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The use of opioids as anti-pain medications in the perioperative period is influenced by intraoperative anaesthesia. There is no conclusive evidence that intraoperative opioids decrease postoperative pain. Opioid-free anaesthesia, which combines several opioid-sparing approaches, has lowered the need for postoperative pain control by reducing the need for restricted pain relief. As a result, the goal of this study is to determine the scope of the benefits of going opioid-free throughout the perioperative period. The electronic databases Google Scholar, Science Direct, and PubMed were searched till May 2021. Analytical reviews, randomized controlled trials, and prospective studies comparing all types of intra-operative opioid general anaesthesia against opioid-free general anaesthesia were included in the study. The first measurement of the pain score at rest and one day after surgery were the key goals. Analgesia was defined as the consumption of comparable intravenous morphine after surgery, as well as rates of postoperative nausea and vomiting in the post-anaesthesia care unit one day after surgery. The opioid-free anaesthesia group had lower mean pain scores at rest at the first measurement and postoperatively than the opioid-free anaesthesia group. In the opioid group, postoperative analgesia intake of iv morphine was lower. There was a statistically significant decrease in nausea and antiemetic medicine use among patients who did not get opioids. The opioid-free group had a longer hospital stay. Opioid-free use did not demonstrate significant results in lowering pain in the postoperative period when compared to those who used opioids. It's also linked to less nausea and vomiting after surgery.

Background: With the rapid growth of the elderly population and the increasing incidence of cancer, an increasing number of geriatric patients are receiving cancer treatment, making the selection of appropriate treatment an important issue. Increasing studies have confirmed that frailty can predict adverse outcomes in geriatric patients with cancer after treatment, but local data from Taiwan are lacking. Therefore, this study aimed to investigate the correlation between frailty and chemotherapy-related adverse outcomes in geriatric patients with cancer. Material and Methods: A total of 234 geriatric patients aged ≥65 years with cancer receiving chemotherapy were enrolled during the study period of September 2016 to November 2018. The collected data included: patients’ basic demographics and Comprehensive Geriatric Assessment (CGA) before treatment, chemotherapy-related adverse outcomes, unexpected hospitalizations, and emergency department visits within 3 months of treatment. We investigated the association between frailty and chemotherapy-related adverse outcomes in geriatric patients with cancer using the chi-square test and logistic regression analysis. Results: The prevalence of frailty in geriatric patients with cancer was 58.1%. Age, marital status, main caregiver, cancer type, and Eastern Cooperative Oncology Group performance status, and physical fitness were factors associated with frailty. Frail geriatric patients with cancer were at higher risk of chemotherapy-related adverse outcomes, such as grades 3–4 thrombocytopenia (odds ratio [OR] = 11.13, p = 0.021) and grades 3–4 hyponatremia (OR = 12.03, p = 0.017), than non-frail patients, and they were at increased risk of unexpected hospitalizations (OR = 2.15, p = 0.025) and emergency department visits (OR = 1.99, p = 0.039). Conclusions: Frailty is a common problem in geriatric patients with cancer and significantly impacts chemotherapy-related adverse outcomes. Our findings suggest that geriatric patients with cancer should undergo frail assessment prior to chemotherapy as a reference to guide future treatment decisions.

BACKGROUND: The philosophical and theoretical values of nursing moved away from a systematic review of the science of nursing and experienced a shift based on paradigms. The results may be interpreted by several nursing theorists in different ways. AIM: This paper aims to analyze the development of a more comprehensive understanding toward the meaning of confidence concept of the nurses and stimulated services health, person, environment and nursing resolutions based on nursing discussions, and nursing-related literature. The definition of this resolution has been completed and synthesized successfully to fit our nursing philosophy. METHODS: The main argument from the researchers shows the renewal of several nursing theorists and critical appraisal adopted by Walker and Avant in eight steps of the broader concept that was agreed at the beginning in the construction of phased planning from positivistic to questionable views of the research the philosophy in nursing provers that nurses confidence is also important. RESULTS: They are academically constructed so that they do not highlight the daily improvement of nurses as nurses need to be confident in performing their job. We need to offer a philosophy of nursing with four things: Social, environmental health, passenger care, and self-confidence. CONCLUSION: The selection of philosophy and ideology of the second paradigm among various options must be agreed on. Nurses must have strong self-confidence and smart collaboration who can make changes in the quality of life of others considering the good and bad for their health.

Advanced practice nurses (APNs) can best support physicians in improving the quality of truth-telling. However, the effectiveness of communication skill training (CST), based on the Japanese SHARE model exclusive to APNs, has not been tested from APNs' and recipients' viewpoints, motivating the author to conduct the present study.A two-group before-after model design was adopted, and 61 APNs from two hospitals were randomly assigned to either an experimental group (EG; N = 28) or an control group (CG; N = 33). APNs in the EG received 6 h of CST under the guidance of qualified facilitators and simulated patients. This study used APNs' subjective assessment (N = 61) (self-confidence and perceptions on truth-telling) and recipients' opinions (N = 480) (cancer patients' and their caregivers' satisfaction with truth-telling and emotional status) to assess the effectiveness of the SHARE CST. Data were collected before CST (baseline, T0), immediately after (T1), and 2 weeks after (T2).APNs in the EG had more confidence (p 0.05) and better perceptions of cancer truth-telling (p 0.01) than APNs in the CG at both T1 and T2. No group differences were found in patients' or their caregivers' satisfaction with truth-telling, emotional distress, and anxiety (p 0.05). In addition, patients in the EG had higher depression than patients in the CG (β = 1.65, p = 0.01).SHARE CST can improve APNs' confidence and perceptions of cancer truth-telling. However, more rigorous studies are required to test the effectiveness of CST from recipients' viewpoint.

