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Schizophrenia is a severe illness with little hope of recovery and requires long-term care. The purpose of this study was to explore the experiences of carers who live with someone with long-term schizophrenia, within the cultural context of Taiwan. The study was conducted in a community setting in central Taiwan. A qualitative phenomenological approach was used to explore the experiences of carers. Purposive sampling was used by selecting the carers who were close relatives of the clients, had lived with the clients for at least 1 year and bore most of the responsibilities. Semi-structured face-to-face interviews were conducted to collect the data and narratives were analysed using Colaizzi's (1978) seven-step method. Data saturation was achieved after interviewing 10 carers. Three themes and eight sub-themes were identified: burdens of caring (helping clients' illness, lack of professional support and family conflicts), emotional burdens (sadness, worry and fear) and strategies of coping (cognitive and religious coping strategies). Our study supported the importance for nurses to understand the cultural aspects of mental illness, particularly the widespread cultural beliefs and patterns of help seeking behaviours, in order to provide culturally sensitive health care. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to develop a theory to guide family members caring for young people with depressive disorders and suicidal ideations., Design: Strauss and Corbin's Grounded Theory., Methods: Theoretical sampling was used to recruit primary family caregivers (aged 22-60) of young people experiencing depressive disorders and suicidal ideations from hospitals and psychiatric clinics in Taiwan. Data were collected using interviews (n = 23) in 2023. Data were analysed using Corbin & Strauss' analytical framework, including open, axial and selective coding until theoretical saturation was reached., Results: A paradigm model was used to link the 13 categories and develop a substantive theory to help guide family members in the care of their young persons with depressive disorders and suicidal ideations. The core category that emerged was 'Struggling to contain the young person's life by adjusting, assisting, and protecting them from diving into depression'. Other key categories interconnected with this core category were-creating a nurturing environment, adjusting to changes, protecting the young person's safety and assisting with their medical treatment., Conclusion: Family caregivers could use this theory as a guide to enhance the care of young persons experiencing depressive disorders and suicidal ideations and accompany them alongside the healing process., Implications for the Profession: Nursing professionals could provide psychoeducation to family caregivers on how to hold the young person gently and acquire compassion for the young persons' lived experience, thoughts and emotions, by creating a nurturing environment, adjusting to changes, protecting their safety and assisting with their medical treatment., Impact: This theory provides valuable guidance for future intervention research aimed at improving family caregivers' ability to care for young persons with depressive disorders and suicidal ideations., Reporting Method: The COREQ guidelines were utilised., Patient or Public Contribution: No patient or public contribution., (© 2024 John Wiley & Sons Ltd.)

Aim: To explore nursing students' thoughts and feelings about self-injuring during their clinical practicums., Background: Unfamiliar clinical environments pose challenges for nursing students, potentially leading to high levels of stress. When students find it difficult to cope with emotional triggers, some contemplate self-injury. Yet, it is rare to explore nursing students' thoughts and feelings related to self-injury during their clinical practicums., Design: A phenomenological approach was used., Methods: Purposive sampling was used and the participants were drawn from nursing students who graduated from universities in Taiwan. In-depth, semi-structured interviews were conducted from August to November 2023. Data saturation was reached after interviewing 15 participants. Colaizzi's seven steps and NVivo software were used for data analysis., Results: Four themes and 14 subthemes emerged. They were: (1) Sensing an emotional crescendo: participants experienced anxieties about clinical educators, assignments, homework and the clinical practicums and these intensified across time. (2) Physical and mental dysregulation: participants experienced physical discomfort, psychological distress and negative thoughts when subjected to overwhelming pressures during their clinical practicums. (3) Unwholesome self-protective behaviors: participants expressed thoughts of self-injury, engaged in self-injurious behaviors, experienced suicidal ideations and attempted suicide as measures of relieving stress. (4) Compassionate self-protective behaviors: participants coped with stress through emotional voicing, modifying situations to adjust stress, reaching out for help, self-compassion and self-care., Conclusions: Findings raise awareness of the need for clinical educators to demonstrate empathy with nursing students who have thoughts of self-injury during their clinical practicums. Further, it is crucial for them to offer timely guidance on the healing process while simultaneously creating nurturing clinical environments wherein students could flourish and grow., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Purpose: Nursing students feel stressed during pediatric clinical practicum due to limited communication encounters with hospitalized children. The purpose of this study was to describe junior nursing college students' experiences of communicating with children during pediatric clinical practicums., Design and Methods: A qualitative phenomenological research design was used. Purposive sampling was used to recruit 18 junior nursing college students who completed their pediatric clinical practicum. Data were collected using semi-structured interviews and were analyzed using Colaizzi's seven-step method for data analysis., Results: Three themes emerged from the data. (1) Difficulties in communicating during initial practicum: fear, rejection, self-doubt of communication abilities, and unfamiliarity with the application of communication techniques posed frustrations among nursing students. (2) Efforts to learn during practicum: self-empowerment, seeking a diverse support system, adjusting communication methods, and striving to establish good relationships allowed nursing students to adapt to the pediatric curriculum. (3) Effective communication at the later stages of practicum: mastering fundamental communication techniques and exercising pediatric therapeutic communication techniques allowed nursing students to feel accomplished., Conclusions: Junior nursing college students initially encountered difficulties and frustration when communicating with children during their pediatric clinical practicum. This study serves as a guide for educators of pediatric nursing to design courses on communication with hospitalized children., Practice Implications: These findings could be used to develop foundation courses on communicating with children for first-time pediatric nursing practicum students; for example, formulating a course on therapeutic play for children that encompasses communication techniques, pediatric ward simulation, and introduction to therapeutic play., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Aim: To explore nursing students' perceptions of their design thinking learning experiences on a human development course., Background: Design thinking is a person-centered analytic and creative learning process that promotes higher order thinking skills rather than knowledge retention alone. Currently, this is the first study that has investigated the use of the design thinking process for nursing students on a human development course., Design: A phenomenological research design., Methods: The participants were first-year nursing students enrolled on a human development course at a Taiwanese university. In-depth, semi-structured interviews were conducted in 2022 and sufficiently high information power was obtained after 15 participants were interviewed. Data were systematically analysed, summarized and decoded using Colaizzi's seven analysis steps., Results: Three themes and twelve subthemes emerged from the data. (1) Challenges experienced with the design thinking learning process: participants experienced anxiety because of the unfamiliar assignments, and they found the assignments to be thought-consuming, time-consuming and energy-consuming, plus the students needed to adapt to working in teams with classmates. (2) Adjustment strategies employed by participants: participants highlighted the importance of teamwork during the design thinking learning process. They achieved consensus through communication and sought support from others to overcome challenges related to design thinking; however, they ultimately needed to engage in problem-solving by themselves. (3) Developing the diversity of academic capabilities: after the human development course, participants experienced enriched mindsets, cognitive abilities, problem-solving skills, interpersonal relationships and knowledge application., Conclusions: Design thinking provides creative teaching opportunities and encourages nursing students to engage in experimental and creative learning, which is a meaningful experience for them. Nurse educators could use the insights thus obtained to design a curriculum that sources design thinking as a learning process while facilitating the complexity and diversity of students' higher order thinking skills and not just repetitive learning., Competing Interests: Declaration of Competing Interest None., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Depression is a common mental disorder. Literature has explored patients' perspectives of the recovering process of depression. However, there is a lack of research to explore both patients' and caregivers' perspectives of the healing process and develop a theory to support patients with depression., Aims: The purpose of this study is to develop a substantive theory that depicts patients with depression toward healing and recovering., Methods: This study used a grounded theory approach and collected data between 2019 and 2020 in a medical center in Taiwan. A theoretical sampling was performed after interviewing 29 participants, including 20 patients who had recovered from depression and nine caregivers; data saturation was achieved. Data analysis was conducted with open, axial, and selective coding and used NVivo Version 11 to aid the process of coding., Results: A substantive theory was developed and the core category was "Patients' fortitude through the healing and recovering process of depression." Other main categories interrelated in this core category were reframing negative thinking and cultivating positive thinking, rebuilding a positive self-worth by embracing self-compassion, and learning to cope with everyday stress., Conclusions: This theory could help health care professionals to work therapeutically with patients and commend their fortitude while experiencing depression and engaging them with the care they planned together; and find some joy in life. Educators and researchers could use this theory to advance nursing care.

