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The aim of the study was to evaluate the psychometric properties of the Chinese version of the Self-Directed Learning Readiness Scale.A cross-sectional survey was designed.A convenience sample of 659 participants was recruited. Exploratory and confirmatory factor analyses were used to evaluate the factorial structure. In addition, the concurrent validity was assessed using the Critical Thinking Disposition Inventory.The exploratory factor analysis revealed that the scale was a 6-factor structure, named love of learning, active learning, effective learning, independent learning, learning motivation and creative learning, which explained 53.30% of the total variance. The findings of the confirmatory factor analysis showed that a 37-item six first-order model produced the best-fit statistics. Internal consistency for the scale was satisfactory, ranging from 0.71 to 0.88. Concurrent and predictive validities also reached significant levels. The utility of the instrument was suggested.

The purpose of this study was to investigate the efficacy of decision support intervention on treatment knowledge, decision self-efficacy, decisional conflict, and decision satisfaction in patients with hepatocellular cancer. The study was a randomized controlled trial. In all, 69 patients with hepatocellular carcinoma (HCC) were recruited and randomly assigned to a decision support group or a control group. Data were collected at baseline, post-test, and follow-up using self-report questionnaires. After controlling for baseline scores, the between-group difference (95% confidence interval [CI]) for treatment-related knowledge in post-test scores was 11.9 (6.1, 17.8). After controlling for baseline scores, the between-group difference (95% CI) for decisional conflict was −7.0 (−12.0, −2.0). There was no statistically significant between-group difference in decision self-efficacy and decision satisfaction. Findings supported the efficacy of decision support intervention to improve treatment knowledge and reduce decisional conflict but had no significant effect on decision self-efficacy and decision satisfaction in patients with HCC.

BACKGROUND Fever frequently occurs in patients with traumatic brain injury and can cause secondary damage to the brain. Critical care nurses play essential roles in assessing and managing fever in these patients. AIM The study aimed to (a) examine the fever causes in and condition of neurosurgical patients with traumatic brain injury in intensive care, (b) identify the factors associated with fever, and (c) determine the effects of fever on hospital stay and prognosis. STUDY DESIGN This study is a retrospective observational design. METHODS Data were collected through chart reviews of 93 traumatic brain injury patients admitted to a teaching hospital's intensive care unit for postoperative care. Fever was defined as at least one episode of body temperature >38°C. RESULTS Of the 93 patients, 76 developed a fever within 1-week post-craniotomy. Of these, 49 were infection-related and 27 were unexplained. Results of logistic regression showed that the preoperative Glasgow coma scale score (s = -.323; P = .013) and length of intubation (s = .480; P = .005) were the key predictors of unexplained post-craniotomy fever, and these two variables (s = -.494; P

Epilepsy is a neurological disease that causes recurrent seizures and can have a significant impact on a person's quality of life (QOL). A self-management intervention (SMI) can allow adults with epilepsy to modify behaviors in order to manage their seizures and evaluate the impact of medication and treatments on their daily lives. The purpose of this study was to investigate the effects of a SMI for adults with epilepsy.This was a longitudinal randomized controlled trial. Adults with epilepsy between the age of 20 and 65 years were recruited from a medical center in northern Taiwan. Participants were assigned to an intervention group (IG) or control group (CG) through simple randomization. Data regarding demographic and clinical characteristics were collected at baseline (T0). In addition, participants answered nine validated self-report questionnaires, which were used as outcome measures. Following collection of baseline data, the CG received routine monthly counseling over the next 3 months. The IG received the routine monthly counseling, as well as individual face-to-face health counseling on self-management 1 h/month and remote counseling via the phone or computer network at least twice per month. After the first month (T1) and at the end of the third (T2) and sixth months (T3) participants answered the nine questionnaires again. Differences in outcomes between the IGs and CGs were analyzed by comparing scores for the nine outcome variables at T0 with scores at T1, T2, and T3 with generalized estimating equations.A total of 210 adults agreed to participate in the study; however, only 155 participants completed the questionnaires for all three time points: 75 in the CG and 80 in the IG. The mean age of the 155 participants was 39.6 years (SD = 10.9). There was no significant difference between demographic or clinical variables between the two groups. The only difference in baseline scores (T0) among the nine self-report questionnaires was in epilepsy knowledge, measured with the Epilepsy Knowledge Profile questionnaire, which were significantly higher for the CG (mean = 32.28, SD = 3.92) than the IG (mean = 23.01, SD = 2.79) (p 0.001). Generalized estimating equations (GEE) analysis showed scores decreased significantly at T3 from baseline for the CG for epilepsy knowledge and QOL (p 0.001). Improvements in scores for sleep quality, anxiety, depression, self-efficacy, coping, and social support did not differ between groups. Classification of the IG by gender showed a significantly greater increase for males compared with females from baseline to T3 for epilepsy knowledge (p 0.001). If we further classified the IGs by seizure frequency, participants with a seizure frequency of ≥1 per year had a more significant increase in epilepsy knowledge and increase in QOL compared with participants with a seizure frequency of1 per year at T3 compared with T0.The lack of improvement in health-related quality of life (HRQoL) following the SMI may indicate that additional time is required to change behaviors that impact this variable for patients with epilepsy. Additional research should focus on variables associated with medication compliance, epilepsy knowledge, medicine symptom distress, self-efficacy, anxiety, and HRQoL.