Purpose This study aimed to identify vulnerable patients with head and neck cancer undergoing concurrent chemoradiation therapy (CCRT) who are susceptible to higher treatment-related adverse effects and have poorer treatment tolerance. This study also aimed to determine whether comprehensive geriatric assessment, developed in the geriatric population, can predict vulnerability to treatment-related adverse events and survival even in nongeriatric patients with head and neck cancer, as well as the prevalence of vulnerability and its effect on toxicities and survival among these patients. Methods and Materials This prospective cohort study examined 461 patients with primary head and neck cancer who underwent definitive CCRT during 2016 to 2017 at 3 medical centers across Taiwan. Vulnerability is defined as susceptibility to cancer- and treatment-related adverse events that result in poor treatment tolerance and unexpected emergent medical needs, such as hospitalization and emergency room visits. Vulnerability was assessed as impairment with ≥2 dimensions on comprehensive geriatric assessment, 7 days before CCRT. The association of vulnerability with treatment-related adverse events and survival was analyzed. Results The prevalence of vulnerability was 22.2%, 27.3%, 30.2%, and 27.9% among patients aged 20 to 34, 35 to 49, 50 to 64, and >65 years, respectively. Survival was poorer in vulnerable patients than in nonvulnerable patients (hazard ratio, 1.97; 95% confidence interval, 1.26-3.07; P = .003). Vulnerable patients showed a higher tendency toward CCRT incompletion (19.5% vs 6.1%, P Conclusions Vulnerability, which is an urgent concern when it presents among patients with head and neck cancer, was independently associated with poorer survival and severe treatment-related complications. Vulnerability assessment should be routinely evaluated in all patients with primary head and neck cancer who are undergoing definitive CCRT, not only in such patients who are geriatric.

As the aging population is increasing significantly, the communication skills training (CST) on transitional care (TC) is insufficient.This study aimed to test the effectiveness of an intervention (the online TC CST [OTCCST] and TC) through the perspectives of healthcare providers (HCPs), older patients, and family members.A total of 38 HCPs caring for older patients were randomized to the experimental (n = 18) or control groups (n = 20), and 84 pairs of patients and family members were enrolled (experimental: n = 42 vs. control: n = 42). The primary outcome was HCP communication confidence; while secondary outcomes included patient quality of life (QoL), activities of daily living (ADL), rehospitalization counts, and family caregiving burden. Data were collected from HCPs using a scale measuring confidence in communicating with patients. Patient outcomes were assessed using the McGill QoL Questionnaire-Revised and Barthel Index. Family members were assessed with the Caregiver Burden Inventory. Rehospitalization counts were tracked for 3 months post-discharge. Data were analyzed using multiple regression analysis.Experimental group HCPs showed a significant improvement in communication confidence over the control group (p = 0.0006). Furthermore, experimental group patients had significantly fewer rehospitalization counts within 3-month post-discharge (p 0.05). However, no significant group differences were found in patient QoL and ADL nor in family caregiver burden.The OTCCST can effectively improve HCP communication confidence, and the combination of OTCCST and TC can reduce rehospitalization counts for older patients. The OTCCST allows HCPs to learn asynchronously at their convenience, ideal for continuing education, especially during the COVID-19 pandemic.

Background Given that the consequences of treatment decisions for end-stage renal disease (ESRD) patients are long-term and significant, good communication skills are indispensable for health care personnel (HCP) working in nephrology. However, HCP have busy schedules that make participation in face-to-face courses difficult. Thus, online curricula are a rising trend in medical education. This study aims to examine the effectiveness of online ESRD communication skills training (CST) concerning the truth-telling confidence and shared decision-making (SDM) ability of HCP. Methods For this single-center, single-blind study, 91 participants (nephrologists and nephrology nurses) were randomly assigned to two groups, the intervention group (IG) (n = 45) or the control group (CG) (n = 46), with the IG participating in ESRD CST and the CG receiving regular in-service training. Truth-telling confidence and SDM ability were measured before (T0), 2 weeks after (T1), and 4 weeks after (T2) the intervention. Group differences over the study period were analyzed by generalized estimating equations. Results IG participants exhibited significantly higher truth-telling confidence at T1 than did CG participants (t = 2.833, P = .006, Cohen’s d = 0.59), while there were no significant intergroup differences in the confidence levels of participants in the two groups at T0 and T2. Concerning SDM ability, there were no significant intergroup differences at any of the three time points. However, IG participants had high levels of satisfaction (n = 43, 95%) and were willing to recommend ESRD CST to others (n = 41, 91.1%). Conclusions ESRD CST enhanced short-term truth-telling confidence, though it is unclear whether this was due to CST content or the online delivery. However, during pandemics, when face-to-face training is unsuitable, online CST is an indispensable tool. Future CST intervention studies should carefully design interactive modules and control for method of instruction.

BackgroundStudies have emphasized that the disclosure of a diagnosis and prognosis is the doctor’s responsibility, but little attention has been given to the importance of interdisciplinary cooperation.ObjectiveTherefore, this study examined and compared the effectiveness of cancer communication skills training (CST) for doctors and interdisciplinary staff in Taiwan.MethodsThis study utilized a quasi-experimental design. The participants were 124 oncology professionals who participated in cancer CST. These 124 professionals included a group of 65 doctors and a group of 59 interdisciplinary professionals, both of which received the same CST. After the participants have received CST, the changes in their disease disclosure skills were evaluated.ResultsSignificant pretest-posttest differences were observed in the overall truth-telling scores for both groups (doctors: t = 6.94, P < 0.001; interdisciplinary professionals: t = 7.71, P < 0.001) and in different constructs. However, in many items, the doctors demonstrated no progress after receiving the training (P > 0.05), whereas the interdisciplinary professionals demonstrated significant progress (P < 0.05). In particular, the doctors’ scores for ‘disclosing information in a monotonous tone’ showed significant retrogression (P < 0.05). There were no significant differences in the overall truth-telling scores of the two groups with regard to pre- and post-CST (P > 0.05 and P > 0.05, respectively), and there were also no significant differences in the four sub-scales’ scores.ConclusionThe CST for interdisciplinary professionals improved their cooperation and communication skills.