This study explored the psychological processes that patients navigated when healing and recovering from depression. A grounded theory approach was used. Twenty patients who had recovered from depression participated. Four categories emerged depicting the psychological processes navigated by the participants during the recovery process: (1) acceptance: acceptance of depression and agreement to treatment; (2) transformation: change of mindsets and behaviours; (3) adaptation: stress regulation and change of focus; (4) integration: progress of depressive symptoms and moving on with 'regular' life. Each phase is related to the other phases, mental health professionals could assist patients with depression achieve the integration phase., Competing Interests: Declaration of competing interest None., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Purpose: To identify associations among social functioning, depression, and quality of life in breast cancer patients., Method: A cross-sectional study was conducted. A total of 180 breast cancer patients were recruited from the surgical units in southern Taiwan hospital in 2021. Path analysis was employed to analyze the relationships between background information and social functioning, depression, and quality of life. Structural equation modeling (SEM) was used for examining the path analysis in this study., Results: The path model showed that respondents with a religious belief (ß = 0.18, p < .000) and less severe disease (ß = -0.29, p < .01) showed better social functioning. Income did not affect social functioning directly but was directly related to the social interaction dimension (ß = 0.30, p < .000). Moreover, younger age (ß = -0.29, p < .000, lower income (ß = -0.10, p < .05) and more severe disease (ß = 0.35, p < .000) increased the level of depression. Less severe disease would also result in a better quality of life (ß = -0.45, p < .000). Breast cancer patients with better social function levels have low levels of depression (ß = -0.82, p < .000) and better quality of life (ß = 0.76, p < .000)., Conclusion: Age, religion, income, and severity are crucial predictors of social functioning, depression, and quality of life. Furthermore, severity variables which combined clinical variables to make this variable a stronger predictor for SF, depression, and QOL., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: Globally, breast cancer is the most common cancer type in terms of incidence for women. Women with breast cancer endure higher levels of psychological distress than other types of cancer because many lose their identity as a woman, which is an additional characteristic of their psychological distress. Research using phenomenology to explore "the meaning of life" is rare among women with breast cancer., Purpose: The purpose of this study was to explore the perspectives of women with breast cancer on "the meaning of life.", Methods: A phenomenological approach was used. Twenty-six women living with breast cancer drawn from a cancer treatment hospital in Taiwan participated in this study. A semistructured interview was utilized to collect the data, and Colaizzi's seven steps were used to analyze the data., Results: Four themes emerged: (a) value of overcoming suffering, (b) value of reciprocal love, (c) value of self-transcendence, and (d) value of spiritual comfort. This means that the participants defined "the meaning of life" through the lens of suffering from cancer, reciprocal love from their families and friends, uncovering and discovering creative pathways that transformed their pain while searching for the value of their existence, and seeking spiritual guidance from religion., Conclusions: The participants identified the most pivotal aspect of healing as transforming their pain and accepting value for their suffering. They acknowledged they could not change the fact that they had cancer, but they could learn to accept it as part of their lived experience. Healthcare professionals may use these four themes at a clinically appropriate time on women's journeys toward healing to inspire women with breast cancer to process their own unique "meaning of life.", Competing Interests: The authors declare no conflicts of interest., (Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc.)

Purpose: To evaluate the efficacy of logotherapy on meaning in life, depression, hopelessness, and suicide ideation in patients with depression., Design and Methods: A quasi-experimental approach was used and 86 participants were recruited from a psychiatric department in Taiwan. The experimental group received logotherapy for 12 weeks. The control group received depression education as usual., Findings: The results revealed significant differences between and within the groups for meaning in life, depression, hopelessness, and suicide ideation., Practice Implications: Logotherapy was an effective method for increasing meaning in life, reducing the degree of depression, hopelessness, and suicidal ideation for patients with depression., (© 2021 Wiley Periodicals LLC.)

What Is Known on the Subject: The meaning in life consists of an individual's values, experiences, goals and beliefs. It has been shown to be negatively associated with depression, hopelessness and suicidal ideation. Depression and hopelessness are related to increased suicidal ideation. Meaning in life has been shown to be a protective factor against depression, hopelessness and suicidal ideation., What the Paper Adds to Existing Knowledge: A path model was developed to clarify the associations among meaning in life, depression, hopelessness and suicidal ideation. For clarity, the outcomes were depression and suicidal ideation, the independent variable was hopelessness, and the mediator was meaning in life. Hopelessness had a direct association with meaning in life, and meaning in life had a direct association with depression, supporting the mediating effect of meaning in life from hopelessness to depression. Meaning in life had the strongest association with depression, and depression had the strongest association with suicidal ideation. Meaning in life did not have a significant direct association with suicidal ideation; it did have an indirect association with suicidal ideation through depression. This study estimated that one-point increase in meaning in life score was associated with 0.47-point decrease in depression score and 0.13-point decrease in suicidal ideation score, respectively., What Are the Implications for Practice: Logotherapy is a meaning-centred therapy to find meaning in life. This study reveals that increased levels of meaning in life are associated with decreasing degrees of depression. Mental health nurses could help patients to find meaning in life by logotherapy and thus associated with reductions in depression. Mental health nurses could help patients to find hope by exploring meaning in life and promoting positive attitudes towards life from meaningless life to meaningful life, there is a reduction in depression, which in turn reduces suicidal ideation indirectly., Abstract: Introduction Meaning in life can be good protective factor against depression, hopelessness and suicidal ideation. Aim To analyse the mediating effect of meaning in life on the associations among hopelessness, depression and suicidal ideation. Method A cross-sectional study was conducted among 90 patients diagnosed with depression. A structural equation modelling approach was applied for this path analysis to examine the mediating effect of meaning in life on the association among hopelessness, depression and suicidal ideation. Results The results showed that meaning in life mediated the association between hopelessness and depression. Hopelessness had a direct positive association with depression (β = 0.23, p < .03), and meaning in life had a direct negative association with depression (β = -0.51, p < .01) and indirect association with suicidal ideation through depression; this indirect association was -0.21 (p < .01). Discussion Meaning in life revealed strong mediating association with the relationship between hopelessness and depression. By reducing the level of depression, meaning in life demonstrated its mediator association with suicidal ideation. Implications for Practice Logotherapy is a meaning-centred therapy to find meaning in life. Mental health nurses could help patients to manage their depression through logotherapy, thus leading to reductions in suicidal ideation., (© 2021 John Wiley & Sons Ltd.)

Aim and Objectives: The aim of this study was to develop a theory to help guide patients with end-stage renal disease to adapt to peritoneal dialysis., Background: Taiwan ranks first worldwide in end-stage renal disease incidence and dialysis prevalence. Many patients cannot accept long-term dialysis treatment and thus face several physical and psychological suffering. No theory has yet been developed to help guide patients with end-stage renal disease to adapt to peritoneal dialysis., Design: A grounded theory approach was used in this study., Methods: A theoretical sampling was performed after interviewing 25 patients who had adapted to peritoneal dialysis at a medical centre in Taiwan from January 2018 to September 2018; data saturation was achieved. Data were analysed using open, axial and selective coding and while using the constant comparison technique. COREQ reporting guidelines were utilised., Results: A substantive theory was developed to help guide patients with end-stage renal disease to adapt to peritoneal dialysis. The core category that emerged from the data collected was 'Confronting peritoneal dialysis to live and co-exist with peritoneal dialysis'. Other key categories linked to and embraced in this core category were as follows: positive self-regulation, regulation of daily life and the process of adaptation to dialysis method., Conclusion: The results could help healthcare professionals to better understand the process of end-stage renal disease patients' adaptation to peritoneal dialysis, thereby facilitating patients' adaptation to dialysis in their daily life, enhancing their quality of life and improving the quality of medical care., Relevance to Clinical Practice: Healthcare professionals could use this theory as reference when providing care for peritoneal dialysis patients to assist them in adapting to life with peritoneal dialysis as soon as possible through positive self-regulation, daily life adjustments and the process of adapting to the dialysis method., (© 2021 John Wiley & Sons Ltd.)