The COVID-19 pandemic has greatly impacted first-line medical staff as well as nursing-student clinical practicum programs. How to cooperate with the government's pandemic-prevention policies and reduce the gap between education and clinical practice represent significant challenges. In this paper, Chang Gung University of Science and Technology (CCUST) is used as an example to show how schools in Taiwan have effectively adapted the fundamentals of nursing practicum programs to the current pandemic using e-learning, group discussions, case analysis, clinical skill practice, and clinical case simulation scenario exercises. The program at CCUST both takes into account the safety of students and has achieved all critical nursing practice goals. After implementation of these adjustments, satisfaction among nursing students with the practicum environment and the clinical instructors was found to be significantly higher for the on-campus clinical practicum than for the off-campus clinical practicum. Furthermore, the results of qualitative data analyses show that nursing students in the on-campus practicum gained significant knowledge and experience and commented positively on their experience. For example, the students indicated that they were satisfied with the simulated clinical environment of the CCC, the teaching strategies and adaptability of the instructor, and the application of virtual reality scenario cases to enhance skill proficiency and learning outcomes. The adjusted nursing clinical practicum described in this paper may be used as a reference to ensure the quality of nursing clinical practicum programs is maintained during epidemics.護理實習於新型冠狀病毒肺炎疫情之挑戰.新型冠狀病毒肺炎（COVID-19）疫情直接影響第一線的醫護人員，同時也影響護理學校之臨床實習，如何配合政府相關之防疫政策，又能兼顧減少學用落差之實作教學，確實是一大挑戰。本文以長庚科技大學為例分享如何有效率因應COVID-19，調整基本護理學實習模式（於臨床技能中心應用數位教材教學、小組討論、案例分析、技術練習、臨床個案模擬情境演練等），兼顧學生安全且達到護理實習目標。於調整護理實習方案後發現，護生對校內實習之實習環境及指導老師面向滿意度顯著高於校外臨床實習，質性資料分析也發現，護生對於校內實習很正向且表示收穫良多，如學生對臨床技能中心仿真之實習環境、指導老師的教學方法及應變能力、應用虛擬實境情境教案強化學生技術的熟練度及學習成效。本文所分享之應變護理臨床實習模式可做為非預期流行疫情下，仍確保護理實習教學品質之參考。.

Yun-Ju Chen,1 Jun-Yu Fan,2 Su-Er Guo,2–4 Su-Lun Hwang,2,3 Tsung-Ming Yang4 1Division of Respiratory Therapy, Chiayi Chang Gung Memorial Hospital,Chang Gung Medical Foundation, Chiayi, Taiwan, Republic of China; 2Graduate Institute of Nursing, College of Nursing, Chang Gung University of Science and Technology, Chiayi, Taiwan, Republic of China; 3Chronic Diseases and Health Promotion Research Centre, Chang Gung University of Science and Technology, Chiayi, Taiwan, Republic of China; 4Division of Pulmonary and Critical Care Medicine, Chiayi Chang Gung Memorial Hospital, Chang Gung Medical Foundation, Chiayi, Taiwan,Republic of China Purpose: Pulmonary rehabilitation (PR) is recognized as the chief non-pharmacologic management approach for patients with COPD, but is clinically under-utilized. In Taiwan, respiratory therapists (RTs) are one of the first-line health care providers who spend vast amounts of time with COPD patients in PR programs. To better enhance patients’ knowledge of and participation in PR, it is necessary to understand how PR is viewed by RTs, as well as how these views influence their behavioral intentions toward promoting PR. This study applied the Theory of Planned Behavior (TPB) to investigate both the behavioral intentions and the influential factors surrounding PR in RTs.Patients and methods: This cross-sectional study used structured self-administered questionnaires at a national symposium for RTs to collect data on their knowledge, attitudes, subjective norms, perceived behavioral controls, and behavioral intentions with regard to promoting PR. Multiple linear regression analysis was used to identify significant factors affecting the intended promotion of PR by RTs.Results: The response rate after excluding respondents with incomplete data was 88.1% (n=379). A majority of the participants were college graduates, aged over 30 years, and women. The respective percentage scores derived from questionnaires gauging the knowledge, attitudes, subjective norms, self-efficacy, and behavioral intentions components of total PR scores were 63.12%, 71.33%, 68.96%, 66.46%, and 80.29%. The factors significantly affecting RTs’ intentions to suggest PR participation to COPD patients or encourage it were attitudes, subjective norms, and self-efficacy. The total model explained 22.5% of the variance in behavioral intentions.Conclusion: The results of the study suggest that RTs strongly intend to promote PR, but are hindered by insufficient knowledge, attitudes, and self-efficacy with regard to it. Applying TPB provided insight into which factors can be addressed, and by whom. For example, enhancing RTs’ self-efficacy can be achieved through PR training via school curricula, further regular continuing education and/or courses, and practical experience. Keywords: behavioral intention, theory of planned behavior, exercise program, self-efficacy, respiratory therapist, COPD

Aim We explored the impact of job content and stress on anxiety, depressive symptoms and self-perceived health status among nurse practitioners (NPs). Background Taiwan's NP roles vary between hospitals as a result of the diverse demands and complex tasks that cause job-related stress, potentially affecting the health of the NP. Methods This study utilised a cross-sectional descriptive design with 161 NPs from regional hospitals participating. Data collection involved demographics, the Taiwan Nurse Stress Checklist, the Job Content Questionnaire, the Beck Anxiety Inventory, the Beck Depression Inventory, a General Health Status Checklist and salivary cortisol tests. Results NPs reported moderate job stress, similar job control to nurses, mild anxiety and depression, and below-average self-perceived health. Being a licensed NP, personal response, competence, and incompleteness of the personal arrangements subscales of job stress, and anxiety predicted self-perceived health after adjusting for other covariates. Conclusions Job stress and anxiety affect NP health. Implications for Nursing Management NPs are a valuable resource, and the healthcare system demand is growing. Reasonable NP staffing, working hours, proper promotion systems, the causes of job stress, job content clarification and practical work shift scheduling need to be considered. The occupational safety and physical and psychological health of NPs are strongly associated with the quality of patient care.

