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目的：透過異常通報資料庫分析，探討96小時對照72小時重置周邊靜脈導管，對於靜脈炎發生率之影響。 方法：方便取樣臺灣南部某醫學中心之異常通報資料庫，分析2011年9月1日至2014年8月31日之72小時重置組，與2014年9月1日至2017年8月31日之96小時重置組，2個時期之住院個案的靜脈炎發生率。 結果：96小時對照72小時重置周邊靜脈導管，並未增加靜脈炎發生率。靜脈炎總發生率（勝算比[odds ratio,OR] = 0.70, p=.0290）與細菌性靜脈炎發生率(OR= 0.11, p=.0097)顯著減少，化學性與機械性靜脈炎發生率則無顯著差異。 結論：本土性資料庫分析結果為在臺灣熱帶海島型潮濕氣候，三班評估無靜脈炎症狀下，96小時重置周邊靜脈導管並不會顯著增加靜脈炎風險，建議醫療機構可據此調整臨床作業規範，落實實證知識轉譯。 "Purpose: To compare the effect of replacement of peripheral venous catheters at 96-hour intervals on the incidence of phlebitis with that at 72-hour intervals through analysis of an incident-reporting database. Methods: Convenience sampling of records from the incident-reporting database of a medical center in southern Taiwan was used to analyze the incidence of phlebitis among hospitalized patients with replacement of peripheral venous catheters at 72-hour intervals (from September 1, 2011, to August 31, 2014) or 96-hour intervals (from September 1, 2014, to August 31, 2017). Result: The analysis revealed that replacing peripheral venous catheters every 96 hours rather than every 72 hours did not increase the incidence of phlebitis. The total incidence of phlebitis (odds ratio [OR]=0.70, p=.0290) and the incidence of bacterial phlebitis (OR=0.11, p=.0097) decreased significantly, and no significant differences in the incidence rates of chemical or mechanical phlebitis were identified. Conclusion: According to the analysis results of a local database, under the humid tropical insular climate of Taiwan, replacement of peripheral venous catheters at 96-hour intervals did not significantly increase the risk of phlebitis in patients who exhibited no symptoms of phlebitis as assessed in three shifts. Medical institutions can adjust their clinical operation standards and implement knowledge translation accordingly. &nbsp

Levofloxacin-based therapy or bismuth-based quadruple therapy are the recommended second-line regimens for Helicobacter pylori eradication after failure of clarithromycin-based therapy. However, resistance to levofloxacin has increased in the past decade. Furthermore, little is known about the long-term effects of H pylori eradication on the antibiotic resistome. In this study, we compared these second-line eradication therapies for efficacy, tolerability, and short-term and long-term effects on the gut microbiota, antibiotic resistome, and metabolic parameters.We did a multicentre, open-label, parallel group, randomised controlled trial at eight hospitals in Taiwan. Adult patients (age ≥20 years) with persistent H pylori infection after first-line clarithromycin-based therapy were randomly assigned (1:1, permuted block sizes of four) to receive levofloxacin-based sequential quadruple therapy for 14 days (EAML14; esomeprazole 40 mg and amoxicillin 1 g for 7 days, followed by esomeprazole 40 mg, metronidazole 500 mg, and levofloxacin 250 mg for 7 days, all twice-daily) or bismuth-based quadruple therapy for 10 days (BQ10; esomeprazole 40 mg twice daily, bismuth tripotassium dicitrate 300 mg four times a day, tetracycline 500 mg four times a day, and metronidazole 500 mg three times a day). All investigators were masked to the randomisation sequence. The primary endpoint was H pylori eradication rate measured byBetween Feb 25, 2015, and Dec 11, 2020, 560 patients were randomly assigned to receive EAML14 or BQ10 (n=280 per group; 261 [47%] men and 299 [53%] women). Mean age was 55·9 years (SD 12·7) in the EAML14 group and 54·9 years (12·3) in the BQ10 group. Eradication of H pylori was achieved in 246 (88%) of 280 participants in the EAML14 group and 245 (88%) of 280 in the BQ10 group according to ITT analysis (risk difference -0·4%, 95% CI -5·8 to 5·1; p=0·90). In the per-protocol analysis, 246 (90%) of 273 participants in the EAML14 group and 245 (93%) of 264 participants in the BQ10 group achieved H pylori eradication (risk difference 2·7%, 95% CI -0·2 to 7·4; p=0·27). Transient perturbation of faecal microbiota diversity at week 2 was largely restored to basal state 1 year after EAML14 or BQ10. Diversity recovery was slower with BQ10, and recovery in species abundance was partial after both therapies. On shotgun sequencing, we observed significant increases in total resistome after EAML14 (p=0·0002) and BQ10 (p=4·3 × 10We found no evidence of superiority between levofloxacin-based quadruple therapy and bismuth-based quadruple therapy in the second-line treatment of H pylori infection. The transient increase in the antibiotic resistome and perturbation of faecal microbiota diversity were largely restored to pretreatment state from 2 months to 1 year after eradication therapy.The Ministry of Science and Technology of Taiwan, the Ministry of Health and Welfare of Taiwan, National Taiwan University Hospital, Taipei Veteran General Hospital, and the Australian Federal Government through the St George and Sutherland Medical Research Foundation.For the Chinese translation of the abstract see Supplementary Materials section.

We aimed to assess the latest prevalence and secular trend of Helicobacter pylori infection and its association with the incidence and mortality of gastric cancer in Taiwan.Adults naive to H. pylori eradication receivedA total of 1494 participants were enrolled, including 294 children or adolescents and 1200 adults. The overall prevalence of active H. pylori infection byThe prevalence of H. pylori infection has declined in Taiwan, which correlates with the declining trends of age-standardized incidence and mortality of gastric cancer in Taiwan.

