face stresses caused by cancer, they need to readjust their roles, interactive patterns and relationships, both inside and outside the family. During the adaptation process, family resources may assist recovery from stress and a return to equilibrium. Most research has emphasised the support resources available to two-parent families during the treatment process. There is a lack of information on the experiences of single-parent families and their available resources together with the functions and roles played by family resources during the adjustment process. Design. Qualitative. Results. Five major themes were identified: (i) facing the disease with courage; (ii) hope kindled by professionals; (iii) constructing parental role ability; (iv) assisting the children to live with the illness; and (v) family flexibility. Conclusion. The results of the current study demonstrate that single-parent families with a child suffering from cancer employ family resources to assist family adjustment and to maintain family function/equilibrium. These results explain the dynamic interactions between the multiple levels of resources available to the family. Relevance to clinical practice. The study results provide evidence-based information that identifies the nature of family resources in single-parent families and describes how these resources can be applied to assist the families.

The purpose of this study was to use a phenomenological approach to explore the essential structure of mothers' life experience when helping their first- to third-grade children with Type 1 diabetes mellitus (T1DM) make life adjustments at school. Twelve mothers whose children had been diagnosed with T1DM participated in this study at a teaching hospital in Taipei, Taiwan. Study results revealed six themes and identified the presence of various dynamic relationships between T1DM symptoms, the children's development, and collaborative self-care.

Background— Endometriosis is a prevalent gynecologic disease associated with systemic chronic inflammation, heightened oxidative stress, and atherogenic lipid profile that may increase women’s risk for coronary heart disease (CHD). Methods and Results— We examined the prospective association between laparoscopically confirmed endometriosis and subsequent CHD among 116 430 women in the Nurses’ Health Study II (1989–2009). Participants with a history of heart disease and stroke were excluded. When compared with women without endometriosis, women with laparoscopically confirmed endometriosis had a higher risk of myocardial infarction (relative risk, 1.52; 95% confidence interval, 1.17–1.98), angiographically confirmed angina (1.91; 1.59–2.29), coronary artery bypass graft surgery/coronary angioplasty procedure/stent (1.35; 1.08–1.69), or any of these CHD end points combined (1.62; 1.39–1.89), independent of potential demographic, anthropometric, family history, reproductive, and lifestyle confounders. Relative risk for the combined CHD end point was highest among women aged ≤40 years (3.08; 2.02–4.70) and decreased as age increased (40< age ≤50 years, 1.65; 1.35–2.02; 50< age ≤55 years, 1.44; 1.07–1.94; and age >55 years, 0.98; 0.56–1.72; P value, test for heterogeneity=0.001). Having had a hysterectomy/oophorectomy was associated with higher risk of combined CHD compared with not having had a hysterectomy/oophorectomy (1.51; 1.34–1.71). A percentage of 42 of the association between endometriosis and CHD could be explained by greater frequency of hysterectomy/oophorectomy and earlier age at surgery after endometriosis diagnosis. Conclusions— In this large, prospective cohort, laparoscopically confirmed endometriosis was associated with increased risk of CHD. The association was strongest among young women. Hysterectomy/oophorectomy was associated with higher risk of CHD and could partially explain the association between endometriosis and CHD.

Background When there is a child with cancer in the family, the entire family is affected. Childhood cancer is a highly stressful experience that affects the adaptation of family member to psychosocial tasks. Many of the family stresses and changes that accompany childhood cancer have a severe impact on siblings. An understanding of the experiences and needs of such siblings is vital. Objective The aim of this study was to understand the nature of the overall experiences of a child who has a brother or sister with cancer. Methods Searches of CINAHL, MEDLINE/PubMed, Science Direct, Scopus, Eric, and Chinese electronic periodical services identified 10 qualitative studies that were published between 1960 and 2013. An appraisal of the primary studies was carried out using the Joanna Briggs Institute Qualitative Assessment and Review Instrument. Results Siblings of children with cancer were found to have experienced 4 themes: (1) the disintegration of life, (2) marginalization within their family relationships, (3) self-transcendence during the normalization of family relationships, and (4) maintenance of family integrity and family normality. Conclusions Siblings of children with cancer experience a great deal of chaos in their family life, and this affects their self-esteem and family intimacy. Being with the sick child may help siblings understand the sick child's suffering and experiences. Implications for practice The findings of this review provide evidence to help health professionals to assess the needs of the siblings to enhance their sense of self within the family. Providing the siblings with suitable resources should result in better adjustment.