Injury is a significant cause of mortality and morbidity. The complicated consequences of injury have received increasing attention, as injuries are predicted to be the world's fourth leading cause of disability by 2030 (Mathers, Boerma, & Ma Fat, 2009). The medical costs for people with injuries are increasing; these costs may not include the substantial costs associated with family or community care. Patients who suffer from an injury experience short-term and long-term disabilities, and those disabilities have been identified systematically (Holtslag, Post, Lindeman, & Van der Werken, 2007; Lee, Chaboyer, & Wallis, 2010). However, the totality of problems experienced by an injured individual may result in expanded responsibilities for the patient's whole family.BackgroundClinicians have become increasingly aware that injury has a long-term adverse impact on family members because they have a critical supporting role in the recovery process (Kreutzer, Marwitz, Godwin, & Arango- Lasprilla, 2010). To enable better outcomes for injured patients and their caregivers, it is necessary to understand the problems faced by patients in healing from an injury, and also to understand the related needs of their caregivers (Griffin, Friedemann-Sanchez, Hall, Phelan, & van Ryn, 2009; Kreutzer et al., 2010). The Common Sense Model of Illness Representation (CSMIR) provides a structure for understanding how an individual perceives the threats of illness and how those perceptions influence the individual's health behaviors (Leventhal, Leventhal, & Cameron, 2001). Illness representation is the central stage of the CSMIR. Five organized components of cognitive beliefs are included in illness representations (Leventhal et al., 2001). The first component, identity of the illness, is used to identify the physical symptoms of an illness. The second component, timeline belief, reflects the perceived progress and duration of an illness (acute, chronic, or cyclic). The third component, consequences, is the experienced consequences of the illness affecting the individual's work, family, lifestyle, and finances. The fourth dimension is control or cure, which is associated with perceptions of how the illness is susceptible to personal control, and whether the illness can be cured or treated. Causal beliefs, the last component, relates to the perceived causes of the illness (Leventhal et al., 2001)Illness representation is described as the internal processes by which individuals create the definitions or the representations of a health threat. An individual's illness representations may influence his or her responses to illness-related problems via parallel cognitive and emotional representations (Leventhal, Brissete, & Leventhal, 2002). The emotional pathway interacts with the cognitive pathway when an individual is forming reactions to the health-threatening experience (Leventhal et al., 2002). Moreover, illness representations consist of perceptions of the given threat to the individual's health based on bodily sensations or symptoms. These symptoms are produced using information from the environment, such as information provided by significant others or the individual's own past experiences with illness (Leventhal et al., 2001). Hence, both internal and external stimuli invoke illness representations from specific health-related situations. Once these representations are formed, coping and appraisal occur. In summary, illness representations assist an individual with the process of self-regulation, which is defined as the regulation of cognitive and emotional perceptions, including the development of coping behaviors used when adapting to an illness (Leventhal et al., 2002).Researchers have sought to understand the factors that influence the development of illness representations. For example, positive illness representations have been found to be associated with better self-regulation in patients with injury (Lee et al. …

The aim of this study was to examine the relationships among depression, anxiety, sleep disturbances, Parkinson’s disease (PD) symptoms, PD medications, and health-related quality of life (QOL) and to identify the predictors of health-related QOL in PD patients. To do this, we administered a battery of questionnaires and rating scales (validated Chinese versions), including the Unified Parkinson’s Disease Rating Scale, 39-item Parkinson’s Disease Questionnaire, Parkinson’s Disease Sleep Scale-2, Beck Depression Inventory, and Beck Anxiety Inventory, to 134 patients with PD whose Minimental State Examination scores were ≥24. We found that patients who reported having poorer QOL had longer disease durations, more severe PD symptoms, higher Hoehn and Yahr stages, and higher levodopa dosages, as well as higher levels of anxiety and depression, more sleep disturbances, and poorer overall cognitive statuses. Among these variables, the cognitive status, dependency of activities of daily living, depression, and anxiety were identified as predictors of QOL in PD patients and were all significant and independent factors of poor QOL in PD patients. The clinicians should be aware of the effects of these factors on QOL and attempt to treat comorbid psychiatric conditions to improve the PD patients’ QOL.

To investigate the associated factors and change trajectories of quality of life (QoL), global outcome, and post-concussion symptoms (PCS) over the first year following mild traumatic brain injury (mTBI). This was a prospective longitudinal study of 100 participants with mTBI from neurosurgical outpatient departments in Chiayi County District Hospitals in Taiwan. The checklist of post-concussion syndromes (CPCS) was used to assess PCS at enrollment and at 1, 3, and 12 months after mTBI; the glasgow outcome scale extended (GOSE), the quality of life after brain injured (QOLIBRI), Chinese version, and the Short Form 36 Health Survey (SF-36), Taiwan version, were used to assess mTBI global outcome and QoL at 1, 3, and 12 months after mTBI. Latent class growth models (LCGMs) indicated the change trajectories of QOLIBRI, PCS SF-36, MCS SF-36, GOSE, and PCS. Classes of trajectory were associated with age ≥40 years, unemployment at 1 month after injury, and educational level ≤12 years. Univariate analysis revealed that employment status at 1 month post-injury was correlated with the trajectories of QOLIBRI, PCS SF-36, MCS SF-36, and GOSE, but not PCS. Employment status was the most crucial associated factor for QoL in individuals with mTBI at the 1-year follow-up. Future studies should explore the benefits of employment on QoL of individuals with mTBI.

1,3,5-trinitro-1,3,5-triazacyclohexane (RDX) or hexogen, a high-insensitivity explosive, the accurately description of its energy and properties is of fundamental significance in the sense of security and application. Based on the machine learning method, high-dimensional neural network is used to construct potential function of RDX crystal. In order to acquire enough data in neural network learning, based on the four known crystal phases of RDX, the structural global search is performed under different spatial groups to obtain 15199 structure databases. Here in this study, we use nearby atomic environment to build 72 different basis functions as input neurons, in which the 72 different basis functions represent the interaction with nearby atoms for each type of element. Among them, 90% data are randomly set as training set, and the remaining 10% data are taken as test set. To obtain the better training effect, 9 different neural network structures carry out 2000 step iterations at most, thereby the 30-30-10 hidden layer structure has the lower root mean square error (RMSE) after the 1847 iterations compared with the energies from first-principles calculations. Thus, the potential function fitted by 30-30-10 hidden layer network is chosen in subsequent calculations. This constructed potential function can reproduce the first-principles results of test set well, with the RMSE of 59.2 meV/atom for binding energy and 7.17 eV/Å for atomic force. Especially, the RMSE of the four known RDX crystal phases from 1 atm to 6 GPa are 10.0 meV/atom and 1.11 eV/Å for binding energy and atomic force, respectively, indicating that the potential function has a better description of the known structures. Furthermore, we also propose four additional RDX crystal phases with lower enthalpy, which may be alternative crystal phases undetermined in experiment. In addition, based on molecular dynamics simulation with this potential function, the α-phase RDX crystal can stay stable for a few ps, further proving the applicability of our constructed potential function.