Background The updated prevalence of Helicobacter pylori (H. pylori) is lacking in Taiwan. We aimed to assess the accuracy of Vstrip® H. pylori Stool Antigen Rapid Test (Vstrip®HpSA) in the detection and surveillance of the updated prevalence of H. pylori in Taiwan. Methods A total of 347 adult subjects including 152 volunteers and 195 symptomatic patients were recruited. Stool samples were collected for detection of H. pylori using Vstrip® HpSA, ImmunoCard STAT!® HpSA and Premier Platinum HpSA® PLUS. All subjects who have completed the stool sample collections were included in the ITT analysis. The sensitivity, specificity, and accuracy of Vstrip® HpSA were calculated compared to gold standard test with 13C-Urea breath test. Results The un-adjusted prevalence of H. pylori infection was 22.5% (95% CI: 18.3–27%) in 2018. The age-standardized prevalence of H. pylori was 21.8% in asymptomatic adults in Taiwan. The sensitivity, specificity, and accuracy of the Vstrip® HpSA, and ImmunoCard STAT!® HpSA tests were 91% (95% CI: 82–96%) versus 76.9% (95% CI: 66–86%), 97% (95% CI: 94.1–98.6%) versus 97% (95% CI: 94.1–98.6%), and 95.7% (95% CI: 92–97%) versus 92.5% (95% CI: 89–95%), respectively. Conclusion The age-standardized prevalence of H. pylori infection in Taiwan was 21.8% in asymptomatic adults in 2018. The Vstrip® HpSA had equivalent performance as the ImmunoCard STAT!® HpSA, and can be used in future mass screening of H. pylori infection for gastric cancer prevention.

BACKGROUND AND AIM The reported prevalence of Helicobacter pylori infection in Taiwan was 54.4% in 1992. An updated prevalence of H. pylori infection in asymptomatic adults is lacking in Taiwan. We aimed to assess the updated age-standardized prevalence of H. pylori infection in asymptomatic subjects and in patients with dyspepsia and to assess the accuracy of H. pylori stool antigen (HpSA) test for screening of H. pylori in Chinese population. METHODS Asymptomatic adult subjects (N = 189) were screened for H. pylori infection using HpSA, serology, and 13 C-urea breath test (13 C-UBT) in 2016-2017. Adult patients with dyspepsia (N = 145) were screened for H. pylori using 13 C-UBT, HpSA, serology, rapid urease test, and histology during 2016-2018. Two types of HpSA, including the Diagnostec HpSA ELISA Kit (HpSA ELISA) and Rapid Test Kit (HpSA Rapid), were used in this study. Sensitivity, specificity, and accuracy of the HpSA tests were calculated using the 13 C-UBT as golden standard test. RESULTS The unadjusted prevalence of H. pylori was 21.2% in asymptomatic adults and 37.9% in patients with dyspepsia (P

Immunotherapy is a newly developed method for cancer treatment, but still generates limited response in partial patients for hepatocellular carcinoma (HCC) because the immunity cycle is limited by the tumor microenvironment (TME). Herein, we introduce multifunctional gold nanocages (AuNCs)-based nanocarriers with Ansamitocin P3 (AP3) loaded and anti-PDL1 binding (AP3-AuNCs-anti-PDL1) which can combine photothermal therapy, chemotherapeutic agent-triggered DCs maturation, and checkpoint immunotherapy in one platform. The AP3-AuNCs-anti-PDL1 using Avidin-biotin to bind anti-PDL1 on the surface of AP3-AuNCs showed specifically cellular targeting compared to AuNCs, which can increase the immune responses. The AP3-AuNCs+NIR-10 min exhibited the highly activated DCs maturation with two-fold higher than control+NIR, which can be attributed to the significant release of AP3. The results illustrated the synergistic effect of tumor-associated antigens (TAAs) and controlled AP3 release under near infrared (NIR) in triggering effective DCs maturation. Among them, AP3 release played the more important role than the TAAs under PTT in promoting T-cell activation. These results illustrate the promising potential of AuNCs-based nanocarriers combined with AP3 and the checkpoint inhibitors to strengthen the positive loop of immunity cycle.

Wen-Chun Chen,1– 3 Chiu-Chu Lin,2,4,5 Chia-Chi Kuo,6,7 Chia-Chen Wu,8 Tz-Jie Liu,9 Mei-Tsu Chen9 1Department of Community Medicine, St. Martin De Porres Hospital, Chiayi, Taiwan; 2School of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan; 3Department of Nursing, Chang Jung University of Science and Technology, Chiayi Campus, Tainan, Taiwan; 4Department of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; 5Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; 6Emergency Department, Chi-Mei Medical Center, Tainan, Taiwan; 7Department of Nursing, Chang Jung Christian University, Tainan, Taiwan; 8School of Nursing, Fooyin University, Kaohsiung, Taiwan; 9Health Management Center, St. Martin De Porres Hospital, Chiayi, TaiwanCorrespondence: Chiu-Chu Lin Email chiuchu@kmu.edu.twObjective: To improve the quality of peer leader training, this study developed a theory-based self-management training program for older adult peer leaders with diabetes and assessed its feasibility.Background: Current self-management programs are designed mainly to be implemented by healthcare professionals, but healthcare staff may not fully perceive the needs and obstacles of older adults in disease management due to a lack of similar illness experience. To target this problem, peer leaders with successful self-management experiences, similar cultural backgrounds and languages, and related illness experiences are trained to guide and mentor peer patients in self-management programs.Study Design and Methods: This study was conducted in two stages. In stage 1, a peer leader training program was developed based on experiential learning theory as the framework and self-regulation theory as the activity design strategy. In stage 2, program feasibility was assessed via participants’ feedback toward the training program by three indicators: attendance, future willingness to lead the peer-led self-management program, and leadership skills evaluated by a peer leader training assessment tool.Results: In this study, peer leaders demonstrated good leadership skills by expressing active willingness to lead self-management programs in the community. Peer leaders’ feedback indicated that the program’s training content was helpful in preparing peer leaders to guide older adults in learning self-management skills and in improving the abilities and confidence of peer leaders in mentoring self-management.Conclusion: Findings in this study showed that peer leader training can impact the effectiveness and success of self-management in older adults with diabetes. Even in a small-scale study, the impact was evident, which demonstrated the feasibility of the program. More large-scale studies on the effectiveness of various peer leader training programs in diverse disciplines are recommended.Clinical Trials Registry: ClinicalTrials.gov Identifier: NCT04298424 (the Peer-Led Self-Management Program).Keywords: older adult, peer leader, diabetes, theory-based, peer-led, self-management