This study explored the perceptions of meaning of life for patients with depression. A qualitative phenomenology approach was used. Patients with depression (n = 20) were recruited until data saturation occurred. Findings revealed four themes all related to their value of: (1) accepting depression; (2) appreciating work (paid and non-paid); (3) embodying love and taking on responsibilities; (4) receiving spiritual comfort. Healthcare professionals could facilitate patients with depression to explore their meaning of life while enduring and transforming the emotional pain that accompanies depression, hence, perhaps, decreasing their suicidal ideations., (Copyright © 2021 Elsevier Inc. All rights reserved.)

SMARCA5 (circSMARCA5) is involved in the occurrence of different cancers, but its role in prostate cancer carcinogenesis and metastatic transformation remains elusive. Thus, we evaluated the circSMARCA5 functional relevance in prostate cancer and its associated molecular mechanism. First, circSMARCA5 expression and function in this cancer were evaluated. To determine the miR-181b-5p/miR-17-3p target and clarify how circSMARCA5 regulates the miR-181b-5p-TIMP3 and miR-17-3p-TIMP3 axis, RNA immunoprecipitation, biotin-coupled microRNA capture, luciferase reporter, Western blot, and quantitative real-time PCR assays were employed. In primary and metastatic prostate cancer tissues, circSMARCA5 was significantly downregulated compared with normal controls. Functionally, circSMARCA5 exhibited a suppressive effect on prostate cancer cells' metastasis and growth. At the molecular level, circSMARCA5 could affect the tissue inhibitor of metalloproteinases 3 (TIMP3) expression through miR-181b-5p or miR-17-3p interactions. Moreover, lysine acetyltransferase 5 (KAT5) induced circSMARCA5 biogenesis and regulated the miR-181b-5p-TIMP3 and miR-17-3p-TIMP3 axis. These results suggested that targeting circSMARCA5-miR-181b-5p-TIMP3 and circSMARCA5-miR-17-3p-TIMP3 axis might be a novel therapeutic strategy for prostate cancer.

Background: Due to the lack of resident physicians in medical institutions, nurse practitioners must assist in clinical care. However, the quality of training courses in training hospitals is varied and, currently, there is no theory to guide nurse practitioners to complete training., Objectives: To develop a theory to guide nurse practitioners to accomplish training programme., Design: This study adopted a qualitative grounded theory approach., Settings: A regional teaching hospital in Taiwan., Participants: Seventeen nurse practitioners, who had passed the oral test within the past six months, were recruited until data saturation was achieved., Methods: Data were collected using a semi-structured interview and data were collected between January 2018 and March 2019. Data were analysed using open, axial, and selective coding and using NVivo 11 to aid the process of coding., Results: A substantive theory was formulated to help nurse practitioners complete their training programme. The core category was 'professional ability to improve nursing quality and excel'. Other important categories and subcategories were 'improving thinking ability' (improving critical thinking ability and differential diagnosis), 'improving clinical care ability' (improving clinical assessment and overall communication skills), and 'active learning' (multi-method learning, repeated practice, and self-improvement)., Conclusions: The findings will facilitate the provision of guidance to nurse practitioner trainees in medical institutions. This will help them successfully complete their training, improve the passing rate for nurse practitioner selection, reduce the wastage of workforce training resources, and improve the quality of care that nurse practitioners provide. Hospitals could use this theory as a reference and create a warm and supportive training environment to help nurse practitioners complete their training programme and improve care quality., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: Nursing students voiced that they were stressed or anxious during their final year at university. Further, they articulated that their anxiety affected their academic performance as well as their motivation to work on their clinical placement., Objectives: This study was designed to describe nursing graduates' perceptions of their lived experiences of anxiety during their final year., Design: Phenomenology was chosen., Settings: Three universities in Taiwan., Participants: A purposive sample of 18 nursing graduates with experiences of anxiety., Methods: Data were collected using a semi-structured interview and analyzed utilizing Colaizzi's seven-step method., Results: Four themes emerged from the findings. The first was: uncertainty about future employment. This included negative clinical practicum experiences impacted on future career choices and uncertainty about future workplace choices. The second theme was: emotional relationships and life experiences becoming chaotic. This included anxiety about the loss of established relationships and financial insecurities. The third theme was: three phases of anxiety experienced in preparation for the national examination. They comprised: feeling anxiety but not taking action to study; increasing anxiety and beginning to study and, exacerbated anxiety and cramming for the national examination. The fourth theme was: adjustment strategies. They involved; looking for support to release emotional stress; changing the situation and fine-tuning the stress; positive thinking and self-affirmations and also, self-reflecting and consolidating learning., Conclusions: Finding could inform nursing teachers on nurses' lived experiences of anxiety during their final year, especially that related to the national examination before registration. Further, findings could be used as a map to facilitate nursing teachers in the provision of suitable teaching and counselling for final year students to alleviate their anxiety., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: Globally, cancer is the second leading cause of death. Breast cancer and gynecological cancer can damage patients' body image and lead to psychological distress, depression, and demoralization syndrome. No studies have explored the effect of logotherapy in gynecological cancer patients' psychological distress, depression, and demoralization., Objective: To evaluate the effects of logotherapy on distress, depression, and demoralization in breast cancer and gynecological cancer patients., Methods: A quasi-experimental design was used in this study, involving 61 breast cancer and gynecological cancer patients: 31 in the experimental group and 30 in the control group. Participants in the experimental group received logotherapy 4 to 6 times during the 12 weeks of intervention. Outcomes were measured by the (1) Distress Thermometer, (2) Patient Health Questionnaire, and (3) Demoralization Scale Mandarin Version (DS-MV)., Results: Distress Thermometer did not differ between groups, but significant differences in favor of the intervention group were noted in the Patient Health Questionnaire (U = 674.500, P = .002); the DS-MV subcategories of loss of meaning (U = 706.500, P = .000), dysphoria (U = 673.000, P = .002), disheartenment (U = 670.000, P = .003), helplessness (U = 621.000, P = .022), and sense of failure (U = 629.500, P = .016); and the total score of the DS-MV (U = 728.500, P = .000)., Conclusion: Logotherapy was effective in the reduction of breast cancer and gynecological cancer patients' depression and demoralization., Implications for Practice: Clinical professionals could add logotherapy to the treatment for breast cancer and gynecological cancer patients to reduce their depression and demoralization.

Background: Hepatocellular carcinoma (HCC) is the sixth most common type of cancer and the fourth leading cause of cancer-related death worldwide. Sarcomatoid HCC, which contains poorly differentiated carcinomatous and sarcomatous components, is a rare histological subtype of HCC that differs from conventional HCC. It is highly aggressive and has a poor prognosis. Its clinicopathological characteristics, surgical outcomes and underlying mechanisms of its highly aggressive nature have not been fully elucidated., Aim: To examine the clinicopathological characteristics and surgical outcomes of sarcomatoid HCC and explore the histogenesis of sarcomatoid HCC., Methods: In total, 196 patients [41 sarcomatoid HCC and 155 high-grade (Edmondson-Steiner grade III or IV) HCC] who underwent surgical resection between 2007 and 2017 were retrospectively reviewed. The characteristics and surgical outcomes of sarcomatoid HCC were compared with those of patients with high-grade HCC. The histological composition of invasive and metastatic sarcomatoid HCCs was evaluated., Results: Sarcomatoid HCC was more frequently diagnosed at an advanced stage with a larger tumor and higher rates of nonspecific symptom, adjacent organ invasion and lymph node metastasis than high-grade HCC (all P < 0.05). Compared with high-grade HCC patients, sarcomatoid HCC patients are less likely to have typical dynamic imaging features of HCC (44.4% vs 72.7%, P = 0.001) and elevated serum alpha-fetoprotein levels (> 20 ng/mL; 36.6% vs 78.7%, P < 0.001). The sarcomatoid group had a significantly shorter median recurrence-free survival (5.6 mo vs 16.4 mo, log-rank P < 0.0001) and overall survival (10.5 mo vs 48.1 mo, log-rank P < 0.0001) than the high-grade group. After controlling for confounding factors, the sarcomatoid subtype was identified as an independent predictor of poor prognosis. Pathological analyses indicated that invasive and metastatic lesions were mainly composed of carcinomatous components., Conclusion: Sarcomatoid HCC was associated with a more advanced stage, atypical dynamic imaging, lower serum alpha-fetoprotein levels and a worse prognosis. The highly aggressive nature of sarcomatoid HCC is perhaps mediated by carcinomatous components., Competing Interests: Conflict-of-interest statement: The authors have no conflict-of interest to disclose., (©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.)