Catechol-O-methyltransferase (COMT), an enzyme that catalyzes the degradation of dopamine, is necessary for both motor and cognitive functions. Few studies have examined the association between COMT variants and cognition in patients with Parkinson's disease (PD).We assessed a cohort of 409 PD patients without dementia who were regularly followed for two years. The Unified Parkinson's Disease Rating Scale (UPDRS) and Mini-Mental State Examination (MMSE) were administered at baseline and during the follow-up. The genetic variants and haplotypes of COMT, including rs6267, rs6269, rs4633, rs4818, and rs4680, were examined.No association was observed between COMT genotypes and baseline cognitive function. After a mean follow-up period of 647.3 days, MMSE scores deteriorated with age. Cognitive decline correlated with age (P 0.05) but not with the motor severity defined using UPDRS part III scores (P = 0.21). Kaplan-Meier survival analyses showed that PD patients carrying the G allele of the rs6269 variant and COMT haplotypes constituting the G allele of rs6269 showed a significantly more rapid decline in the MMSE scores over the follow-up period (log-rank test, P 0.01). Cox proportional regression analysis adjusted for covariates revealed that among patients with PD, those carrying the high-COMT activity haplotype (G_C_C_G for rs6269, rs4633, rs4818, and rs4680) showed a high risk of cognitive decline (hazard ratio = 3.24; P = 0.02).Our findings suggest that the high-COMT activity haplotype is associated with cognitive decline in patients with PD.

Background Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are the leading causes of liver cirrhosis and hepatocellular carcinoma. Little is known about the relationship between health-related behaviors and health status among HBV or HCV carriers. Objective The purpose of this study was to explore the relationship between health status (eg, specific biomarkers) and health-related behaviors (eg, alcohol consumption) in individuals with or without HBV or HCV infection. Methods A cross-sectional descriptive design was used, and a community-based health screening survey was conducted between August 2011 and July 2012 in Taiwan. Results In total, 6 805 community residents 20 years or older participated in the study. The HBV and HCV infection rate was 18.7% and 20.8%, respectively, and HBV/HCV infections were significantly associated with current alcohol use, smoking, and self-medication. Multivariate analysis indicated that HBV/HCV infection, overweight status, higher fasting blood sugar level, higher systolic blood pressure, and 3 unhealthy habits were independent risk factors for abnormal liver function. Conclusion Our findings suggest that both HBV and HCV carriers are more likely to have unhealthy habits and a poor health status. In addition to some factors that cannot be modified, being overweight, drinking alcohol, betel nut chewing, smoking, and self-medication are all risk factors for poor liver health among both hepatitis carriers. Implications for practice For clinicians, the results could be applied by providing more education to help the community better understand the relationships between specific risk factors and liver health, encouraging hepatitis carriers in rural areas to undergo annual physical check-ups.

As a common threat to the public safety, gas explosion and its damage on structures have drawn more and more attention in the academic fields. In this paper, a series of numerical simulations are conducted to study the behavior of autoclaved aerated concrete block infilled walls under gas explosion loading. Firstly, considering the difference between the blocks and the mortar, a refined numerical model is established, and the constitutive model of Brittle Damage in LS-DYNA is hired to describe the material behaviours of both materials. Based on the laboratory material test data, the parameter of the material model are selected reasonably. Then, massive numerical calculation is carried out and the dynamic response of autoclaved aerated concrete block infilled walls is captured and discussed. At last, the anti-blast ability of block infilled walls is compared with that of clay infilled wall of the same thickness. It is found that the anti-blast ability of block infilled walls is weaker than the clay infilled walls for the difference of material density and boundary conditions.

Pain is a distressing symptom of Parkinson disease (PD). We aim to determine whether the genetic variants of chronic pain-related genes contribute to pain in PD patients. We included 418 PD patients and evaluated pain severity on King’s PD pain scale. We genotyped rs6267, rs6269, rs4633, rs4818 and rs4680 of COMT, rs6746030 of SCN9A, and rs1799971 of OPRM1. In total, 193 participants (46.2%) experienced pain. Compared to pain-free PD patients, PD patients with pain had an earlier age of onset, longer disease duration, and higher depression and motor severity (P COMT rs4680 “A” allele were higher in PD patients with pain than those without pain (46.1% vs. 31.1%, P P = 0.02), and COMT rs6267 T allele (P COMT rs6267 “GT” genotype and pain severity remained significant (P COMT rs4680 “GG” and “GA” genpotypes than those having “AA” genotype (P = 0.04). We concluded that depression and COMT rs4680 “GG” and “GA” genotypes and COMT rs6267 “GT” genotype contribute to pain in PD patients.

Aims and Objectives: To scrutinize the evidence of response shift effect on published quality of life (QOL) studies investigating the patient-reported outcome to obtain accuracy data as evaluating clinical practice. Background: People may alter their internal standards, known as response shift, when they experience changes in their health status. This phenomenon can falsify patient-reported measures, and has gained increasing attention recently in explaining research paradoxical findings. Nevertheless a rigorous evidence-base about this effect on cancer patients QOL is lacking. Design: A systematic review was carried out under adhered to the guideline of the Quality of Reporting of Meta-Analyses. Methods: A comprehensive search was conducted on seven English and Chinese databases to identify and collect studies focus on cancer patients QOL. Methodological quality assessment was performed to assess the strength of evidence. Results: Using pre-determined keywords, 584 relevant titles were identified. Eventually 14 papers satisfied the inclusion criteria and entered the quality assessment stage. All the articles were written in English and published between 1996 and 2013. A majority of the studies used the then-test method, which is also known as the retrospective pretest-posttest design method. The weighted mean effect size (WMES) was 0.47 (95% CI 0.31 to 0.63). Using data from the six studies for assessing then-test/pre-test comparison on the outcome measure fatigue, the WMES was -0.21 (95% CI -0.32 to -0.10). Conclusion: The alternation of self-internal standard occurs when cancer patients evaluated their QOL over a period of time. Relevance to clinical practice: This review emphasizes the need for a more sensitive approach to inspect the clinical impact of response shift by measuring changes in QOL. Patients’ adaptation to the disease can then be more precisely acquired.