Chili peppers are an important food additive used in spicy cuisines worldwide. However, the yield and quality of chilis are threatened by anthracnose disease caused by Colletotrichum acutatum. Despite the impact of C. acutatum on chili production, the genes involved in fungal development and pathogenicity in this species have not been well characterized. In this study, through T-DNA insertional mutagenesis, we identified a mutant strain termed B7, which is defective for the growth of C. acutatum on a minimal nutrient medium. Our bioinformatics analysis revealed that a large fragment DNA (19.8 kb) is deleted from the B7 genome, thus resulting in the deletion of three genes, including CaGpiP1 encoding a glycosylphosphatidyl-inisotol (GPI)-anchored protein, CaNRT2.1 encoding a membrane-bound nitrate/nitrite transporter, and CaRQH1 encoding a RecQ helicase protein. In addition, T-DNA is inserted upstream of the CaHP1 gene encoding a hypothetical protein. Functional characterization of CaGpiP1, CaNRT2.1, and CaHP1 by targeted gene disruption and bioassays indicated that CaNRT2.1 is responsible for the growth-defective phenotype of B7. Both B7 and CaNRT2.1 mutant strains cannot utilize nitrate as nitrogen sources, thus restraining the fungal growth on a minimal nutrient medium. In addition to CaNRT2.1, our results showed that CaGpiP1 is a cell wall-associated GPI-anchored protein. However, after investigating the functions of CaGpiP1 and CaHP1 in fungal pathogenicity, growth, development and stress tolerance, we were unable to uncover the roles of these two genes in C. acutatum. Collectively, in this study, our results identify the growth-defective strain B7 via T-DNA insertion and reveal the critical role of CaNRT2.1 in nitrate transportation for the fungal growth of C. acutatum.

Background Incarcerated persons are a special population with higher hepatitis C virus (HCV) prevalence and should be prioritized for microelimination. In this study, we investigate the seroprevalence and evaluate the effectiveness and safety of direct-acting antiviral (DAA) therapy in custodial settings. Methods Incarcerated persons in Yunlin Prison were recruited to receive anti-HCV antibody screening. Patients with positive HCV ribonucleic acid (RNA) were treated with glecaprevir/pibrentasvir (GLE/PIB) in our special chronic hepatitis C (CHC) clinic in prison. The primary endpoint was sustained virologic response at week 12 off therapy (SVR12). Results A total of 1402 incarcerated persons were invited to anti-HCV screening and 824 (58.7%) accepted. The prevalence of anti-HCV positivity was 33.5% (276 of 824), and the viremic rate (detectable HCV RNA) was 69.2% (191 of 276). According to fibrosis index based on 4 factors, patients with F3 stage were 6 (3.1%), but none met the criteria of F4 stage. However, 6 (3.1%) had liver cirrhosis with splenomegaly, confirmed by findings of ultrasonography. The median log10 HCV RNA level at baseline was 6.235 (2.394–7.403). Genotype (GT) 6 was predominant (39.3%), followed by GT 1a (22.0%) and 1b (14.1%). Mixed GT HCV infection accounted for 3.6% of total infections. In total, 165 patients received GLE/PIB therapy. The overall SVR12 rates were 100%. Conclusions Direct-acting antiviral therapy is highly effective and safe for incarcerated patients in Taiwan. Our special prison-based CHC clinic, linking universal screening to medical care, can serve as a model for microelimination of HCV in custodial settings., We established a special hepatitis C clinic in prison and offered universal hepatitis C screening for incarcerated persons. The prevalence of anti-HCV positivity was 33.5%, and the viremic rate (detectable HCV RNA) was 69.2%. All treated patients achieved SVR.

Background: Glecaprevir/pibrentasvir (GLE/PIB) is a pangenotypic direct-acting antiviral agent for the treatment of chronic hepatitis C virus (HCV) infection. Real-world data of GLE/PIB in Asian patients other than Japanese are limited. We thus investigated the effectiveness and safety profile of GLE/PIB in Taiwanese patients with chronic hepatitis C (CHC). Methods: CHC patients who received 8, 12, or 16 weeks of GLE/PIB between August and October of 2018 were consecutively enrolled. The treatment duration was determined according to drug label. The hepatic fibrosis was staged according to liver histology, transient elastography, fibrosis index based on 4 factors (FIB-4), or findings of ultrasonography/endoscopy. The primary endpoint was sustained virological response at week 12 off therapy (SVR12). The safety profiles were also assessed. Results: A total of 110 CHC patients with 51% of males were enrolled. The median age was 70 years. A majority (82%) of patients were infected with HCV genotype 2. Forty-six (42%) and 64 (58%) patients had advanced hepatic fibrosis and compensated cirrhosis, respectively. Forty-five (41%) non-cirrhotic patients were treated for 8 weeks. The overall SVR12 rates were 100%, regardless of baseline clinical characteristics. The common adverse events (AEs) were pruritus (12%), anorexia (6%), and fatigue (5%). Nine (8%) serious AEs unrelated to GLE/PIB occurred. Three (2%) patients had Grade 3 elevation of total bilirubin level. None had premature treatment termination, hepatic decompensation, or death. Conclusion: Interferon-free GLE/PIB regimen is highly effective and safe for Asian chronic hepatitis C patients with advanced hepatic fibrosis or compensated cirrhosis. Keywords: Chronic hepatitis C, Direct-acting antiviral, Glecaprevir, Pibrentasvir, Taiwan