Background There is a lack of studies investigating gender differences in cancer truth-telling, especially from the Asia Pacific countries. Objective The aim of this study was to compare preferences for cancer truth-telling between male and female cancer patients in Taiwan. Methods We used a quantitative cross-sectional design. Cancer patients (aged ≥18 years) were enrolled from 6 hospitals across Taiwan. A Taiwanese version of the Japanese truth-telling questionnaire was used to collect data. Multiple regression and independent t test were used for analysis. Results A total of 590 patients (49.6% male, 50.4% female) participated in this study. A multiple regression showed no gender differences in total scale and subscales (setting, method of disclosure, additional information, and emotional support). However, in item analysis, we found that female patients preferred detailed medical information (t = -1.973, P = .049). Both male and female patients preferred to know their medical condition (t = -1.259, P = .209), direct and frank truth-telling (t = -0.262, P = .794), and assistance in treatment decision-making (t = -0.467, P = .641). There was no gender difference in willingness to know the life expectancy (t = -0.769, P = .442) and families' presence during truth-telling (t = -0.416, P = .678). Conclusion Few gender differences exist in the preferences of truth-telling for cancer patients. Implications for practice Our findings can increase the sensitivity of truth-telling among nurse and other healthcare personnel when taking care of cancer patients of different genders and thereby likely improve the quality of cancer care.

Background Comprehensive Geriatric Assessment (CGA) is the gold standard for detecting frailty in elderly patients with cancer. Since CGA is time- and resource-consuming, many alternative frailty screening tools have been developed; however, it remains unknown whether these tools are suitable for older and adult patients with cancer. Therefore, we used the data collected for a large longitudinal study to compare the diagnostic performances of two frailty screening tools (Geriatric 8 [G8] and Flemish version of the Triage Risk Screening Tool [fTRST]) to identify frailty risk profile among patients with cancer. Material and methods Patients aged ≥20 years with newly diagnosed cancer were enrolled. Frailty screening with G8, fTRST, and CGA were performed before anti-cancer treatment. Diagnostic characteristics obtained using G8 and fTRST were analyzed by C-index, and the validity of G8 and fTRST was also determined. Results 40.9% of the 755 patients with cancer displayed frailty on CGA. Both G8 and fTRST showed high sensitivity (80.6–88.4%) and negative predictive value (81.0–81.2%). The C-index of G8 was higher than that of fTRST (0.77 vs 0.71, p = .01). Moreover, the best G8 and fTRST cut-off points were ≤13 and ≥ 2, respectively. The validities of G8 and fTRST were also confirmed; however, frailty age differences were not observed in our study. Conclusion Frailty is a common problem for patients with cancer, and routine frailty screening is essential for both older and adult patients. G8 and fTRST are simple and useful frailty screening tools, while G8 is more suitable than fTRST for Taiwanese patients with cancer.

Background: Oral targeted therapy is increasingly used worldwide to treat patients with advanced lung cancer. The adverse skin toxicity that is associated with treatment with epidermal growth factor receptor inhibitors often results in acneiform rash, dry skin (xerosis), pruritus, and paronychia, which may cause discomfort in patients and affect their quality of life. Purpose: This study was designed to explore changes in skin toxicity and quality of life (measured overall by three subscales) as well as the correlation between skin toxicity and overall quality of life over a 3-month period for patients with advanced lung cancer receiving oral targeted therapy. Methods: This study used a longitudinal research design. Baseline data were collected before initiating targeted therapy. Data for the effects of targeted therapy on skin toxicity and quality of life were collected at 2, 4, 8, and 12 weeks after therapy initiation. Data on skin toxicity were collected using the Common Terminology Criteria for Adverse Events Version 4.03, and quality of life was measured using the Chinese version of the Functional Assessment of Cancer Therapy-Epidermal Growth Factor Receptor Inhibitor-18 questionnaire. Demographic and clinical data were analyzed using descriptive statistics, and Spearman's rank correlation coefficient was used to measure the correlation between skin toxicity and quality of life. Results: Thirty-two patients participated in this study. The symptoms of skin toxicity that increased over the 3-month study period included xerosis and paronychia, whereas acneiform rash and pruritus fluctuated during this period. Over the study period, more than 70% of the participants exhibited symptoms of skin toxicity. Skin toxicity was the greatest and quality of life was the lowest, respectively, at the end of the study. All of the symptoms of skin toxicity were significantly correlated with quality of life, although each varied over time (r = .36-.61, p ＜ .05). Conclusions/Implications for Practice: The results of this study indicate that healthcare providers should consider the impact of skin toxicity on quality of life in patients with advanced lung cancer who are receiving oral targeted therapy. These findings may be used to design interventional measures for skin and medical care to improve quality of life in patients with advanced lung cancer.

Objective Despite the significant role played by cancer patients' families in medical decision-making in Asian countries, inconsistencies have hitherto not been evaluated between patients' and families' preferences and doctors' actual practices with regard to cancer truth telling. Methods For this quantitative comparative study of cancer patients' and families' truth-telling preferences and their experiences of doctors' practices, 532 patients, 551 family members, and 127 doctors (N = 1 210) were enrolled from five hospitals across Taiwan over 2 years. Truth telling was assessed using the Taiwanese version of a modified Japanese truth-telling scale. Results Patients' truth-telling preferences and their experiences of doctors' truth-telling practices differed significantly in scores on the overall truth-telling scale and each subscale, including method of disclosure, emotional support, additional information, and setting (P

Background Patients' personality traits, especially age, gender, and cancer stage, tend to affect doctors' truth-telling methods. However, there is a lack of studies investigating the influence of patients' gender on truth-telling, especially for Asian cultures. Objective The aims of this study were to qualitatively investigate the differences in preferences for truth-telling for patients with cancer of different genders and explore patients' preferences for decision making. Methods For this descriptive qualitative study, in-depth interviews were conducted with 20 patients with cancer (10 men and 10 women) using a semistructured interview guide. All interviews were audiotaped and transcribed verbatim. Data collection and analysis occurred concurrently; content analysis developed categories and themes. Results Data analysis revealed 2 themes: (1) similar gender preferences for truth-telling and decision making: knowledge of their medical condition, direct and frank truthfulness, and assistance in decision making for subsequent treatment programs, and (2) preferences in truth-telling that differed by gender: women wanted family members present for confirmation of diagnosis, whereas men did not; men preferred truth-telling for only key points of their cancer, whereas women wanted detailed information; and men did not want to know their survival period, whereas women wanted this information. Conclusions Our study revealed similar gender preferences for truth-telling regarding knowledge and decision making; however, preferences differed for family support, scope of information, and survival time. Implications for practice These findings can serve as a reference for nurses and other healthcare personnel when implementing truth-telling for patients given a diagnosis of cancer. Strategies can be targeted for specific preferences of men and women.