Given the complex clinical situations and the dynamic nature of nursing, the greatest challenge for nursing educators is performing objective evaluation of students’ clinical competence. The Objective Structured Clinical Evaluation (OSCE) is designed to address this challenge and it has been widely used in nursing education. However, its implementation in nursing education in Taiwan has been limited. Accordingly, a quasi-experimental design was utilized to examine students’ clinical performance and stress levels using a 12-station OSCE assessment. Further, we investigated the inter-rater reliability and internal consistency of the OSCE. After controlling for scores of clinical performance, overall differences in pre- and post-practicum stress in the OSCE group were significantly higher than in the control group (F (1, 89) = 4.89, p = 0.03). There was no group effect on practicum performance after controlling for grade point average (F (1, 89) = 2.69, p = 0.14). Cronbach’s alpha for 12 OSCE stations ranged from 0.22 to 0.80 and inter-rater reliability for all 12 stations showed Pearson’s r ranging between 0.76 and 1.00. Cohen’s kappa ranged from 0.70 to 1.00 (p

This study examined the differences between illness representations of injured patients and those of their caregivers.A comparative descriptive survey was used.The study setting was the surgical wards of a teaching hospital in Taiwan. Data were collected at 3 to 6 months after hospital discharge. Participants were 127 pairs of injured patients and their caregivers. The participants completed sociodemographic data and completed the Chinese Illness Perception Questionnaire Revised-Trauma, which is composed of eight subscales. Clinical data of the injured patients was obtained from medical records.Injured patients and their caregivers were pessimistic about the injury. Patients perceived significantly more physical symptoms than caregivers did. Caregivers for patients who were severely injured or admitted to an intensive care unit (ICU) had more negative perceptions than did those who were providing care for moderately injured patients or those not admitted to an ICU. Caregivers who did not share their caring responsibilities had more negative perceptions than did those who shared their caring responsibilities with others.This study found that patients and caregivers had negative illness representations several months after injury. Caregivers who provided care for severely injured patients or who did not share caring responsibilities perceived different extents of illness perceptions about the injury. The interventions should highlight the need to assist patients and caregivers after injury.Exploring the discrepancies in illness perceptions between injured patients and their caregivers can help clinicians to provide individualized care, and to design interventions that meet patients' and caregivers' needs.

Aim The aim of this study was to describe the current state of nurses' shift work in Taiwan and how it affects nurses' stress, sleep quality and self-perceived health status. Background To enable the provision of 24-hour patient care, nurses need to work various shifts. Long-term shift work significantly affects nurses' overall physical and mental health. Method Nurses from four Chiayi County district hospitals in Taiwan (n = 266) participated in this cross-sectional study from August to September 2010. Demographics, work schedule forms, a stress checklist, a sleep-quality measure and a health-status measure were used to collect data. Independent t-test, one-way anova, Pearson's r, and hierarchical regression were applied for analysis. Results The results showed that regardless of the amount of shift work they performed, nurses reported moderate job stress, poor sleep quality and moderate self-perceived health. The following significant relationships were observed: job stress was inversely related to sleep quality, which was directly related to self-perceived health status. Conclusion and implications for nursing management Hospital managers need to ensure more healthy shift work scheduling in order to improve nurses' clinical performance and personal health status, thereby also improving the quality of patient care.

To date, patients with bony metastases were only a small fraction of the samples studied, or they were entirely excluded. Patients with metastatic cancers, such as bone metastases, are more likely to report pain, compared to patients without metastatic cancer (50-74% and 15%, respectively). Their cancer pain results in substantial morbidity and disrupted quality of life in 34-45% of cancer patients. Massage therapy (MT) appears to have positive effects in patients with cancer; however, the benefits of MT, specifically in patients with metastatic bone pain, remains unknown. The purpose of this randomized clinical trial was to compare the efficacy of MT to a social attention control condition on pain intensity, mood status, muscle relaxation, and sleep quality in a sample (n=72) of Taiwanese cancer patients with bone metastases. In this investigation, MT was shown to have beneficial within- or between-subjects effects on pain, mood, muscle relaxation, and sleep quality. Results from repeated-measures analysis of covariance demonstrated that massage resulted in a linear trend of improvements in mood and relaxation over time. More importantly, the reduction in pain with massage was both statistically and clinically significant, and the massage-related effects on relaxation were sustained for at least 16-18 hours postintervention. Furthermore, massage-related effects on sleep were associated with within-subjects effects. Future studies are suggested with increased sample sizes, a longer interventional period duration, and an objective and sensitive measure of sleep. Overall, results from this study support employing MT as an adjuvant to other therapies in improving bone pain management.

Nurses caring for traumatic brain injury (TBI) patients with intracranial hypertension (ICH) recognize that patients whose intracranial adaptive capacity is reduced are susceptible to periods of disproportionate increase in intracranial pressure (DIICP) in response to a variety of stimuli. It is possible that DIICP signals potential secondary brain damage due to sustained or intermittent ICH. However, there are few clinically accessible intracranial pressure (ICP) measurement parameters that allow nurses and other critical care clinicians to identify patients at risk of DIICP. The purpose of this study was to investigate whether there are specific minute-to-minute trends in ICP variability during the first 48 hr of monitoring that might accurately predict DIICP in patients with severe TBI. A total of 38 patients with severe TBI were sampled from the data set of a randomized controlled trial testing bedside monitoring displays and cerebral perfusion pressure management in individuals with TBI or sub-arachnoid hemorrhage. The investigators retrospectively examined the rates of change (slope) in mean, standard deviation, and variance of ICP on a 1-min basis for 30 consecutive min prior to a specified DIICP event. There was a significantly increasing linear and quadratic slope in mean ICP prior to the development of DIICP, compared with the comparison data set (p < .05). It is feasible to display moving averages in modern bedside monitoring. Such an arrangement may be useful to provide visual displays that provide immediate clinically relevant information regarding the patients with decreased adaptive capacity and therefore increased risk of DIICP.