Objective Nurse burnout is a global issue; however, it remains unclear how coping strategies over a maintained period of time may influence nursing burnout. This meta-analysis aimed to evaluate the literature on the effects of coping strategies in reducing nurse burnout. Methods Systematic reviews of English and Chinese articles were conducted for relevant articles published between 1979 and 2014 in six electronic databases (PubMed, CINAHL, The Cochrane, PsycARTICLES, Airiti Library, and the Index of the Taiwan Periodical Literature System). The search terms included ‘nurse,' ‘burnout' and ‘coping.' Studies were included in the review if they were randomized controlled trials or controlled clinical trials, and they used the measurement tool, Maslach Burnout Inventory-Human Service Survey. Three hundred fifty-one studies were identified, and seven studies were ultimately included in the meta-analysis. Results A total of 1,521 participants were included in the meta-analysis for each burnout subgroup. Participants were measured immediately after the intervention and 6months, 1year, 2years, 2.5years, and 4years thereafter. Coping strategies were hypothesized to decrease burnout. The maintained period for coping strategies was 1year for emotional exhaustion and depersonalization and 6months for personal accomplishment. Conclusions Coping strategies can reduce nurse burnout and maintain effectiveness between 6months and 1year.

Aim To synthesize the effects of Internet empowerment-based self-management interventions on adults with metabolic diseases. Background Metabolic diseases are prevalent and burden healthcare systems; they have become a major health problem worldwide. The effects of IESMIs on lifestyle changes have been shown to improve adults' physiological and psychological conditions. However, we found no systematic review evaluating these effects. Design Systematic review and meta-analysis of randomized and non-randomized controlled trials, conducted according to the Cochrane handbook. Data resources A literature search was conducted using the Airiti Library, Association for Computing Machinery, CINAHL, Cochrane Library, Embase, ProQuest, PubMed/MEDLINE and Index of the Taiwan Periodical Literature System databases (earliest-June 2016). Review methods Two reviewers used the Cochrane Collaboration bias assessment tool to assess the methodological quality of included studies. Extracted data were entered and analysed using RevMan 5.3.5 software. Inverse variance was used to estimate effect sizes. Weighted and standardized mean differences with 95% confidence intervals were calculated using a random effects model. Subgroup and sensitivity analyses were performed. Results Twenty-one randomized controlled trials were reviewed. Meta-analysis showed that the intervention significantly improved adults' exercise habits, glycated haemoglobin (HbA1c) levels, body weight, empowerment levels and quality of life. Conclusion The intervention significantly improve the health status of adults with metabolic diseases, in particular their exercise habits, HbA1c levels, body weight, empowerment and quality of life. The intervention provides more convenient and faster access to healthcare for busy individuals with time constraints. These results suggest that healthcare professionals could develop accessible and friendly interactive online interfaces for patients to expand the use of these interventions in the clinical setting.

Peripheral intravenous access is a common and invasive procedure that is performed in pediatric clinical settings. Children often have difficult intravenous-access problems that may not only increase staff stress but also affect the timeliness of immediate treatments.To determine the efficacy of near-infrared devices in facilitating peripheral intravenous access in children, using a systematic review and meta-analysis.Six databases, namely the Index to Taiwan Periodical Literature System, Airiti Library, CINAHL, Cochrane Library, PubMed/MEDLINE, and ProQuest were searched for related articles that were published between the earliest year available and February 2017. The search was limited to studies on populations of children that used either a randomized controlled trial or controlled clinical trial approach and used the key words "near-infrared devices" AND "peripheral intravenous access." The 12 articles that met these criteria were included in the analysis. The Cochrane Collaboration bias assessment tool was used to assess the methodological quality. In addition, RevMan 5.3.5 software was used to conduct the meta-analysis.The near-infrared devices did not significantly improve the first-attempt success rate, number of attempts, or the procedural time of peripheral intravenous access in children. However, the subgroup analysis of difficult intravenous-access factors revealed a significant improvement in the first-attempt success rate of children with difficult intravenous access scores (OR = 1.83, p = .03).Near-infrared devices may improve the first-attempt success rate in children with difficult intravenous access by allowing healthcare professionals to visualize the peripheral veins. Therefore, we suggest that the difficult intravenous-access score be used as a screening tool to suggest when to apply near-infrared devices to children with difficult peripheral intravenous access in order to maximize efficacy of treatment.近紅外線設備輔助兒童周邊靜脈注射之效應—系統性文獻回顧與次族群統合分析.周邊靜脈注射是兒科常見的侵入性處置。兒童普遍有困難靜脈注射問題，常造成護理人員注射壓力，影響立即性治療時效。.透過系統性文獻回顧暨統合分析，探討近紅外線設備於輔助兒童周邊靜脈注射之效應。.搜尋台灣期刊論文索引、華藝線上圖書館、CINAHL、Cochrane Library、PubMed/MEDLINE、ProQuest資料庫，2017年2月以前之文獻，鍵入「近紅外線」與「周邊靜脈注射」等關鍵字，限制兒童族群，及隨機控制試驗或臨床控制試驗，共12篇文獻符合標準。依據Cochrane偏差風險評估文獻品質，並使用RevMan 5.3.5軟體進行統合分析。.近紅外線設備並未顯著改善兒童周邊靜脈注射之第一次注射成功率、注射次數與注射時間。然而， _困難靜脈注射因素之次族群分析顯示近紅外線設備可顯著提升評分為困難靜脈注射兒童的第一次注射成功率（OR = 1.83, p = .03）。.近紅外線設備可幫助健康照護專業人員透視困難靜脈注射兒童的周邊靜脈，提高第一次注射成功率。建議臨床善用困難靜脈注射評估量表，以適當篩選與運用近紅外線設備於困難靜脈注射兒童的周邊靜脈注射。.