The study aim was to compare the long-term effect of Western medicine and combined treatment with Traditional Chinese Medicine (TCM) and Western medicine on the prognosis (survival rate, symptom distress, physical function, and quality of life) of patients with lung cancer.Longitudinal study.Two medical centers, one each in Northern and Southern Taiwan.Patients newly diagnosed with lung cancer and treated with Western medicine (n = 54) or TCM plus Western medicine (n = 30).Symptom distress, physical function, and quality of life were measured by using the Symptom Distress Scale, Eastern Cooperative Oncology Group-Performance Status Rating, and European Organization for Research and Treatment of Cancer Quality of Life Questionnaires (EORTC QLQ-C30 and EORTC QLQ-LC13), respectively. Data on these measures were collected at baseline (before treatment) and 1, 3, 6, and 12 months after starting treatment. Survival was estimated by Kaplan-Meier curves. Group differences in outcomes were analyzed by generalized estimating equations.Treatment groups did not differ significantly at baseline for demographic information; disease severity; symptom distress; or EORTC QLQ-C30 and QLQ-LC13 scores, except for pain and dyspnea. After adjustment for these baseline effects, the combined-treatment group had better physical function and role function than the Western medicine group at 6 months (p 0.05). The combined treatment group had better cumulative survival, but this difference did not reach significance.To more precisely estimate the long-term effectiveness of combined treatment on the prognosis of patients with lung cancer, future studies should standardize the number of TCM visits; increase the number of participants by continuous recruitment; and ask patients to complete daily logs with single-item measures of outcomes, such as symptom distress, quality of life, and physical function. Similar studies are suggested in patients with different cancers to develop a collaborative model using Western medicine and TCM.

Summary Background This study explored the effects of acupressure on fatigue of lung cancer patients undergoing chemotherapy. Patients and methods For this experimental study, 57 subjects were randomly assigned to three groups: acupressure with essential oils ( n =17), acupressure only ( n =24), and sham acupressure ( n =16). Acupoints were Hegu (LI4), Zusanli (ST36), and Sanyingjiao (SP6). All subjects received acupressure once every morning for 5 months, with each acupoint pressed for 1min. Fatigue, functional status, anxiety, depression, and sleep quality were measured before initial chemotherapy (T0), on Day 1 of third chemotherapy (T1), and on Day 1 of sixth chemotherapy (T2). Outcome differences between groups were analyzed at T0, T1, and T2 by general estimating equations. Results After controlling for baseline outcome values, age, and adherence to acupressure, subjects who received acupressure with essential oils and acupressure had significantly less fatigue in daily living activities and sleep better quality at T1 than subjects who received sham acupressure. Subjects who received acupressure with essential oils had significantly better sleep quality at T2 than the sham acupressure group. Subjects who received acupressure with or without essential oils had greater odds of better functional status at T1 than the sham group. Conclusion It is plausible that acupressure with or without essential oils helps lung cancer patients undergoing chemotherapy reduce cancer-related fatigue and increase activity level. Further study is wanted to test this hypothesis.

Introduction Traditional Chinese medicine (TCM) is popular in Taiwan, but little is known about how patients build their trust in TCM. This study explored Taiwanese cancer patients’ trust in traditional Chinese medicine. Methods For this descriptive qualitative study, 12 cancer patients were individually interviewed using a semi-structured guide. All interviews were audio-taped and transcribed verbatim. Data were concurrently collected and analyzed by constant comparative method to develop main themes and categories. Results Our first main theme was that participants’ trust in TCM was moulded by their cultural background and by their own and family members’ experience of using TCM. Our second major theme was that trust in TCM was augmented by the conventional medicine system: this included categories of doubts about TCM's effectiveness for cancer treatment, cooperation between the medical and TCM departments in the study hospital, and institutional guarantees. Conclusions Knowing how advanced stage cancer patients build trust in TCM can increase understanding of their medical care-seeking behavior in TCM. These results may be helpful for clinicians in Asian countries where TCM is used along with conventional medicine and in countries treating Asian cancer patients.

Background Communication skills training (CST) based on the Japanese SHARE model of family-centered truth telling in Asian countries has been adopted in Taiwan. However, its effectiveness in Taiwan has only been preliminarily verified. This study aimed to test the effect of SHARE model-centered CST on Taiwanese healthcare providers' truth-telling preference, to determine the effect size, and to compare the effect of 1-day and 2-day CST programs on participants' truth-telling preference. Method For this one-group, pretest–posttest study, 10 CST programs were conducted from August 2010 to November 2011 under certified facilitators and with standard patients. Participants (257 healthcare personnel from northern, central, southern, and eastern Taiwan) chose the 1-day (n = 94) or 2-day (n = 163) CST program as convenient. Participants' self-reported truth-telling preference was measured before and immediately after CST programs, with CST program assessment afterward. Results The CST programs significantly improved healthcare personnel's truth-telling preference (mean pretest and posttest scores ± standard deviation (SD): 263.8 ± 27.0 vs. 281.8 ± 22.9, p 0.05) except for the setting subscale. Most participants were satisfied with the CST programs (93.8%) and were willing to recommend them to colleagues (98.5%). Conclusions The SHARE model-centered CST programs significantly improved Taiwanese healthcare personnel's truth-telling preference. Future studies should objectively assess participants' truth-telling preference, for example, by cancer patients, their families, and other medical team personnel and at longer times after CST programs. Copyright © 2013 John Wiley & Sons, Ltd.

Objective:The spiritual well-being of terminally ill cancer patients is an important indicator of the quality of their lives and of the quality of hospice care, but no validated tools are available for assessing this indicator in Taiwan.Method:The present cross-sectional study validated the Spiritual Well-Being Scale–Mandarin version (SWBS–M) by testing its psychometric properties in 243 cancer patients from five teaching hospitals throughout Taiwan. Construct validity was tested by factor analysis and hypothesis testing. Patients' spiritual well-being and quality of life were assessed using the SWBS–M and the McGill Quality of Life Questionnaire (MQoL), respectively.Results:Overall, the SWBS–M had an internal consistency/reliability of 0.89. Exploratory factor analysis showed that the SWBS–M had an underlying two-factor structure, explaining 46.94% of the variance. SWBS–M scores correlated moderately with MQoL scores (r= 0.48,p< 0.01). Terminally ill cancer patients' spiritual well-being was inversely related to their average pain level during the previous 24 hours (r= –0.183,p= 0.006). Cancer patients' spiritual well-being also differed significantly with their experience of pain (t= –3.67,p< 0.001); terminally ill cancer patients with pain during the previous 24 hours had a lower sense of spiritual well-being than those without pain.Significance of results:Our findings support a two-factor model for the SWBS–M in terminally ill Taiwanese cancer patients. We recommend testing the psychometric properties of the SWBS–M in different patient populations to verify its factorial structure in other Asian countries.