Background Intracranial hypertension due to primary and secondary injuries is a prime concern when providing care to patients with severe traumatic brain injury. Increases in intracranial pressure vary depending on compensatory processes within the craniospinal space, also referred to as intracranial adaptive capacity. In patients with traumatic brain injury and decreased intracranial adaptive capacity, intracranial pressure increases disproportionately in response to a variety of stimuli. However, no well-validated measures are available in clinical practice to predict the development of such an increase.Objectives To examine whether P2 elevation, quantified by determining the P2:P1 ratio (=0.8) of the intracranial pressure pulse waveform, is a unique predictor of disproportionate increases in intracranial pressure on a beat-by-beat basis in the 30 minutes preceding the elevation in patients with severe traumatic brain injury, within 48 hours after deployment of an intracranial pressure monitor.Methods A total of 38 patients with severe traumatic brain injury were sampled from a randomized controlled trial of cerebral perfusion pressure management in patients with traumatic brain injury or subarachnoid hemorrhage.Results The P2 elevation was not only present before the disproportionate increase in pressure, but also appeared in the comparison data set (within-subject without such a pressure increase).Conclusions P2 elevation is not a reliable clinical indicator to predict an impending disproportionate increase in intracranial pressure.

Summary Background Competency-based education is known to improve the match between educational performance and employment opportunities. Objectives This study examined the effects of competency-based education on the learning outcomes of undergraduate nursing students. Design The study used a quasi-experimental design. Participants A convenience sample of 312 second-year undergraduate nursing students from northern and southern Taiwan participated in the study. Methods The experimental group ( n =163) received competency-based education and the control group received traditional instruction ( n =149) in a medical–surgical nursing course. Outcome measures included students' scores on the Objective Structured Clinical Examination, Self-Evaluated Core Competencies Scale, Metacognitive Inventory for Nursing Students questionnaire, and academic performance. Results Students who received competency-based education had significantly higher academic performance in the medical–surgical nursing course and practicum than did the control group. Required core competencies and metacognitive abilities improved significantly in the competency-based education group as compared to the control group after adjusting for covariates. Conclusions Competency-based education is worth implementing and may close the gap between education and the ever-changing work environment.

The shortage of working nurses has made Taiwan's low nursing retention rate a critical issue in domestic healthcare. Main reasons for new nurses leaving their jobs include high pressure, overtime work, heavy workload, interpersonal relationship problems with colleagues, and inadequate support from administrators. In response, nursing educators designed the "last mile" program to improve the hands-on competence of nursing students with the goal of increasing post-graduation retention rates. This article introduces the last mile program in its present form and discusses the challenges faced in transitioning the program from the classroom into the clinical training environment. The authors suggest establishing a challenge test prior to implementing the last mile program, recruiting role-model preceptors, adjusting training program / project budgets, and developing partnerships between nursing educators and clinicians to enhance the clinical competence of new nurses and ultimately increase professional nurse retention rates, competence, and accountability.談最後一哩與新進護理人員臨床教育之銜接在檢討護理人力短缺的一片聲浪中，新進護理人員的之高離職率，一向備受重視。工作壓力大、超時工作、工作量負荷重、職場環境中之人際互動不佳、未感受到主管的支持和經驗／技術及學理的準備度不足，往往是導致新進護理人員不留任的原因。學校端為強化學生實作能力，於學生畢業前夕推動「最後一哩」計畫，期望提升新進護理人員「留任率」。本文將先介紹目前學校護理之「最後一哩」、新進護理人員臨床教育、與「護理臨床教師」之現況，並探討「最後一哩」與新進護理人員臨床教育銜接上所面臨的挑戰，最後再針對如何強化兩者的銜接，提出進行建議的策略：如進行相關技能檢定、聘用角色典範型之護理人員擔任護理臨床教師、適切調整專款經費之運用、培養情緒管理的能力及學界與業界形成夥伴關係，將最後一哩納入護理職前訓練等因應策略，期許學界與業界能攜手合作，共同培育高留任率且具紮實專業知能與敬業樂群之護理人員。

Background: People older than 65 years old account for about 10.9% of Taiwan's total population; it is also known that the older adults experience a higher incidence of depression. Public health nurses play an important role in promoting community health. Policymaking for community healthcare should reflect the relationship between health-promoting behavior and depression in community-dwelling seniors. Therefore, the encouragement of healthy aging requires strategic planning by those who provide health promotion services. Objective: This study was designed to elicit the health-promoting behaviors of community seniors and investigate the relationship between geriatric depression and health-promoting behaviors among seniors who live in rural communities. Methods: We used a cross-sectional, descriptive design and collected data using a demographic information datasheet, the Health Promotion for Seniors and Geriatric Depression Scale short forms. Results: The study included 427 participants. Most were women; mean age was 75.8 years. Most were illiterate; roughly half engaged in a limited number of health-promoting activities. The Geriatric Depression Scale score was negatively associated with health-promoting behavior. Social participation, health responsibility, self-protection, active lifestyle, and total Health Promotion for Seniors score all reached statistical significance. Multivariate analysis indicated that geriatric depression and physical discomfort were independent predictors of health promoting behavior after controlling the confounding factors. Conclusions/Implications for Practice: Participants practiced less than the recommended level of health-promoting behaviors. We found a negative correlation between the geriatric depression score and health-promoting behavior. Results can be referenced to develop strategies to promote healthy aging in the community, especially with regard to promoting greater social participation and increased activity for community-dwelling older adults experiencing depression.

Two separate contacts are incorporated into the different arms of Quantum Cascade lasers with asymmetric Mach-Zehnder interferometer type cavities. Preliminary results reveal an almost-continuous single mode tuning range of 20 cm−1 at 80K.