Aims The aim of this study was to determine the effects of nursing preceptorship on the competence, job satisfaction, professional socialization and retention of new nurses. Background Although studies have focused on the effects of nursing preceptorship on new nurses’ competence and retention, a systematic review of the overall effects is lacking. Design A quantitative systematic review. Data sources Five English/Chinese databases were searched for original articles published before June 2015 and only six articles published between 2001–2014 were included in the final analysis. Review methods Joanna Briggs Methodology was used to process one randomization control trial, one quasi-experimental study and four observational studies. Two appraisers independently reviewed each study using the standardized critical appraisal tools from the Joanna Briggs Institute. Results The most adopted preceptorship was a fixed preceptor/preceptee model and one-on-one for 1–3-month duration. It showed that new nurses’ overall competence increased significantly due to preceptorship. Only a few studies explored the effects of preceptorship on the job satisfaction and professional socialization of new nurses. Clear conclusions regarding the effect of preceptorship on nurses’ retention rate could not be made because of inconsistent time points for calculation and a lack of control groups in the study design. Conclusions Preceptorship can improve new nurses’ nursing competence; however, more studies are needed to ascertain its effects on new nurses’ retention rates, job satisfaction and professional socialization to promote nursing care quality and resolve nursing shortages.

Background Management of chronic metabolic diseases has recently become an important global health issue. Extensive research on empowerment-based self-management interventions (EBSMIs) for patients with chronic metabolic diseases has been conducted, but no systematic review has evaluated their effects. Aim To evaluate the effects of EBSMIs on patients with chronic metabolic diseases. Methods A systematic review and meta-analysis was conducted. Five electronic databases (Airiti Library, CINAHL, Cochrane Library, PubMed/ MEDLINE, and Index of Taiwan Periodical Literature System) were searched from the earliest year available to October 2012. Controlled trials about the effectiveness of interventions on patients with chronic metabolic diseases were included. Each study was appraised by three reviewers and assigned a level of evidence based on the modified Jadad scale. Extracted data were entered and analyzed using Review Manager 5.2. Findings Nineteen studies were reviewed. Most studies showed that EBSMIs improved patients’ hemoglobin A1c test (HbA1c) (p < .00001), waist circumference (p = .02), and empowerment level (p = .004). Four studies compared the effect on body weight and body mass index, but the overall effect was not significant (p = .33 and .73, respectively). Five studies compared the effect on self-efficacy, four of which indicated significant increase. However, the overall effect on self-efficacy was not compared because studies used different scales. Linking Evidence to Action EBSMIs improved HbA1c test results, waist circumference, self-efficacy, and empowerment level in patients with chronic metabolic diseases. When implementing the EBSMIs, healthcare institutions need to provide training programs related to empowerment from which health professionals can acquire competence in patient empowerment. Moreover, healthcare leaders should assess and overcome barriers (e.g., time, manpower, cost, etc.) to implementing EBSMIs in clinical settings.

Background: Ice pack therapy has been widely used in treatment for soft tissue injuries. However, no studies have yet explored the most appropriate and effective duration for ice therapy with ice packs.Purpose: This study explored the antiswelling and analgesic effects of different ice pack therapy durations on soft tissue injuries as well as patient discomfort.Methods: An experimental design including pretest and three posttests with three groups was used in this study. Using convenience sampling and randomized block assignment, 99 participants with soft tissue injuries from the emergency department of a medical center in southern Taiwan were included in this study. With 33 participants in each group, three groups with ice pack therapy for 10, 20, and 30 minutes were indicated to compare skin temperature, swelling, and pain differences in ice treated areas as well as participant discomfort.Results: This study found no significant differences in the effect of different ice pack therapy durations among the three groups. However, this study identified significant differences between pretest and each posttest in terms of changes in skin temperature, pain, and numbness and rash-related discomfort in each group.Conclusion/Implications for Practice: Research results found that the three different ice pack therapy durations could lower skin temperature and reduce partial pain. The different ice pack therapy durations would cause similar discomfort incidence rates in the three groups. Ice pack therapy for 10 minutes could reduce partial swelling and pain effectively. Accordingly, we suggest that 10 minutes is the optimal ice pack therapy duration for persons with soft tissue injuries. However, the ice pack therapy duration should be adjusted according to individual needs and situation.

OBJECTIVE The common adverse effects associated with targeted therapy for cancer, such as epidermal growth factor receptor inhibitors (EGFRIs), are dermatologic toxicities that cause the patient physical discomfort and affect treatment. Colloidal oatmeal lotion (COL) has been proven to help prevent dermatitis and xerosis. Evidence of its effect on EGFRI-induced dermatologic toxicities, however, is limited. The purpose of this study was to explore the effect of COL on EGFRI-induced dermatologic toxicities. DESIGN AND SETTING This study used a 1-group pretest-posttest design with a convenience sample of 30 patients with cancer who developed EGFRI-induced dermatologic toxicities from a medical center in southern Taiwan. All participants applied topical COL 3 to 5 times a day for 4 consecutive weeks and received a pretest and 4 posttests. OUTCOME MEASURES A generalized estimating equation was used to assess the impact of demographics, disease characteristics, and weeks of COL use on dermatologic toxicity severity, body surface area affected, and level of pruritus. MAIN RESULTS Significant differences were found between the pretest and all posttests after using COL with regard to the severity, body surface area affected, and level of pruritus in participants who developed EGFRI-induced dermatologic toxicities (P < .05). There were no significant differences in demographics or disease characteristics on EGFRI-induced dermatologic toxicities. CONCLUSIONS Based on the study results, COL could improve the symptoms of dermatologic toxicities in those receiving EGFRIs with no adverse effects. Therefore, the authors suggest the use of COL in clinical settings.