Objectives The aetiologies of endometriosis, systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) are all characterised by immune dysfunction. SLE and RA occur more often in women, and reproductive and hormonal factors have been shown to be related to increased risk. However, only one previous study has evaluated the temporal association between endometriosis and SLE or RA. We sought to investigate the association between laparoscopically confirmed endometriosis and subsequently diagnosed SLE and RA. Methods We analysed data from the Nurses’ Health Study II (n=114 453 women) over a 22-year follow-up period. Multivariable, time-varying Cox proportional hazards models were used to calculate HRs and 95% CIs for the association between laparoscopically confirmed endometriosis and confirmed incident SLE or RA. Results From 1989 to 2011, 103 incident cases of SLE and 390 cases of RA were confirmed. Laparoscopically confirmed endometriosis was significantly associated with subsequent SLE diagnosis (HR=2.03; CI 1.17 to 3.51) and RA diagnosis (HR=1.41; CI 1.05 to 1.89). These associations were robust to adjustment for SLE or RA risk factors and for potential confounders; however, adjustment for hysterectomy and oophorectomy attenuated both relations such that they were no longer significant. No significant differences by infertility status or age ( Conclusions Our findings suggest an association between endometriosis and risk of SLE and RA. It remains to be understood whether and how endometriosis itself, or hysterectomy or other factors associated with endometriosis, is related to risk of SLE or RA.

The role of the acute care nurse practitioner in Taiwan has changed significantly since the 1990s due in significant part to a shortage of interns and resident physicians in acute care settings. The first year of professional practice represents an important transitional year during which new professionals develop their competency to provide high-quality care to hospitalized patients. As the actual experience of individuals undergoing this transitional process into their new role has yet to be fully explored, this research studied and categorized the experiences of acute care nurse practitioners during their first year of role transition under the collaborative model of practice. We used a qualitative inquiry method with in-depth interviews to investigate the relevant experiences of 10 acute care nurse practitioners working at a medical center in Taiwan. Results show that the experience of expert nurses in their transition to acute care nurse practitioners passed through three phases during the first year under the collaborative practice model. These phases include the role ambiguity, role acquisition, and role implementation phases. Each phase contained a set of sub-themes which describe the multiple dimensions of this experience. This study highlights the experiences, stresses and accomplishments of acute care nurse practitioners during their initial year of advanced practice.

Aim. This paper reports a study examining the stress that fathers experience when caring for a child with epilepsy. Background. A seizure, which is frightening and potentially damaging, creates uncertainty about its possible effects and threatens the integrity of family systems. In the Chinese social context, epilepsy is stereotyped ‘sudden craziness’ of people and affected family feel shamed by the diagnosis. When a child has epilepsy, the stereotype of epilepsy affects the family experience in terms of stress and their coping process. Few studies have focused on how a father with an ill child adapts to family stress. Methods. This study was based on the resiliency model of family stress, adjustment, and adaptation, and was designed to examine the relationships among fathers’ uncertainty, coping strategies, and depression. From three teaching hospitals in Taiwan, 210 fathers were recruited. A pilot study was conducted to establish the reliability and face validity of the Chinese language version of the Coping Health Inventory for Parents. Findings. Results showed that paternal uncertainty was negatively associated with the total Coping Health Inventory for Parents score for family coping patterns for factors I, II, and III. Uncertainty and coping strategies for factors II and III were indicators of paternal depression and accounted for 10·3% of the total variance. Conclusions. The results give insight into the unique family stress that fathers experience as a result of the interaction between the social context of a child with epilepsy and the family's coping patterns. They also suggest ways to improve family-centred nursing interventions to help parents establish effective caring patterns to manage the family stress.

By using the contextual model of family stress, this study examined fathers' family stress experience when caring for a child receiving cancer treatments. A descriptive correlational study was designed to examine the relationships between fathers' uncertainty, sense of mastery, and anxiety. Eighty fathers were recruited from two teaching hospitals in Taiwan. A pilot study was conducted to establish the reliability and validity of the Chinese language version of the above instruments. These instruments showed an acceptable internal consistency and satisfactory construct validity. Results showed that fathers' level of education had a significant effect on paternal anxiety. Uncertainty and fathers' education level equal to or higher than university are good predictors of paternal anxiety, which explain 25% of the variance. The results provide insight into the paternal experience of family stress and suggest ways to improve family-centered nursing interventions and thereby establish better family well-being.

The purpose of this study was to use a descriptive correlational design to examine the relationship among maternal uncertainty, boundary ambiguity and depression in families having a child with epilepsy. Three hundred and twenty-four mothers from the child epilepsy day-clinics of three teaching hospitals in Taiwan participated in this study. Data collection was performed by well-trained research assistants who helped mothers fill out the well-developed Chinese version of the Parental Perception of Uncertainty Scale, the Boundary Ambiguity scale, and the Beck Depression Inventory. Uncertainty was positively associated with boundary ambiguity and depression. Boundary ambiguity was positively associated with depression. Stepwise regression analysis demonstrated that boundary ambiguity, uncertainty and mother's age are predictors of a mother's depression which account for 21.49% of the total variance of depression. The results provide a scientific knowledge base for nursing interventions that aim to provide clear information about the child's illness and help to establish appropriate patterns of parent-child interaction in terms of maintaining family boundary integrity and mothers' functional adaptability.