Aims and Objectives: To explore the lived experiences of family caregivers of epidermolysis bullosa (EB) patients., Background: Patients with EB need long-term care. Their family experiences physical and mental stress while proving that care. However, very little research has explored the family caregivers' actual lived experiences when caring for EB patients., Design: This is a qualitative research using the phenomenological approach., Methods: Data were collected with the assistance of the Taiwan Foundation for Rare Disorders (TFRD). Interviews were conducted between 2015 and 2017 with primary family caregivers (n = 10) who had cared for EB patients for at least five years. Data were analysed using Colaizzi's (1978) seven-step phenomenological method. COREQ reporting guidelines were utilised., Results: Four themes and eleven subthemes emerged after data analysis: (a) transformation and helplessness: changing expectations and helplessness associated with the rare, unknown disease; (b) mother's responsibility: mothers loving and protecting their children, surviving through adversity and challenges and self-experiencing a child's pain; (c) physical and mental fatigue experienced by the whole family: physical and mental exhaustion, and unbalanced lives; and (d) adjustment and social support: providing mutual assistance to mitigate adversity, hopeful search for treatments, the importance of patient associations and rare disease foundations, and social assistance requirements., Conclusion: Family caregivers experience many challenges when caring for EB patients and experience substantial stress and overwhelming burdens. Consequently, they would benefit greatly from various support systems to reduce the burden of caring for EB patients., Relevance to Clinical Practice: Healthcare professionals can use the findings from this study to understand the circumstances faced by family caregivers and tailor care and education specifically to support each family's financial, social and household needs, thereby helping them reduce the stress of caring for EB patients., (© 2020 John Wiley & Sons Ltd.)

BACKGROUND: Substance use is a global mental health issue. There has been limited research exploring the relationships among body, mind, and spirit well-being and the possibility of relapse across different categories of substance users. AIMS: The purpose of the current path analysis was to examine the relationship between body-mind-spirit well-being and the possibility of relapse intention as well as other relevant predictors in people who had a history of substance use. METHODS: A cross-sectional survey was used. Participants were recruited in Southern Taiwan between December 2015 and June 2016. Data were collected from 467 participants who had a history of using controlled substances. RESULTS: Path analysis results revealed that body-mind-spirit well-being was negatively predictive of the possibility of relapse intention. Out of several predictors, stress influence and duration of substance use had direct effects on body-mind-spirit well-being and the possibility of relapse intention, respectively. Stress influence and duration of substance use were associated with decreased body-mind-spirit well-being and increased relapse intention scores. In addition, no history of health problems and male gender were associated with increased body-mind-spirit well-being. CONCLUSIONS: Stress management and the duration of substance use play an important role in body-mind-spirit well-being and relapse intention in people with a history of substance use. Health care professionals could teach substance users coping strategies to address their stress and problems, which may improve their health and reduce the possibility of relapse intention.

Aims and Objectives: This study was designed to explore the psychological processes experienced by nursing students caring for suicidal patients during their first psychiatric clinical practicum., Background: Nursing students expressed fear when caring for patients who presented with suicidal behaviours. Yet, there is a lack of research exploring nursing students' feelings and thoughts when caring for suicidal patients., Design: A grounded theory study., Methods: A theoretical sample of 22 undergraduate nursing students who had cared for suicidal patients for at least 5 days during their psychiatric clinical practicum. Data were collected from 2016-2017, in three universities in Taiwan, using a semi-structured interview and constant comparative analysis. COREQ reporting guidelines were utilised., Results: Four categories emerged depicting the psychological processes and revealing that the student nurses navigated four phases when caring for patients exhibiting suicidal behaviours. The phases were as follows: (a) apprehension and fear: involving students being frightened about patients attempting suicide; (b) frustration and powerlessness: concerning students finding it challenging to focus on changing patients' suicidal ideations; (c) support and catharsis: covering the students having to ask for psychological support from other people and explore their painful emotions; (d) confidence and empathy: meaning that the students incorporated enhanced confidence and cultivated advanced empathy, leading to the integration of competent care competencies towards suicidal patients., Conclusions: Findings could help nursing teachers to understand students' psychological processes when caring for suicidal patients. Teachers could provide appropriate support to help reduce students' negative thoughts and feelings and increase their care competencies when nursing suicidal patients during their psychiatric clinical practicum., Relevance to Clinical Practice: Clinical nurse teachers could support and facilitate students to develop their competencies and confidence as they negotiate the four phases and, actually, complete their internship goals on their clinical practicums., (© 2019 John Wiley & Sons Ltd.)

Research concerning this issue demonstrates that nursing students initially feared interacting with and caring for patients with suicidal tendencies. However, there is a lack of research, which examines the care that is provided to patients that are suicidal, by nursing students. The aim of this study was to develop a theory to guide nursing students when caring for patients with suicidal tendencies on their psychiatric clinical practicum. A qualitative approach using Grounded Theory was used. A total of 22 nursing students who had provided care for suicidal patients were interviewed. The core category that emerged from the data was the 'changing of mindsets towards caring for suicidal patients and promotion of suicidal care competencies'. Other key categories linked to and enfolded within this core category were: suicidal risk assessment; protecting patients' safety; and, developing therapeutic communication competencies to advance suicidal care. This study could help fill a theory-practice gap for both psychiatric nursing teachers and students. Nurse teachers could use this theory as a map to help guide students caring for patients with suicidal tendencies and develop nursing students' suicidal care competencies., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: Nurses in intensive care units (ICUs) must be capable of employing appropriate conflict handling styles in order to communicate with medical teams, patients, and patient family members effectively. There is a current lack of research on the interpersonal communication competence and conflict handling styles of ICU nursing staffs in Taiwan., Purpose: This study aimed to: (1) explore the interpersonal communication competence and conflict handling styles of ICU nurses and related factors and (2) examine the relationship between the interpersonal communication competence and conflict handling styles of ICU nurses., Methods: A cross-sectional correlational research approach was adopted and convenience sampling was used to recruit 351 ICU nurses from three hospitals in southern Taiwan. Data were collected using a demographic questionnaire, interpersonal communication competence scale, and conflict handling styles scale., Results: (1) ICU nurses demonstrated a moderate or higher level of overall interpersonal communication competence, with "integrating" identified as the most commonly used conflict handling style. (2) Higher educational attainment and job position were both associated with better interpersonal communication competence. (3) The adoption of "compromising" and "avoiding" styles was significantly affected by age; the adoption of "obliging", "compromising", "avoiding", and "integrating" styles was significantly affected by education level; the adoption of "obliging", "compromising", and "integrating" styles was significantly affected by job position; and the adoption of "dominating", "compromising", and "integrating" styles was significantly affected by seniority. (4) Interpersonal communication competence correlated significantly and positively with the adoption of "dominating", "obliging", "compromising", and "integrating" styles., Conclusions / Implications for Practice: Future study of the views of ICU nurses toward their own styles in handling interpersonal conflicts is needed. Furthermore, holding training courses annually to orient ICU nurses with the advantages and disadvantages of interpersonal conflict handling styles is recommended.