Aims and objectives To explore the factors associated with the numbers of remaining teeth among type 2 diabetes community residents. Background Promoting oral health is an important nursing role for patients with diabetes, especially in disadvantaged areas. However, limited research has been carried out on the relationship between numbers of remaining teeth, diabetes-related biomarkers and personal oral hygiene among diabetic rural residents. Design A cross-sectional, descriptive design with a simple random sample was used. Methods This study was part of a longitudinal cohort study of health promotion for preventing diabetic foot among rural community diabetic residents. It was carried out in 18 western coastal and inland districts of Chiayi County in central Taiwan. In total, 703 participants were enrolled in this study. Results The findings indicated that a high percentage of the participants (26%) had no remaining natural teeth. Nearly three quarters (74%) had fewer than 20 natural teeth. After controlling for the potential confounding factors, multivariate analysis demonstrated that the factors determining numbers of remaining teeth were age (p

Objectives Improving diabetes control is a critical issue world-wide, because mortality rates and costs are increasing dramatically. Maintaining a healthy lifestyle is positively associated with diabetes control. However, the availability of practical screening tools suitable for determining and modifying healthy or unhealthy lifestyle choices is limited. The main aim of this study was to determine the appropriateness of the type 2 diabetes and health promotion scale (T2DHPS) for use in patients with type 2 diabetes. Methods This study examined the Cronbach's alpha, content validity, construct and concurrent validity of the Chinese language version of the T2DHPS for assessing lifestyle and disease control among patients with type 2 diabetes. The dimensions of the T2DHPS were generated from the Chinese version of adult health promotion and interviews with experts, and were corroborated by the literature. A total of 323 patients previously diagnosed with type 2 diabetes were recruited. A cross-sectional, descriptive design questionnaire was developed and tested at diabetes outpatient departments in three teaching hospitals between August 2010 and June 2011. Construct validity was established using factor analysis. The total and subscale scores of the T2DHPS were correlated with biomarkers of diabetes control for concurrent validity. Results Kaiser–Meyer–Olkin (KMO) and Bartlett's sphericity tests showed that the sample met the criteria required for factor analysis. A 28-item Likert-type scale of the T2DHPS was established, and explained 56.7% of the total variance. The simplified version of the T2DHPS was made up of six dimensions of behavior: physical activity, risk reduction, stress-management, enjoy life, health responsibility and a healthy diet. The reliability coefficient for the total scale was 0.89, and alpha coefficients for the subscales ranged from 0.63 to 0.86. Concurrent validity indicated that the T2DHPS is significantly positively associated with diabetes control. Conclusions T2DHPS was shown to be a reliable and valid tool for assessing patients with type 2 diabetes, and can possibly predict diabetic control. This scale appears to be a useful screening tool for type 2 diabetic people in primary health care settings, to promote health status through modification of an unhealthy lifestyle.

Purpose: The purpose of this study was to compare the time needed to reach a specified temperature and the efficiency of two warming methods-warm cotton blankets and a radiant warmer-for hypothermia patients in a postanesthetic care unit (PACU) after spinal surgery.Design: This study was conducted according to a quasi-experimental design. Data were collected from a medical referral center in northern Taiwan. A total of 130 post-spinal surgery patients with hypothermia were recruited in the study.Methods: Of the 130 patients in the PACU, 65 were warmed by the radiant warmer (group R); whereas the other 65 patients were warmed by warm cotton blankets (group B). Tympanic temperature was measured for each patient every 10 min until it reached 36°C in the PACU. Analysis of covariance and generalized estimating equation regression analysis were performed to compare the time needed to reach a specified temperature and the efficiency of the two wanning methods, respectively.Findings: Both groups were similar in their baseline chara cteristics. After adjusting for temperature upon arrival at the PACU, group R needed a significantly shorter time for rewarming to 36°C than group B (F [1, 125] = 58.17, p Conclusions: Using the radiant warmer may be a more efficient method than providing warm cotton blankets for wanning post-spinal surgery hypothermia patients in the PACU.Clinical Relevance: For hospitals that are unable to use forced-air warming to warm postsurgical hypothermia patients in the PACU, the radiant warmer is a more efficient device to rewarm patients.Key wordsHypothermia, postoperative, spinal surgery, warming methodSurgical patient hypothermia is a common phenomenon that may occur before, during, or after operations. Numerous preoperative, intraoperative, and postoperative hypothermia-related research studies have been conducted since 1980. Studies have reponed that postoperative hypothermia, defined as having a core temperature of less than 36°C, occurs in 20% to 60% of all patients (Defina & Lincoln, 1998; Vaughan, Vaughan, & Cork, 1981). Spinal surgery involves a wide spectrum of procedures during which the spinal cord, nerve roots, and blood vessels are frequently at risk for injury (Gonzalez, Jeyanandarajan, Hansen, Zada, &* Hsieh, 2009). For patients undergoing spinal surgery, intraoperative active warming is difficult, since they are placed in the prone position, which allows only the legs to be covered with warming devices (Murat, Berniere, & Constant, 1994). The following questions thus arise: what can the clinical staff do to decrease this inadvertent hypothermia after spinal surgery, and which of the devices readily available in hospitals are the most effective for rewarming these patients in the PACU?Literature ReviewThermoregulatory MechanismsHumans are capable of maintaining homeostasis under fluctuating environmental conditions. For example, under normal circumstances, body temperature usually remains between 36.5°C and 37.5°C, with most changes being within I0C (Cooper, 2006). The center for regulation of body temperature is situated in the hypothalamus, which is responsible for the precise balancing of heat production and conservation, heat loss, and redistribution of heat via three major thermoregulatory mechanisms: vasoconstriction, shivering, and sweating (Wagner, 2006a). In surgical patients undergoing general or major regional anesthesia, hypothermia develops immediately after the induction of anesthesia because heat is redistributed from the center of the body to the periphery (Wagner, 2006b). …