Serum N-terminal pro b-type natriuretic peptide (NT-pro-BNP) testing is recommended in the patients with heart failure (HF). We hypothesized that NT-pro-BNP, in combination with other clinical factors in terms of a novel NT-pro BNP-based score, may provide even better predictive power for in-hospital mortality among patients with HF. A retrospective study enrolled adult patients with hospitalization-requiring HF who fulfilled the predefined criteria during the period from January 2011 to December 2013. We proposed a novel scoring system consisting of several independent predictors including NT-pro-BNP for predicting in-hospital mortality, and then compared the prognosis-predictive power of the novel NT-pro BNP-based score with other prognosis-predictive scores. A total of 269 patients were enrolled in the current study. Factors such as "serum NT-pro-BNP level above 8100 mg/dl," "age above 79 years," "without taking angiotensin converting enzyme inhibitors/angiotensin receptor blocker," "without taking beta-blocker," "without taking loop diuretics," "with mechanical ventilator support," "with non-invasive ventilator support," "with vasopressors use," and "experience of cardio-pulmonary resuscitation" were found as independent predictors. A novel NT-pro BNP-based score composed of these risk factors was proposed with excellent predictability for in-hospital mortality. The proposed novel NT-pro BNP-based score was extremely effective in predicting in-hospital mortality in HF patients.

Serum N-terminal pro b-type natriuretic peptide (NT-pro-BNP) testing is recommended in the patients with heart failure (HF). We hypothesized that NT-pro-BNP, in combination with other clinical factors in terms of a novel NT-pro BNP-based score, may provide even better predictive power for in-hospital mortality among patients with HF. A retrospective study enrolled adult patients with hospitalization-requiring HF who fulfilled the predefined criteria during the period from January 2011 to December 2013. We proposed a novel scoring system consisting of several independent predictors including NT-pro-BNP for predicting in-hospital mortality, and then compared the prognosis-predictive power of the novel NT-pro BNP-based score with other prognosis-predictive scores. A total of 269 patients were enrolled in the current study. Factors such as “serum NT-pro-BNP level above 8100 mg/dl,” “age above 79 years,” “without taking angiotensin converting enzyme inhibitors/angiotensin receptor blocker,” “without taking beta-blocker,” “without taking loop diuretics,” “with mechanical ventilator support,” “with non-invasive ventilator support,” “with vasopressors use,” and “experience of cardio-pulmonary resuscitation” were found as independent predictors. A novel NT-pro BNP-based score composed of these risk factors was proposed with excellent predictability for in-hospital mortality. The proposed novel NT-pro BNP-based score was extremely effective in predicting in-hospital mortality in HF patients.

Objective Truth telling or transmitting bad news is a problem that all doctors must frequently face. The purpose of this cross-sectional study was to investigate if medical students' opinions of truth telling differed from their observations of attending physicians' actual clinical practice. Methods The subjects were 275 medical clerks/interns at a medical center in northern Taiwan. Data were collected on medical students' opinions of truth telling, their observations of physicians' clinical practice, students' level of satisfaction with truth telling practiced by attending physicians, and cancer patients' distress level when they were told the truth. Results Students' truth-telling awareness was significantly higher than the clinical truth-telling practice of attending physicians (p

Aims and objectives. This paper is a report of a study conducted to investigate differences between nurse practitioners’ perceptions of the importance of required competencies and their self-evaluated existing competencies, and the main factors influencing these differences. Background. The difference between nurse practitioners’ perceptions of required competencies and their existing competencies has never been investigated. Therefore, it is still uncertain whether these two competencies differ. Design. A nationwide survey study was authorised by the Department of Health (DOH) in Taiwan. Methods. For this nationwide survey study, the Questionnaire of Competencies in the Nurse Practitioner’s Role was mailed to all nurse practitioners who qualified for the first annual national NP licence exam in Taiwan. Of 582 questionnaires distributed, 374 valid questionnaires were returned for a response rate of 64·2%. Results. The scores for required competencies were all higher than existing competencies. The competencies with largest differences were (in increasing order) clinical research, direct care, and leadership and reform. The competencies with smallest differences were (in ascending order) medical assistance, communication and coordination, and ethical decision-making. Differences in the total score between required and existing competencies were significantly influenced by nurse practitioners’ age, seniority as nurse practitioner, whether the nurse practitioners’ institution had a nurse practitioner advancement system, and the number of patients under their care. Conclusions. Nurse practitioners’ perceptions of the importance of their expected role competencies were significantly greater in most cases than their actual competencies. Relevance to clinical practice. These findings could serve as a reference to improve cultivation of the NP system in Taiwan, to strengthen professional competencies in NP training programs.

Aims and objectives. To understand fatigue in chronic heart failure patients and its related factors. Background. Fatigue is a common symptom in patients with chronic heart failure, but little is known about this phenomenon. Design. Correlational study. Methods. This correlational study sampled 107 chronic heart failure patients from a medical centre in northern Taiwan. Data were collected on objective outcomes (ejection fraction, EF; New York Heart Association classification, NYHA; beta-blocker use and haemoglobin, Hb) and subjective outcomes (depression and fatigue). Since the main outcome variable, fatigue, is multidimensional, it was measured by two scales: Lee’s Fatigue Visual Analog Scale and a researcher-developed scale, the Tang Fatigue Rating Scale. Results. Subjects experienced a medium level of fatigue. Fatigue was significantly higher (p