Two new monoterpene indole alkaloids, naucleaoffines A (1) and B (2), together with six known alkaloids (3-8), were isolated from the stems and leaves of Nauclea officinalis. The structures of 1 and 2 were elucidated by extensive spectroscopic methods and the known compounds were identified by comparisons with the data reported in literature. All isolated compounds were evaluated for their anti-inflammatory activities and anti-HIV-1 activities. Compounds 1-8 exhibited significant inhibitory activities on nitric oxide (NO) production induced by lipopolysaccharide in mouse macrophage RAW 264.7 cells in vitro with IC 50 values comparable to that of hydrocortisone. In addition, compounds 1-8 showed significant anti-HIV-1 activities with EC 50 ranged from 0.06 to 2.08 µM. These findings suggest that the discoveries of these indole alkaloids with significant anti-inflammatory activities and anti-HIV-1 activities isolated from N. officinalis could be of great importance to the development of new anti-inflammatory and anti-HIV agents., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Drug abuse adversely affects the health of populations in many counties and contributes immensely to social issues. Schedule III and IV controlled drug abuse is popular in young adults. Medical education is one of the most stressful academic fields for students. The aim of this study was to compare the health differences in body, mind, and spirit among Schedule III and IV controlled drugs users, nursing students, and psychology students. This study uses a cross-sectional comparative study on a convenience sample. Four hundred eleven participants were recruited from three different samples that include Schedule III and IV controlled drug users (n = 211), nursing students (n = 100), and psychology students (n = 100), all from either a drug abuse prevention center or two universities in Southern Taiwan. Relying on the Health of Body, Mind and Spirit Scale, a linear regression model was used to identify the health differences among drug users, nursing students, and psychology students. The results show that drug users scored higher on the physical subscale (ß = -.249, p < .001), the mental subscale (ß = -.120, p < .05), the spiritual subscale (ß = -.154, p < .01), and the Health of Body, Mind and Spirit Scale (ß = -.210, p < .001) than psychology students. The nursing students scored higher on the mental subscale (ß = .146, p < .01) than drug users did. These results could help health staff and instructors understand the differences and improve the physical, mental, and spiritual health among Schedule III and IV controlled drug users, nursing students, and psychology students. Furthermore, future study could further investigate the factors that may affect physical, mental, and spiritual health.

Many nurses in Taiwan use quantitative research for their master's thesis. However, qualitative research explores humankind in depth providing a more holistic approach relating to nursing. The purpose of this study was to explore the rationale postgraduate students used to choose the research methods for their masters' theses in Taiwan. A descriptive qualitative research design was used. Data were collected through semi-structured interviews of sixteen nursing students studying a master's from seven different Universities in Taiwan in 2016. Data were analyzed using thematic analysis. Finding revealed three themes (1) Students' personal and professional backgrounds; (2) Myths about quantitative research; (3) Misperceptions about qualitative research. Nurse educators could use these findings as a reference to design post-graduate nursing courses. It is essential to provide a balanced educative experience between delivering qualitative and quantitative modules to enhance respect of research method, knowledge and skills. Further, this could facilitate students' choice in research methods when designing their master's theses., (Copyright © 2018. Published by Elsevier Ltd.)

Assessing the recovery ability of individuals who have attempted suicide is crucial for psychiatric health nurses. The purpose of this study was to develop and test a psychometric Suicidal Recovery Ability Scale (SRAS). Confirmatory factor analysis (CFA) indicated that three subscales with 15 items best fit the data. The global SRAS score showed significant negative correlation with the Beck Hopelessness Scale (BHS) score. The Cronbach's α and test-retest reliability scores for the global SRAS and the subscales all exceeded 0.70. Nurses can use the SRAS to assess the recovery ability of individuals who have attempted suicide and provide proper care to help them.

Background: Adrenal ganglioneuromas (AGNs) are extremely rare benign neoplasms. This study is to share our experience regarding diagnostic and operative management of these tumors., Methods: Clinical details as well as follow-up data were retrospectively analyzed in 42 primary AGN patients who received operative resection at a tertiary referral hospital in China between May 2005 and July 2016., Results: The mean age of the patients at diagnosis was 35.3 years (range 13-59 years). Among the patients, 28 were asymptomatic. The mean preoperative size was 5.3 ± 2.2 cm (range 2.1-14.0 cm), and 17 cases were larger than 5 cm. All patients underwent operative resection as open adrenalectomy in 20 patients and laparoscopy in 22 patients. The mean tumor size on pathologic examination was 6.0 ± 2.6 cm (range 2.2-17.0 cm). Laparoscopic operation showed its advantages over open surgery on the postoperative duration (5.0 vs. 7.3 days, p < 0.001) and estimated blood loss (69.5 vs. 157.5 ml, p = 0.047). No patient had recurrence or metastasis during a median follow-up of 70.5 months (range 3.7-164.3 months)., Conclusions: We describe the largest AGN series reported to date. The preoperative diagnosis of AGN remains difficult despite of the progression of imaging examination. After complete resection, the prognosis of AGN patients is excellent. Laparoscopic approach has its advantages in the resection of AGNs.

Background: Cirrhosis is a chronic, progressive, and currently incurable disease. Cirrhotic patients often experience uncertainty due to poor control of symptoms and disease recurrence. Although fatigue is a common symptom in patients with liver cirrhosis, this symptom is often ignored by healthcare professionals due to the lack of efficacious treatment options. Improper management of fatigue may trigger greater uncertainty and affect adaptation success., Purpose: To explore the relationship between fatigue and uncertainty and the factors that respectively relate to these two concepts in liver cirrhosis patients., Methods: A cross-sectional, correlational design and convenience sampling were used to recruit 76 liver cirrhotic inpatients from one hospital. Three structured questionnaires, including the Personal Demographic Questionnaire, Brief Fatigue Inventory-Taiwan Form, and Mishel's Uncertainty in Illness Scale, were used for data collection., Results: (1) The participants suffered from fatigue at a moderate or higher level, with an average score of 5.39 ± 2.34, which affected their daily activities and greatly impacted their recreational activities. Factors that were found to be associated with fatigue included disease severity, albumin level, total bilirubin level, ascites, and the degree to which fatigue affected the performance of daily activities. (2) Uncertainty was found to be at a moderate or higher level, with an average score of 71.81 ± 10.67. Level of fatigue, the degree to which fatigue affected the performance of daily activities, disease severity, and albumin level were found to relate significantly to level of uncertainty., Conclusions / Implications for Practice: Fatigue and uncertainty are prevalent and distressing experiences for patients with liver cirrhosis. A comprehensive assessment and broad-based approach to nursing interventions are necessary in order to alleviate fatigue and uncertainty effectively.

Aims and Objectives: To develop the Health of Body, Mind and Spirit Scale (HBMSS), which was designed to assess drug abusers' health condition., Background: Helping drug abusers to become healthy is important to healthcare professionals. However, no instrument exists to assess drug abusers' state of health., Design: A cross-sectional questionnaire survey was implemented to examine the validity of the HBMSS., Methods: Data were collected from 2015-2016 at one drug abuse prevention centre in Taiwan. Participants (N = 320) who had abused drugs were invited to complete a preliminary 64-item version of the HBMSS. An item analysis, criterion-related validity analysis (using the Relapse Prediction Scale [RPS] score), split-half reliability testing and confirmatory factor analysis (CFA) were conducted to examine the psychometric properties of the HBMSS., Results: The final version of the HBMSS contained 15 items that were divided into three subscales: the health of the body, mind and spirit. Cronbach's α and split-half reliability coefficients were all above .85. The factor loading of each item was between .74-.95. The HBMSS had satisfactory criterion-related validity with the RPS score (r = -.50, p < .001). A second-order CFA was conducted on the HBMSS. The fit indexes were good, χ 2  = 184.060, df = 94, χ 2 /df = 1.958 (p = .000)., Conclusions: The entire HBMSS and the subscales had satisfactory reliability and validity., Relevance to Clinical Practice: Healthcare professionals could use the HBMSS to evaluate the condition of the health of individuals with a drug abuse history., (© 2017 John Wiley & Sons Ltd.)

Aims and Objectives: The aim of this study was to explore the factors predicting suicide recovery and to provide guidance for healthcare professionals when caring for individuals who have attempted suicide., Background: The high rate of suicide is a global health problem. Suicide prevention has become an important issue in contemporary mental health. Most suicide research has focused on suicidal prevention and care. There is a lack of research on the factors predicting suicidal recovery., Design: A cross-sectional design was adopted., Methods: A correlational study with a purposive sample of 160 individuals from a suicide prevention centre in southern Taiwan was conducted. The questionnaires included the Brief Symptom Rating Scale-5, Suicidal Recovery Assessment Scale and Beck Hopelessness Scale. Descriptive statistics and linear regressions were used for the analysis., Results: The mean age of the participants was 40.2 years. Many participants were striving to make changes to create a more stable and fulfilling life, had an improved recovery from suicide and had a good ability to adapt or solve problems. The linear regression showed that the Beck Hopelessness Scale scores (ß = -.551, p < .001) and Brief Symptom Rating Scale-5 (ß = -.218, p = .003) and past suicidal behaviour (ß = -.145, p = .008) were significant predictors of individuals' recovery from suicide. They accounted for 57.1% of the variance., Conclusions: Suicidal individuals who have a lower level of hopelessness, a better ability to cope with their mental condition and fewer past suicidal behaviours may better recover from suicide attempts., Relevance to Clinical Practice: The nurses could use the results of this study to predict recovery from suicide in patients with attempted suicide., (© 2017 John Wiley & Sons Ltd.)