This study explores parental lived experience following admission of their child to a pediatric intensive care unit. The interview data used were collected from 10 randomly chosen families from the Family Impact of Catastrophic Childhood Illness Project recruited during the early phase of critical care hospitalization of their child. A 3-stage contextual analysis procedure integrating interactional and contextual perspectives into Colaizzi's phenomenological approach was used to reduce text data to thematic content. The analysis uncovered a multidimensional and holistic phenomenon consisting offourorganizing concepts: initial boundaryambiguity, parents'coping patterns, family resources, andfunctioning of thefamily boundary. These results provide evidence of a collective family level perception of stress when experiencing the health crisis of a child and supportfurther use offamily stress perception as afamily levelphenomenon that represents family meaning construction during critical illness of a child.

Qualitative translational research refers to the "bench-to-bedside" enterprise of harnessing knowledge from the basic sciences to produce new treatment options or nursing interventions for patients. Three evidence-based translational problems related to qualitative translational research discussed this year address the interfaces among the nursing paradigm, the basic sciences, and clinical nursing work. This article illustrates the definition of translational science and translational blocks of evidence-based practice; discusses the qualitative research perspective in evidence synthesis, evidence translation and evidence utilization; and discusses the research questions that must be answered to solve the problems of the three translational gaps from the qualitative research perspective. Qualitative inquiry has an essential role to play in efforts to improve current healthcare-provider nursing interventions, experiences, and contexts. Thus, it is vital to introduce qualitative perspectives into evidence-based practice from the knowledge discovery through to the knowledge implementation process.質性轉譯研究之臨床應用質性轉譯研究旨在將基礎研究產生的新的治療或護理介入措施推動上市的過程。此研究過程包含了護理典範基礎科學及臨床護理應用面的相互交織的互動與影響。轉譯研究中三個轉譯障礙是近年實證照護殷切討論的議題。本文將討論在實證研究中轉譯研究及轉譯障礙的定義，也將以質性研究觀點討論實證統整、實證轉譯及實證應用的意涵。並於如何應用質性研究觀點來解決轉譯障礙的未來研究問題及現象進行討論。質性研究對提供照護者在建構臨床介入措施、生活經驗及提供照護的脈絡是重要的。因此，強化質性研究觀點於實證照護過程中的知識的發現到應用是刻不容緩的。

Background DTB was efficacious and well tolerated in patients with Huntington’s disease (HD) chorea (First-HD). In the absence of a head-to-head trial with TBZ, we compared safety and tolerability outcomes of TBZ versus DTB using an indirect treatment comparison method and an NNH metric. Methods Safety data from First-HD and TETRA-HD were used to calculate the NNH, where serious adverse events (SAEs), discontinuation (all cause- and adverse event [AE]-related), and specific AEs (in > 10% of patients) were defined as undesirable outcomes. The difference between the proportions of undesirable outcomes was estimated by subtracting the applicable placebo-adjusted risk from both studies (TETRA-HD minus First-HD). NNH estimates, defined as the number of patients to be treated with TBZ instead of DTB for an average of one additional patient to experience an AE, were calculated as the inverses of the risk differences. P-values were obtained from z-tests, which approximate normal distribution. Results First-HD (N = 90) and TETRA-HD (N = 84) cohorts were of similar age (53.7 years vs 49.2 years) and gender (proportion of females 44% vs 62%), and baseline chorea scores were 12.7 vs 14.9. TBZ demonstrated a significant NNH vs DTB of 3 (95% CI: 1, 8; P Conclusions In this NNH analysis, DTB demonstrated significantly better outcomes than TBZ on several safety measures. Further analysis adjusting for demographic differences between trials should be conducted to confirm these findings.

e20549Background: A Phase 2 clinical trial of veliparib + carboplatin (C) and paclitaxel (P) in patients (pts) with previously untreated metastatic/advanced NSCLC showed that veliparib may improve ...

Fatigue is one of the most distressing and prevalent symptoms reported by pediatric oncology patients. With the increase in cancer survival rates, medical teams have focused on methods that control cancer-related fatigue in children during the disease and its treatment in order to increase the quality of life for these patients.The objective of this systematic review was to synthesize the best available evidence concerning the effectiveness of nonpharmacological interventions for fatigue in children and adolescents with cancer.The search strategy was designed to retrieve studies published between 1960 and 2010 in either English or Chinese. This review included randomized controlled trials and quasi-experimental studies. The studies that were selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical-appraisal instruments.The review included six studies, and the meta-analysis revealed a statistically significant effect of exercise interventions in reducing general fatigue (effect size = -0.76; 95% CI [-1.35, -0.17]) in children and adolescents with cancer.The review provides an evidence-based guide to future priorities for clinical practice. Exercise interventions could reduce the levels of general fatigue in children aged 6-18 years. In particular, exercise interventions for fatigue are feasible and safe.