Due to its geographic position and the effect of changes in both global and island-specific environments, Taiwan is an area highly prone to natural disasters. While responsibility for national disaster prevention and rescue are distributed amongst various authorities, healthcare agencies hold sole responsibility for the treatment of injuries sustained during disaster events. Disaster casualties require differing levels of medical assistance. In order to respond systematically to disaster events, the government should require that all healthcare facilities operate a hospital emergency incident command system (HEICS). Past experience shows the important role that nurses play in the disaster relief process. The 911 disaster in the United States both helped reorient the direction of nursing education and emphasized teaching practical strategies, standard operating procedures, and frequently asked questions for nurses. Recognizing the limited research done worldwide on disaster nursing, the World Society of Disaster Nursing (WSDN) was established in 2008 in Kobe, Japan. The main purposes of the WSDN is to promote international academic exchange, establish an Internet information exchange platform, and organize international disaster nursing related activities. The WSDN has suggested that future research may focus in on critical issues that include post-disaster health status follow-up, exploration of the healthcare needs and other issues of disaster survivors, care skills development, and the potential for development of cooperative support networks between medical institutions.

Studies indicate that weight perception among adolescents is associated with weight control, certain risky behaviors, and mental health. The aims of this study were to explore the perception of body size among overweight adolescents and to determine whether they consider it necessary to adjust weight and adopt healthier life habits and associated health-promoting behaviors. A cross-sectional descriptive design was used to investigate a convenience sample of 217 overweight adolescents(mean body mass index = 27.01 kg/m2, SD = 3.44 kg/m2) in the Taoyuan County, Taiwan, between January 2005 and December 2006. Results showed that 93% (202/217) of participants perceived a need to adjust weight. However, only 59.9% (121/202) took weight-reducing action. Of those who took action, only 32.2% (39/121) employed "healthy" methods (including healthier eating and greater exercise), with 28.1% (34/121) focusing on exercise only and 20.7% concentrating on altering eating behavior only. The remaining 19% chose alternative strategies, such as restricting their diet, skipping breakfast, or taking herbs. Adolescents who perceived it necessary to adjust their weight and take appropriate action had higher scores on health promotion practices than those of adolescents who did not. This study provides valuable insight, showing that overweight adolescents, although eager to lose weight, are likely to choose unhealthy methods. School and family health promotion counseling may help encourage overweight adolescents to adopt more healthy habits.

Background and object There was no Chinese questionnaire to evaluate the health-related quality of life (HRQoL) in patients with hemifacial spasm (HFS). In this study, we aimed to validate a new disease-specific HRQoL scale for HFS (HFS-36) in Chinese version, and compared it to SF-36, a generic HRQoL scale. Patients and Methods The HFS-36 Chinese version was modified from English version of HFS-30, including subscales of mobility, activities of daily living (ADL), emotional well-being, stigma, social support, cognition, bodily discomfort, and communication. All the items were scored on the 5-point scales, ranging from 0(never) to 4(always). Patients with HFS were asked to answer HFS-36 and SF-36 questionnaires on the same day before and 6-8 weeks after Botulinum toxin (BTX) injections, respectively. The reliability and validity of HFS-36 scale were evaluated statistically. Results Totally, 103 patients (68 females; 35 males) were recruited in this study, with a mean age of 57.6 ± 11.5 years and a mean duration of HFS for 7.6 ± 5.8 years. The intra-class correlation (ICC) and Cronbach's α were over 0.7 in the majority of items. HFS-36 showed a good correlation to HFS severity before BTX treatment and a significant improvement of subscale scoring after BTX treatment. HFS-36 also had a significant correlation to the mental health of SF-36. Conclusions The Chinese version of HFS-36 demonstrated a good reliability and validity in subscales of motility, ADL, emotion well-being, stigma and bodily discomfort. The HRQoL was significantly improved after BTX treatment assessed by HFS-36 or SF-36. Compared to SF-36, HFS-36 scale was more sensitive and specific to evaluate the HRQoL in HFS.

Intracranial hypertension due to primary and secondary injuries is a prime concern when providing care to patients with severe traumatic brain injury. Increases in intracranial pressure vary depending on compensatory processes within the craniospinal space, also referred to as intracranial adaptive capacity. In patients with traumatic brain injury and decreased intracranial adaptive capacity, intracranial pressure increases disproportionately in response to a variety of stimuli. However, no well-validated measures are available in clinical practice to predict the development of such an increase.To examine whether P2 elevation, quantified by determining the P2:P1 ratio (=0.8) of the intracranial pressure pulse waveform, is a unique predictor of disproportionate increases in intracranial pressure on a beat-by-beat basis in the 30 minutes preceding the elevation in patients with severe traumatic brain injury, within 48 hours after deployment of an intracranial pressure monitor.A total of 38 patients with severe traumatic brain injury were sampled from a randomized controlled trial of cerebral perfusion pressure management in patients with traumatic brain injury or subarachnoid hemorrhage.The P2 elevation was not only present before the disproportionate increase in pressure, but also appeared in the comparison data set (within-subject without such a pressure increase).P2 elevation is not a reliable clinical indicator to predict an impending disproportionate increase in intracranial pressure.

Head elevation is a conventional nursing procedure for brain-injured individuals with intracranial hypertension; it is performed with the intent of reducing intracranial pressure (ICP) by means of a noninvasive physical intervention. However, in certain circumstances, head elevation puts the brain-injured individual at risk for secondary cerebral injury because of impaired arterial blood pressure and compromised cerebral perfusion pressure (CPP). A systematic literature search was conducted to evaluate existing evidence regarding the effect of changing the backrest position on ICP and CPP in brain-injured individuals. Eleven articles were retrieved. In nine articles it was concluded that ICP significantly decreased at 30 degrees of head elevation compared with a flat position. Five of the nine articles showed no statistical significance in the magnitude of change in CPP from a flat position to 30 degrees of head elevation. Major limitations in the 11 articles were small sample sizes and unclear study protocols, which may have caused a failure to detect the effect of head elevation. In clinical practice, intensive care unit staff members need to cautiously perform head elevation with a thorough understanding of its physiologic effect and potential hazard. Future research should investigate the effects of therapeutic positions on different neurological and neurosurgical populations and explore the combination of head elevation and lateral side-lying positions.