Aims and objectives. To study quality of life (QOL) and its important correlates among family caregivers of terminally ill patients receiving in-home hospice care. Background. Caregiver QOL has been identified as a core outcome variable in studies of dying patients and their families, but few studies have assessed QOL among caregivers of patients with terminal illness, particularly those in hospice care. Design. For this cross-sectional correlational study, 60 caregivers were recruited from two local in-home hospice programmes in the Midwestern United States. Methods. Self-report data were provided by caregivers using the Caregiver Quality of Life Index – Cancer, Spiritual Well-Being Scale, American Pain Society Patient Outcomes Questionnaire, Eastern Cooperative Oncology Group Performance Status Rating and Medical Outcome Study Social Support Survey to measure their QOL, spirituality, health status and social support. Results. Caregivers’ educational status, physical health status, spirituality and qualitative and quantitative social support, as a set, explained 42% of the variance in their QOL. Caregivers with higher education, better physical health status, greater spirituality and more qualitative and quantitative social support, had a significantly better QOL. Conclusions. QOL for this sample of hospice caregivers was significantly predicted only by physical health status and spirituality, likely because of collinearity among the independent variables. Additional research is needed to explore the factors that sustain or promote caregivers’ QOL over time. Relevance to clinical practice. In the delivery of hospice services, the family caregiver is both a vital member of the health care team and a recipient of care. Health care providers should therefore pay more attention to the health status and spirituality of major caregivers, thus helping them maintain and improve their QOL.

SUMMARY Background Severe acute respiratory syndrome (SARS) is a new respiratory tract infectious disease caused by the highly contagious coronavirus (SARS-CoV). Its propagation and symptom progress are very rapid. This study evaluated the clinical characteristics, laboratory results and mortality factors of probable SARS cases. Methods This study was adopted with a retrospective research design to study probable SARS cases from the Chang Gung Memorial Hospital in Linkou and Kaoshiung from August 2003 to February 2004, with a total of 78 cases (average age, 44 years; standard deviation, 18 years; age range, 13–84 years) including 24 males (30.8%) and 54 females (69.2%). Results Most of the 78 cases involved nosocomial infection (56.4%). A total of 24 patients died, and the mortality rate was as high as 30.8%. Logistic regression analysis found that intubation (odds ratio, 115; p < 0.001) was the mortality forecast factor. Conclusion The mortality rate of intubation patients was 115 times higher than that of those who did not require intubation. Therefore, special care must be taken with SARS disease with severe infiltration chest X-ray images and respiratory distress. Positive medical treatment should be performed to lower the mortality rate.

Background Internship, the transition period from medical student to junior doctor, is highly stressful for interns in the West; however, little is known about the experience of interns in coping with stress in Taiwan. This study aimed to develop a model for coping with stress among Taiwanese interns and to examine the relationship between stress and learning outcomes. Methods For this qualitative study, we used grounded theory methodology with theoretical sampling. We collected data through in-depth interviews and participant observations. We employed the constant comparative method to analyse the data until data saturation was achieved. Results The study population was 124 medical interns in a teaching hospital in northern Taiwan; 21 interns (12 males) participated. Data analysis revealed that the interns encountered stressors (such as sense of responsibility, coping with uncertainty, and interpersonal relationships) resulting from their role transition from observer to practitioner. The participants used self-directed learning and avoidance as strategies to deal with their stress. Conclusions A self-directed learning strategy can be beneficial for an intern’s motivation to learn as well as for patient welfare. However, avoiding stressors can result in less motivation to learn and hinder the quality of care. Understanding how interns experience and cope with stress and its related outcomes can help medical educators and policy makers improve the quality of medical education by encouraging interns’ self-directed learning strategy and discouraging the avoidance of stressors.

Despite the significant role played by cancer patients' families in medical decision-making in Asian countries, inconsistencies have hitherto not been evaluated between patients' and families' preferences and doctors' actual practices with regard to cancer truth telling.For this quantitative comparative study of cancer patients' and families' truth-telling preferences and their experiences of doctors' practices, 532 patients, 551 family members, and 127 doctors (N = 1 210) were enrolled from five hospitals across Taiwan over 2 years. Truth telling was assessed using the Taiwanese version of a modified Japanese truth-telling scale.Patients' truth-telling preferences and their experiences of doctors' truth-telling practices differed significantly in scores on the overall truth-telling scale and each subscale, including method of disclosure, emotional support, additional information, and setting (P .001). Similar findings were obtained for families' preferences and doctors' actual practices (P .001). Patients' and families' truth-telling preference scores were higher than doctors' actual practice scores. Multiple regression analysis revealed a dose-dependent effect of doctors' monthly truth-telling frequency on their truth-telling preferences, but this effect was only borderline significant (P = .08). This multiple regression model explained 30% of the total variance in doctors' truth-telling preferences (F = 1.38, P = .22).Taiwanese medical educational policies need to be revised to better equip doctors to practice truth telling in accordance with the preferences of cancer patients and families. Communication skills training should be prioritized for doctors who refrain from truth telling in actual practice.

Aims and objectives The objective of this study was to test the reliability and construct validity of the Nurse Practitioners' Roles and Competencies Scale. Background The role of nurse practitioners has attracted international attention. The advanced nursing role played by nurse practitioners varies with national conditions and medical environments. To date, no suitable measurement tool has been available for assessing the roles and competencies of nurse practitioners in Asian countries. Design Secondary analysis of data from three studies related to nurse practitioners' role competencies. Methods We analysed data from 563 valid questionnaires completed in three studies to identify the factor structure of the Nurse Practitioners' Roles and Competencies Scale. To this end, we performed exploratory factor analysis using principal component analysis extraction with varimax orthogonal rotation. The internal consistency reliabilities of the overall scale and its subscales were examined using Cronbach's alpha coefficient. Results The scale had six factors: professionalism, direct care, clinical research, practical guidance, medical assistance, as well as leadership and reform. These factors explained 67·5% of the total variance in nurse practitioners' role competencies. Cronbach's alpha coefficient for the overall scale was 0·98, and those of its subscales ranged from 0·83–0·97. Conclusion The internal consistency reliability and construct validity of the Nurse Practitioners' Roles and Competencies Scale were good. The high internal consistency reliabilities suggest item redundancy, which should be minimised by using item response theory to enhance the applicability of this questionnaire for future academic and clinical studies. Relevance to clinical practice The Nurse Practitioners' Roles and Competencies Scale can be used as a tool for assessing the roles and competencies of nurse practitioners in Taiwan. Our findings can also serve as a reference for other Asian countries to develop the nurse practitioner role.