Peripheral intravenous access is a common, invasive procedure that is performed in clinical practice. Difficult intravenous access may not only jeopardize patient safety but also increase staff stress, nursing hours, and material costs.To explore the efficacy of ultrasound-guided peripheral intravenous access in difficult intravenous-access patients and in the two subgroups of adult patients and pediatric patients using systematic review and meta-analysis.Six Chinese and English databases, including the Index to Taiwan Periodical Literature System, Airiti Library, CINAHL, Cochrane Library, PubMed/MEDLINE, and ProQuest, were searched for related articles that were published between the earliest year available and April 2016. The search was limited to studies that used randomized control trials (RCTs) or controlled clinical trials (CCTs) and the associated key words "ultrasound-guided" AND "peripheral intravenous access". The 12 articles that met these criteria were used in the analysis. The Joanna Briggs Institute (JBI) critical appraisal checklist was used to assess methodological quality and RevMan 5.3 software was used to conduct the meta-analysis.The ultrasound-guided technique was found to improve the success rate of intravenous access significantly (OR = 3.00, p.0001) and to decrease the number of attempts (MD = -0.61, p = .03) in the overall group of difficult intravenous-access patients. The subgroup analysis found a significantly improved success rate and decreased number of attempts in difficult intravenous-access adult patients and significantly decreased procedural times in difficult intravenous-access pediatric patients.The ultrasound-guided technique may improve the efficacy of intravenous access by helping health care professionals visualize the peripheral veins. We suggest that patient characteristics, ultrasound accessibility, and the feasibility of staff training be assessed in order to provide ultrasound guidance that improves the efficacy of intravenous access.超音波導引周邊靜脈注射之效應—系統性文獻回顧暨統合分析.周邊靜脈注射是臨床普遍的侵入性處置，當遭遇困難靜脈注射（以下簡稱困難靜注）問題時，將危及病人安全，增加護理人員壓力，耗用護理時數與衛材費用。.透過系統性文獻回顧暨統合分析，探討超音波導引於困難周邊靜脈注射病人之效應，及其在兒童與成人次族群的效應。.搜尋台灣期刊論文索引、華藝線上圖書館、CINAHL、Cochrane Library、PubMed/MEDLINE、ProQuest六個中英文資料庫，2016年4月以前之文獻，鍵入「超音波導引」與「周邊靜脈注射」等關鍵字，限制隨機控制試驗與臨床控制試驗的研究設計，共12篇文獻符合標準。依據Joanna Briggs Institute嚴格評讀查核表，做研究方法之品質評估，並使用RevMan 5.3軟體進行統合分析。.超音波導引技術可顯著提升困難靜注病人的注射成功率（OR = 3.00, p.0001）與減少注射次數（MD = -0.61, p.03）；次族群分析顯示，其可顯著提高困難靜注成人的注射成功率與減少注射次數，及顯著減少困難靜注兒童的注射時間。.超音波導引技術可幫助健康照護專業人員透視周邊靜脈，提高靜脈注射成效。建議臨床可考量病人特性、超音波可近性、人員訓練可行性，適當運用超音波於提升周邊靜脈注射成效。.

An integrated optical sensing chip for multiple bio-signal detections (MBSD) including peripheral capillary oxygen saturation (SpO 2 ), pulse rate (PR), and fingerprint (TP) is proposed and prototyped in standard 0.18um CMOS technology. A MBSD CMOS optical sensing chip with a 128×64 dual-mode CMOS image sensor (CIS) array is implemented to achieve the multi-domain (temporal and spatial) signal detection using a single sensing array and shared LED source. In oximeter (OXI) mode (temporal-domain), the proposed sensing chip reports the continuous photoplethysmogram (PPG) signal for SpO 2 calculation with a measured photo-sensitivity of 7.271nA/Lux, an achieved error of ±0.81% for R∗ ratio, a resulting error of ±1.01% for SpO 2 , and a total power of 99μW (without LEDs). In optical fingerprint (OFP) mode (spatial-domain), the fingerprint pattern is successful demonstrated by captured images with a measured sensitivity of 1.983V/Lux•s and a low FPN of 0.098% at 30fps. ∗R = (AC of Red / DC of Red) / (AC of IR / DC of IR).

Scutellaria austrotaiwanensis is a new species first described in 1997. It is a rare and endemic species in southern Taiwan. In this study, 16 polymorphic microsatellite loci were isolated from Scutellaria austrotaiwanensis using a magnetic bead enrichment method. Several genetic indices, including observed heterozygosity (Ho), expected heterozygosity (He), number of effective alleles (Ne), and polymorphism information content (PIC), were calculated. Deviation of heterozygosity was detected by the fixation index (Fis) and Hardy–Weinberg equilibrium was tested by possibilities (P HWE) using a chi-squared test. Allele numbers ranged from 4 to 8, with observed heterozygosity ranging from 0.611 to 1.000. Five microsatellite markers showed deficient heterozygosity by Fis > 0. No loci exhibited a departure from Hardy–Weinberg equilibrium, possibly due to a stable population. No loci pairs revealed significant linkage disequilibrium. The microsatellite markers reported here should be useful to evaluate the population structure of S. austrotaiwanensis for conservation efforts.