Background: The suicide rate of cancer patients is high in Taiwan. Breast cancer has a high incidence rate and is the leading cause of cancer in women. There is a lack of research examining breast cancer-related depression, suicidal ideation, and quality of life., Objectives: This study evaluated the effects of muscle relaxation and therapeutic walking on depression, suicidal ideation, and quality of life in breast cancer patients receiving chemotherapy., Methods: An experimental approach was adopted. A group of 87 breast cancer patients receiving chemotherapy were randomly assigned into an experimental group (n = 44) or a control group (n = 43). The subjects in the experimental group received 2 interventions for 3 months. This study used 3 instruments, including (1) the Center for Epidemiological Studies Depression Scale, (2) the Beck Scale for Suicidal Ideation, and (3) the World Health Organization Questionnaire on Quality of Life., Results: The results showed no significant difference in any outcome variable in the pretest. The results of the posttest indicated that the 2 groups scored significantly differently only on the Center for Epidemiological Studies Depression Scale (U = 638.00, P < .05). The breast cancer patients who participated in the 3 month muscle relaxation and therapeutic walking interventions had a lower level of depression (RE¯ = 37.00) than those who did not (RC¯ = 51.16)., Conclusion: The muscle relaxation and therapeutic walking program was effective in the reduction of breast cancer patients' depression., Implications for Practice: Nursing staff could teach muscle relaxation and therapeutic walking to breast cancer patients to reduce their depression.

This study was designed to explore Category 3 and 4 controlled drug users' perceptions of participating in health-prevention lectures. A phenomenological approach was used. Twelve participants were interviewed after completing the lectures. Findings revealed five themes (1) mixed emotions; (2) self-development; (3) finding the lectures lacked practicality and relevance; (4) highlighting three stages for discontinuing drug-usage; and, (5) suggesting tips for the advancement of lectures. These findings could be used as a map to help health professionals understand drug users' perceptions of attending health prevention lectures and provide insight into how young people might stop using drugs., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Aim: This study aimed to evaluate the prognostic value of glutathione-S-transferase M3 (GSTM3) gene promoter methylation in patients with acute-on-chronic hepatitis B liver failure (ACHBLF)., Methods: A total of 119 patients with ACHBLF, 60 patients with chronic hepatitis B and 30 healthy controls were enrolled. We used a quantitative methylation detection technique, MethyLight, to examine the methylation levels of GSTM3 in peripheral blood mononuclear cells., Results: The GSTM3 methylation level was significantly higher in patients with ACHBLF than those in patients with chronic hepatitis B and healthy controls (both P < 0.05). In patients with ACHBLF, GSTM3 methylation level percentage of methylated reference (PMR) positively correlated with total bilirubin, international normalized ratio, and Model for End-stage Liver Disease (MELD) score, and negatively correlated with prothrombin activity and albumin (all P < 0.05). The PMR for GSTM3 of non-survivors was significantly increased compared to that of survivors (P < 0.05). Multivariate analysis indicated that GSTM3 methylation level was one of the independent prognostic factors for 3-month mortality of ACHBLF (P = 0.000). The area under the receiver-operator characteristic curve of PMR for GSTM3 in predicting 3-month mortality of ACHBLF was not statistically different from that of MELD score (0.798 vs. 0.716, P = 0.152). However, the area under the curve of PMR for GSTM3 was significantly higher than that of MELD score in predicting 1-month mortality (0.887 vs. 0.737, P = 0.020)., Conclusion: Promoter methylation levels of GSTM3 in peripheral blood mononuclear cells closely correlated with disease severity and could be used to predict prognosis of patients with ACHBLF., (© 2016 The Japan Society of Hepatology.)

Background and Aim: Liver biopsy remains the gold standard to evaluate liver histology. However, it has several limitations. This study aims to construct a noninvasive model to predict liver histology for commencing antiviral therapy in HBeAg-positive chronic hepatitis B (CHB) with aminotransferase (ALT) ≤ 2 upper limit of normal (ULN)., Methods: Two hundred and ninety-eight patients with HBeAg-positive CHB, ALT ≤ 2ULN and HBV-DNA ≥20 000 IU/ml were enrolled and randomly divided into a training group and a validation group. A noninvasive model was constructed in the training group to predict significant liver histological change [necroinflammatory activity grade (G) ≥ 2 or fibrosis stage (S) ≥ 2] and then validated in the validation group., Results: Aspartate aminotransferase, HBsAg, platelet, and albumin were identified as independent predictors. A model was constructed by them. It had an area under the receiver operating characteristic curve of 0.875 in the training group, 0.858 in the validation group and 0.868 in the entire cohort. Using a cut-off point of -0.96, it showed 93% sensitivity, 90% negative predictive value (NPV) in the training group and 95% sensitivity, 94% NPV in the validation group. Using a cut-off point of 0.96, it showed 95% specificity, 91% positive predictive value (PPV) in the training group and 89% specificity, 80% PPV in the validation group., Conclusions: This study constructed a noninvasive model to predict liver histology in HBeAg-positive CHB with ALT ≤ 2ULN, which might reduce the clinical need for liver biopsy., (© 2016 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.)

Background: In Taiwan, breast cancer is the most common cancer in women. Most breast cancer patients are willing to receive chemotherapy and experience adverse effects and suffering during the process of chemotherapy., Objectives: The aim of this study was to explore patients' psychological process when receiving initial chemotherapy for breast cancer., Methods: A qualitative grounded theory approach was used. Data were collected through semistructured interviews of 20 patients who were from 1 district teaching hospital during 2012 to 2013., Results: A substantive theory was generated to describe the psychological process experienced by breast cancer patients in their initial treatment. The core category was "rising from the ashes." Four categories emerged and represented 4 stages of the psychological process experienced by breast cancer patients. They were (1) fear stage: patients are frightened about permanent separation from family, chemotherapy, and the disease getting worse; (2) hardship stage: patients experience physical suffering and mental torment; (3) adjustment stage: patients fight against the disease, find methods for adjustment, and get assistance from supporting systems; (4) relaxation stage: patients were released from both the physical and mental sufferings, and patients accepted the disease-related change in their lives., Conclusion: Each stage is closely related to the other stages, and each is likely to occur repeatedly. It is important to help patients achieve the relaxation stage., Implications for Practice: The results of this study may enhance nurses' understanding of the psychological process of patients receiving initial chemotherapy for breast cancer, thereby helping nurses to provide appropriate assistance to improve the quality of patient care.

Background and Aim: Methylation of tissue factor pathway inhibitor 2 (TFPI2) gene has been detected in hepatocellular carcinoma (HCC). However, the clinicopathologcial significance and prognostic value of TFPI2 methylation in HCC remains largely unknown. This study aimed to investigate the prognostic value of TFPI2 methylation in HCC after hepatectomy., Methods: Methylation status of TFPI2 gene was examined in 178 surgical specimens of HCC and 20 normal liver samples using methylation-specific polymerase chain reaction., Results: Methylation of TFPI2 gene was detected in 44.9% (80 of 178) of primary HCC samples, 10.7% (19 of 178) of the corresponding non-tumorous liver samples, and 5.0% (1/20) of the normal liver samples. The mRNA concentrations of TFPI2 in primary HCC tissues were significantly lower than those in corresponding non-tumorous liver tissues and those in normal liver tissues. TFPI2 methylation was significantly associated with higher TNM stage. Patients with TFPI2 methylation demonstrated a significantly poorer prognosis than those without TFPI2 methylation for both overall survival and disease-free survival (P < 0.001, respectively). Multivariate analyses confirmed that TFPI2 methylation was an independent prognostic factor for both overall survival (P = 0.002) and disease-free survival (P = 0.000) in HCC after hepatectomy. Moreover, TFPI2 methylation was found to be the only independent predictor for early tumor recurrence of HCC after resection based on multivariate analysis (P = 0.002)., Conclusions: Methylation of TFPI2 predicts high risk of advanced tumor stage, early tumor recurrence, and poor prognosis, and it could be a potential prognostic biomarker in patients with HCC after hepatectomy., (© 2015 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.)