Corrosive injury results from the intake of corrosive-acid-based chemicals. However, this phenomenon is limited to a small number of cases and cannot be extrapolated to the epidemiology of corrosive injuries in actual situations. This study focuses on the annual incidence of corrosive injury and its connection to gender, risk factors, and in-hospital mortality. All patients with corrosive injury (ICD-9 947.0–947.3) were identified using a nationwide inpatient sample from 1996 until 2010. Chi-squared tests and multivariate logistic regression were used to examine risk factors of gender differences and in-hospital mortality of corrosive injury. Young adults comprised the majority of patients (71.2%), and mean age was 44.6 ± 20.9 years. Women showed a higher incidence rate of corrosive injuries, age, suicide, psychiatric disorder, and systemic complications compared with men (p<0.001). The present study demonstrated that age (OR = 10.93; 95% CI 5.37–22.27), systemic complications (OR = 5.43; 95% CI 4.61–6.41), malignant neoplasms (OR = 2.23; 95% CI 1.37–3.62), gastrointestinal complications (OR = 2.02; 95% CI 1.63–2.51), chronic disease (OR = 1.30; 95% CI 1.08–1.56), and suicide (OR = 1.23; 95% CI 1.05–1.44) were strongly associated with in-hospital mortality. Educational programs may be helpful for reducing the incidence of ingestion of corrosive chemicals.

Background: The Medical Outcomes Study Social Support Survey (MOS-SS) is a multidimensional, self-administered instrument used to assess various functional dimensions of social support. Less is known regarding its value for a Chinese population. Objective: The aim of this study was to assess the psychometric properties of the MOS-SS on an adult sample in Taiwan. Methods: A total of 265 adult family caregivers of patients with cancer from four different hospitals in the north, middle, and south regions of Taiwan completed the MOS-SS. Results: In the original five-factor model, unsatisfactory item discriminant validity was found in almost half of the items; the item-own subscale correlation was lower than the item-other subscale correlation. A two-factor model accounting for 68.98% of the variance was found using exploratory factor analysis. The first factor (emotional support) accounted for 62.28% of the total variance, whereas the second factor (tangible support) accounted for 6.7%; the interfactor correlation was .71. The two-factor model seemed to have satisfactory reliability and validity and better discrimination between different subscales than did the original five-factor model. Discussion: Good reliability and validity were demonstrated in the MOS-SS when applied to an adult sample in Taiwan. A two-factor model, instead of a five-factor model as found in the Western countries, was found for this sample. Confirmation of the two-factor model and exploration of the two-factor model in related concepts are suggested for future studies.

Article-at-a-Glance Background Many benefits have been associated with the use of clinical pathways, yet developing them can be costly, and implementing them is not always successful. A 300-bed Midwestern community hospital began a clinical pathways program in 1995, and by fall 1998, 15 pathways were in various stages of implementation, with 3 under development. Many challenges had been encountered, but hospital leaders were eager to find ways to increase pathway use. Methods A qualitative case study design was used to investigate four clinical pathways, two perceived as being "used" and two that were perceived as "not used." Each pathway was analyzed as a separate case, followed by cross-case analysis. Qualitative data were collected in 65 semistructured interviews with administrators, physicians, physicians' office staff, nurses, and allied health professionals at the hospital. Data were also collected through observation and document analysis. Results The two used pathways had been introduced as part of a larger change in care, whereas the two pathways not used had been introduced as standalone innovations. Confusing and inadequately developed aspects of the hospital's clinical pathways program included its purposes, the definition of pathway use, pathway procedures, accountability, education, and incentives. A new case management department, ongoing administrative support, and a sophisticated medical information system were viewed as supports for continued growth in the program. Conclusions Implementation of clinical pathways was delayed and complicated by the varied perceptions of the program among stakeholders. Lack of clarity and consistency in how information about the program was communicated made it difficult for clinicians to develop a shared understanding of clinical pathways.

Although it is clear that ventilated intensive care unit (ICU) patients have worse outcomes than those who are not, information about the risk factors of in-hospital mortality remains important for medical groups to target interventions for these patients.The purpose of this study was to identify predictive factors of in-hospital mortality in ventilated ICU patients with an admission diagnosis of acute respiratory failure.We conducted a prospective cohort study in 3 medical ICUs in a 3600-bed university hospital. Consecutive patients with acute respiratory failure who received mechanical ventilation (MV) for at least 96 hours without evidence of pre-existing neuromuscular diseases were followed until discharge. Upon inclusion, the following parameters were collected or evaluated: demographics, clinical history (admission body mass index [BMI], etiology of acute respiratory failure, comorbidity, Charlson comorbidity index, laboratory data), Acute Physiology and Chronic Health Evaluation (APACHE) II, and right and left quadriceps femoris muscle force. The days of MV before extubation, ICU length of stay, survival status at discharge, and hospital length of stay were recorded from the hospital discharge summary. The primary endpoint was in-hospital mortality.In all, 113 patients (65.49% males) were recruited with a mean age of 69.78 years and mean APACHE II score of 22.63. The mean ICU length of stay was 14.88 ± 9.79 days. Overall in-hospital mortality was 25.66% (29 out of 113 patients). Multivariate analysis showed that the essential factors associated with increased in-hospital mortality were lower BMI (P = .013), and lower scores on the right or left quadriceps femoris muscle force (P = .002 and .010, respectively).Our study suggests that lower BMI and lower scores on lower limb muscle force may be associated with increased in-hospital mortality in ventilated ICU patients.