A 1.5V(A)/0.8V(D) high dynamic range (HDR) readout integrated circuit (ROIC) with tunable sensitive range and fixed pattern noise (FPN) reduction for infrared focal plane arrays (IR FPAs) is presented. A pulse width modulation (PWM) readout with capacitive trans-impedance amplifier (CTIA) front end, dual-exposure extended-counting (DEEC) [1], and aligned time-control ramp (ATCR) generator are developed for dynamic range boost. Auto-zeroing and offset cancellation (AZOC) mechanisms are implemented to reduce readout noise and FPN. The digital supply voltage of logic part is decreased to 0.8V for power reduction. The ROIC prototype with an embedded test CMOS image sensor array of 64×64 and 15μm×15μm pixel pitch has been designed and fabricated in 0.18μm CMOS technology. The experimental results show an achieved high dynamic range of 132dB, a FPN in dark of 0.02%, a frame rate of 230fps, and an iFOM of 1.27 nW/frame.pix at 1.5V(A)/0.8V(D) operation.

Isoguanosine (3) underwent a coupling reaction with diaryl disulfides in the presence of tri-n-butylphosphine when its 6-amino group was protected by N,N-dimethylaminomethylidene. The synthesis of 5-deoxyN 3 ,5-cycloisoguanosine (6) and its 2,3-O-isopropylidene derivative (11) were accomplished in excellent yields from isoguanosines (3 & 10) in the presence of triphenylphospine and carbon tetrachloride in pyridine. Chlorination at the 5-position of isoguanosine (3) with thionyl chloride followed by the aqueous basepromoted cyclization afforded the same product 6. The structures were elucidated by spectroscopic analysis including IR, UV, 1-D and 2-D NMR.

High performance liquid chromatography (HPLC) with chemically removable derivatizing reagents for the analysis of methanol has been developed. Methanol was derivatized with 4-[N-methyl, N-(1-naphthylmethyl)]-amino-4-oxo-butanoic acid (NAOB), using 4-dimethylaminopyridine (DMAP) and 1-ethyl-3-(3-dimethylaminopropyl)carbodiimide hydrochloride (EDC) as activators. NAOB and the activators are chemically removable and can be removed by aqueous base and acid treatment after derivatization to minimize reagent interference in chromatography. The method can simultaneously determine methanol, ethanol and 1-propanol. The proposed HPLC method was validated for linearity, specificity, accuracy and reproducibility. The method was applied to the analysis of methanol spiked in Ipecac fluid extract with a satisfactory recovery (>95%).

Microsatellite primers were developed for the native perennial cycad Cycas taitungensis to evaluate the genetic variation of this endangered insular species.Using a magnetic bead enrichment method and EST data, 16 primer sets were developed and identified for the native Taiwan cycad C. taitungensis. The primers amplified dinucleotide, trinucleotide, and complex repeats with 1-9 alleles per locus. Most primers also amplified DNA from C. revoluta and C. debaoensis.These results indicate the utility of primers for future studies of the genetic structure of C. taitungensis. In addition, the primers are useful for further phylogeographic studies between C. taitungensis and C. revoluta, which is a closely related species.

Background Gastrodia flabilabella is a mycoheterotrophic orchid that obtains carbohydrates and nutrients from its symbiotic mycorrhizal fungi. The species is an endemic and vulnerable species enlisted in the “A Preliminary Red List of Taiwanese Vascular Plants” according to the IUCN Red List Categories and Criteria Version 3.1. G. flabilabella dwells the underground of broadleaf and coniferous forest with richness litter. Based on herbarium records, this species is distributed in central Taiwan. Twenty eight microsatellite loci were developed in G. flabilabella and were tested for cross-species amplification in additional taxa of G. confusoides, G. elata, and G. javanica. We estimated the genetic variation that is valuable for conservation management and the development of the molecular identification system for G. elata, a traditional Chinese medicine herb. Results Microsatellite primer sets were developed from G. flabilabella using the modified AFLP and magnetic bead enrichment method. In total, 257 microsatellite loci were obtained from a magnetic bead enrichment SSR library. Of the 28 microsatellite loci, 16 were polymorphic, in which the number of alleles ranged from 2 to 15, with the observed heterozygosity ranging from 0.02 to 1.00. In total, 15, 13, and 7 of the loci were found to be interspecifically amplifiable to G. confusoides, G. elata, and G. javanica, respectively. Conclusions Amplifiable and transferable microsatellite loci are potentially useful for future studies in investigating intraspecific genetic variation, reconstructing phylogeographic patterns among closely related species, and establishing the standard operating system of molecular identification in Gastrodia.

Management of chronic metabolic diseases has recently become an important global health issue. Extensive research on empowerment-based self-management interventions (EBSMIs) for patients with chronic metabolic diseases has been conducted, but no systematic review has evaluated their effects.To evaluate the effects of EBSMIs on patients with chronic metabolic diseases.A systematic review and meta-analysis was conducted. Five electronic databases (Airiti Library, CINAHL, Cochrane Library, PubMed/ MEDLINE, and Index of Taiwan Periodical Literature System) were searched from the earliest year available to October 2012. Controlled trials about the effectiveness of interventions on patients with chronic metabolic diseases were included. Each study was appraised by three reviewers and assigned a level of evidence based on the modified Jadad scale. Extracted data were entered and analyzed using Review Manager 5.2.Nineteen studies were reviewed. Most studies showed that EBSMIs improved patients' hemoglobin A1c test (HbA1c) (p.00001), waist circumference (p = .02), and empowerment level (p = .004). Four studies compared the effect on body weight and body mass index, but the overall effect was not significant (p = .33 and .73, respectively). Five studies compared the effect on self-efficacy, four of which indicated significant increase. However, the overall effect on self-efficacy was not compared because studies used different scales.EBSMIs improved HbA1c test results, waist circumference, self-efficacy, and empowerment level in patients with chronic metabolic diseases. When implementing the EBSMIs, healthcare institutions need to provide training programs related to empowerment from which health professionals can acquire competence in patient empowerment. Moreover, healthcare leaders should assess and overcome barriers (e.g., time, manpower, cost, etc.) to implementing EBSMIs in clinical settings.