Background: The Fundamental Nursing clinical practicum is an essential module for nursing students. Some feel stress or anxiety about attending this first placement; however, evidence demonstrates that it is rare to explore the feelings of anxiety felt by the nursing students concerning their first clinical practicum., Objective: This study was designed to explore student nurses' experiences of anxiety felt regarding their initial clinical practicum while studying for their University degree., Design: A phenomenological approach was used., Settings: A university in Southern Taiwan., Participants: A purposive sampling of fifteen student nurses with anxiety reactions who had completed their first clinical practicum., Methods: Data were collected using a semi-structured guide and deep interview. Data were analyzed using Colaizzi's seven-step phenomenological method., Results: Three themes surfaced in the findings. The first theme was anxiety around their first clinical practicum, which stirred up anxiety about: self-doubt, worry and fear; difficulty coping with the learning process; worry hampered establishing therapeutic relationships with patients; the progress of the patients' illness could not be predicted; and anxiety felt about lecturer-student interactions. The second theme was three phases of anxiety reactions, which included increasing anxiety before clinical practicum; exacerbated anxiety during clinical practicum, and relief of anxiety after clinical practicum. The third theme was coping behaviors. This comprised: self-reflection in preparation for clinical practicum; finding ways to release emotions; distractions from the anxiety; and, also facing their difficulties head-on., Conclusion: The findings could help raise the awareness of lecturers and students by understanding student nurses' anxiety experiences and facilitating a healthy preparation for their initial clinical practicum, consequently proactively helping reduce potential anxiety experiences., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Promoter methylation of tumor suppressor gene SOX11 has been reported to contribute to the diagnosis and prognosis of various cancerous diseases, including gastric cancer, hematopoietic malignancies and nasopharyngeal carcinoma. However, there is no data on the diagnostic potential of serum SOX11 promoter methylation in hepatocellular carcinoma (HCC). This study was therefore aimed to investigate the potential role of serum SOX11 promoter methylation as a noninvasive biomarker in the diagnosis of patients with hepatitis B virus (HBV) associated HCC. A total of 205 subjects were retrospectively included, which consisted of 111 HCC patients, 66 chronic hepatitis B (CHB) and 28 healthy controls (HCs). Methylation of SOX11 promoter was determined by methylation-specific polymerase chain reaction. The methylation frequency of serum SOX11 promoter in HCC patients (69.4%, 77/111) was significantly higher than that in CHB patients (13.6%, 9/66; χ2 = 51.467, P<0.001) and HCs (10.7%, 3/28; χ2 = 31.489, P<0.001). There was significant difference of serum SOX11 promoter methylation in HCC patients with vascular invasion (49/58) and those without vascular invasion (28/53; χ2 = 13.058, P<0.001). Furthermore, the sensitivity of 69% was identified for SOX11 methylation in discriminating HCC from CHB, which was significant higher than the sensitivity of 57% for serum alpha-fetoprotein (AFP) (P<0.05). Notably, SOX11 promoter methylation plus AFP showed a sensitivity of 85% in discriminating HCC from CHB. These results suggested that serum SOX11 promoter methylation might serve as a useful and noninvasive biomarker for the diagnosis of HCC.

Accessible Summary: What is known on the subject? Suicide is a global mental health issue. Taking care of suicidal individuals is a substantial challenge. Most studies emphasize the suicidal individual. Few studies have emphasized the family caregivers of suicidal individuals. No study has explored the relationship between family caregivers' caring stress with suicidal attitudes and suicide care ability. What this paper adds to existing knowledge? The main results indicated that the older family caregivers tended to have a more negative attitude towards suicidal individuals. Female family caregivers' stress was higher than that of male family caregivers. A mild level of caring stress would help family caregivers have a more positive attitude towards suicidal individuals. Furthermore, a positive attitude would help family caregivers improve their caring ability. What are the implications for practice? Mental health nurses could help family caregivers, especially female family caregivers, reduce their holistic caring burden by looking for support resources and enhancing their coping strategies. Mental health nurses could help family caregivers promote positive attitudes towards suicidal relatives by understanding suicidal individuals' suffering., Introduction: Suicide is a global mental health issue. Family caregivers play a key role in preventing suicide attempts., Aims: The aim of this study was to examine the relationship among stress due to the family caregiver's role, suicidal attitude of the family caregiver and suicide care ability among family caregivers. Additionally, instruments of caring stress, attitudes towards suicidal relatives and caring abilities used in the study were tested to measure construct validity., Methods: A cross-sectional correlational study was conducted with 164 family caregivers of people who are suicidal. The following three questionnaires were used: the Caring Stress Scale, the Suicidal Attitudes Scale and the Suicidal Caring Ability Scale. Structural equation modelling was performed using SPSS AMOS 19.0 to examine the path relationships among variables., Results: Bivariate analyses showed that age was negatively correlated with suicidal attitude. In the final path model, caring stress had a positive effect on suicidal attitudes. Suicidal attitude and suicide care ability were highly positively correlated. Gender had a direct effect on caring stress, which indicated that female family caregivers experienced more stress from their role., Implications for Practice: Mental health nurses could help family caregivers become aware of the emotional pain that suicidal people experience and then promote their positive attitudes towards their suicidal relatives. Furthermore, family caregivers could increase their ability to care for their suicidal relatives, which could reduce the numbers of suicides., (© 2015 John Wiley & Sons Ltd.)

Background: Glutathione-S-transferase P1 (GSTP1) methylation has been demonstrated to be associated with oxidative stress induced liver damage in acute-on-chronic hepatitis B liver failure (ACHBLF)., Aim: To evaluate the methylation level of GSTP1 promoter in acute-on-chronic hepatitis B liver failure and determine its predictive value for prognosis., Methods: One hundred and five patients with acute-on-chronic hepatitis B liver failure, 86 with chronic hepatitis B (CHB) and 30 healthy controls (HC) were retrospectively enrolled. GSTP1 methylation level in peripheral mononuclear cells (PBMC) was detected by MethyLight. Clinical and laboratory parameters were obtained., Results: GSTP1 methylation levels were significantly higher in patients with acute-on-chronic hepatitis B liver failure (median 16.84%, interquartile range 1.83-59.05%) than those with CHB (median 1.25%, interquartile range 0.48-2.47%; P < 0.01) and HC (median 0.80%, interquartile range 0.67-1.27%; P < 0.01). In acute-on-chronic hepatitis B liver failure group, nonsurvivors showed significantly higher GSTP1 methylation levels (P < 0.05) than survivors. GSTP1 methylation level was significantly correlated with total bilirubin (r = 0.29, P < 0.01), prothrombin time activity (r = -0.24, P = 0.01) and model for end-stage liver disease (MELD) score (r = 0.26, P = 0.01). When used to predict 1- or 2-month mortality of acute-on-chronic hepatitis B liver failure, GSTP1 methylation showed significantly better predictive value than MELD score [area under the receiver operating characteristic curve (AUC) 0.89 vs. 0.72, P < 0.01; AUC 0.83 vs. 0.70, P < 0.05 respectively]. Meanwhile, patients with GSTP1 methylation levels above the cut-off points showed significantly poorer survival than those below (P < 0.05)., Conclusions: Aberrant GSTP1 promoter methylation exists in acute-on-chronic hepatitis B liver failure and shows high predictive value for short-term mortality. It might serve as a potential prognostic marker for acute-on-chronic hepatitis B liver failure., (© 2015 John Wiley & Sons Ltd.)