Studies exploring the perceptions of patients whose lives are maintained by mechanical ventilation highlight the stressful nature of this type of experience. The objective of this meta-synthesis study was to describe the nature of the experience of adult ventilator-dependent patients. A systematic literature search of English and Chinese databases was undertaken, covering the period between 1970 and 2012. Qualitative research findings were extracted and pooled using the Joanna Briggs Institute Qualitative Assessment and Review Instrument. A total of 1004 papers were identified from various database and hand searches. Nineteen papers were critically appraised and 16 met inclusion criteria. Five meta-synthesis themes emerged from the analysis: (1) the feelings of fear due to being dependent on a ventilator and the loss of control of life; (2) disconnection with reality; (3) impaired embodiment; (4) construction of coping patterns; (5) trust and caring relationship. Suggested implications for practice include enhancing the trust relationship with health professionals, as well as nursing actions throughout the suction procedure relating to release of patient's psychological distress and empowering their resilience factors.

Children and adolescents with cancer are confronted with many challenges. This review considered studies that used qualitative methods to examine the body image experience of children and adolescents with cancer. A systematic literature search of English and Chinese databases was undertaken, covering the period between 1960 and October 2010. Qualitative research findings were extracted and pooled using the Joanna Briggs Institute Qualitative Assessment and Review Instrument. Eight papers met the inclusion criteria. The derived four metasyntheses included being distanced from the body, loss of self-identity, self-protective strategies and support, and getting rid of the shackles of the body. In conclusion, children and adolescents with cancer also experience various problems associated with changes in their body image. Repeated courses of treatment lead to loss of a normal, orderly life, and might even result in changes in interpersonal interactions. In response to body image change, individuals with cancer develop self-protective, coping strategies. Children and adolescents who experience life-threatening cancer come to face body image change positively, and might hold a confident attitude toward their future.

The Humanistic Clinical Care and Nurse Healing series of graduate studies courses at National Yang-Ming University reflects the mission and goals of the master's and doctoral programs to cultivate the core competence of students. The humanistic nursing curriculum is designed to engender nurse subjectivity by integrating multidisciplinary knowledge. Courses focus on humanistic ideals and ontological, epistemological and methodological nurse fitness while cultivating nurses' humanistic caring competence and humanistic knowledge development. The Humanistic Clinical Care and Nursing Healing curriculum addresses core subject areas including psychoanalysis and humanistic caring, humanistic clinical knowledge exploration, western philosophy and humanistic caring, imaging art and humanistic caring, and the humanistic caring aspect of helping others as well as discusses creative and evidence-based ideas in health promotion and humanistic nursing. The curriculum begins with identifying and understanding concepts, then advances toward applying concepts in practice, reflection, and healing. This paper introduces curriculum structure and content, evaluates student learning through focus groups and assignment content analysis, and discusses the future development potential of humanistic clinical care and nurse healing.

There has been little qualitative research in Taiwan on the experiences of nurses who encounter the moment of child's death from their own perspective.Using a phenomenological approach, this study worked to understand the essence of the caring experience for nurses at the moment of a cancer child's death from the nurses' own perspectives.Researchers used Colaizzi's (1978) phenomenological method and collected data using purposive sampling and in-depth, tape-recorded interviews. Data were analyzed using the Colaizzi (1978) method. Ten registered nurses from a medical center participated into this study. The trustworthiness of the study was examined using Lincoln and Guba (1985) principles.Five major themes emerged, including introspection on caring for dying children after their death; coping patterns of nurses; toleration and ability to help to ensure the child has a good death; facing death and consoling the soul; and accompanying parents though the moment of death.Study findings provide evidence-based information on nurses to care for cancer children and their families facing the moment of death.

With the advancement of economic globalization, not only the product determines success in enterprise competition, but also by its quality of the after-sale service. After-sale service is a series of activities including introduction, delivery, maintenance, repair and technical training (support) given by the manufacturer or supplier during and after a warranty period. The main cost is called fixed cost which remains (more or less) unchanged irrespective of the output level or sales revenue. The cost plus contract is used traditionally. Under a cost-plus contract, a contractor is reimbursed for the cost incurred, and is paid an agreed upon percentage of such costs as contractor’s profit. This contract is widely used for a long time for the preconcerted product performance. Master of Science (Computer Integrated Manufacturing)