The empowerment concept has been applied to chronic metabolic diseases. However, literature reviews to date are inadequate to assess their utilization status.This study was developed to assess the application of empowerment elements and strategies to chronic metabolic diseases and then propose suggestions for improvement.A literature review was conducted using five Chinese- and English-language electronic databases, including PubMed/MEDLINE. A total of 21 articles on randomized clinical trials related to the application of empowerment intervention program to chronic metabolic diseases were appraised to examine empowerment element and strategy usage.The empowerment concept was applied mostly with diabetes groups (90.48%). Application rates for the six major elements were 95.24% in action, 47.62% in dialogue, 33.33% in feedback, 23.81% in building partnership, 23.81% in reflection, and 19.05% in listening. Application rates for the six major strategies were 95.24% in action planning and behavior change, 80.95% in goal-setting and plan, 52.38% in problem solving and obstacle overcoming, 47.62% in identifying concerns and problems, 33.33% in motivation and self-awareness, and 23.81% in review and continuous self-management. CONCLUSION / IMPLICATIONS FOR PRACTICE: Healthcare professionals are found generally lacking in the application of elements including "building partnership," "listening," and "reflection" and strategies including "motivation and self-awareness" and "review and continuous self-management" when applying empowerment programs to chronic metabolic disease patients. Therefore, the authors suggest that healthcare professionals fully apply the six major empowerment elements and strategies to clinical practice and studies to help thoroughly promote the spirit of empowerment and empower patients with chronic disease to take charge of their life and recovery.

Aims and objectives This study presents a discussion of the physiological and psychological efficacy of a self-regulation protocol in lowering acute exacerbation symptoms in patients with chronic obstructive pulmonary disease. Background Patients with chronic obstructive pulmonary disease are often troubled by acute exacerbation and must learn how to prevent this. Design A two-group, pretest–post-test experimental design was used in this study. Methods Data were collected between January–July 2008. Sixty-four participants were randomly assigned either to an intervention (n = 33) or to a comparison (n = 31) group. Both groups were assessed on four separate occasions, namely pretest, post-test 1 (5th week), post-test 2 (9th week) and post-test 3 (13th week). The intervention group received a four-week self-regulation protocol. The comparison group received the self-regulation guidebook only. The Borg Dyspnea Scale, the Symptom Distress Scale, the Pulmonary Functional Status Scale, the chronic obstructive pulmonary disease Self-Efficacy Scale and the peak expiratory flow were used to measure differences between pretest and post-test values. Results On the 5th, 9th and 13th weeks after the self-regulation protocol intervention, we found significantly better scores in the four scales in the intervention group compared to those in the comparison group. On the 9th and 13th weeks, there was a significantly greater peak expiratory flow in the intervention group. The intervention group also showed a lower rate of unscheduled physician visits because of acute exacerbation than the comparison group. Conclusion The findings indicate that the self-regulation protocol developed in this study could significantly assist participants to control their individual symptoms and avoid acute exacerbation. Relevance to clinical practice Healthcare professionals could apply the protocol developed in this study to assist patients to learn the strategies of self-regulation to prevent their acute exacerbation symptoms.

The task of defining, maintaining, and mutually adapting the nurse-patient relationship has been ongoing since modern nursing's earliest days. The nurse-patient relationship changes with social changes and paradigm shifts. Most medical centers today strive to incorporate the concept of partnership into the nurse-patient relationship in response to patient-centered medical care. What is the implication of this relationship? Is it suitable for all nurse-patient situations? What are the impacts on nurses and patients? How should nurses adapt to change in nurse-patient relationships? This article analyzes and reflects upon the nurse-patient relationship within a postmodernist framework guided by concepts of "deconstruction", "de-centralization", "multiplicity", and "inter-subjectivity." We derive a "dual-active" and "dual-expert" partnership between nurses and patients that centers on patient disease management. Core values of this partnership are respect and caring, and strategies include emancipation, enlightenment, and empowerment.

Two representative S-cyclonucleosides, 8,5′-anhydro-2′, 3′-O-isopropylidene-8-mercaptoadenosine (3) and 8,2′-anhydro-3′,5′-O-(tetraisopropyldisiloxane-1,3-diyl)-8-mercaptoguanosine (8), were prepared in good yields by dropwise addition of one equivalent each of triphenylphosphine and DEAD in DMF into a mixture of 2′,3′-O-isopropylidene-8-mercaptoadenosine (2) or 3′,5′-O-(tetra-iso-propyldisiloxane-1,3-diyl)-8-mercaptoguanosine (7), respectively, in DMF. Treatment of compound 2 with two equivalents each of triphenylphosphine and DEAD in DMF afforded N-[8,5′-anhydro-2′,3′-O-isopropylidene-8-mercaptopurin-6-yl]triphenylphospha-λ5-azene (4) in 87% yield.

Appraisal is a cognitive response by an individual facing an event within a given environment. When the individual has passed through a thought process that gives the event meaning, the coping process is finally completed. Coping heightens an individual's well-being. Negative appraisal will induce an emotional coping response and affect one's quality of life, mental state and health. Several researchers applied the concept of appraisal to their disciplines. The concept of appraisal, however, is poorly defined. This article applies the methodology outlined by Walker and Avant (1995) to analyze the concept of appraisal. The definition of appraisal, examples, and empirical references provided in this paper will be useful in nursing practice in relation to the role of appraisal in coping.