Aim: To evaluate tumor necrosis factor-α converting enzyme (TACE) methylation status in patients with chronic hepatitis B (CHB)., Methods: Eighty patients with hepatitis B e antigen (HBeAg)-positive CHB, 80 with HBeAg-negative CHB, and 40 healthy controls (HCs) were randomly enrolled in this study. Genomic DNA was extracted from peripheral blood mononuclear cells and methylation status of TACE promoter was determined by methylation-specific polymerase chain reaction. The clinical and laboratory parameters were collected., Results: One hundred and thirty of 160 patients with CHB (81.25%) and 38 of 40 HCs (95%) displayed TACE promoter methylation. The difference was significant (χ (2) = 4.501, P < 0.05). TACE promoter methylation frequency in HBeAg-positive CHB (58/80, 72.5%) was significantly lower than that in HBeAg-negative CHB (72/80, 90%; χ (2) = 8.041, P < 0.01) and HCs (χ (2) = 8.438, P < 0.01). However, no significant difference was observed in the methylation frequency between HBeAg-negative CHB and HCs (χ (2) = 0.873, P > 0.05). In the HBeAg-positive group, TACE methylation frequency was significantly negatively correlated with HBeAg (r = -0.602, P < 0.01), alanine aminotransferase (r = -0.461, P < 0.01) and aspartate aminotransferase (r = -0.329, P < 0.01)., Conclusion: Patients with HBeAg-positive CHB have aberrant demethylation of the TACE promoter, which may potentially serve as a biomarker for HBeAg seroconversion.

Background: Medication administration errors (MAEs) account for most medication errors, which not only threaten the safety of patients and increase hospital medical costs but also damage the personal and professional development of affected nurses. A feasible instrument measures the perceptions of committing an MAE that may provide support for nurses., Purpose: The purpose of this study was to conduct psychometric testing of the Inventory of Perceptions for Medication Administration Errors (IPMAE)., Methods: Psychometric testing of the IPMAE used snowball sampling to collect data from nurse volunteers. Six hundred eighteen nurses completed the IPMAE and a personal profile. The construct validity and the Cronbach's alpha of the inventory were tested., Results: The results indicated that the 12-item IPMAE consisted of four factors, including coping strategy, emotional reaction, fear of blame, and segregation behavior. These four factors accounted for 78.8% of the total variance. The IPMAE showed that both fit indices and Cronbach's alpha coefficients (overall = .90 and subscales = .83-.88) were acceptable., Conclusions/implications for Practice: The IPMAE is a valid and reliable instrument for measuring perceptions of MAE occurring among nurses. Nursing directors may use the results generated by the IPMAE to help reduce the negative consequences of MAE events among nurses.

Suppressor of cytokine signalling 1 (SOCS1) was demonstrated to play an important negative role in fulminant hepatitis and might be involved in acute-on-chronic hepatitis B liver failure (ACHBLF). This study was therefore to identify the potential role of SOCS1 and its promoter methylation pattern in ACHBLF patients. Sixty ACHBLF patients, 60 chronic hepatitis B (CHB) patients and 30 healthy controls were investigated in this study. We found that expression of SOCS1 mRNA in CHB and ACHBLF patients was significantly higher than that in healthy controls. The serum level of IL-6, IFN-γ and TNF-α was significantly higher in ACHBLF than CHB. Increased serum level of IL-6, IFN-γ and TNF-α was correlated with total bilirubin, ALT, PTA and MELD scores in ACHBLF. The degree of methylation of the SOCS1 in ACHBLF patients (35.0%, 21/60) was significantly higher than that in CHB patients (16.7%, 10/60). Furthermore, methylated group showed lower level of SOCS1, and higher MELD scores and mortality rate when compared with unmethylated group of ACHBLF. These results suggested that SOCS1 might contribute to immune-related liver damage in ACHBLF, and its aberrant methylation may be a key event for the prognosis of ACHBLF., (© 2014 John Wiley & Sons Ltd.)

The G-protein-coupled bile acid receptor Gpbar1 (TGR5) has been demonstrated to be able to negatively regulate hepatic inflammatory response. In this study, we aimed to determine the methylation status of TGR5 promoter in patients with acute-on-chronic hepatitis B liver failure (ACHBLF) and its predictive value for prognosis. We enrolled 76 consecutive ACHBLF patients, 80 chronic hepatitis B (CHB) patients and 30 healthy controls (HCs). Methylation status of TGR5 promoter in peripheral mononuclear cell (PBMC) was detected by methylation-specific polymerase chain reaction (MSP). The mRNA level of TGR5 was determined by quantitative real-time polymerase chain reaction (RT-qPCR). We found that the frequency of TGR5 promoter methylation was significantly higher in ACHBLF (35/76, 46.05%) than CHB patients (5/80, 6.25%; χ(2) = 32.38, P < 0.01) and HCs (1/30, 3.33%; χ(2) = 17.50, P < 0.01). TGR5 mRNA level was significantly lower (Z = -9.12, P < 0.01) in participants with aberrant methylation than those without. TGR5 methylation showed a sensitivity of 46.05% (35/76), specificity of 93.75% (75/80), positive predictive value (PPV) of 87.5% (35/40) and negative predictive value (NPV) of 64.66% (75/116) in discriminating ACHBLF from CHB patients. ACHBLF patients with methylated TGR5 showed significantly poor survival than those without (P < 0.01). When used to predict 3-month mortality of ACHBLF, TGR5 methylation [area under the receiver operating characteristic curve (AUC) = 0.75] performed significantly better than model for end-stage liver diseases (MELD) score (AUC = 0.65; P < 0.05). Therefore, our study demonstrated that aberrant TGR5 promoter methylation occurred in ACHBLF and might be a potential prognostic marker for the disease., (© 2014 John Wiley & Sons Ltd.)

Objectives: To find a biomarker to predict the prognosis of acute on chronic hepatitis B liver failure (ACHBLF)., Methods: Expression gene profiles in wnt pathway were determined in serum from 63 patients with ACHBLF, 60 patients with chronic hepatitis B (CHB) and 30 healthy controls (HCs)., Results: Serum wnt5a concentration of 1.553 ng/ml showed a poor prognosis with a sensitivity of 69.23% and a specificity of 83.33% in ACHBLF patients., Conclusions: Serum wnt5a gene expression might be a potential biomarker for predicting the prognosis of ACHBLF.

Objective: To explore the molecular mechanism of pain associated with chronic prostatitis and chronic pelvic pain syndrome (CP/CPPS) in the rat model of prostatic inflammation., Methods: Thirty-six male SD rats were equally randomized to an experimental and a control group, the former injected with 50 μl of 3% λ-carrageenan into the ventral prostate to make the model of non-bacterial prostatic inflammation, while the latter with the same volume of sterile saline solution. At 1, 2 and 4 weeks after modeling, the prostate, L6-S1 dorsal root ganglion (DRG) and spinal cord were harvested for examination of the expressions of the nerve growth factor (NGF), transient receptor potential ankyrin 1 (TRPA1), and calcitonin-gene-related peptide (CGRP) by immunohistochemistry and Western blot., Results: The expressions of NGF, TRPA1 and CGRP in the prostatic tissue were all significantly increased in the experimental group as compared with the control (P <0.05), with a gradual decrease with the prolonging of time (P <0.05). In the L6-S1 DRG and spinal cord, the expressions of NGF, TRPA1 and CGRP exhibited no significant differences between the experimental and control groups at 1 week after modeling (P >0.05) and kept at high levels in the experimental group at 2 and 4 weeks, though not significantly different from those at 1 week (P >0.05). Statistically significant differences were observed in the expressions of the three proteins in the experimental rats among different time points (P <0.05), but not between the two groups at any time point (P >0.05)., Conclusion: The molecular mechanism of CP/CPPS can be evaluated in the rat model of prostatic inflammation established by injecting λ-carrageenan into the prostate. TRPA1 may play an important role in connecting the upstream and down-stream pathways of CP/CPPS-associated pain.

With the widespread use of non-invasive imaging modalities, the incidental detection of myelolipoma has become more common. We analyze the clinical data of 4 typical cases of unilateral adrenal myelolipomas, including 1 hormonally inactive patient and 3 hormonally active cases with hyperaldosteronemia, hypercortisolism and hyperandrogenemia. Obvious differences were found in the pathological sections. To our knowledge, this is the first article discussing the etiology of adrenal myelolipoma from pathologic analyses.