Male nurses account for 1.08% of Taiwan's total professional nursing workforce. While work values are known to impact the practice of female nurses, the work values of male nurses have never been fully evaluated.The aim of this study was to explore the work values of male nurses in Taiwan and related factors.We applied a cross-sectional design that targeted all male nurses nationwide and used a structured questionnaire distributed by mail to collect data.Data were collected from 1,087 Taiwan-based male nurses with 745 valid responses. Mean score for overall work value was 2.78 (on a maximum scale of 4). Socio-demographic differences contributed to work value variance among respondents. Major factors of influence on work value included education, work unit, work position, work rank, salary, hospital classification, and reason for choosing a nursing career.This study found personal characteristics, occupational roles, job performance, and reason for choosing a career in nursing to all correlate strongly with work value.台灣男性護理人員工作價值觀及其相關影響因素之初探目前我國男性護理人員的比例僅佔全體護理人員人數的1.08%，與女性比例相差懸殊。過去的研究顯示，工作價值觀會影響女性護理人員的執業意願，但是目前男性護理人員工作價值觀相關研究仍然闕如。探討台灣男性護理人員工作價值觀及其相關影響因素。為橫斷性之調查研究，以全台灣男性護理人員為研究對象，利用普查郵寄問卷方式進行資料蒐集。共發出問卷1,087份，回收有效問卷745份。男性護理人員其整體工作價值觀的平均得分為2.78（滿分4分）。不同社會人口學變項的男性護理人員在工作價值觀上有差異。教育程度、工作單位、工作職位、工作職級、薪資所得、執業機構層級、以及選擇護理專業之原因，是影響男性護理人員工作價值觀的重要因子。台灣男性護理人員的個人屬性、職場的角色、工作表現、以及選擇護理專業之原因與其整體工作價值觀有密切的關係。

Communication skills training (CST) based on the Japanese SHARE model of family-centered truth telling in Asian countries has been adopted in Taiwan. However, its effectiveness in Taiwan has only been preliminarily verified. This study aimed to test the effect of SHARE model-centered CST on Taiwanese healthcare providers' truth-telling preference, to determine the effect size, and to compare the effect of 1-day and 2-day CST programs on participants' truth-telling preference.For this one-group, pretest-posttest study, 10 CST programs were conducted from August 2010 to November 2011 under certified facilitators and with standard patients. Participants (257 healthcare personnel from northern, central, southern, and eastern Taiwan) chose the 1-day (n = 94) or 2-day (n = 163) CST program as convenient. Participants' self-reported truth-telling preference was measured before and immediately after CST programs, with CST program assessment afterward.The CST programs significantly improved healthcare personnel's truth-telling preference (mean pretest and posttest scores ± standard deviation (SD): 263.8 ± 27.0 vs. 281.8 ± 22.9, p0.001). The CST programs effected a significant, large (d = 0.91) improvement in overall truth-telling preference and significantly improved method of disclosure, emotional support, and additional information (p0.001). Participation in 1-day or 2-day CST programs did not significantly affect participants' truth-telling preference (p0.05) except for the setting subscale. Most participants were satisfied with the CST programs (93.8%) and were willing to recommend them to colleagues (98.5%).The SHARE model-centered CST programs significantly improved Taiwanese healthcare personnel's truth-telling preference. Future studies should objectively assess participants' truth-telling preference, for example, by cancer patients, their families, and other medical team personnel and at longer times after CST programs.

Truth telling or transmitting bad news is a problem that all doctors must frequently face. The purpose of this cross-sectional study was to investigate if medical students' opinions of truth telling differed from their observations of attending physicians' actual clinical practice.The subjects were 275 medical clerks/interns at a medical center in northern Taiwan. Data were collected on medical students' opinions of truth telling, their observations of physicians' clinical practice, students' level of satisfaction with truth telling practiced by attending physicians, and cancer patients' distress level when they were told the truth.Students' truth-telling awareness was significantly higher than the clinical truth-telling practice of attending physicians (p0.001), and the means for these parameters had a moderate difference, especially in three aspects: method, emotional support, and providing additional information (p0.001). Regardless of this difference, students were satisfied with the truth telling of attending physicians (mean ± SD=7.33 ± 1.74). However, our data also show that when cancer patients were informed of bad news, they all experienced medium to above average distress (5.93 ± 2.19).To develop the ability to tell the truth well, one must receive regular training in communication skills, including experienced attending physicians. This study found a significant difference between medical students' opinions on truth telling and attending physicians' actual clinical practice. More research is needed to objectively assess physicians' truth telling in clinical practice and to study the factors affecting the method of truth telling used by attending physicians in clinical practice.

The paradox of patients who are in pain yet satisfied with their pain management has been documented repeatedly. Pain relief constitutes only one part of patient satisfaction with pain management. The quality of cancer pain management in Taiwan has not been evaluated from the patient's perspective. A cross-sectional design was used to survey 1,370 terminally ill cancer patients in Taiwan to characterize the status of, and satisfaction with cancer pain management by investigating the relative importance of pain intensity, pain relief experiences, and clinicians’ pain management practices. Cancer patients with pain had unsatisfactory pain relief within one week of admission (47.4 percent) and inadequate pain medication (23.6 percent). However, these patients perceived that clinicians adequately informed them about pain treatment. Patient satisfaction with pain management was primarily determined by examining the perceptions that medication dose was just right, responses to requests for pain medication were prompt, and understandable and consistent information about pain treatment was offered. In conclusion, Taiwanese cancer patients’ satisfaction with pain management was influenced more by perceived pain management practices than by pain relief itself.

Family caregivers' quality of life (QOL) is an important indicator for end-of-life care, but appropriate assessment tools are unavailable in Taiwan. This correlational study therefore tested the psychometric properties of the Caregiver Quality of Life Index-Cancer Mandarin version (CQOLC-M) in 359 dyads of cancer patients with terminal illness and their family caregivers from 5 teaching hospitals throughout Taiwan. Caregivers' QOL, spiritual well-being, social support, pain intensity, and economic situation were assessed using the CQOLC-M and 4 established scales. The CQOLC-M had internal consistency reliability of .87. Construct validity was supported by factor analysis, hypothesis testing, and known-group comparison. Exploratory factor analysis showed 7 underlying factors explaining 48.15% of the variance. Caregiver Quality of Life Index-Cancer Mandarin version scores correlated moderately with caregivers' social support (P < .01) and spiritual well-being (P < .01). Caregivers' QOL was inversely related to both patients' (F = 4.90; P = .008) and caregivers' average pain (t = -4.22; P < .001) in the past 24 hours. We suggest removing 4 items with factor loading of less than 0.4. Since caregivers' QOL depends on patients' and caregivers' physical dimensions, we recommend adding physical-related items to the CQOLC-M. Clinicians can improve caregivers' QOL not only by maintaining their health, social support, and spirituality but also by better managing the pain of patients with terminal illness.